Semiotic Analysis is Lanvin Paris Research Paper

Semiotic Analysis is Lanvin Paris - Research Paper Example Semiosis has the ability to make models, which means that people have the capacity to produce and comprehend the specific types of images required for codifying perceptual inputs (Sebeok and Danesi 2000). Semiosis allows for representation and understanding this representation, which is a capacity of all human beings. The exploratory stage of knowing and understanding an object constitutes a sensory modeling phase required of codifying an image (ibid). Â  Lanvin Paris was founded in 1889 by Jeanne Lanvin and is considered the oldest French couture house. It has become a reference for fashion, accessories, and perfume for the Parisian industry. Lanvin Paris is apparently named after the person who conceived it and is now recognized worldwide for its elegance in style and refinement. Artists and young talents from several domains surround the fashion firm in which an outstanding cultural heritage is a result. This artistic tradition is perpetuated by Lanvin through its advertising campaigns.Lanvin is geographically situated in the place where it was first established, a street known for its standing in the luxury market, particularly at 15 & 27 Faubourg Saint-Honore, Paris. The Lanvin brand has become a reference for luxury in terms of perfumes and fashion even in the US, Europe, Asia, and other continents.Fashion advertising, like the kind of advertising pursued by Lanvin, is an excellent example of identity-image producing media. Fashion possesses a cultural language of style which it is acknowledged for, and identity is said to be tied to the nature of the product being worn since they are shown for public display (Rhodes and Zuloago 2003). The domain of high fashion advertising is said to describe a certain identity which is unified according to general types of what they signify - young women, high-class people, high status, etc. in which this identity is set by the constant repetition and variation of images (ibid). This set of imagery is created in a unified manner by highly paid artists, designers, photographers, models who promote image identities to the general public by advertising the products according to image-based identity. Products such as high fashion, in particular, are marketed to a select few of consumers due to their high cost, although the identity promoted by these products is meant for the general public by advertising them to glossy magazines. Lanvin Paris is an example of this produc t.It is clear that an advertising image is analyzed semiotically in order to disclose the underlying meaning embodied in a text or an image itself. Since semiotics constitutes the sign systems within texts and their role in creating meaning, the sign becomes an iconic sign as it resembles or implies what it signifies.

White Collar and Corporate Crime Essay Example | Topics and Well Written Essays - 2500 words

White Collar and Corporate Crime - Essay Example Concealment of misconduct usually involves falsifying records or documents to disguise discrepancies. The higher the degree of effort to conceal a corporate misconduct the more difficult detection will be for unsuspecting management, the public, investors, directors, auditors, and the government. Crime was defined only by traditional "street crimes" during the 30-year period between 1940 and 1970, and there was minimal public concern with the issue of corporate criminal conduct. Since the early 1970s, however, "crime in the suites" has emerged as an important political, social, and economic problem. The extent and seriousness of criminal behavior by corporations, corporate officials, and employees led to the development of organized crime as a separate type of white-collar crime and, more importantly, an increased recognition of the need for criminal statutes that address corporate misconduct and more severe criminal corporate sanctions (Clinard, Marshall, and Peter Yeager. 1980, 132). Sutherland defined white-collar crime as "crime committed by a person of respectability and high social status in the course of his occupation," and used the term to refer primarily to "business managers and executives." (Edwin Sutherland, 1961, p. 19) His studies and conclusions indicate, however, that white-collar c... Organized crimes were initially defined as "the offenses committed by corporate officials for their corporation and the offenses of the corporation itself" and occupational crimes were the "offenses committed by individuals for themselves in the course of their occupations and the offenses of employees against their employers." (Marshall B. Clinard and Richard Quinney, 1973, p. 188). Occupational crimes are committed by lawyers, doctors, businessmen, and politicians, for example, and may include crimes like income tax evasion, embezzlement, and check kiting. Corporate crimes are organizational crimes and can only occur in the context of the complicated relationships among executives, corporate officers, managers, and corporate agents on the one hand, and among parent corporations, corporate divisions, and subsidiaries on the other hand. Nevertheless, a distinctive feature of organized crime is that the crime is committed primarily for the benefit of an ongoing legitimate business enterprise rather than for the individual who actually carries out the offense. Thus, organized crime is a specific type or form of white-collar crime and includes criminal conduct, intended to benefit the corporation, by corporations and by individual corporate employees, officials, or agents. In the late 1980s and early 1990s has served to bring potentially dangerous corporate activities to the general attention of the public and has inspired the academic legal community to pay greater consideration to several very basic questions concerning the potential use of the criminal law in this area. (Fisse, B And Braithwaite, J, 1993, 134) The criminal statistics show unequivocally that crime, as

Piracy Ruining the Music Industry Essay Example for Free

Piracy Ruining the Music Industry Essay For many people, music is a large part of their lives. They listen to it to as often as they can. In their cars, while they work out, study, and many other daily activities. But does anyone think about how important music is to those who work in the music industry? Some people buy CD’s, others may buy digital copies online (often referred to as mp3’s). However, there are others who download free copies of music from file sharing websites, such as FrostWire and Napster. This is a crime, and many people are not aware of it. There needs to more stringent measure to protect the music industry from these acts of piracy and copyright infringements. Piracy has affected the music industry drastically over the years. It would appear all is well for those in the recording industry. However, the music industry is worth more than half of what it was in 1999 and the decline doesnt look as if it will improve. The RIAA (Recording Industry Association of America) reported that in 1999, the revenue for music sales topped $14.6 billion. Over time, total revenue from U.S. music sales and licensing plunged to $6.3 billion in 2009 (Alexandra. â€Å"The History of Recording Industry Sales, 1973-2010†). File sharing is the reason for the decline in album sales over the years. Because it is so easy to get free music, people do not find a need to purchase it. In 1984, the Supreme Court, ruled in the Universal City Studios vs. Sony Corporation case, that home recording of copyrighted materials, would be legal under the fair use provision (Stevens, Law of Cornell.). The decision was made so that it would be legal for home users to make copies of copyrighted material without obtaining any permission of the copyright holder to do so. This ruling covered music, television shows, and movies. Many people argued that they wanted to be able to use the recording devices that they purchased. There needs to be new laws to reflect the change in technology since that time. In 1984 we did not have the different file sharing sites that gave people the opportunity to upload their recordings. Piracy is very popular in many countries. This is because many cultures are interested in the American lifestyle. It is very hard for other cultures to obtain American media, so they rely on file-sharing websites to stay connected. This has affected the American economy drastically. There has been a loss of around 71,060 jobs, a decrease of worker earnings of 2.7 billion dollars and a loss of U.S tax revenue of 422 million dollars. It is estimated that the cost of piracy in the global economy in 2012 was 35.4 billion dollars, and 12.5 billion dollars affecting the music industry individually. (Goldman,† Musics lost decade: Sales cut in half†) The U.S. government has attempted to prevent piracy by bringing lawsuits against companies such as, LimeWire, Mega Upload, and Pirate Bay. Sites such as these may be stopped, but within months another company begins a similar or more-improved service. â€Å"Would you go into a CD store and steal a CD?† questioned an angry Britney Spears in an industry-funded advert. â€Å"It’s the same thing, people going into the computers and loggin’ on and stealing our music.† Piracy is ruining the entertainment industry. The music industry has a diminished profitability, and significant job loss has occurred, and will only get worse, unless there are more stringent measures to regulate the internet and its’ file-sharing sites.

Care Of Suprapubic Catheter Protocol Health And Social Care Essay

Care Of Suprapubic Catheter Protocol Health And Social Care Essay Urinary catheterization is used in approximately 15% to 25% of all hospitalized patients (Griffiths Fernandez, 2007). A physician may decide when it is appropriate for a catheter to be used as part of a patients therapeutic regimen. There are different catheter options for patients depending on each individuals situation. Urethral urinary catheters are traditionally selected and used in short term cases, and require no surgery (Khan Abrams, 2008). A suprapubic catheter, (SPC), requires a surgical procedure and has a longer recovery time. According to one Urologist, the ratio of urethral urinary catheters to suprapubic catheters used specifically in his practice was 300:1 (J. Banno, personal communication, February 13, 2011). This is based on physician preference as well as duration the patient will need to have the catheter in place. In the case where long-term catheterization is indicated, SPC have become the superior option (Khan Abrams, 2008). While the initial insertion of a s uprapubic catheter remains the responsibility of a physician, it is within the scope of practice for a nurse to provide care and exchange the tubing with the proper teaching (Illinois Compiled Statutes, 2008). In response to this change, hospital systems have enacted protocols that allow registered nurses (RNs) to perform the suprapubic catheter exchange. Changes should be performed by staff that have been adequately instructed in regards to the technique for changing the catheter, and are able to identify possible complications of SPC changes. Additionally, offering the option of patients and their caregivers to be trained is also important in adding to the patients independence (Harrison, Lawrence, Morley, Pearce, Taylor, 2011). The procedure of a suprapubic catheter exchange has been performed by RNs in the community setting with an existing protocol, and more recently the idea that this task be carried out within in the hospital has been explored. This procedure is done by the family members, caregivers, and even the patient themselves in a discharge at home setting safely and efficiently for many years (Anderson, 2002). Therefore adding this protocol into an acute care setting for RNs to complete in the hospital setting is a practical implementation. A nurse led, outpatient services in Musgrove Park Hospital, Taunton has been performing the suprapubic catheter insertions since 2004, and the program had an 89% successful rate over a period of a couple years (Khan Abrams, 2008). This study shows evidence that nurses are capable of effectively managing a patients suprapubic catheter Since there is no present protocol for suprapubic catheter exchange or patient care by RNs within the Advocate Christ Hospital system, development of such a protocol has been explicitly requested by stake-holders including physicians and nurse in management within the system. When staff training and education is poor, there is a likelihood of an increase in complications (Harri son et al., 2011). Practice guidelines better enables nurses in providing patients with their specific care needs. The goal for this project was to create a suprapubic catheter care and exchange protocol based on the best evidence available so that these needs can be met. Review of Literature A suprapubic catheter is a urinary drainage system inserted into the bladder via an incision through the anterior abdominal wall, and may be is used when a urethral catheter is contraindicated. A suprapubic catheter is a popular choice for patients having to have long-term catheter placement and replaces the need for an indwelling catheter. Suprapubic catheters consist of 4% of hospitalized patients with urethral catheters in situ (Rigby, 2009). Although a small percentage of suprapubic catheters are used compared to other urinary catheter options, there is little literature of published guidelines related to suprapubic catheter management, and at the same time there is a growing need to increase awareness of both the risks and benefits of using a SPC (Harrison et al., 2011). Making this information accessible may increase the successful use of the device in future patient care. Indications Suprapubic catheters are used for a wide variety of patients, and for a number of reasons. A catheter insertion may be an elective procedure, or happen in an emergency situation depending on each patients circumstances. Neurological disease, urinary incontinence, postoperative care, bladder trauma, and palliative care are all reasons a clinician may consider using a suprapubic catheter in a patients care (Harrison et al., 2011). Many of these conditions require long term catheterization, and each patient and their physician need to discuss if a SPC option is a modality that best fits their specific lifestyle. Presently, SPCs have become more prevalent than indwelling catheters for patients who require long term catheterization (Khan Abrams, 2008). This may be due to the maintenance of these catheters over a longer period of time. Contraindications Under certain circumstances, a SPC should not be used. These include: bladder cancer, if the patient is receiving antiplatelet therapy, presence of abdominal wall sepsis, or if a subcutaneous vascular graft in the abdominal area exists (Harrison et al., 2011). Advantages Advantages for the placement of a suprapubic catheter compared to a urethral urinary catheter are evidenced in the cases of a urethral blockage; there is less incidence of leakage in SPC, and a reduced risk of pressure sore damage in wheelchair users. SPC tends to be more comfortable and sexually non-inhibiting. With the use of SPC there is less chance of catheter migration. Studies suggest a lower incidence of bladder cancer in patients managed with an SPC, less than 0.39% over 5 years, compared to indwelling urethral catheters (Khan, Matheur, Timoney, 2007). Suprapubic catheters have been shown to have a lower infection rates than catheters placed transurethral. A study found that 26% of the transurethral group encountered a urinary tract infection verses only 6% of the patients with the supra pubic catheters (Wells, Steed, Capstick, Schepanksy, Hiltz, Faught, 2008). Disadvantages Although SPC is a good option for many urethral catheter recipients, there are disadvantages nurses and patients need to be aware of when caring for SPC in situ. Some possible disadvantages include: dangerous bowel perforation, urethral leakage and spasm, increased incidence of stone formation, and alteration of body image. One study found that in 185 cases of SPC insertion, 2.7% incidence of bowel perforation occurred with one incidence that had a fatal outcome (Harrison et al., 2011). SPC is also contraindicated in patients with bladder cancer. Technical issues, for example speed of reinsertion, can also result in disadvantages of SPC usage (Rigby, 2009). It is important that if a catheter removed only when a new one can be reinserted immediately to avoid complications. (See complication section) SPC insertion The initial insertion procedure requires surgical skill, special equipment, and additional training; it is therefore considered a surgical procedure conducted by a physician. After the initial insertion, the catheter is usually left in place for 4-6 weeks to allow the cystostomy channel time to form (Rigby, 2009; Robinson, 2008; Wimpenny, 2010). This allows time for the catheter track to mature. Subsequent changes following the first change should be done every 6 to 8 weeks and can be done by a trained RN or caregiver (Robinson, 2008; Wimpenny, 2010). For every day that the catheter stays in place approximately 5% of patients will develop bacteriuria and up to 50% may progress over one week, and virtually all patients requiring indwelling urinary catheters for longer than a month become bacteriuria (Dixon, 2010; Rigby, 2009). Having trained personnel available to exchange the catheter in a timely fashion may help decrease these risks. Protocol Need Within a hospital system, it is important for protocols of specific procedures to be written step by step so that guidelines can be followed by staff members so consistent care is provided. Policies and procedures provide guidance in patient care for nurses and strive to achieve the goal of safe practice (Long, Burkett, McGee, 2009). Having uniformity within a hospital system can help deliver expectations for the patient and health care staff. According to the Guidelines for Use of Medical Protocols (2004), each protocol should be individualized for different types of patients, include a time frame required for patient evaluations, well as be readily available to heath care staff. Many tasks that a nurse uses while providing care for require up to date, evidence based information made into a protocol for the nurse to follow to ensure the most uniform care. According to Balakas, Potter, Pratt, Rae, Williams (2009), agencies including the Magnet Recognition Program have incorporated evidence based practice and research as themes for their organizations to improve the education of the healthcare professionals. Creating a suprapubic catheter exchange protocol is necessary so that nurses can be trained and can execute this task using a step-by-step guideline of care. Nursing Care Proper care for a suprapubic catheter is paramount in preventing future complications such as infection, and ensuring the catheters functionality for as long as possible. It is important to maintain a good standard of cleanliness to reduce the risk of infection (Robinson, 2008). While a patient is hospitalized, it is the responsibility of the health care team to ensure that the insertion site is appropriately maintained. Nursing care for a suprapubic catheter site should be assessed once every shift and actions should be taken depending on the findings. Infection. Nurses have the responsibility to assess the patient daily so that complications are caught as early as possible. Like all other procedures completed in the hospital, proper hand hygiene is crucial in decreasing the chance of infection (Rigby, 2009; Rushing, 2006; Robinson, 2005; Robinson, 2008). Hand washing should be done before entering a room, when leaving a room, and any time the healthcare provider changes gloves. Rushing (2006) states that if there is a dressing present at the cystostomy site, after removing it and disposing of the gloves, hand hygiene should be performed again before cleaning the site. This further decreases the chances of infection by evidence stating that gloves should be changed after every contact with an infective material that may contain a high concentration of microorganisms (Best Practices, 2003). Dressing. A dressing change may not be applicable to certain patients depending on the amount of time the patient has had the catheter, and depending on if the doctor has ordered a dressing to the site or not. Suprapubic catheters are used for long-term bladder management, and can be a permanent part of a patients life (Khan Abraham, 2008). Once the suprapubic catheter has been in place for at least 6 weeks, the site has healed enough to be uncovered from the dressing (Robinson, 2008). If a patient has had the catheter initially inserted within the last 6 weeks, a dressing may be placed in order to aid the site in healing while keeping infection out. If applicable, all used dressings should be carefully removed and disposed of appropriately when cleaning the site. After the first exchange has taken place, the site will remain exposed for everyday life unless otherwise stated by the doctors orders. The nurse can also use his or her own judgment and skills to decide if each specific p atient needs a dressing over the site depending on the initial assessment. Assessment. While the cystostomy site is exposed, it should be carefully inspected for signs of infection, skin integrity and any drainage of urine, blood, purulent matter or any other exudates (Rigby, 2009; Robinson, 2008). These cues can be the first signs of complications and need to be addressed immediately. If the nurse suspects infection or has any doubts, a swab can be obtained and sent for culture per doctors orders (Robinson, 2005). The nurse must also assess the catheter tube for patency. According to the literature, the tube can come occluded with sediments or clots. This could cause the tube to become dislodged requiring reinsertion by a surgeon. The nurse needs to keep in mind that the catheter should never be irrigated unless ordered by the physician. Irrigation when not ordered could cause complications in the drainage system. It is also essential for the nurse and other staff members to keep the collection container below the patients bladder level. When turning the patient or when the patient is ambulating, the healthcare staff must ensure that this is followed. The urine itself can also provide indications as to the status of the patients bladder drainage system. The clarity, color, and odor all need to be assessed as well as measuring the urine at least every 8 hours (Rushing, 2006). The color can detect a possible urinary tract infection, and effective output measurement is important to the patients t herapeutic regimen. (Rushing, 2006) Before the nurse is done with the assessment it is also important to check the placement of the tubing and make sure that it is secured. This should be done by taping the tubing to the patients abdomen making sure to leave enough room for the patient to comfortably move. Since the tape is attached to the skin, this must also be included in the daily assessment so that possible skin breakdown can be avoided. (Rushing, 2006) Exchange Studies have shown that when a suprapubic catheter is changed by the shift nurse for that patient verses the urologic consult physician, the patient complains of less pain and more comfort during the exchange. Patients are given the opportunity to be premeditated with pain medication when the RN is completing the procedure since the RN is better able to plan for the exchange and give the medication accordingly. (Anderson, 2002) Sutured. Suprapubic catheters are often sutured in place during the initial insertions to allow healing time for the cystostomy and ensure the catheter maintains correctly placement. Once the cystostomy channel has formed and healed the sutures are usually removed. This may not be the case in all suprapubic catheter placements, but if sutures are present, the exchange will remain the responsibility of the physician. A urology consult would likely then be made and a physician would be required to complete the procedure. In cases where the sutures are permanent, this usually designates that the suprapubic catheter has been recently placed, or the catheter is at risk of being pulled out or dislodged based on each individual patient/physician basis and preference. In these circumstances the nurses responsibilities will be limited to cleaning and maintenance care of the patients cystostomy site. (See nursing and patient teaching sections for more information regarding care and maintenance .) Unsutured. A properly positioned SPC with adequate cystostomy does not necessitate sutured abdominal placement. Once healing has occurred sutures are not needed to hold the tubing in place. After the first change has been conducted, a registered nurse then has the option to exchange the suprapubic catheter (Rigby, 2009). The best evidence in regards to how often to exchange a suprapubic catheter is found to be every 6 8 weeks (Robinson, 2008; Wimpenny, 2010). The procedure for the exchange of SPC uses an aseptic technique, and the equipment required is similar to that used for urethral catheterization (Robinson, 2008). When changing a suprapubic catheter speed is very important. The new catheter should be inserted within 5-10 minutes of removal of the old catheter. (Rigby, 2009; Wimpenny, 2010). The longer the site is exposed the more chance that bacteria can become a problem. Also, the catheter track will close very rapidly once the catheter has been removed (Harrison et al., 2011) . The catheter should never be removed unless an immediate change will take place. When a patient comes to the hospital with a SPC, the health care team should make sure to always have a spare catheter available at the patients bedside in case of accidental removal (Rigby, 2009). The exchange of a suprapubic catheter follows a very similar procedure to that of insertion of a urinary catheter. The nurse must check the doctors orders to ensure the correct size and type of catheter are being used during an exchange (Robinson, 2005). In completing this task the nurse is ensuring that he or she has all of the supplies necessary to begin and complete the procedure within reach. While providing the patients privacy, the nurse should first explain the procedure and obtain the consent of the patient (Chaikind, 2004). Subsequent to this, the patient should be instructed to lie in the supine position, exposing the suprapubic catheter insertion site. Next, the nurse will wash his or her hands with soap and water or antibacterial solution in an effort to decrease the risk of infection during the exchange procedure. Contact isolation precautions should be taken during this procedure since the cystostomy creates a new route to the bladder that may lead to infection. An asep tic approach should be taken throughout the process. A gown and non-sterile gloves should be worn at all times, unless sterile gloves are order. (Best Practice, 2003) Using aseptic technique, open the sterile packages and prepare a clean, convenient working space that is close to the patient. This will further decrease the risk for infection (Best Practice, 2003). If there is a dressing on the clients cystostomy site it should be removed and cleaned with 0.9% sodium chloride solution to avoid introducing bacteria into the channel during the exchange of the catheter. Remember to clean the site from the inside out and never wipe over a previously cleaned section to decrease the risk of bacteria contaminating the cystostomy channel. The balloon catheter needs to be deflated before the catheter can be removed. Use the empty syringe provided to remove the sterile water from the balloon. With the contaminated gloves still on, remove any tape or straps holding the catheter and catheter bag to the patient. (Rigby, 2009; Robinson, 2005; Wimpenny, 2010) Next, remove the catheter steadily and slowly to avoid balloon cuffing or possible pain to the patient. Grip catheters at the skins surface area and remove the catheter slowly making sure there is no resistance and the patient is not in any pain. Studies have shown that if there is no resistance or pain in the first 1-2 cm of removal it is unlikely there will be any complications during the removal (Robinson, 2005). Rotating the catheter while removing it aids in reducing the risk of channel damage. Measuring the catheter that was inside the patient will ensure correct placement of the new catheter. After removal of the old catheter, quickly clean the surface area of the patients cystostomy site of any urine or exudates that may have come out during the removal process. Next, while holding the new catheter at the distance measured from the old catheter, insert the tubing down the cystostomy channel. The new catheter should be inserted as quickly as possible after the removal of the o ld catheter. The time between removal and insertion of the new catheter should be within 5 to 10 minutes (Rigby, 2009; Wimpenny, 2010). Attach the prefilled syringe containing 10ml of sterile water and inflate the catheter 3-5ml full. It is suggested that this should be done slowly and carefully so that the risk that the catheter tip does not pass into the urethra (Harrison et al., 2011). Pull back slightly until resistance is felt against the bladder wall, then completely inflate the catheter balloon with the remaining sterile water (Rigby, 2009; Robinson, 2005; Robinson, 2008; Xue, 2009). Attach a new drainage bag to the catheter and secure the new bag in place. Make sure the abdomen and cystostomy site are clean and dry before dressing and taping the new catheter to the patient. Cleaning and drying the area will create a better foundation for the new catheter and lessen the chance of accidental removal as well as decrease irritation and infection risk. Also, taping the catheter tubing to the patients abdomen will secure it in place and lessen the chance for the catheter to be accidentally removed. Make sure the patient is comfortable and make efforts to reduce any pain throughout the procedure. Dressing. Generally if a patients cystostomy site is clean and dry, it is not necessary to put a dressing around the tubing and insertion site. Although some patients may prefer for the area to be covered, topical dressing can be used per patient preference and hospital protocol. Refer to the patient teaching section regarding proper care and maintenance of a suprapubic catheter for more information. (Robinson, 2005) Complications. As with any medical device, utilization of a suprapubic catheter presents specific and often predictable problems associated with its use. The patient, their family, and associated healthcare providers must assess for complications and take measures to minimize occurrences. If a complication should occur interventions should be implemented to correct these problems as soon as possible. Common complications include: bladder calculi, balloon cuffing, abdominal wall and urethral infections, bleeding, altered body image, latex allergy, over granulation, bypassing whether by urethral and/or entry site, and obesity (Rigby, 2009; Robinson, 2005; Robinson, 2008; Xue, 2009). Bladder calculi. Occlusion of the catheter causes a variety of problems in addition to compromising the functionality of the device. SPC has a lower incidence of urinary tract infection compared to urethral catheterization although it may increase the incidence of bladder calculi (Wells et al, 2008). One-third of patients with long-term SPC developed bladder stones over a ten-year period (Khan et al., 2007; Sugimura, 2008). Under alkaline conditions minerals precipitate on the outside of the inserted portion of the catheter, especially the tip. This can cause recurrent blockage in around 40% to 50% of long-term catheterized patients. Replacing catheters regularly reduces blockage, and blocked catheters should be replaced promptly (Rigby, 2009). If a patient is having repeated occurrences of this, exchanging the catheter more often may be helpful in preventing such buildups (Harrison et al., 2011). Balloon cuffing. Many patients report pain upon the removal of the suprapubic catheter. This is partially due to the detrusor muscle contracting during stimulation. Additionally, it is estimated that the diameter of the catheter increases in size at the location of the cuff even after deflation. Upon removal this size increase is responsible for causing additional pain. In suprapubic catheterization the catheter passes through the detrusor muscle. As the catheter is being removed, the detrusor muscle is stimulated. Stimulation causes the bladder wall to contract, tightening its hold on the catheter. As more force is used to remove the catheter due to restriction and tightening of the bladder wall an accordion type of effect which causes ridges in the deflated catheter balloon and bunching at the catheter tip (Robinson, 2003). Balloon cuffing causes the silicone to stick, which in turn causes pain to the patient and possible lesions down the cystostomy channel. Hydrogel coated latex c atheters are now increasingly used in suprapubic sites, unless the patient is allergic to latex (Parkin, Scanlan, Woolley, Grover, Evans, Feneley, 2002; Robinson, 2003). Having the patient relaxed and encouraging the patient to deep breathe will lessen the constriction on the detrusor muscle resulting in less pain for the patient. Properly premeditating the patient with pain medications prior to the procedure may also help to reduce the anxiety and pain (Anderson, 2002). This problem has been seen more commonly with silicone catheters due to ridges being formed in the balloon that may hinder the catheter withdrawal (Harrison et al., 2011). Abdominal wall and urethral infections. The patient and/or trained caregiver should inspect the cystostomy site for infection daily and any time the site is exposed. The chance of catheter site infection is always a possibility. Bacteria are inevitably present at some time in a patients usage of a urinary catheter for a long period of time. This should be treated with antibiotics unless cellulitis is present (Harrison et al., 2011). Additionally, the healthcare provider should assess for signs and symptoms of infection. If the patient is presenting with signs of infection (i.e. foul smelling urine, urine has a cloudy appearance, redness or puss around insertion, etc.) inform the patients physician and send a sample of the urine or puss to the lab for a culture (Robinson, 2005). For every day that the catheter stays in place approximately 5% of patients will develop bacteriuria and up to 50% over one week, and virtually all patients requiring indwelling urinary catheters for longer th an a month become bacteriuria (Rigby, 2009). The best practice evidence shows that the catheter should be changed every 6 8 weeks and should be cleaned daily (Robinson, 2008; Wimpenny, 2010). This will further prevent infectious microorganisms from leading to future complications. If an infection is apparent whether at the insertion site or within the patients urine, the patients physician should be contacted immediately in order to avoid further complications (Best Practice, 2003). Risk for bleeding. Hematuria or bleeding of unknown cause can occur at any time. Encrustation and cuffed catheter balloons can cause bleeding along the cystostomy tract. In situations like these, the bleeding should stop fairly quickly (Robinson, 2005). Patients should be aware of the risk for bleeding and contact their healthcare provider in the event of bleeding that continues. During the exchange process bleeding may occur. Nurses need to be aware of possible injuries and evaluate each scenario based on the individual patient. Light bleeding is not a cause for worry, but should be monitored for clotting and infection. Bleeding and failure of the catheter to drain properly may indicate that the tip of the catheter is lodged in the urethra. If this has occurred, the catheter balloon should be deflated so that the catheter can be positioned correctly (Harrison et al., 2011). If the bleeding does not stop or the site becomes painful or inflamed consult a physician. Latex allergy. Latex allergy will present a problem when latex catheters are used. The nurse needs to ask the patient if they have a latex allergy. The nurse must be informed whether the replacement catheter includes latex prior to exchanging it. Silicone catheters are available for patients who have a latex allergy. (Robinson, 2005) Over granulation. The bodys natural healing process may generate over granulation around the cystostomy and is a common occurrence at the suprapubic entry site (Robinson, 2003). Over granulation is described as a buildup of scar tissue inside the cystostomy site and around the stoma. This over production of cellular growth will cause a narrowing at the insertion site making exchange very difficult. Depending on the degree of over granulation no action may need to be taken but this area needs to be observed. However if over granulation is increasing, this problem needs to be treated (Robinson, 2005). Use nursing judgment to decide if and when the physician needs to be notified because over granulation has begun to cause blockage at the insertion site. Harrison et al. (2011) suggests that the use of silver nitrate can be used to help manage the granulation growth, as long as a barrier cream is used on the surrounding skin so that only the desire area is treated. Bypassing whether by urethral or entire catheter. Occasionally urine may travel through the urethra or within the channel created by SPC placement. Bypassing through the urethra or cystostomy channel is a common problem in SPC patients. Unless the bladder neck has been surgically closed, it acts as a safety valve. A nurse should also check the catheter for blockage to make sure the urine is not being sent back into the bladder and out the urethra causing the leakage. Additionally, it is recommended to check for incorrect fitting of the drainage system. If the catheter seems like it does not fit snuggly inside of the channel, consult the physician to make sure the right sized catheter is being used and nothing is wrong with the channel itself. Antispasmodics and anticholinergic medications can be used in the instance of bladder spasms being the cause for leakage. Use nursing judgment and refer the patient to a urology consult if the leakage continues once all other possibilities have been ruled out. (Robinson, 2005) Obesity. If the patient is obese a second person may be used to separate the folds of overlapping skin to aid access to the cystostomy site. In some cases the patient may be able to assist the RN, to hold back the extra skin, creating a comfortable, sterile working field for the RN that is doing the exchange. Obese patients also have trouble maintaining a clean, infection free area for SPC placement. Tailored hygiene instruction and reverse demonstration should be done with obese patients to warrant safe effective home care. (Robinson, 2005) Autonomic dysreflexia. Autonomic dysreflexia is a common complication in spinal cord injury patients and the healthcare provider should be aware of signs and symptoms related to this disorder. Suprapubic catheters are used in many spinal cord injury patients. Therefore, special attention needs to be given to patients with injuries above T6. Complications of autonomic dysreflexia can be life threatening. If there is a kink in the catheter tubing autonomic dysreflexia may occur due to an over reaction of the autonomic nervous system causing excessively and suddenly high blood pressure. The health care professional would need to immediately recognize this condition, set the patient in an upright position and un-kink the tubing or remove the catheter if symptoms do not subside. (Schottler, 2009) Documentation Documentation is an important aspect when giving care. Not only does this show evidence of the patients progress, but also it is helpful when communication among multiple healthcare staff that may be involved with an individuals care. Insertion site, skin integrity, catheter patency, urine appearance and amount, and patients pain all need to be documented in each assessment made (Rushing, 2006). The documentation process may be different depending on what type of patient charting is done, but the content will remain the same. Documentation should be completed every shift and include findings from each assessment care rendered and complications should be thoroughly noted. Document the procedure per the hospital protocol making sure to include the type of catheter, length of the catheter inserted, date and time the change took place, size of the catheter used, how much sterile water was used to secure the catheter in place, and how the patient responded to the procedure (Rigby, 2009; R obinson, 2005; Robinson, 2008; Xue, 2009). Documentation of the insertion site should include the color of the skin, presence of any breakdown, tenderness, and exudates that may be present. Patency of the drainage tube needs to be documented. The urine appearance should be documented based on color, odor, and amount. This is done so that an accurate output can be determined. Depending on a patients specific needs, strict intake and output may affect the p

Leadership In Ancient Civilizations Essay -- essays research papers

During the period of the Roman Republic and the Roman Empire, different leaders exhibited different styles of leadership and employed different political strategies. In addition, these leaders came to power and maintained their control in their own unique ways. Each leader seemed to have his own agenda, which set the tone for that era. Five prominent leaders of this time period were Agricola, Augustus, Julius Caesar, and the brothers Tiberius and Gaius Gracchus. The point to be made with respect to these particular men is related to the obvious correlation between the nature of a leader’s agenda and the impact of his reign. In the end, a ruler’s fate was dependent not on his agenda, but on style and strategy with which he pushed his agenda. Those leaders whose methods were completely altruistic were heralded as great leaders, while those with devious and/or unethical methods of pushing their agendas were hastily assassinated. First consider Tiberius Gracchus. It is imperative to analyze his style of leadership and his political strategies. During his term as tribune, Tiberius’ major goal was to pass a land reform bill. This bill was biased toward the masses. Tiberius tried fairly and squarely to gain the support of the Roman senate, but this effort was to no avail. Tiberius then resorted to unfavorable tactics when he impeached another tribune, Octavius, the major opponent of Tiberius’ bill. Thus Tiberius willingly destroyed the long-held and quite favored notion of an immune tribune. However, this is what the common people wanted. Tiberius’ big mistake was blatantly opposing, thus disrespecting the Roman senate. As a result, the senate assassinated Tiberius. The lesson to be learned here is not that Tiberius’ agenda was constructed out of self-interest or greed. Tiberius simply wanted to help the common people. However, Tiberius’ methods were not proper for that time in that place. And it is probable that Tiberius could easily have been persuaded to compromise. Thus, Tiberius’ downfall was not his agenda, but his style and political strategy. A different example of the same principle is summed up with the story of Tiberius’ younger brother, Gaius Gracchus. Gaius worked not to appease the senate, but to appease the people. Although this seems quite noble of him, it was still a mistake to oppose the senate. Granted, this notion is counter-intuitive. One wo... ...in accordance with the main point we have been discussing, he did so with a particular style and political strategy, so as not to offset social order. He ruled very subtly. He saw to it that he got what he wanted, yet he did so with such caution that it was disguised as interest in providing for the good of the citizens. Therefore, Augustus’ reign supports the theory that a ruler can drive a selfish agenda, yet as long as the style and political strategy of the leader in question is favored by the people, then the leader can still be considered a good ruler.   Ã‚  Ã‚  Ã‚  Ã‚  Therefore, upon considering the lives of Tiberius and Gaius Gracchus, Julius Caesar, Agricola, and Augustus Caesar, it is clear that people in the Roman Republic and the Roman Empire considered a leader’s particular actions more that his agenda when deciding whether or not a leader is worthy of being called â€Å"great† or being assassinated. Obviously, a leader’s agenda and accomplishments are important factors, but we have seen with these five particular leaders that sometimes accomplishments do not matter. What matters greatly are the steps taken by a leader to obtain goals or satisfy certain needs.

Grapes Of Wrath :: essays research papers

During the Dust Bowl, hundreds of thousands of southerners faced many hardships, which is the basis of the novel called The Grapes of Wrath. John Steinback wrote this fiction novel to portray the harsh conditions during the Dust Bowl. However, is the portrayal of the Dust Bowl in The Grapes of Wrath valid? When one considers the merit of this novel, one thinks, how can Americans treat other Americans so horribly. After reviewing American History, the mistreatment of the "Okies" in The Grapes of Wrath can be concluded as being valid. After slavery, blacks were terribly treated. During the Civil War, Americans were divided. During the Red Scare, Americans mistrusted other Americans. These three different periods of U.S. history display how Americans can treat fellow Americans so cruelly. 	African Americans were terribly treated after slavery. Although they were Americans just like the whites, many of the whites hated them because they were different. One example of mistreatment of the African Americans was segregation, which was the division of local places by race. The blacks were thought to be so "dirty", and the whites were scared of them. The whites did not want the blacks to mix with the whites. Public areas such as schools were segregated so the blacks and whites went to different schools. It was like the whites wanted to rid the U.S. of the blacks. In The Grapes of Wrath, the Californians wanted to rid the "dirty" Okies from California because they were afraid of them. They were afraid that the Okies would take their land. Blacks were also beaten for no just reason. Racial group such as the KKK, beat up blacks because they hated the blacks. They wanted the blacks to go away or die. In The Grapes of Wrath, Okies were unjustly beaten. The California police beat them for no just reason because they wanted the Okies to leave the state. The police killed Casey for no just reason. They killed him just because they thought the was a Okie fighting for more rights. The Californians did not like the Okies even though they were Americans, just like how the Blacks were not liked by the whites, even though they were Americans. White mistreatment of African Americans was not the only Americans mistreatment of Americans; there was also the infamous Red Scare. The Red Scares is another situation in which Americans mistreated Americans.

Call of the Wild

Zach Maes English 2 8-30-2011 Call of the Wild 1. Some readers see the hardships and suffering of the dogs in the sled team as symbolic of workers in a Capitalistic system. Identify and explain these similarities. â€Å"He had killed man, the noblest game of all, and he had killed in the face of the law, of club and fang† (ch. 7) Capitalism is an economic system in which the workers only are paid enough to eat and survive. The dogs in the sled team have to work hard and are only fed enough to survive.The workers in the Capitalistic system are treated the same as the dogs, in which they are given the bare minimum to live, and only to live, they do not receive enough money to do more then eat. The sled dogs have to work hard like the workers, and are rewarded with food. They relate because the bare minimum is given whether it is the sled dogs or the Capitalistic workers. 2. Trace Buck’s development from a â€Å"monarch† to a working dog to a â€Å"free† dog. Specifically, how is Buck’s transitional experience a â€Å"Call of the Wild†? Consider such quotes as Pete’s: â€Å"When he was made, the mold was broke. † â€Å"His eyes turned bloodshot, and he was metamorphosed into a raging fiend. So changed was he that the judge himself would not have recognized him† (Ch. 1) Buck starts the novel as a ruler of his household. His experience becomes a â€Å"Call of the Wild† because he is an animal and that is where he naturally came from.He goes through several stages of life from living in a royal palace to working hard pulling a sled for the Canadian Government. And then to falling in love with someone that he belongs with, and then getting it all ripped away from him again. He was bred to fight, and bred to be a leader and to be alone in the wilderness, and to conquer the wilderness and to answer the â€Å"Call of the Wild†. 3. Compare Buck at the beginning of his journey with Buck at the end of his journey. What are the changes and what causes them?Would you call him a hero? Why or why not? What is the most valuable lesson learned? â€Å"He was older than the days he had seen and the breaths he had drawn. He linked the past with the present, and the eternity behind him throbbed through him in a mighty rhythm to which he swayed as the tides and seasons swayed. † (Ch. 6) At the beginning of Bucks journey he didn’t know a lot about himself, but as his journey continued he slowly began to learn more about himself, like how much pain he could handle, and how much fight he had.He learned that he could withstand anything, and he learned a lot more about himself then he could of he spent the rest of his life at the Judge’s house. He learned that he could live by himself in the wild and that he needed to kill and he needed to eat fresh meat to live. Living in the wild was what he was made to do, it was in his blood, passed down from generation to generation from his parents, and all that was needed was to be introduced to the wild, and when given that opportunity he flourished. ? London, Jack (1903). The Call of the Wild.