Essay about Business Communications - 1526 Words

THE IMPORTANCE OF WRITING SKILLS IN BUSINESS COMMUNICATIONS: HOW AND WHY TO IMPROVE EMPLOYEES’ WRITING Abstract This essay describes how poorly written communication can lead to misunderstanding and a possible loss of business. Through this paper the author wants to persuade the employer to sponsor a workshop for all employees to improve their writing skills, to increase business communications and to avoid arguments through poor communication. This paper demonstrates the effectiveness of writing skills and why business communication is important in any kind of business. What can your business achieve with good writing skills and what it the impact of good writing skills on business. THE IMPORTANCE OF WRITING SKILLS IN†¦show more content†¦Success in any business depends on one thing: the ability and knowledge to communicate. The knowledge of good business writing is a very important factor and part of our day-to-day business. We have to understand and take some time in writing business letters. It will require a little planning and some thought, but for the company, it can make the difference between successful and failed business deals. We must not forget that our aim is to build a lasting relationship with our internal and external clients. Some people say that writing is the most important way to conduct business. Business writing can illuminate, clarify, and specify; it should also communicate and convince people to do business with a company. A good business letter should be friendly and approachable with simple words, in short sentences and brief paragraphs. If we start to write business letters like this, there will be a higher possibility that the letters and memos are actually read. We have to teach our employees that it is important in business writing that correspondence should not be too overstated, but to the point, and we should not keep repeating ourselves. We should not write about how lucky the client will be if he/she would continue to work with the company. The writing should convey and communicate the positive influence on the client and make the point about what the company can do for the client. We have seenShow MoreRelatedBusiness Communication4956 Words   |  20 PagesOverview Business communication (or simply communications, in a business context) encompasses such topics as marketing, brand management, customer relations, consumer behavior, advertising, public relations, corporate communication, community engagement, reputation management, interpersonal communication, employee engagement, and event management. It is closely related to the fields of professional communication and technical communication. According to Excellence in Business Communication Tenth editionRead MoreBusiness Communications2007 Words   |  9 Pages | |BTEC National Business |Unit 4 Business Communications. | |Learner name | Assessor name | Department | | |All Business Enterprise team |Y- CSI Read MoreBusiness Analysis : Business Communication Essay1539 Words   |  7 PagesBusiness communication Task 1 Types Business example Purpose Source Verbal- A spoken method of communication usually face to face e.g. a meeting with staff. Tesco staff meeting to organise a fundraiser for a nearby charity raising money for Cancer research. The purpose of this would be to invite support for activities e.g. Bag packing campaign or family fun day. Internal: Administration/marketing departments discuss how they will raise money for the charity. External: Local council. Tesco asksRead MoreBusiness Communication8242 Words   |  33 PagesIIBM INSTITUTE OF BUSINESS MANAGEMENT Answer Sheet Business Communication Rahul Sancheti 14/07/2015 The Detailed study Of The Business Communication has Been Submitted To The IIBM Institute Of Business Management â€Æ' Answer Sheet Business Communication Section A: Objective Type Short Questions Part one: Multiple choice: 1. __________is an essential function of Business Organizations: a. Information b. Communication c. Power d. None of the above Ans:B 2. PhysiologicalRead MoreImportance of Business Communication1271 Words   |  6 PagesImportance of Business Communication In business, reputation and credibility need to be built up in order to get clients’ trust and confidence. Having a sense of professionalism will bring a lot to the business, especially in a long term relationship with employees and clients. There is a need to make sure that every business deal is attended to promptly. Business communication encompasses not only communicating with external contacts but also with employees within the organization. This willRead MoreBusiness Communications Essay1516 Words   |  7 PagesTHE IMPORTANCE OF WRITING SKILLS IN BUSINESS COMMUNICATIONS: HOW AND WHY TO IMPROVE EMPLOYEES WRITING Abstract This essay describes how poorly written communication can lead to misunderstanding and a possible loss of business. Through this paper the author wants to persuade the employer to sponsor a workshop for all employees to improve their writing skills, to increase business communications and to avoid arguments through poor communication. This paper demonstrates the effectiveness ofRead MoreRole of Communication in Business1086 Words   |  5 PagesUnderstanding the communication process in managerial position is very important. It guides the communicator in conveying the right message to the right recipient. The mode of communication determines the content of information channelled, and where the managers feel that the information is urgent; they will opt for the right means of communicating. According to the case study in consideration, effective communication leads to positive outcomes from the employees work. It boosts the loyalty displayedRead MoreThe Barriers Of Business Communica tion1268 Words   |  6 PagesBefore I will discuss how to overcome the barriers in business communication I will introduce the different barriers in global business communication; 1) Physical barriers these are inadequate equipment such as out dated computer, phones with poor signal, background noise, poor lightning, temperature that is too high or too cold, tangible item that can interfere with communication. 2) Attitudes sometimes strong emotion like anger, sadness or happiness can take your objectivity. Also being nervousRead MoreEffective Business Communication4674 Words   |  19 PagesResearch Study on Effective Business Communication At American Express Financial Centre TABLE OF TABLE Table 1: Recruitment Methods 13 Table 2: Forms of written communication 15 Table 3: Formal Meetings 15 Table 4: External Communications 16 Table 5: Informal channels of communication 21 TABLE OF CONTENTS ACKNOWLEDGMENT 4 EXECUTIVE SUMMARY 5 INTRODUCTION TO BUSINESS COMMUNICATION 6 LITERATURE REVIEW 6 PROBLEM OF STUDY 7 OBJECTIVE OF STUDY 7 KEY TERMS 8 BRIEF OUTLINERead MoreBusiness Communication M11862 Words   |  8 PagesM1 Business Communication INTRODUCTION In P1 I talked about types of communications used by Asda and these are Verbal, written, on- screen. In this task I am going to show you the advantages and disadvantages of each type of communication referring it to my chosen company and that is Asda. ADVANTAGES OF VERBAL/ORAL Oral communication or speech is often the preferred medium to exchange information in in informal situations since it provides a number of immediate benefits when attempting to pitch

Bryan and John challenged Jesse and her daughter Lynette...

Bryan and John challenged Jesse and her daughter Lynette to another kayak race and the four went to the boathouse to pick up their life jackets. John was a tall, wiry, young man with laughing hazel eyes. He looked athletic likely from working out at the fire hall. On the way to the kayaks Jesse asked, â€Å"Did you boys leave your girlfriends at home?† John said, â€Å"I’ve been single for a while now.† â€Å"As for me,† Bryan said, â€Å"I have a girlfriend but this isn’t her kind of thing, plus she’s working this weekend.† Jesse smiled at John and walked beside him until they reached the kayaks. Lynette ignored the rest of the conversation. The race started, with Lynette and Jesse taking a slight lead, which John and Bryan struggled to regain. The†¦show more content†¦They secured the vessel against a tree and rushed down the trail to the place where they thought they had heard the scream. Marina Sharpe lay in fetal position by the side of the path. She was perfectly still. â€Å"I didn’t much like that lady, so now we don’t have to listen to her prattle while we complete the game,† whispered Jesse with a giggle. â€Å"Mom, something’s not right,† said Lynette, kneeling down by Marina. Lynette frowned, obviously perplexed, as she took Marina’s pulse. â€Å"What’s happening?† â€Å"Mom! This is for real.† There was no pulse. â€Å"It couldn’t have been an accident with all her screaming.† Run back to the lodge and have them call 911. This murder is real.† Lynette surveyed the scene. Blood seeped out of Marina’s head. Lynette thought she might have hit her head on a rock. She didn’t want to touch the body beyond taking the pulse, yet she was convinced Marina was dead. Her stomach churned with dread. â€Å"Guys,† Lynette yelled out to John and Bryan. â€Å"Get up here. We need you.† Bryan arrived first and said, â€Å"Looks like she’s a goner.† â€Å"She is,† Lynette, said. â€Å"I’m a homicide detective, in real life.† Lynette, John, and Bryan remained at the scene of the crime, if that was indeed what it was. She knew not to disturb the crime scene, yet due to professional habit, she meticulously scanned the area for visual clues. Lynette noticed theShow MoreRelatedAnalysis Of The One Thousand And One Nights 1592 Words   |  7 Pagesmuch I love the Arabian night’s stories and he used this knowledge to get me to change my initial decision of not reading any book during the summer. So failure to recognize the strength in others makes us blind to our own weaknesses. In the One Thousand and One Nights text, some of its characters experience changes due to the fact that they failed to recognize the strength and abilities or capabilities of other opposing characters. In the frame tale, The Story of King Shahrayar and Shahrazad, hisRead MoreUnfair Balance Of Power : One Thousand And One Nights1362 Words   |  6 PagesUnfair Balance of Power One Thousand and One Nights is a collection of stories from Middle East and South East Asian countries that have been translated by various authors over hundreds of years. Even though it is a collection of stories from different counties, they are all centered around the frame story of King Shahryar and his wife, Scheherazade, who narrates the stories for a span of one thousand and one nights in an effort to stop the King from killing more innocent young women as punishmentRead MoreCapital One1085 Words   |  5 PagesCapital One Financial Corporation 1. How is Capital One’s use of IT different from other mass customization strategies? Capital One uses IT through its information-based strategy (IBS) to â€Å"record, organize, and analyze data on the characteristics and behaviors of their customers,† as stated by CEO Richard Fairbank. Their philosophy was to exploit information by constructing scientific models that could be used to both assess the creditworthiness of potential cardholders throughRead MoreThe Thousand and One Nights1472 Words   |  6 PagesInfluence of Cultures on The Thousand and One Nights Stories like Sindbad, Aladdin and the Magic Lamp and other popular stories are very common today in the western culture. Animated movies were also made for the entertainment of kids on these popular stories. One might wonder that where these stories originated and how it came down and made place in the western culture. Although these stories are very popular in both the western culture and the eastern culture but the original literary workRead MorePower of One Essay923 Words   |  4 PagesIn Bryce Courtenay’s The Power of One, the main character, Peekay the majority of his friends by means of a violent and unexpected death. â€Å"Death was violent and ugly like Grandpa Chook and Geel Piet, or even a macambre like Big Hettie. Death, as I had come to know it in Africa, had no gentle slipping awayness about it, no dignity.† Depending on your faith, death can bring about new life, or an end to everything. If you choose to believe the latter, as it can be assumed that Peekay did, theseRead MoreThe Thousand and One Nights Essay931 Words   |  4 PagesThe Thousand and One Nights, generally known to the English, speaking world as the Arabian Nights, is a compendium of Arabic tales compiled between the twelfth and the fourteenth centuries. The collection starts with the story of King Shahrayar. Betrayed by his adulterous wife, he swears never to trust a woman again, deciding instead to marry a different virgin every night and have her executed the next day. He carries out his plan for three years, until his Vizier can no longer find a virgin toRead MoreThe Evolution of Peekay in the Power of One1544 Words   |  7 PagesThe Evolution of Peekay in the Power of One Think back to when you were five years old. Were you sent to a boarding school with kids a couple years older than you? Were you persecuted and bullied for being a â€Å"redneck† or for just being who you were? Chances are, the answer to these questions should be â€Å"no†. However, a small little boy growing up in Africa during the mid-1990s can probably describe every single tortuous day that he went through in this situation. His name is Peekay, and he is theRead MoreOne of Ours by Willa Cather785 Words   |  3 Pageslove once with Eric, but just for a moment. For her whole life, Margaret â€Å"had searched the faces of men for the look that lay in his eyes. She knew that look had never shone before, would never shine for her on earth again, that such love comes to one only in dreams or in impossible places like this, unattainable always. This was Love’s self, and in a moment it would die† (Great Short Works, 29). For Willa Cather this is how love ex ists. Happy relationships are plentiful, but the enchanted, all encapsulatingRead MoreGoogle Nexus One Strategy952 Words   |  4 Pagesproduct/market expansion grid strategies and explain which strategy Google implemented with the Nexus One. The four product/market expansion grid strategies are Market Penetration, Market Development, Product Development, and Diversification. The Market Penetration strategy is when a company is introducing a new product into the market that has similarities to current products in the market. One of the most effective ways to use this strategy is to encourage their current customers to continue buyingRead MoreFormula One Racing Essay504 Words   |  3 PagesFormula One Racing Formula one is the fastest racing car in the world. It is called the greatest car show in the world. Formula one has a great influence on the people. Millions of people sit in front of the TV set or around the circuit and watch the race. The drivers are often called kings of speed and they show their ability to drive fast every second week of the season. People wondered about this racing many years ago. The cars were very different from today’s formula ones. The question

Nursing Care Plan Essay Example For Students

Nursing Care Plan Essay Course: NUR 1210LInstructor: Dates of Care: 12, 13, 19 20 Sept 96Date Submitted: 11/15/96Student Names: Anthony Bernardi, SN/SPJCHOLISTIC NURSING CARE PLANSTUDENT Anthony BernardiGRADEDATE November 15, 1996Client’s Clinical Picture (5)(Initial Cephacaudal assessment)Textbook Description of Diagnosis (5)Summary of Client’s Progress (5)Completion of Holistic NCP Tool (30)NURSING DIAGNOSIS (15)GOALS (10)INTERVENTIONS (10)RATIONALES (5)EVALUATIONS (10)REFERENCES (5)TABLE OF CONTENTSSUBJECT PAGE #? Cover Page 1? Grading Point Scale 2? Table of Contents 3? Summary Page 4? Client’s Clinical Picture (Cephacaudal Assessment) 5? Medical Diagnosis 6? Textbook Description of Disease 6-12? Treatments and Procedures 13? Summary of Caregiver Progress Notes 14? Diagnostic Values Out Of Normal Range Clinical Implications 16? Radiology 17? Medications 18-52? Holistic Nursing Care Plan Form 53-62? List of Nursing Diagnosis 65? Five Nursing Diagnoses 66-70? References 71CLIENT CLIN ICAL PICTURE:Please see attached Cephacaudal Assessment (Pages 5)MEDICAL DIAGNOSIS: Current diagnosis:Necrotizing pneumonia, cachexia secondary to malnutrition / infection, hypothroidism, NIDDM, empyema RUI, Aspergilloma, RUI, and depression. HX: HTN, atrial fibrillation, COPD, asthma TEXTBOOK DESCRIPTION OF DIAGNOSIS:See attached Disease Process Description (pages 6-12-)SUMMARY OF CAREGIVER PROGRESS NOTES: See attached Caregiver Progress Notes (page 14-15)CLIENT CLINICAL PICTURE Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for â€Å" atypical chest pain and hemoptysis†. V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit. Pt. is able to do all his ADL’s with limited assistance. He wants to get better and leave the HSP. Pt. Stated’ 90 days is to long to be here†. Pt. States that he is concerned about caring for his tube site when he goes home and does not feel that his wife can do this for him. Diet: Pureed Hi protein, low fat, anti-dumping with Calorie count (all meals) and drink supplements between meals. TPN @ 79cc/hr 12hr around the clock through PICC lineMEDICAL DIAGNOSIS: Empyema, Hemoptysis, Necrotizing pneumonia, Aspergillosis (Aspergillus fumigatus) cachexia secondary to malnutrition/infection, hypothyroidism, Diabetes Type II melitius , and depression. PATHOPHYSIOLOGY HEMOPTYSIS: Expectoration of blood arising from the oral cavity, larynx, trachea, bronchi or lungs (Tabor’s, 17th ed. 1989 p.879)CACHEXIA SECONDARY TO MALNUTRITION/INFECTION : The state of ill health, malnutrition, and wasting It may occur in any chronic diseases, certain malignancies and advanced pulmonary tuberculosis. (Tabor’s, 17th ed. 1989 p.287)NECROTIZING PNEUMONIA: Aspiration pneumonia. Aspiration pneumonia is frequently called necrotizing pneumonia because of the pathologic changes in the lungs. It usually follows aspiration of material in the mouth into the trachea and subsequently the lungs. The aspirated material. Either food, water, or vomitus, is the triggering mechanism for the pathology of this type of pneumonia. If the aspirated material is an inert substance (e.g. barium or nonacid stomach contents), the initial manifestation is usually caused by obstruction of airways. When the aspirated materials contain gastric acid, there is chemica l injury to the lung parenchyma with infection as a secondary event usually 48 to 72 hours later. The infecting organism is usually one of the normal oropharyngeal flora. The clinical manifestations proceed as those of a classic pneunococcal or streptococcal pneumonia. Fungi may also be a cause of pneumonia. These infections are not transmitted from person to person, and the patient does not have to be placed in isolation. The clinical manifestations are similar to those of bacterial pneumonia. Skin and serology tests are available to assist in identifying the infecting organism. However, identification of the organism In a sputum specimen or in other body fluids is the best diagnostic indicator. (Lewis, S.M. Collier, p. 643-644)ASPERGILLOSIS INFECTIONS : There are several forms of Aspergillosis infections. All are caused by one or more of the many different Aspergillus fungus species; only a few of these organisms are capable of producing disease in humans. These species are sprea d through the air and can be found almost any place in the world. Because these spores are inhaled, they usually affect the lungs or other airway passages such as the bronchial tubes, nose and sinuses. The fungi can be invasive, affecting any tissue, mucous membrane or vital organ of the body. Allergic Bronchopulmonary Aspergillosis (ABPA) is an immune disorder that occurs in people with asthma or chronic obstructive pulmonary disease (COPD) infected with Aspergillosis fungi. It causes an excess of certain white blood cells (eosinophils), an infiltration of the lungs, and impaction of the bronchial tubes with eosinophils and Aspergillus organisms. Symptoms of this disease may consist of fever, shortness of breath (dyspnea), chest pain, wheezing, a cough with sputum (with or without blood) or a generalized feeling of ill-health (malaise). This form of Aspergillosis is not usually invasive, but it can lead to a chronic dilation of the bronchial tubes (bronchiectasis). Pulmonary Mycetoma, also known as Aspergilloma or fungus ball, is a form of Aspergillosis that often occurs as a result of the Aspergillus fungus growing together (colonization) in a cavity of the lungs. These cavities are usually caused by other pulmonary diseases such as tuberculosis, sarcoidosis, histoplasmosis or coccioidomycosis. The fungus ball can be seen on x-rays. This form of Aspergillosis is characterized by a chronic cough, weight loss, a generalized feeling of ill-health (malaise) and the spitting up of blood (hemoptysis). Fulminative or Invasive Aspergillosis is another form of this disorder that can cause distribution of the Aspergillus fungus to other parts of the body. This disease can progress from a localized infection to a widespread erosion and ulceration of the bronchial system and an inflammation of the vascular system (vasculitis). Vasculitis is a narrowing of the inside of a blood vessel that can obstruct the flow of blood to the tissues. This lack of blood can cause damage to the tissues (necrosis), and a possible formation of blood clots (thrombosis). Invasive Aspergillosis is usually first confined to the lungs but it can spread through the blood to other organs especially the liver, brain, kidneys, skin, gastrointestinal tract and other sites. This can be a very serious disease which can have a slow or rapid course. It is seen in those whose immune system has been weakened by other illnesses, especially people with cancer (e.g., Leukemia, Hodgkins Disease), kidney transplant patients or those undergoing certain drug therapies. Occasionally, Aspergillosis can cause Infective Endocarditis which is an infection of the inner lining of the heart muscle (endocardium). A type of infective endocarditis, prosthetic valvular endocarditis (PVE), may develop in patients who have previously had artificial (prosthetic) heart valve replacement. This infection may occur as a result of contamination of the operating room area by the Aspergillus spores. Drug addicts are also more susceptible to this form of Aspergillosis. Mycetoma, also known as Madura Foot, is a chronic infection produced by Aspergillosis as well as several other fungi. It is a progressive fungal disease that is characterized by lesions of the foot, face, trunk, hand or leg. These lesions can cause swelling, hardening, pus formation, sinus drainage and abscesses that can lead to bone destruction and deformities. It is more commonly seen in tropical climates. Aspergillosis is a group of infectious diseases that are caused by the inhalation of the Aspergillus fungus. The spores that cause these infections can be found in decaying vegetable matter, grains, grass, leaves, soil, wet paint, air conditioning systems, on refrigerator walls and in construction and fireproofing materials. It is not known why most people resist infection from this common fungus, and why others are more susceptible to infection. A weakened immune system, or an abnormal immune response to the fungus, may cause the fungus to proliferate and become a threat to ones health. Aspergillosis is a rare disorder that affects males and females in equal numbers. It is seen more often in those people who have chronic respiratory problems or whose immune system has been weakened by other serious illnesses or drug therapy. DEPRESSION: Depression is the most common functional disorder. Signs of depression include sadness, low energy, diminished memory and concentration, sleeping disturbances, appetite disturbance, with withdrawal, irritability, alcohol abuse, expressed feelings of helplessness and hopelessness, apathy, impaired attention span, and expression of suicidal wishes. Depression is often treatable and reversible through use of antidepressant medications and counseling. (Brunner/ Suddarth, 1988)HYPERTENSION: Hypertension can be defined arbitrarily as persistent levels of blood pressure in which the systolic pressure is above 140 mm Hg and the diastolic pressure is above 90 mm Hg. In the elderly population, hypertension is defined as systolic pressure above 160 mm Hg and diastolic pressure above 90 mm Hg. Hypertension is a major cause of heart failure, stroke, and kidney failure. It is called the â€Å"silent killer† because the person who has it is often symptom free. Gerontological Cons iderations: Changes in the peripheral vascular system are responsible for the changes in blood pressure that occur with age. As the age related process of atherosclerosis evolves, the ability of the vessels to distend and recoil is reduced. Consequently, the aorta and large arteries are less able to accommodate the ejected stroke volume, and a decrease in cardiac output and increase in peripheral resistance result. Systolic blood pressure increases as a result of the increased peripheral resistance, and pulse pressure widens subsequent to the diastolic fall that accompanies reduced distensibility of the aorta. The risk factors for high blood pressure that are present in the population in general continue into old age. These are approximately the same for elderly men and women. (Brunner/ Suddarth, 1988)CHRONIC OBSTRUCTIVE PULMONARY DISEASE : Chronic obstructive pulmonary disease (COPD) is the most common cause of death and disability due to lung disease in the United States. COPD is a broad classification that includes a group of conditions associated with chronic obstruction of air flow entering or leaving the lungs. Airway obstruction is diffuse airway narrowing, causing increased resistance to air bronchiectasis, emphysema, and asthma. Basically, the person with COPD has (1) excessive secretion of mucus within the airways not due to specific causes (bronchitis or bronchiectasis), (2) an increase in the size of the air spaces distal to the terminal bronchioles with loss of alveolar walls and elastic recoil of the lungs (emphysema), and (3) narrowing of the bronchial airways that varies in severity (asthma). As a result there is a subsequent derangement of airway dynamics for example, loss of elasticity and obstruction of air flow. There is often an overlap of these conditions. (Brunner/ Suddarth, 1988 )ASTHMA : Asthma is an intermittent, reversible, obstructive airway disease characterized by increased responsiveness of the trachea and bronchi to various stim uli. This results in narrowing of the airways, causing dyspnea This narrowing of the airway changes in degree, either spontaneously or because of therapy. Asthma differs from other obstructive lung diseases in that it is a reversible process, and patients may exhibit no symptoms for a prolonged period of time. Asthma is a reversible diffuse airway obstruction. The obstruction is caused by one or more of three developments: (1) contraction of muscles surrounding the bronchi, which narrows the airway (2) swelling of membranes that line the bronchi and (3) filling of the bronchi with thick mucus. In addition, there is bronchial muscle enlargement, mucous gland enlargement, thick, tenacious sputum, and hyperinflation or air trapping in the alveoli but most of what is known involves the immunologic system and the autonomic nervous system. (Brunner/ Suddarth, 1988 ATRIAL FIBRILLATION: Atrial fibrillation (disorganized and uncoordinated twitching of atrial musculature) is usually associate d with atherosclerotic heart disease, rheumatic heart disease, CHF, thyrotoxicosis, or pulmonale, or congenital heart disease. Atrial fibrillation is characterized by the following- lowing: Rate: An atrial rate of 350 to 600 beats per minute ventricular response usually 120 to 200 beats per minute. P waves: No discernible P waves: irregular undulation, termed fibrillary or â€Å"f† waves, is seen; PR interval cannot be measured. QRS complex: Usually normal. Conduction: Usually normal through the ventricles. Characterized by an irregular ventricular response, because the AV node is incapable of responding to the rapid atrial rate. Impulses that are transmitted cause the ventricles to respond irregularly. Rhythm: Irregular and usually rapid, unless controlled. Irregularity of rhythm is due to concealed conduction within the AV node. A rapid ventricular response reduces the time for ventricular filling and hence the stroke volume. The atrial kick, which is 25 to 30% of the cardi ac output, is also lost. Congestive heart failure frequently follows. There is usually a pulse deficit, the numerical difference between apical and radial pulse rates. Treatment is directed toward eliminating the cause, decreasing the atrial irritability, and decreasing the rate of the ventricular response. In patients with chronic atrial fibrillation, anticoagulant therapy may be used to prevent thromboemboli from forming in the atria. Drugs of choice to treat atrial fibrillation are similar to those used in the treatment of paroxysmal atrial tachycardia, digitalis preparation is used to slow the heart rate, and an antidysrhythmic such as quinidine is used to correct the dysrhythmia. (Brunner, Suddarth 1988). TYPE II DIABETES MELLITUS: In diabetes, insulin is not secreted in proportion to blood glucose levels because of several possible factors: deficiency in the production of insulin by the beta cells, insensitivity of the insulin secretory mechanism of the beta cells, delayed or insufficient release of insulin, or excessive inactivation by chemical inhibitors or â€Å"binders† in the circulation. In some non-insulin dependent persons with diabetes, however, insulin secretion is increased, resulting in higher , circulating insulin levels. Although excess insulin is present, it is not utilized because of an inadequate number of insulin receptors present on cells. This mechanism has been observed in obese patients. With weight loss, the number of insulin receptors on the cells increases, thereby allowing glucose to enter the cell. This may result in return of a normal glucose tolerance. (Burner/ Suddarth, 1988 )HYPOTHYROIDISM : Hypothyroidism is a condition in which there is a slow progression of thyroid hypofunction, followed by symptoms indicating thyroid failure. More than 95% of patients with hypothyroidism have primary dysfunction of the thyroid gland itself. When the thyroid dysfunction is due to failure of the pituitary gland, it is known as sec ondary hypothyroidism; when failure of the hypothalamus is the underlying cause, the term tertiary hypothyroidism is used. When thyroid deficiency is present at birth, the condition is known as cretinism. In such instances, the mother may also suffer from thyroid deficiency. (Brunner/ Suddarth, 1988) TREATMENTS AND PROCEDURESPatients activity orders are as tolerated with wheel chair transport. Pt needs partial assist with ADLs. He is continent of B B with assistanceNeeds to be turned in bed Q 2 hr, elevate heels in bed . Pt has a special mattress. Encourage I.S. Q 1 hr w/a. IV flush q shift peripheral line. PICC line flush. Chest tube to water seal to 20cm, with cont. suction 55-60 wall green. DO NOT DISCONTINUE SUCTION. Chest tube dressing change no deviations from present form. Accurate IO’s . VS. Q shift and prn. with lung sounds assessment. Skin assessment q 2 hr with wound assessment at the same time(abrasion on the back ) and finger ulceration. FSGs q 6 hr with Sliding scale coverage. Weight every week on Monday. SUMMARY OF CARE GIVER NOTES:All times are approximate07:30 Received report on G.B. from night shift. 08:00 Spoke with G.B. before breakfast was delivered. Vital signs taken and noted. Insured patency of chest drainage tubes and amount of fluid from last shift. Noted time and initialed on collecting container. 09:00 09:00 medications given and noted09:30 Assisted G.B. with ADL’s. Pt stated that he wasn’t very hungry. Pt. Ate only 25% of solid food. Noted intake of 250ml. Urine output after breakfast 225ml. Pt. Performed own bed bath and oral care. Lotion applied to Pt. Pt. Helped into bedside commode. Curtains drawn for privacy. 10:30 Dressing change on tube insertion site as ordered. Skin assessment done and lung sounds checked. Check position of G.B. He had re-positioned himself for comfort10:45 X-Ray of G.B. performed in room. G.B. dressed and assisted into wheel chair. 11:00 Reported pt status to Team Leader. 11:00 Documented morning activities in appropriate charts, i.e. Nsg Notes, treatment book and V/S charts. 11:15 Returned to room to interview G.B. . Pt was cheerful but stated that he was feeling tired and wanted to be helped back into bed. 11:45 Noted I O 12:00 G. B. In bed resting comfortably. Reported pt status to team leader and report off floor to post-conference. DIAGNOSTIC VALUES OUT OF NORMAL RANGE CLINICAL IMPLICATIONSBUN 32H 10-26 A. Increased BUN levels (azotemia) 1. The most common cause of increased BUN level is inadequate excretion due to kidney disease or urinary obstruction, frequently- : occurring in cases of prostate enlargement. (A) An increased BUN of 50 to 150 mg / 100 ml indicates serious impairment of renal function. (Fishbach p. 312)Creatinine .5H 0.7-1.4 A disorder of kidney function reduces excretion of creatinine, resulting in increased levels of blood creatinine. The test is used to diagnose impaired renal function. It is a more specific and sensitive indicator of kidney disease than BUN, although in chronic renal disease, BUN correlates more accurately with symptoms of uremia than does the blood creatinine.( (Fishbach p. 312)WBC 10.4H 5-10 A. Leukocytosis (white blood cell count above l0000 / gl) 1. Leukocytosis is usually due to an increase of only one type of White cell and is given the name of the type of cell that shows white cell and is given the name of the type of cell that shows the main increase. .In increase in circulating leukocytes is rarely due to a proportional increase in leukocytes of all types. When it occurs it is usually to hemoconcentration. Leukocytosis occurs in acute infections in which the degree of increase of white cells depends on, 1. The severity of the infection, 2. The patient’s resistance, 3. The patient’s age.(Fishbach p. 25.)RBC 2.96L 4.2-5.6 Decreased RBC Values . Anemia, a condition in which there is a reduction in the number of circulating RBCs, in the amount of hemoglobin, and/or in the volume of packed cell(hematocrit).(Fishbach p. 41)HGB 10.L 13.1-17.2 AnemiaHCT 29.3L 39-50 decreased hematocrit values are an indicator of anemia. In hematocrit of 30 or less means the patient is moderately to severely anemic. ALBUMIN 3.1l 3.9-5 decreased albumin levels severe hypoalbuminemia is often associated with edema and decreased transport function such as hypocalcemia. Decreased albumin levels are caused by many different conditions i.e. Nephrosis (Fishbach p. 363)LY# 1.2L 1.8-2.6 AnemiaMCH 34H 26-34 An increase of the MCH is associated with macrocytic anemia. MCV 99.2H 87 -103 Note VA values differ from Fishbach. F the MCV is greater than 103 mm3, the red cell 5 are macrocy tic. PLT 433H 150-350 Abnormally increased numbers of platelets (thrombocythemial thrombocytosis) occur in iron-deficiency and posthemorrhagic anemia acute infections and many other diseases. In 50% of those patients who exhibit an unexpected increase in plate- lets, a malignancy will be found. This malignancy is usually disseminated, advanced, or inoperable. MPV 6.3L 8 -10L This test is done in the investigation of various hematologic disorders such as thrombocytopenic purpura, and study of alcoholics under treatment. Na+ 135 135-148 Hyponatremia usually reflects a relative excess of body water rather than a low total body sodium. K 4.6 2.7-4.5 Hyperphosphatemia (increased phosphorus levels) The most common causes of elevated blood phosphate levels are in association with kidney dysfunction and uremia. This is because phosphate is so closely regulated by the kidneys. Renal insufficiency and severe nephritis (accompanied by elevated- : BUN and creatine) Albumin 3.1 3.8-5.0 albumin is a protein that is formed in the liver and that helps to maintain normal distribution of water in the body (colloidal osmotic pressure). It also helps in the transport of blood constituents such as ions, pigments, bilirubin, hormones, fatty acids, enzymes, and certain drugs. Decreased albumin levelsDecreased albumin levels are caused by many different conditions- inadequate iron intake, Severe liver diseases Malabsorption, Starvation, excessive administration of IV glucose in water RADIOLOGYF/Y empyema status no change since 9/3/96. F/U bilateral sever pulmonary emphysema interstitial fibrosis. CBC shows high levels of WBC’s and bends indicative of ongoing infection. Chemistry shows elevated liver enzymes. UA and CS are negative. Blood cultures are also negative. Sputum CS and Gram Stain show WBC* 25, Eph.*10 and presence of Alpha streptococcus neisseria. NATO EssaySelf-Expression Reflection, reminiscence, self-actualizing pursuits within physical capabilities. BW p 898 Neat, clean, well groomed; articulate; Affective response consistent with norms. Articulate; expresses self well. Concerned about his future at home. â€Å"Who will help me take care of my tubes at home?† Client expresses accep-tance of stage in life but not physical limitations. Skin Tissue Integrity Skin more fragile less elastic, less SC fat, blood vessels more fragile; Increases risk of skin tears. Vascular insufficiency increases risk of decubitus ulcer BW p 974 Warm, pale, good turgor. Reddened area on coccyx Understands import. of being turned in bed, moving extremities, ingesting adequate fluids food. Good personal hygiene. Client demonstrates a little anxiety about the possibility of developing a decubitis ulcer. Client verbalizes anxiety about possibility of skin tissue breakdownNutrition Body maintenance and repair, type and quality of food, calories must be rich in nutrients. Lowered calorie requirements due to lower BMR BW p 1082 Cachexia secondary to malnutrition, poor intake. TPN q 12 hrs, supplements Client understands his need to increase the food intake for adequate nutrition healing. Client does not like hospital food but tries to eat as much as possible. He also dislikes his supplements. Client wants to gain weight stating, †I try to eat more than I want.†Fluid Balance Decreased renal concentra-tion fx. Increased loss amounts of water salt, muting of thirst response, decreased intake. BW p1558 Good skin turgor, no edema IO’s q shift Client understands the need for adequate fluid intake. No emotional relationship seen with regard to fluid balance. Understands importance of adequate fluid intake in health maintenance. Elimination Loss of muscle tone in bladder bowel changes elimination patterns, that vary with diet, lifestyle, medications. BW p 1136 Continent of bowel bladder. Uses toilet with assistance. Bowel sounds present X4. Urine clear yellow Client recognizes the need for regular bowel schedule. Non-verbalized discomfort with having to go to the bathroom while in bed. Client verbalizes no concerns. Oxygenation Some loss of lung elasticity; pO2 decreased, especially if smoked. BW p 1227 Resp. rate 18-24/min. lung sounds slightly diminished Understands the need for O2 and reason for SOB. Does not like the idea of needing O2 inhalers to control SOB. Client admits to periods of SOB, and pain with coughing. Sleep-RestPatterns/Pain Incr. Time to get to sleep, incr.# times awaken, decrease total sleep time. Daytime naps may compensate. BW p 1321 Client naps several times during day, sleep-rest poor at night. Being turned q2hrs and pain from chest tube wakes up. Verbalized that being turned q 2 hrs interrupted his sleep causes