Military and Technology Essay Example | Topics and Well Written Essays - 1500 words

Military and Technology - Essay Example Politics is another major factor that determines the acceptance of a certain technology. Military technology is associated with various engineering fields like the mechanical, chemical, mechatronics etc. And the use of this technology requires basic military training as result; some of these harmful gadgets are not left to the civilians like the bombs, guns, missiles etc. However, some technologies were meant for the militants but with time and advancements the government allowed the civilians to be in their possessions (General Books LLC, 2010). My work focuses on the global positioning system (GPS) technology. GPS is space technology that helps in locating objects directed by the satellites. It also indicates the surrounding weather. A GPS receiver is the gadget that uses the space technology to give locations among other benefits. The signals received by the GPS receiver from the satellite is analyzed accompanied by some calculations then the receiver gives feed back in terms of t he transmit time and the distance to the satellite all displayed on the receivers’ screens hence can be used by the militants to locate positions. This technology was developed in 1973 to solve the problems associated with navigation. Man had a problem with locating places and this made navigation-a very important aspect in the military so difficult. Before this invention, man tried to solve the positioning and navigation problems by using the stars which were not reliable as they only existed during some nights. The star pattern kept changing, giving wrong information in terms of positioning. Pendulums on the other hand were used to indicate time and they were not only slow but also cumbersome to carry and count the swings. It was also not accurate hence could not be relied on. Design and the principles behind this space technology were not original but were adopted from some radio based systems of navigations that include the Loran as well as the Decca technology which were found in 1940. Atomic clocks used the gravitational forces to indicate time and this solved part of navigation problems however, it gave vague information to the militants as it only showed time but not positioning hence some innovations were still required. Another prior related innovation was the omega system of navigation and it also had several limitations as it was not accurate. The greatest need that led GPS technology innovation was during the cold war ant the United States wanted to use the nuclear bombs for attack. The submarines were to be accurately positioned before releasing their missiles. The air force had to navigate accurately to get the correct positions to release their missiles. The weight and urgency of these needs led to innovation of GPS but the first technology was in adequate as it’s slow to the fast moving air force planes. The technology was advanced to assist in timing too and by around 1974 it had atomic clock. A better product was attained by in corporating the ideas of navigation, and timing hence a better GPS. This was further advanced to Navistar GPS. The invention was based on scientific knowledge i.e. the effect of time in a strong electromagnetic region. It was found that time is slowed and this could be used to indicate time as well as navigation. However, the experiments were based on trial and error method and this cost the government a lot of cash until some positive feedback was attained. The combination of timing and the navigation component was basically on trial

Digital Digest of Mexican Art in the News Essay Example | Topics and Well Written Essays - 500 words

Digital Digest of Mexican Art in the News - Essay Example One of the works of art that still being admired in today’s era is the Nativity Group with Angel of the 18th Century Guatemalan. This piece of art describes the era of crucifixion and shows the mother of Christ, Mary and his father Joseph. They are clothed in silk robes which signify a touch of the Asian fashion. This drawing depicts the Virgin Mary as in the face of a Hispano-Philippine. This is deduced from the eyes being heavy-lidded and the oval face that is braced with pure countenance. The drawing also depicts the usual culture of the silk from the Chinese that is attained through the Galleon trade. The design that was generated by the workshops that created the Guatemalan sculptures maintained a constant style over the years. The paint also demonstrates the influence of Guatemalan estofado through the use of gold textiles and silk that was lavish. This was achieved through a unique form of painting that had more freedom to try out different styles enables variety witnessed in the sculptures. They used a variety of patterns and the painting can therefore effectively be used to determine the setting that was intended to be expressed. This painting is of great value and is also describes the culture of Spanish American style. The portrait is put together with wood, polychrome and glided. It has eyes made of glass and halos that are silver-glint. Jose Manuel de Cervantes y Velasco is a portrait that dates to 1805. It is of a toddler and depicts him lying in a coffin that is lace-trimmed. This toddler is dressed just like the Archangel Michael with wings that are jewel studded and a crown that is plumed. Both of the above paintings, though from different artists are a depiction of culture and a window into historical beliefs. The Nativity group angel and the Jose Manuel de Cervantes y Velasco are portraits that were developed with great keenness to detail. The grace captured in the portraits is almost tangible at

Psychological Contracts Paper Essay Example | Topics and Well Written Essays - 2500 words

Psychological Contracts Paper - Essay Example Psychological contract is a term used to refer to the mutual relationship existing between organization and its employee in terms of reciprocal obligations and promises implied in the employment relationship. It is good to understand that these contracts fall under the category of promissory contracts. On the other hand, this mutual understanding is mainly subjective to person’s perceptual and cognitive limits. This contract comes into effect the moment when the physical i.e. employment offer contract is signed. It is worth noting that obligations under psychological contract unlike the physical contract are not signed rather they are implied. These obligations are merely promises and expectations. Thus, in general terms this contract refers to the mutual perceptions, beliefs and imprecise or informal responsibilities between an employee and an employer. Psychological contracts due to them being subject to emotional and social factors they are usually changeable in nature unli ke the physical employment contracts (Makin, Cooper & Cox1996 pp 3-6). Types of Psychological Contracts There are usually three types of psychological contracts. ... Finally, we have the the â€Å"hybrid† or balanced form of psychological contract which entails aspects of the two mentioned above contracts i.e. relational characteristics such as long-term mutual committments and also the transactional attributes such as the renegotiations and job roles and functions. Nature of Psychological Contracts These contracts are assumed dynamic, informal, voluntary and subjective in nature. They change in line with the changes occurring in relationship and expectations of both the employer and employee. There is usually no tangible agreement or contract; however, the following are deemed the obligations and components of this contract; The employees are anticipated to offer hard work, loyalty and commitment, or sacrifice while in employment. The organization is required to provide high pay, advancement, training and development, and job security Features of psychological Contracts a) It is a voluntary choice: A psychological contract is entered into voluntarily by the employee, afterwhich he will be motivated/obligated to fulfill his commitments to the employers organisation. b) There usually is a belief in mutual agreement: These psychological contract are based largely on the employee perceptions and understanding of the terms and conditions. Consequently, the employee offers his/her services relying on the pressumpton that the contract was mutually agreed upon in total disregard of the reality. c) Psychological contracts are Incomplete. These contracts evolve and change over the relation and period of employment unlike the physical contracts which are usually complete at the beggining of employment. d) Multiple

NETWORK SECURITY I Research Paper Example | Topics and Well Written Essays - 2500 words

NETWORK SECURITY I - Research Paper Example With networking in place, real time communication has been made possible through emails, VOIP, teleconferencing, online chats among other channels. However, these networks are vulnerable to numerous security threats, which have the capacity to cause extensive damage and losses for the users (Andress, 2011). This paper is a critical evaluation of network security threats and their solutions. Network Security Threats A network is an interconnection of two or more computers for the purpose of sharing resources, such as hardware and software (Wetherall, 2010). There are various types of networks which include, but not limited to, local area networks (LAN), wide area networks (WAN) and metropolitan area networks (MAN). Local area networks are commonly found in institutions and offices, whereby sharing of resources is internal, for example, between departments or various workstations in an office. Wide area networks facilitate sharing of information on a wide geographical location, whereby numerous LANs around the world are interconnected for this purpose. The internet and the World Wide Web are examples of LAN as they can be accessed by users from every corner of the globe as long as they are connected to an internet service provider (ISP). MAN, on the other hand, exists in a smaller geographical location than WAN but larger than that of LAN (Wetherall, 2010). These networks have facilitated criminals with an avenue to make money through illegal activities especially due to the fact that millions of people around the world utilize one or all of the above mentioned networks on daily basis. Loads of data and sensitive information are exchanged over these networks on hourly basis and due to this; criminals have taken advantage through their technical skills to conduct cyber attacks, either for economic benefits or for malicious purposes (Zalewski, 2011). The internet, for example, has facilitated users with an avenue to conduct businesses and transactions through onlin e shopping. Online shopping is a mode of doing business whereby manufacturers and retailers design interactive websites, in which they display their products and details. Interested shoppers are only required to visit the websites from the comfort of their personal computers, from which they can evaluate and compare prices of commodities offered by different companies. Processes, such as cataloguing and placing orders are made through the same media thus making it easy and cheap for marketers and consumers to fulfill their desires without necessarily having to travel to the physical business location. This has also facilitated globalization as digitizing the world in this manner brings the world citizens closer thus forming a global village (Schneider, 2011). However, online shopping has been noted as being one of the major targets and facilitators of cyber crime. Rogue programmers have continued to develop phishing sites, which they utilize to steal users’ personal informati on for the purposes of committing fraud. Phishing sites are websites, which impersonate genuine websites such that it becomes difficult for users to differentiate between the genuine and the rogue websites. These websites usually request users to input their personal details, such as credit card numbers, emails, names, bank details among other sensitive

Contemporary International Relations Essay Example | Topics and Well Written Essays - 3750 words

Contemporary International Relations - Essay Example It is then an attempt to the resolution of such disputes, the experts and philosophers presented different possible theories that can explain the said case. The most prevalent of such theories are the theory of the clash of civilization and the theory of the clash of fundamentalism. These theories pointed out the possible reasons for the conflicts that had been occulting in relation to the contemporary International Relations. Upon the determination of the said theories, it can be considered that the problems, conflicts and disputes that are being faced by the international community can be resolved. To be able to determine the feasibility of the two theories, it is important to determine the issues that are covered by the two theories. Upon determination of the background information regarding the said concepts, a comparative analysis can be undertaken. There are different views that can be related to the Clash of Civilization. The most common and dominant of which are the views of Samuel Huntington and Bernard Lewis. Generally, the theory of the Clash of Civilization is aimed to explain and analyse the different conflicts that can be observed in the contemporary era specifically in the international community and the relationship among nations. Samuel Huntington presented the Clash of Civilization as a view on the International Relatio... Specifically there factors are considered as the main reasons for conflict in the international community according to the theory of Huntington which is founded on the different events and scenarios in the political and economic world. In addition, the said theory is a presentation in relation to the work of Francis Fukuyama's work (Huntington 1). On the basis of his view then, differences can arise on the basis of cultural backgrounds. The differences and the individuality along with other sources of differences that can be related to the culture and traditions of the people can considered covered even the different philosophies, language, history and religion. In general, he referred to civilizations as the highest form of the said grouping. The civilizations divide the world into different groups. The Western civilization though is one of the most evident, thus, in terms of the view with regards to conflict, the nations that are included in the West are commonly included and often seeking allies from different regions (Huntington 1). Such view then can explain the division of the contemporary era, the west and the eastern civilization. Although there are other civilizations, the clash in the present era commonly involves the Western civilization and the area wherein the Muslim religion had originated. This can be related to the other theory which is the Clash of Fundamentalism. Bernard Lewis' View The view of presented by Bernard Lewis can be considered as the earlier one, basically due to the fact that the term can be traced from the study that he had undertaken and presented that was entitled The Roots of

Channel Tunnel Project Essay Example for Free

Channel Tunnel Project Essay Channel Tunnel project, which aimed to create a fixed connection between Britain and France, is one of the largest private funded projects in the world. It required the use of newest technology and great management skills in order to deal with unexpected changes. Also the cooperation of two countries’ governments, several constructors, banks and other agencies are needed to make this project run smoothly. This essay divided the whole project into 4 steps in analyzing: conceive, develop, execute and finish. Further, it demonstrates the key advantages and disadvantages of Chunnel project including project scheduling, risk management, people management, cross-culture communication and so on with critical thinking. In addition, recommendations are provided due to the improvement in these procedures. Background The channel tunnel is one of the longest undersea rail tunnels in the world. It has an overall length of 50.5-kilometre and links Folkestone in the UK and Calais in the France. (Anderson, 1994) The proposal of building a fixed link across the English Channel was firstly created as early as 1802 by an engineer in France but it was shelved due to security and political reasons. In 1957, Louis Armand formed the Channel Tunnel Study Group and then presents a design of railway tunnel, bored of submerged, comprising a twin rail tunnel with a service tunnel to the government in 1960. (eurotunnelgroup.com) However, the British minister cancelled the project in 1975 due to financial problems and oil crisis. The project started again until the British and French government reached an agreement, which is finding private promoters for the construction without public funding in 1984. Finally, after negotiate with governments, banks and shareholders, constructions began in 1987 and completed in 19 94. The American Society of Civil Engineers recognizes Channel Tunnel as one of the Seven Wonders of the Modern World. (Reynolds, 1996) Phase 1: Conceive From a project management perspective, the whole project can be divided into 4 stages which are conceive, develop, execute and finish. During conceive phase, it is necessary to focus on the project’s overall strategy. It considers the projects goal, potential problems and opportunities, possible solutions and the links of projects to other projects. Also it should be clarified projects’ basic assumptions. In 1981, the British and French governments are agreed to launch the project. Four plans including Eurobridge, Euroroute, Channel Expressway and Channel Tunnel were submitted to the government and Channel Tunnel Group/ France–Manche (CTG/FM) won the bid eventually. After that, an map of organizational structure had been designed: Source: channel tunnel project overview The picture above reveals the structure of all participants. Eurotunnel is an international company originally formed by CTG/FM. It is the owner and operator of the whole project. And it provided the construction contract to TML. From 1985- 86, Eurotunnel was controlled by CTG/FM and banks. Each of them holds 50% of it. Later on, Eurotunnel became independent company and then transferred to its shareholders and banks. A 55 years contract had been reached between Eurotunnel and the government of Britain and France based on the proposal submitted. The Construction Contract between Eurotunnel and TML sets out the Eurotunnel is also linked to the banks by a loan agreement and to national railways by a usage agreement. Furthermore, governments hired several experts to build an agency called IGC (Intergovernmental Commission) to ensure the project is under control. IGC was permitted for demanding changes in the process of project to keep it â€Å"healthy and safety†. During the stage of planning, the total cost of the project was 5.5 billion dollars and the whole project would be private financed without any government aids. On the consideration of CTG/FM owned an agreement, which gave group the sole right of Channel operation during 55 years, over 200 banks around the world offered loan to the project. (Genus, 1997) However, for a project this large, the lack of scope makes to resource planning, budgeting and cost calculating very difficult, thus it would be a challenge to use ROI (return on investment) to provide accurate data. Because ROI only gives results based on assumptions from TML Schedule management plays an important role in the first stage as well. Several milestones were built including (Fairweather, 1994): 1. 1974, idea of tunnel gathered, but abandoned 2. 1978, British and French discussions continued 3. 1985, British and French government asked for bids 4. 1986, The Treaty of Canterbury was signed allowing the project to proceed and CTG/FM won the contract 5. 1987, Channel tunnel project started 6. 1994, the project complete The schedule was planned to build 3 tunnels, two rail tunnels and one service tunnel allows mixed traffic at short headway (3 minutes between trains) and high speed (100 to 160 km/h) of national trains and its shuttles. These special Shuttles allow rail transportation of cars from one country to another. This made designer to illustrated 12 tunneling faces worked by 11 boring machines. A very complex schedule was made in logistics management and WBS development (work breakdown structure) due to high requirements of activity arrangements and activity duration estimate. Quality and risk management is another significant part of preparation stage. Management team needs to evaluate potential risks of technical, commercial, political, and financial aspects because if risks are identified early enough, an effective response strategy can be made. A risk impact matrix can be made in analyzing process

Nursing Care Plan for Left Knee Replacement

Nursing Care Plan for Left Knee Replacement Student Name ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­: Elizabeth (Beth) Andrews Brief Patient History including medical diagnosis and summary of assessment findings: The patient is a 59 year old female, widowed, who entered the Braintree Rehabilitation Center for transitional care after left knee arthroplasty due to osteoarthritis. She has a history of COPD; obstructive sleep apnea; spinal stenosis; degenerative joint disease; depression; obesity; fibromyalgia; dyslipidemia; hypothyroidism; lymphedema; tachycardia; and idiopathic tremors. She experienced a pulmonary embolism in 2009. The total knee replacement (TKR) was conducted at Metrowest/Leonard Morse Hospital on 5/21/12. The patient was transferred to Braintree Rehabilitation Center on 5/24/12. She had difficulty emerging from anesthesia and experienced urinary retention. She subsequently emerged from anesthesia and the urinary retention resolved. A neurological consult was ordered to assess the patient’s difficulty emerging from anesthesia; no source of this difficulty was identified during examination. The consultation suggested that her lethargy might be attributable to oxycodone (patient is allergic to milnapricine and several other drugs) which the patient takes for ongoing pain and fibromyalgia. The patient has otherwise experienced good recovery with physical therapy 1-2 hours per day/5 days per week. She continues to experience edema of the left operative extremity; no thromboembolus was identified and her physician ordered an additional diuretic. Her incision was healing well with no local swelling, warmth, or exudates and the wound erythema was receding from the marking drawn around the incision. Staples remained intake. The patient is a former smoker with COPD; she quit smoking just prior to the current surgery and seems to be managing this well. She is obese and indicates that she struggles with this and is aware of the relationship of her obesity to her osteoarthritis and current procedure as well as to other current and potential diagnoses. Her past medical history is noteworthy for fibromyalgia from which the patient experiences considerable disability. She associates the onset of fibromyalgia subsequent to being involved in a physically and emotionally abusive intimate adult relationship and to self-described post traumatic stress disorder relative to childhood sexual abuse. In addition, her past medical history is noteworthy for obstructive sleep apnea; patient uses a CPAP. The patient is widowed and lives alone in Natick. She has four children who live locally and whom she indicates are very supportive. One son comes to her home everyday to cook her dinner. The patient does not cook for herself and is maintained during the day with tea until her son comes to make her dinner. The patient is very focused on understanding and accessing information about her conditions/diagnoses and treatments. When I first met her, she was reviewing information provided to her by the transitional care unit pertaining to difficulties in emerging from anesthesia and about her medications. The patient’s life appears to revolve around her illnesses and conditions; she describes herself as a multiply disabled person. She does not leave her home very much except to attend medical appointments and is highly dependent upon her family for her needs and care. The patient reports that depression is a significant factor in her life related to prior physical, emotional and sexu al abuse and to her general state of disability. The patient is noteworthy for high level of health seeking behavior and a high degree of medicalization. According to the patient, her home is outfitted with multiple assistive devices which include a CPAP, a walker, a cane, an electronic chair to take her upstairs and a bidette to help her with personal hygiene. In spite of her many disabilities, the patient is progressing well and will be discharged in about a week. Additional Nursing Diagnosis without Care Planning Specification Activity Intolerance Acute Pain Anxiety Chronic Low Self Esteem Chronic Pain Deficient Diversional Activity Depression Disturbed Body Image Disturbed Sleep Pattern Disuse Syndrome Fatigue Health Seeking Behaviors Hopelessness Imbalanced Mobility: Greater than Body Requirements Impaired Bed Mobility Impaired Comfort Impaired Communication Impaired Gas Exchange Impaired Individual Resilience Impaired Physical Mobility Impaired Social Isolation Impaired Transfer Ability Impaired Walking Ineffective Activity Planning Ineffective Breathing Pattern Ineffective Coping Post Trauma Syndrome Powerlessness Readiness for Additional Health Seeking Behavior Risk for Cardiac/Vascular Complications Risk for Caregiver Role Strain Risk for Complications of Deep Vein Thrombosis Risk for Complications of Musculoskeletal Dysfunction Risk for Constipation Risk for Falls Risk for Hypothermia Risk for Impaired Cellular Regulation Risk for Impaired Skin Integrity Risk for Ineffective Respiratory Function Risk for Infection Risk for Injury Risk for Loneliness Risk for peripheral Neurovascular Dysfunction Sedentary Lifestyle Self Care Deficit NANDA Approved Nursing Diagnosis I Impaired Physical Mobility Clients Medical Diagnosis: Osteoarthritis, degenerative joint disease, spinal stenosis, status post total left knee replacement, fibromyalgia, obstructive sleep apnea, obesity, dyslipidemia, hypothyroidism, lymphedema, tachycardia, idiopathic tremors Definition : â€Å"A limitation in independent, purposeful physical movement of the body or one or more extremities† (Ackley Ladwig, 2011, p. 548). Defining Characteristics : â€Å" Decreased reaction time; difficulty turning; engages in substitutions for movement (e.g., increased attention to other’s activity, controlling behavior, focus on pre-illness disability/activity; exertional dypsnea; gait changes, jerky movements; limited ability to perform gross motor skills; limited ability to perform fine motor skills; limited range of motion; movement-induced tremor; postural instability; slowed movement; uncoordinated movements† (Ackley Ladwig, 2011, p. 549). Related Factors â€Å"Activity intolerance; altered cellular metabolism; anxiety; body mass index above 75th age-appropriate percentile; cognitive impairment; contractures; cultural beliefs regarding age-appropriate activity; deconditioning; decreased endurance; depressive mood; decreased muscle control; decreased muscle mass; decreased muscle strength; deficient knowledge regarding value of physical activity; developmental delay; discomfort; disuse; joint stiffness; lack of environmental supports (e.g., physical or social); limited cardiovascular endurance; loss of integrity of bone structures; malnutrition; medications; musculoskeletal impairment; neuromuscular impairment; pain; prescribed movement restrictions: reluctance to initiate movement; sedentary lifestyle; sensoriperceptual impairments† (Ackley Ladwig, 2011, p. 549). â€Å"Suggested functional level classifications include the following: 0-Completely independent 1-Requires use of equipment or device 2-Requires help from another person for assistance, supervision or teaching 3-Requires help from another person and equipment device 4-Dependent (does not participate in activity)† (Ackley Ladwig, 2011, p. 549) Instructions for Student In the space below, enter the subjective and objective data gathered during your client assessment. A S S E S S M E N T Subjective Data Entry Patient reported pain of â€Å"4†related to current acute pain â€Å"4† and â€Å"6† for chronic pain at home prior to admission based on scale of from â€Å"0† to â€Å"10† Patient reported that she uses assistive devices at home: walker, cane, electronic chair for climbing stairs while seated, bidette to assist with personal care; CPAP for sleep Patient reported that she engages in little social activity when at home, going out only for medical appointments Patient reported that she often sleeps during the day and has difficulty sleeping at night Patient reported that she is frequently fatigued and that movement around the home is difficult even with assistive devices Patient reported that chronic pain is related to osteoarthritis and fibromyalgia Patient reported that she is dependent upon family member for meals Patient reported that she is able to manage some dressing and bathing, but is dependent upon bidette for some of her perianal care Patient self-reports depression, PTSD, and fibromyalgia related to past physical, emotional and sexual abuse and to current status of general disability Objective Data Entry Vital signs: Temp: Oral 97.3, HR, 105, Respirations, 20, BP: r: 121/75; L 123/79 Pulses: Radial 105, L and R pedal pulses present Height: 4 ft 11 inches Weight 259 lbs Cognition: Alert and Oriented to person place and time X3 Affect: Pleasant, conversant, but subject to inattention due to dozing during conversation Integumentary: Hair: clean, gray color, neat haircut, no lesions on scalp Nasal: moist, pink Oral: mucosa : moist, pink, tongue: moist, pink, no oral lesions. Skin Color: Pink Skin: Color: pink Temp: warm to touch Texture: smooth Moisture/Hydration: moist, turgor positive at sternum Breakdown: the only current manifestation of breakdown is skin rashes in groin area and under breasts. Operative incision is erythmetous, but erythema is receding as evidenced by line drawn around erythema. No swelling, warmth or exudate at the operative incision Respiratory: Respirations: 20, depth even and rhythm even, O2 saturation 94% at rest on room air. Observed patient fatigue upon walking a short distance from bed to bathroom, Cardiovascular:Apical Pulse: 105; Rhythm: regular; Radial pulses: left and right present Pedal Pulses: left and right present Capillary refill observed L X 5 fingers and R X 5 fingers; L X 5 toes and R X 5 toes Musculoskeletal: poor mobility. Left hand slightly weaker than right; tremors appeared in left when squeezing fingers General: Patient experiences generalized pain chronically and current acute pain at operative site. Patient used ice pack and lidocaine strips to moderate localized pain (in addition to pain medications). Patient experiences chronic sleep disturbances, in particular, chronic obstructive sleep disorder. Sleep is only moderately relieved by use of CPAP Objective evidence includes patient frequent dozing during interview. Patient is obese: weight 259 lbs/height 4 feet, 11 inches BMI 52.3 Evaluate Student Instructions: To be sure your client diagnostic statement written below is accurate you need to review the defining characteristics and related factors associated with the nursing diagnosis and see how your client data match. Do you have an accurate match or are additional data required, or does another nursing diagnosis need to be investigated? D I A G N O S I S Diagnostic Statement Nursing Diagnosis (specify) Impaired Physical Mobility (Carpenito-Moyet , 2010, p. 285) related to pain, fatigue, obesity and sleep disturbances as evidenced by patient fatigue upon walking a short distance, patient report of limited mobility, patient dozing during interview, patient pain reports of â€Å"4† and â€Å"6† on scale of from â€Å"0† to â€Å"10† , patient BMI 52.3 P L A N N I N G Desired Outcome The Client will: and Client Criteria: Reduce weight by 20% after one year compared to baseline of 259 lbs Reduce feelings of depression by 20% as measured by the PHQ-9 questionnaire after one year Improve mobility by 20% after one year compared to baseline determined by physical therapist assessment Reduce pain by 50% after one year compared to baseline of â€Å"6† on scale of from â€Å"0†toâ€Å"10† Improve feelings of self esteem and self-efficacy by patient report after one year Evaluate The desired outcome must meet criteria to be accurate. The outcome must be specific, realistic, measurable, and include a time frame for completion. Does the action verb describe the clients behavior to be evaluated? Can the outcome be used in the evaluation step of the nursing process to measure the clients response to the nursing interventions listed below? Interventions Referral to mental health counseling to identify and treat depression, issues of self-esteem and self efficacy Referral and active participation in physical therapy to improve mobility Undertake regular exercise that includes ambulation for longer distances, higher frequency and increased repetition of performing ankle pumps, gluteal sets and quadriceps sets. Use heat and cold, stretching and range of motion exercises to manage symptoms of fibromyalgia Referral to pulmonologist for sleep disturbance assessment. Referral to pain management specialist for assessment, planning and treatment related to various sources of patient pain Referral to nutritionist for assessment and planning related to nutrition and weight reduction. Set realistic goals for weight reduction, encourage patient to keep food diaries, provide patient with information about the relationship of weight management to pain reduction and mobility improvement, identify stress issues related to obesity and support systems that can help patient in weight reduction. Rationale for Selected Intervention and References Research indicates that attention to psychosocial issues and mental health counseling can have a positive impact on reduction in obesity (Yilmaz et al, 2011). Depression has been related to weight control in patients with osteoarthritis (Possley et al, 2009). Mood disorders are related to fibromyalgia (Dell, 2007). Research has shown that active participation in physical therapy is important to improved mobility post TKR (Hall, Hardwick, Reden, Pulido, Colwell, 2004). Research indicates that behaviors such as ambulation for longer distances, higher frequency and increased repetition of performing ankle pumps, gluteal sets and quadriceps sets are related to greater self-efficacy in patients who have had total joint replacement (Moon Backer, 2000). Regular exercise improves pain, physical function and contributes to weight reduction in patients with osteoarthritis (Seed, Dunican Lynch, 2009). Active physical exercise has achieved modest positive results in reduction of signs and symptoms of fibromyalgia (Turk, 2009). Research has shown that heat and cold, stretching and range of motion exercises improves symptoms of fibromyalgia ((Turk, 2009). Research has shown that sleep disturbances should be evaluated and treated as a component of treatment of fibromyalgia (Dell, 2007). Patient has pain related to many sources and may influence the patient’s approach to obesity and mobility. Pain has been related to obesity (Janke, Collins, Kozak, 2007). Realistic goals, food diaries/monitoring/ understanding of the relationship between pain and mobility, stress issues and support systems have been shown to support successful obesity self care and illness prevention (Hindle Dell, 2012). E V A L U A T I O N Evaluate Do your interventions assist in achieving the desired outcome? Do your interventions address further monitoring of the clients response to your interventions and to the achievement of the desired outcome? Are qualifiers: when, how, amount, time, and frequency used? Is the focus of the actions verb on the nurses actions and not on the client? Do your rationales provide sufficient reason and directions? What was your clients response to the interventions? (theoretic) Weight is reduced by 20% after one year (evaluation outcome 200 lbs) Feelings of depression are reduced by 20% as measured by the PHQ-9 questionnaire after one year Mobility is improved by 20% after one year compared to baseline established by physical therapist assessment Pain is reduced by 50% after one year (evaluation outcome â€Å"3† on a scale of from â€Å"0† to â€Å"10† Feelings of self esteem and self-efficacy are improved by patient report after one year References Ackley, B.J. Ladwig, G.B. (2011). Nursing diagnosis handbook-an evidence-based guide to planning care. Ninth Edition. Mosby Elsevier, St. Louis, Missouri, 2011 Carpenito-Moyet, L.J. (2010) Handbook of nursing diagnosis, 13th Edition, Used by arrangement with Wiley-Blackwell Publishing, a company of John Wiley Sons, Inc, Publisher Wolters Kluwer Health/Lippincott Williams Wilkins, Philadelphia, Baltimore, New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo Dell, D.D. (2007) Getting the point about fibromyalgia. Nursing 2007, February 2007, 61-64. Retrieved from: http://web.b.ebscohost.com.mbcproxy.minlib.net/ehost/pdfviewer/pdfviewer?vid=4sid=2a85447c-cc47-4b86-8e31-250d1b9e754d%40sessionmgr111hid=114 Janke, E.A., Collins, A. Kozak, A. T. (2007) Overview of the relationship between pain and obesity: what do we know? Where do we go next? Journal of Rehabilitation Research Development, Vol 44, No 2, 245-261. Retrieved from: http://web.b.ebscohost.com.mbcproxy.minlib.net/ehost/pdfviewer/pdfviewer?vid=5sid=2a85447c-cc47-4b86-8e31-250d1b9e754d%40sessionmgr111hid=114 Hall, V.L., Hardwick, M., Reden, L., Pulido, P. Colwell, C. (2004) Unicompartmental knee arthroplasty –an overview with nursing implications. Orthopaedic Nursing, Vol 23, No 3, May/June 2004, 163-173. Retrieved from: http://web.b.ebscohost.com.mbcproxy.minlib.net/ehost/pdfviewer/pdfviewer?vid=6sid=2a85447c-cc47-4b86-8e31-250d1b9e754d%40sessionmgr111hid=114 Hindle, L. Mills, S. (2012) Obesity self-care and illness prevention. Practice Nursing, Vol 23, No 3, 130-134. Retrieved from: http://web.b.ebscohost.com.mbcproxy.minlib.net/ehost/pdfviewer/pdfviewer?vid=10sid=2a85447c-cc47-4b86-8e31-250d1b9e754d%40sessionmgr111hid=114 Moon, L.B. Backer, J. (2000) Relationships among self-efficacy, outcome expectancy, and postoperative behaviors in total joint replacement patients. Orthopaedic Nursing, 19 (2) 77-85. Retrieved from: http://web.b.ebscohost.com.mbcproxy.minlib.net/ehost/detail?vid=7sid=2a85447c-cc47-4b86-8e31-250d1b9e754d%40sessionmgr111hid=114bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzhAN=2000051848 Possley. D. et al. (2009) Relationship between depression and functional measures in overweight and obese persons with osteoarthritis of the knee. Journal of Rehabilitation Research Development, Vol 46, No 9, 1091-1097. doi:10.1682/JRRD.2009.03.0024 Seed, S.M., Dunican, K.C., Lynch, A.M. (2009) Osteoarthritis: a review of treatment options. Geriatrics, Vol 64, No 10, 20-28. Retrieved from: http://web.b.ebscohost.com.mbcproxy.minlib.net/ehost/pdfviewer/pdfviewer?vid=9sid=2a85447c-cc47-4b86-8e31-250d1b9e754d%40sessionmgr111hid=114 Turk, D.C. (2009). Fibromyalgia syndrome: a guide for the perplexed. Psychiatric Times, 26(2), 50-54. Retrieved from: http://web.b.ebscohost.com.mbcproxy.minlib.net/ehost/detail?vid=8sid=2a85447c-cc47-4b86-8e31-250d1b9e754d%40sessionmgr111hid=114bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=cin20AN=2010211647 Yilmaz, J. et al. (2011) Adopting a psychological approach to obesity. Nursing Standard, Vol 25, No 21, 42-46. http://dx.doi.org/10.7748/ns2011.01.25.21.42.c8289