Case study and history of hypertension

Case study and history of hypertension History of Present Illness: Mr. AS is an 85 year old Caucasian male with a past history of hypertension and chest pain who currently presents to us with dementia and complaints of not knowing how he got here. Our patient was diagnosed with hypertension at the age of 40 and developed chest pain at the age of 45 when he was told he needed a pace maker. The pace maker was placed and he has had no heart complications since then. At the age of 55 our patient was diagnosed with dementia which he lived with independently at home until two years ago when he had a stroke. He was admitted to ALF on April 28, 2009 where he was told that he had a stroke and could not walk. Mr. AS has been staying at the facility since admission. Our patient currently denies any chest pain, headaches or vision changes. Mr. AS does complain of a cough that becomes productive at times with clear sputum. He stopped smoking 20 years ago and has a 160 pack year history. He also states that he thinks he hears himself wheezing at times. Mr. AS states that his legs don’t allow him to walk anymore and that the exercises that are done with the walker hurt his arms. He states that he has feeling in his legs but that movement is the problem. Mr. AS stated during the interview that he has accepted the fact that he will not be able to walk again and that he is content with his life as long as he can breathe and talk. Our patient also stated that he has problems remembering recent events and is better at remembering events that occurred during his childhood. Past Medical History: Hypertension at the age of 40 which is controlled with medication. Chest pain at the age of 45 which was fixed with the placement of a pacemaker. Dementia was diagnosed at the age of 55 Stroke at the age of 83 Appendectomy at the age of 10 due to an appendicitis Inguinal hernia repair at the age of 10 Current Medications Mirtazapine 15mg PO QD for depression Namenda 10mg PO Bid for treatment of alzheimer ’s symptoms Allopurinol 300mg PO QD for hyperuricemia Aspirin 81mg PO QD for general health and relief of minor pain Certavite antioxidant 18mg PO QD to prevent vitamin deficiency and undernutrion Loratadine 10mg PO QD for allergies Nifedipine 90mg PO QD for treatment of hypertension and angina Metoprolol tartrate 25mg PO QD for treatment of hypertension and angina Nasal decongestant 0.05% SP 2 sprays for each nostril Bid for allergies Omeprazole 20mg PO Bid for gastroesophageal reflux Aricept 10mg PO QD for dementia associated with alzheimer’s Tamsulosin HCl 0.4mg PO QD for benign prostatic hyperplasia Zolpidem Tartrate 5mg PO QD for help sleeping Acetaminopen 500mg PO every 6 hours for high temperature Allergies No known allergies Family History: Grandma had TB, patient could not remember cause or time of death and chart did not contain any information. Information about the mother and father could not be obtained by the patient or the c hart. Information about siblings could not be obtained by the patient or the chart. Patient states that he has one son who has back pain and is overweight. No other information could be provided by the patient or the chart. Patient states that he has no grandchildren Married twice and both deceased, cause unknown by patient and not stated in chart. Family members will need to be contacted to obtain more information on history of cancer, hypertension, heart disease, diabetes mellitus, or psychological illnesses. Social:

Measuring Cancer Cost Behaviour under Prospective Payment System in Essay

Measuring Cancer Cost Behaviour under Prospective Payment System in Clinical Coding - Essay Example Either way, the increased economic disparities and healthcare challenges have necessitated a rational management of financial resources allocated for healthcare service provision. This paper looks at the role of managers in healthcare financing with respect to the functions of the National Healthcare Service. Besides, the paper provides a succinct discussion on the importance of clinical coding in promoting proper channelling of finances for purchasing healthcare services. In particular, this paper examines the role of clinical coding in measuring the cost of cancer care and how such data promotes evidence based decision making for equitable allocation of healthcare resources. According to Berger (2008), healthcare systems are organized in a manned that allows strategic achievement of three specific objectives. The first objective relates to collection of revenue from various sources including government, donors and individuals. The second objective of healthcare system is to enhance pooling of resources from all stakeholders such that the risk of ill health is shared among every member of the pool. Lastly, every healthcare system aims to provide an affordable and accessible platform of purchasing healthcare services that suits the best expectations of individual members of the society. With these objectives in mind, financial management of healthcare resources becomes a central focus at every stage in order to strike a balance between quality services and scarcity of resources as argued by Bodenheimer and Fernandez (2005, p.27). In the hierarchy of the National Healthcare Service, there are several healthcare trusts and public hospitals that work together to deliver health services to clients. Through the NHS, healthcare managers and commissioners are delegated the main duty of ensuring that various service providers deliver quality healthcare within the available financial resources allocated

Business strategy-business game Essay Example | Topics and Well Written Essays - 3000 words

Business strategy-business game - Essay Example A single strategic direction for the firm is selected which is the differentiation strategy as per the Bowman’s strategy clock. The Bowman’s strategy clock is used to identify one or multiple strategic aspects that may be taken up by a company for developing competiveness, sustainability and continued success (Chesbrough and Rosenbloom, 2002). This is because the results of the analysis and the study of the external market indicate that the adoption of a differentiation strategy can be beneficial for the company for ensuring greater levels of success and sustainability for the future years. The number of companies operating in the athletic footwear segment in which the case company belongs ranges from 4 to 10 main companies. However, for the analysis, three main competitors of APanda Shoes are considered which are Diversity Footwear, C Athlete Company and Bold Athletics Company. The company APanda Shoes operates in multiple geographical regions. The company has its manufacturing plants in North America, Asia pacific, Europe, Africa and Latin America. This makes the athletic footwear manufacturing company much vulnerable towards the political norms in the different countries of its operation. The political factors like the stability of the political environment, the formulation of government policies, taxation policies, export and import policies and duties levied on the athletic footwear products are some of the common factors that would affect the business decisions and operations of APanda Shoes. The economic factors like inflation rates, Gross Domestic Predict (GDP), economic and business cycles, disposable income level and Purchasing Power Parity (PPP) are some of the economic factors that would directly influence the profitability, sales and sustainability of the company in the four operational regions. The volatility of currency exchange systems and the fluctuations in the foreign exchange

Brazilian Sweet Fifteenth Birthday Party Essay -- Personal Narrative D

  Ã‚  Ã‚  Ã‚  Ã‚  Quinceanera, which is Spanish for Sweet 15, is a very popular celebration in the Spanish community. This is a very special day to both the mother and the daughter. This day signifies the transformation from a little girl to a young lady. It is a way of introducing a new woman to society. Turning 15 is the most important birthday for Spanish communities. Quinceaneras tend to be a big and elegant celebration in which every family member and friends collaborate to give the birthday girl the best party she has ever had. To my understanding every Sweet 15 was celebrated the same in every Spanish country. But after attending my friend’s Brazilian Sweet 15 my opinion has changed for the better.   Ã‚  Ã‚  Ã‚  Ã‚  My friend Stephane Rene and I were invited to a Sweet 15 a couple weeks ago. The birthday girl was related to one of our friend, Kim. At first, I did not even think of using this event to write my paper because I thought that I knew what a Sweet 15 was all about. I was primarily going to focus on the Brazilian culture because even though my friend is Brazilian I had never had the opportunity to share an event with Brazilians being the dominant group. But soon after the ceremony got started I found myself surprised and amused of what was in front of me. First, there is ceremony before the reception which is held at a church. The family is catholic therefore the ceremony was held at the catholic church of the town. After everybody was sitting down, Jennily walked down the aisle toward the front of the church. Here, the priest was waiting to give her the appropriated blessings. She was wearing a long gorgeous pink silky dress which represented her new status as a you ng woman. Jennily was also wearing soft pink slippers which she would change later into a more elaborate one. I was familiar with the ceremony at the church before the party because it is a way of blessing her and to appreciate her day of celebration which simultaneously represents her rebirth as a woman. But I did not hesitate to ask one of the family members, what did it signify to them to be blessed by the priest the day of her birthday? To my surprise, thru their blessings they also pray for her future and her new start. Once the priest was done, her aunt and uncle stood up and recall her first fifteen years of life in a very sentimental and biographical speech. Throughout the speech they kept referr... ...ized by they own people than an outsider because it would make no difference for me to see someone of their group acting a particular way. In actuality, it would be hard for me to notice that there is something a little odd.   Ã‚  Ã‚  Ã‚  Ã‚  Regardless of the difference of culture, language and customs, I learned so much about the Brazilian culture in the United States. For example, they have huge families like Dominicans and they stay together as a community one hundred percent. In addition, I myself might incorporate some of their traditions onto mine, maybe not for myself but for my cousins and even for my future daughter. I like they way in which everything was very detailed and organized. Also, I liked how everything had a meaning and a reason for being there. This party has motivated me to go out there and explore all the different cultures that exist in the society that I live in. This event has also taught me a lesson about life, in order for us to find ourselves we need to identify with our ancestors and continue our traditions. There is nothing more pretty than being able to bring our beliefs and customs with us. This is what identifies who we are, and who are children would be.

Assess Hume’s Reasons for Rejecting Miracles

Assess Hume’s reasons for rejecting miracles Hume defined miracles as a â€Å"violation of the laws of nature† and consequently rejected their occurrence as both improbable and impractical. This view has been supported by modern scientists and philosophers such as Atkins, Dawkins and Wiles to a certain extent. However Aquinas, Tillich and Holland and Swinburne to a certain extent reject Hume’s reasons, instead arguing that miracles have a divine cause and that Hume’s arguments are weak.This essay will argue that Hume’s reasons for rejecting miracles are not valid and in doing so consider his two main arguments; lack of probability and Hume’s practical argument. Hume’s first reason for rejecting miracles was a lack of probability. He argued that evidence from people’s experience of observing the world showed the laws of nature to be fixed and unvarying. However to suggest a miracle occurred was to say that the laws of nature had been violated, hence his definition of miracles being a â€Å"violation of the laws of nature. Miracles were reported has having occurred by eyewitnesses, as is stated in the Bible in the case of Jesus raising Lazarus from the dead. However for Hume it was far more likely that the eyewitnesses were mistaken in what they witnessed, than for Jesus to have actually raised Lazarus from the dead and in doing so violated fixed laws of nature. A violation of the laws of nature was therefore an improbable occurrence. Wiles’ agrees with Hume’s point that it is more likely the eyewitness was wrong than a miracle occurred, in doing so raising the problem of evil.It was illogical to suggest God was omnipotent and good if he showed clear favouritism through creating miracles whilst at the same time many people were suffering. It would be more likely that a witness made a mistake or did not understand what they saw than an ominbenevolant and omnipotent God showed clear signs of bia s and favouritism through miracles therefore Hume’s first argument is valid. Swinburne supports Hume’s view that laws of nature are defined by the experiences of people observing the world, as he believes that people’s observations are the basis for all natural laws.Additionally Hume’s argument that miracles are improbable is supported by Dawkin’s view that it would be highly unlikely that someone could simply learn to walk again after being paralysed as a result of a miracle, as this would constitute a violation of the laws of nature. This also supports the idea that Hume’s argument is valid. However he rejects Hume’s concept of the laws of nature being fixed and unvarying, as he believed them to be â€Å"corrigible† due the possibility new discoveries and observations about the world could result in them being altered in some way.Additionally Swinburne disagrees with Hume’s idea of what an improbable event is. Whilst f or Hume this means an event which it would be foolish to suggest occurs at all, such as the sun staying the sky, Swinburne argues that miracles are more â€Å"probalistic† such as picking out a red grain of sand, highly unlikely but not totally impossible therefore the validity of Hume’s first argument can be questioned.Additionally Swinburne criticises Hume’s definition of miracles as a â€Å"violation of the laws of nature† as he believes that whilst a miracle such as that of Jesus’ resurrection clearly does not fit in with the laws of nature, on it’s own it is not enough to prove the laws of nature have been violated, a view supported by Aquinas who suggests miracles have a divine origin. The contingency argument, supported by Holland and Tillich also criticises Hume’s definition of miracles as a â€Å"violation of the laws of nature. It uses evidence from the Bible, such as Jesus feeding the five thousand, to highlight that Godâ €™s aim with miracles is not to fit in with the framework of modern concepts but to for God to reveal Himself to the people. Tillich himself argues that miracles do not have to involve the violation of nature as they can be possible events, such as a train stopping just in front of a child on a crossing, which hold religious significance for some people. Therefore a miracle does not have to be an improbable event, suggesting that Hume’s argument is not significant.Hume’s second reason for rejecting miracles is presented in his practical argument. He considered levels of education to be a significant factor as miracles were only reported to have occurred by those who were not educated enough to understand the scientific explanation of an event. The stories these people reported were usually circulated and exaggerated, altering them significantly as is the case with urban myths, such as that after Hurricane Katrina stating that law and order had broken down.Hume also considered the general level of education of the country as a whole to be important. He highlighted how the early history of countries is full of miracles and visions due to the ignorant and barbarous populations, such as the very long life of Adam. However as the country becomes more developed and the populations better educated such stories disappear. Therefore for Hume, Adam living to 930 was simply a story made up by the uneducated, as living so long would suggest the laws of nature to be false.Additionally Hume believes that miracles used by religions to prove their religion true would be cancelled out, as not every religion could be true. Dawkins presents a key strength of Hume’s second argument, by supporting his belief that miracles are only reported by the uneducated, as he believes there is a scientific explanation for the effects, such as Jeanne Fretel being cured at Lourdes.The miracles of people being cured at Lourdes, as well as those reported in the Bible simp ly show that miracles were used to cover up a lack of understanding of a way the world worked and to increase people’s faith in God, something which is no longer necessary as most people no longer rely on God for guidance therefore Hume presents a relevant argument rejecting miracles. Atkins supports Hume’s argument that the typical educated person would not be inclined to report the occurrence of a miracle as they would know better.According to Atkins it is only the publicity seeker or someone deluded or hallucinating who would claim to have witnessed such an event as they may lack the scientific level of understanding of their peers, therefore Hume’s argument is relevant. However this view has been criticised by Swinburne as it raises questions about how to define terms Hume raises. It is unclear at what stage a person becomes â€Å"educated† sufficiently to reject miracles. It is also unfair to assume that a person believes in miracles simply because t hey do not know any better, as it is possible to both have a strong belief in God and a good understanding of Science.Further to this it is unclear what constitutes being â€Å"ignorant and barbarous† as whilst earlier nations may now seem uneducated compared to modern times, the nation may have been highly educated for the time as the standards change. Therefore the relevance of Hume’s second argument can be questioned. In conclusion Hume believes that miracles are â€Å"violations of the laws of nature† which are fixed and unvarying, and that they are only experienced by uneducated people who do not understand Science.This view rejected by Aquinas, Swinburne Holland and Tillich. Swinburne believes the laws of nature to be â€Å"corrigible† whilst Holland and Tillich argue that miracles are not violations of the laws of nature but sign events revealing God to the people. However Dawkins and Atkins support Hume’s view that miracles are only experie nced by the uneducated. Overall Hume’s reasons for rejecting miracles are valid to only a minimal extent, as he does not consider the different definitions of a miracle, and does not define what constitutes ignorant and barbarous.

Women’s Significance in To Kill a Mockingbird - 2102 Words

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International Business Case Study - 7015 Words

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