Objective Structured Clinical Examination Method

Question: Discuss about the Objective Structured Clinical Examination Method. Answer: Introduction: Mr. Harry Jones is 68-year-old man and is admitted to the medical ward suffering from Rapid Atrial Fibrillation. He has allergy with penicillin , and has a past medical history of asthma and hypertension. Mr. Jones is currently on Salbutamol 5mg two puffs four times per day and, oral cardiprin 100mg once a day and oral enalapril 10mg daily. He has a known family history of acute myocardial infarction, migraines in mother , and cancer of the colon in his father.This report includes pathophysiology of atrial fibrillation, and the rationale of administrating amiodarone as his initial medical management, and action and the therapeutic benefits of both the drugs warfarin and dabigatran as well as the side effects to decide which drug most suitable for him. Mr. Jones was prescribed aspirin to prevent the heart stroke, which can occur due atrial fibrillation since he has an age of 68 years. This drug was given because of low risk of bleeding, easy to use and monitoring is not required while giving this drug(Lip, 2013).The Mode of action of aspirin involves inhibiting the activation and aggregation of platelets and also the inhibition of enzyme cyclo xygenase that is platelet dependent. This leads to the inhibition of prostaglandin synthesis. The side effects of aspirin involves fever that lasts for 3 days, vomiting, pain in the stomach and nausea. Cardiprin is used for thinning of blood during heart strokes and atrial fibrillation. It has an active ingredient as aspirin and functions by the suppression of the production of prostaglandins hormones. There are various side effects of Cardiprin such as nausea, vomiting(Ng Ho, 2017). Asthma and problems related to digestion. Nursing interventions for administering Cardiprin involves proper knowledge about the current medicaments the patient is taking, allergic responses and any future surgery and pregnancy. The patient should inform the doctor about any issues of asthma, high blood pressure, heartburn or any other cardiac diseases. The nurse should give the medicine to the patient by checking on the outer packaging and as prescribed by the clinician. It can also lead to irritation in the stomach so it should be taken along with milk. The pathophysiology of atrial fibrillation involves pathological changes such as fibrosis in the artria that is progressive in nature. The fibrosis occurs due to the ageing process, dilation of the chamber, genetic reasons and inflammation. Atria gets dilated due to various structural abnormalities in them heart such as high blood pressure, valvular heart disease or a congestive failure of the heart (Heitner, 2013).Atrial fibrosis can also occur due to the mutation in the lamin AC gene. The renin-aldosterone angiotensin pathway is activated by the atrial dilatation due to stretch and this in turn increases the protein disintegrin and matrix metaproteinase in the walls of the atria. This pathway leads to the release of cytokines, oxidative stress and the formation of factors that lead to growth and promote fibrosis(Wakili, Voigt, Kb, Nattel, 2014). It also initiates various cell-signalling processes that increase the level of calcium inside the cells. The Renin aldosterone angiotensin system (RAAS) includes various enzymes such as Angiotensin 2, aldosterone and angiotensin converting enzyme and they are increased during atrial fibrillation as they are synthesized on a local level in the atrial myocardium. The increase in the level of these enzymes leads to fibrosis and atrial remodeling and results in the loss of muscle mass of atria.There are two types of fibrosis that is Reactive interstitial fibrosis, which helps in the separation of muscle bundles, and Reparative fibrosis that helps in replacing the cardiomyocytes. Fibroblasts can be coupled to the cardiomyocytes in an electrical manner and help in promoting the ectopic activities when their number is increased(Dan Camm, 2013). Amiadarone is given to Mr Jones to prevent myocardial infarction since his mother had a past medical history of the same disease. Amiadarone is also used to help the heart to beat in a normal manner as he is suffering from atrial fibrillation. It may lead to side effects if given to Mr Jones since he is allergic to pencillin and is suffering from asthma and serious heart issues(Barber Blundell, 2013).It should also be not given to patients suffering from thyroid diseases, implantation of pacemaker, eyesight issues, low balance of electrolyte and low or high blood pressure. There are various side effects of amiodarone such that it can have a negative effect on the liver and lungs in Mr Jones. The nursing interventions include various measures after administering this drug to the patient such as continuous monitoring of ECG and rhythm and heart rate and keeping a check if the patient suffers from jaundice, pain in the chest and stomach breathing issues, dark coloured urine and blood i n the cough(Schalij, 2014). Amiodarone should not be given to females who are pregnant as it can have a negative effect on the health of the baby because it passes to the mothers milk. Anticoagulants such as warfarin and dabigatran are used to reduce the risk of blood clotting and hence the heart stroke. The most common medicine is warfarin but it has a disadvantage that it can interact with foods, medicines and alcohol. But dabigatran has an advantage that it has a low interaction rate with medicaments, alcohol and food items .Warfarin requires regular blood tests to check the clotting time of blood in the body and dabigatran does not require regular blood tests(Wislff Klemp, 2014). According to, the National Institute for Health and Care Excellence (NICE), warfarin is used to decrease the risk of heart stroke. Its main disadvantage is heavy bleeding so to avoid it, a Vitamin K injection is given to stop the bleeding. Dabigatran blocks the effect of thrombin and helps in preventing the blood clots. Thrombin is a protein which is formed in the body for the formation of blood clots. Dabigatran gets collected in the blood of the patients who suffer from kidney probl ems as the kidney is not able to remove the drug from the body(Giugliano, Ruff, Braunwald, Murphy, Wiviott, Ruzyllo, 2013). There are various precautions while taking the drug dabigatran such as the capsule should not be opened before giving then dose to the patient that will lead to an increase in the concentration of drug in the body of the patient and hence lead to an increase in the risk of bleeding. Another disadvantage of this drug is that it is degraded when comes in contact with moisture and hence precautionary measures should be followed to keep the bottle closely tight. It should be used within 30 days after the bottle is opened. A side effect of dabigatran is that it leads to indigestion and stomach upset in patients if it is discontinued because the drug needs an acidic environment to get absorbed in the body(Mooney, 2013).It can also lead to heart stroke or heart attack if this medicine is stopped from taking. The side effects of warfarin are fever, bleeding from the gums, pain and swelling, irritation and diarrhea. Warfarin is more effective and safer than dabigatran and dabigatran should no t be taken by patient suffering from kidney and liver problems as it lead to increase in bleeding. Salbutamol is used in the treatment of asthma by providing relaxation to the muscles in the walls of airways present in the lungs. The normal dose for patients is 1-2 inhalations those who are adults and one puff for children in the age group of 6-11 years. It should be used only after prescribed by the doctor. (Salvi, 2013). Mr Jones will be instructed to remove the cover from the mouthpiece and shake the inhaler profusely then hold the inhaler and breathe out in a gentle manner. Then the mouthpiece should be immediately kept on the mouth. He will be advised to seal the mouthpiece totally with lips and start to breathe slowly with the mouth. After breathing slowly, press the inhaler firmly to release the medication and continued to breathe in(Zhang, Liu, Hu, Tan, 2015). If the patient misses the dose he should continue with the regular dosage schedule. It should be store at a room temperature and kept out of reach from children. It should be kept away from hot devices such as stove and heater. The patients who are allergic to salbutamol and milk proteins such as lactose should not take salbutamol puffers. Side effects of this medication include drowsiness, dizziness, fatigue, coughing and faster rate of heartbeat(Lahiri, 2017). It can be concluded that Mr Jones has a high risk of heart stroke since he is an elderly person. He should take proper care of himself and follow the medicaments prescribed by his clinician properly. He should take a well balanced diet and exercise daily that will decrease the chances of heart stroke. He should take warfarin that will help to decrease the risk of heart stroke and it is more effective and safer as compared to other drugs such as dabigatran. He should follow proper nursing interventions and follow precautionary measures to recover from Rapid Atrial Fibrillation. Bibliography Barber, Blundell, P. . (2013). Further Esstentials of Pharmocology For Nurses. Maidenhead: McGraw-Hill Education . Dan, Camm, B. d. (2013). Atrial fibrillation therapy. . Giugliano, Ruff, Braunwald, Murphy, Wiviott, Ruzyllo, H. . (2013). Edoxaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine , 369(22), 2093-2104. Heitner, H. . (2013). Cardiology in Family Practice. A practical guide . Lahiri. (2017). vidence behind use of levosalbutamol over salbutamol to prevent cardiac side effects. . International Journal of Contemporary Pediatrics , 4(3), 674-678. Lip, . L. (2013). Stroke prevention with oral anticoagulation therapy. Circulation Journal, Volume 77(6), pp1380-1388. . Mooney. (2013). Use of dabigatran to prevent stroke in patients with atrial fibrillation. .Nursing standard, Volume 27(27), , pp 35-41. Ng, Ho, C. . (2017). Comprehension by older people of medication information with or without supplementary pharmaceutical pictograms. Applied Ergonomics , 58, 167-175. Salvi, B. . (2013). Aspirin and asthma. CHEST Journal Volume118 (5 , p1470-1476.doi:10.1378/chest.118.5.1470. Schalij, V. E. (2014). Amiodarone: an effective antiarrhythmic drug with unusual side effects. Heart, Volume , 96(19). Use of dabigatran to prevent stroke in patients with atrial fibrillation. (2013). Nursing standard, , Volume 27(27), pp 35-41.41. Van Erven, L., Schalij, M. J. (2010)Amiodarone: an effective antiarrhythmic drug with unusual side effects. . (2013). Heart, Volume 96(19) , 96(19). Wakili, Voigt, Kb, Nattel, D. (2014). Reccent advances in the molecular pathophysiology of atrial fibrillation. Journal of clinical investigation , p2955-2968. Wislff, Klemp, H. . (2014). conomic evaluation of warfarin, dabigatran, rivaroxaban, and apixaban for stroke prevention in atrial fibrillation. . Pharmacoeconomics , 32(6), 601-612. Zhang, Liu, Hu, Tan, X. (2015). An aerosol formulation of R-salbutamol sulfate for pulmonary inhalation., . Acta Pharmaceutica Sinica B , 4(1), 79-85.

The Secret of Unique Evaluation Essay Topics That Nobody Is Discussing

The Secret of Unique Evaluation Essay Topics That Nobody Is Discussing A Startling Fact about Unique Evaluation Essay Topics Uncovered Analyze all you read in order to strengthen your ideas in writing. Write carefully, so that someone else searching for help with the exact thing could choose whether to hire that person. If you consider it long enough, the proper topic will just pop up in your mind and you'll wonder how you could miss something as easy. Utilizing interesting, unique speech topics is an excellent way to pull a bigger audience and keep people engaged. The New Angle On Unique Evaluation Essay Topics Just Released Do not be scared to ask question about the task in case you do not understand what the instructor would like to see in the paper. If that's the case, your evaluation is going to be a beaten job. It's a fact that every evaluation will involve the inclusion of some form of opinion, so as to be accomplished correctly, the evaluation should not read as thou gh it's opinionated. You ought to make sure you plan your paper out so you create a cohesive piece. It might be necessary to liaise with other people to recognize the good compare and contrast essay topics. Remember that virtually any paper can be become a sarcastic or humorous piece offered by you. The experts ought to be in a position to deliver the essay within the mandatory time frame. The option of evaluation essay topic is a significant step before writing. At times the procedure for choosing evaluative essay topics becomes a true challenge. An evaluation essay is comparable to a review because you have to examine both the beneficial and negative facets of something. In the majority of sorts of essays, you will need a strong thesis to compose a strong paper. The thesis gives you a guideline on how best to go about with writing the essay. A general thesis also needs to be offered. The Lost Secret of Unique Evaluation Essay Topics Evaluate the newest funny play you've watched on theatre. You shouldn't use a topic to just get attention and after that deviate from it once you've got an audience. An argumentative essay requires you to choose a topic and have a position on it. Figure out how funny argumentative essay topics can receive the interest of your tutor. Opt for an intriguing essay topic, and you will begin enjoying it. The search for a very good topic for your psychology essay can be quite frustrating should you not understand where to get started. Even your tutor can be pivotal once you are seeking a superb researchable title. Elaborate guide on how best to begin an essay After an instructor assigns an essay, among the very first questions that students ask is the best way to begin their essays. Adhere to the orders your teacher has given you. What Does Unique Evaluation Essay Topics Mean? Once more, in the event the criteria, judgments and evidence are clear, the general thesis ought to be too. If you're likely to write decent thesis statements, you will need to understand what makes one good. At exactly the same time, the points which you ought to place into your paper might even reflect your understanding about the issue which you ought to write about. Evaluation papers provide value judgments related to different subjects. Another style of starting this kind of essay is to describe some event and analyze its consequences. To the contrary, it can likewise be quite interesting to work on only in case you have good topic in your hands since it is thought of as the backbone of an evaluative essay. Education scholars are continuously evolving the way that they think about how we learn and what's taught. Another aim of the analytical essay is to assess thinking and that which you would do in various circumstances.

How Do You Get the College Board Sample Essay Right?

How Do You Get the College Board Sample Essay Right?How do you get the college board sample essay right? You need to write the essay in a way that is professional. Of course, this is a task that can be delegated to you. But it does take work.The process of writing a college board sample essay involves proper grammar and using the correct spelling and punctuation. This also involves writing the essay correctly. Using correct spelling and grammar help prevent mistakes that will affect your grade.Although some writing samples are straightforward, the college board sample essay does have some slightly more complex sections. In order to avoid mistakes in these sections, you will need to use the correct sentence construction. For example, in this section, you are required to write the word 'interesting' as if it were an adjective. Instead of writing 'interesting,' write 'a lot of interesting things.' When writing this section, do not just copy the example word, but instead use the word in context, meaning what it means in the sentence.The final section of the college board sample essay, the conclusion, should be included. The conclusion should explain why the writer would like to continue his or her education. It should also offer the student some strategies for applying the information learned in the essay. The essay can provide information about a specific college, but only if the student has chosen the school to continue his or her education at. For example, if the student chose a certain state university, the writer should mention this information.Another tip for writing the essay is to determine the purpose of the essay before you begin writing it. Do you want to obtain high marks, or do you want to establish your reputation as a writer? The essay can also be a reflection of the student's personality. The student can use this essay to describe himself or herself.In addition to researching the subject matter, research the topic of the essay, too. This helps a stu dent to relate the essay to other things he or she has written on in the past. By comparing the two essays, the student can compare how he or she writes, and this will show a different style. The essay can also be about a certain subject, such as philosophy, and this will help the student to find a general theme or idea to write about.The last tip for writing an essay is to read it over a few times and revise it. Anytime you feel it does not flow, change it! Reading over the essay a few times will allow you to make the necessary changes. You will also be able to determine if there are spelling or grammar mistakes. With enough revisions, the college board sample essay will become flawless.Take some time to write the college board sample essay, but be sure to follow all of the tips above. Remember, you do not have to worry about getting it right. The reason that you are writing it is to get high marks in the essay. If it is something that you do not think you can do, then find someone who can.

Waiving Writing the Essay

Waiving Writing the EssayWaiving writing the essay is a great strategy to use when you need to learn how to organize your thoughts. The essay is one of the most difficult parts of your higher level study. It is tough to write an essay that will not come across as unprofessional. Since you are the one who will be reading it, it makes sense to make it look and sound polished.It's always a good idea to get a writing partner for this essay. This way you can help each other out. You may also want to have another person write a critical section so that you can be sure that you are reviewing what the essay is supposed to say.Having someone write the essay is a good idea for several reasons. First of all, you want to make sure that the person is not only going to learn how to format the essay, but they should also be able to identify the content. They should also be able to read what you have written and get it the way you want it without having to copy and paste it all over again.If you are not comfortable with writing, this essay is not for you. The person that is going to write the essay should be able to do it with no problems. With any writing that you do, you will learn how to read sentences. Most people are not as skilled as writers because they usually want to come up with something quickly.If you are afraid that your friend or someone else will ask questions about it after you have finished, it is a good idea to make a draft before hand. Then take the time to edit it carefully. You don't want it to look like a kindergartener's essay. After you are finished, have a friend look at it.If you need to revise it, then you don't need to worry about the editing. However, if you know that you are getting questions about it after you have submitted it, then it is probably a good idea to make a draft for editing. Find someone that can look over your writing for you. If you don't think that your friend will be able to get it to work, then do it yourself.Once you have had a chance to write the essay, do not forget to make a mark on the end of the paper. It is customary to leave a little note. You do not want to forget to write anything and make it seem like you didn't even try. If you don't know how to format the essay, make sure that you use the easy way to format the essay.In order to format the essay, take a minute to look over the examples. These will help you figure out what kind of formatting you should use for your essay. You will not have to know how to format it. It will just come out the way you thought. You can learn how to format your own essay.

Do International Students Has to Do College Essay?

Do International Students Has to Do College Essay?There are many people who are wondering whether or not an international student has to do a college essay. The answer is yes, an international student does have to do college essays, but there are other things that you can do besides a college essay to show your academic achievements.When a university evaluates a student who is submitting an English essay, it will need to look at the fact that the student wrote the essay. Not all students have writing skills and are not able to write an essay, especially one that has been well written. It is very important for a student to meet a certain level of writing skills to be accepted into a college.The most important fact is that students who are accepted into college have to do an English essay. There are many essay styles and reading skills that a college accepts, and an essay should be about two thousand words long. Because an English essay is a rather detailed composition, it is usually l ong enough for a student to write the same question over again, therefore this is where the essay style comes in.There are many different essay styles available, such as story-telling, analytical, historical, word-for-word, etc. These styles have been categorized and labeled, however, it is up to the individual teacher to make a determination on which style is best for the student. An example of an essay style would be essay based on a story.A global student may not necessarily be an English writer, however, they may have much experience writing reports are much more informative than an essay which is based on a story. This style of writing allows the student to convey their point of view on an essay.Another aspect of writing an essay for an international student would be to use style guides. These guide helps to make sure that the essay is grammatically correct and easy to read.Regardless of the style of writing that you use, when you are asked to write a college essay, you should consider doing an essay based on a story. This gives you the freedom to go off on a tangent and think of something else to say.

Types and levels of planning in organizations

metabolism essays

metabolism essays Carbohydrates are a good source of fuel while lipids are a good storage fuels. Skeletal muscles and the liver store significant amount of carbohydrates. Triacylglycerols are stored in adipose tissues. At the starting of race, the body is resting. Glucose is then taken into the body, storing in the skeletal muscles and in liver as glycogen. Digested lipids from the small intestine are absorbed across the intestinal walls and converted into triacylglycerols. Triacylglycerols are incorporated with cholesterol and apolipoproteins, into chylomicrons. Triacylglycerols are hydrolysed into glycerol and fatty acids here and are taken by adipose tissues and liver. After the race has started for five minutes, eighty-five percent of the energy is supplies by carbohydrates. This is because they are soluble due to their OH group and can travel quickly and directly in the blood to wherever the body needs them; on the other hand, lipids cannot. For lipids to be mobilized, they need to be carried in the blood bound to proteins that counteract their insolubility and these processes are time-consuming. The fuel comes from glycogen in the muscles and liver. Glycogen in the skeletal muscles is converted to glucose-1-phosphate by the enzyme glycogen phosphorylase while in the liver, glucagon is released to signal low sugar levels and liver releases glucose by gluconeogenesis. Glucose goes through a ten reaction pathway in which glucose is degraded to pyruvate. This process known as glycolysis. The first five reactions are known as the preparatory phase and consume two ATPs. The next five phases are called the payoff phases where four ATPs and 1 NADH is produced. At this stage of the race, muscles rely mainly on the anaerobic pathways. Therefore, pyruvate is converted to lactate and carbon dioxide. The net gain of ATP for this fermentation is two. After the race has begun for forty-five minutes, most carbohydrate sources would have depleted. L ...