Scrutinise the concept of secession, with comparative reference to at Essay

Scrutinise the concept of secession, with comparative reference to at least two countries - Essay Example (Premdas 1990:12-31) While occupying the intermediate condition as a protected autonomous entity within an extensively decentralized sovereign state, the movement tends to continue to articulate the desire for a separate an independent destiny with these two goals oscillating between moments of satisfied accommodation and periodic bursts of renewed determination for outright secession. In the end, the objective remains constant - exit completely. (Premdas 1990:12-31) Separatism may be conceived broadly as a quest for autonomous survival either within or without a state; secession strictly speaking is a variant of separatism in which the secessionists seek outright separation and independence in a sovereign state. The quest for self-determination by a community within a plural state is often caught up in upheaval. As an act of territorial and political assertion, a secessionist struggle is usually prolonged, punishing, and prohibitively costly. Furthermore, the logic of the self-determination principle in sanctioning the demand of each people for its own state, embedded doctrinally in the nature of the state as it has evolved, has been the source of territorial fragmentation accompanied with mass expulsions and genocide not merely with the claims of the Third World states after WWII but this has been the case since the French Revolution. There have been waves of self-determination drives ever since the inception of the nation-state as aunit of national and international social organization. With the fall of the multi-ethnic great empires run by the Turks, the Hapsburgs, and the Russians, the cultural fragments sought separate destinies in acts of self-determination. Practically the entire globe was under European imperial control where new states after the European model were engrafted willy nilly on ethnically diverse populations. In these territories, self-determination drives for freedom were enacted one

Investment Advice for Microsoft Research Proposal

Investment Advice for Microsoft - Research Proposal Example Microsoft - major industry player - is headed by Mr. Steven A. Balmer, Microsoft’s 49-year old Chief Executive Officer (CEO).   The company’s co-founder, the illustrious Mr. Bill Gates, also sits in the Board of Directors and acts as its Chief Technological Architect.   As at end of the fiscal year 2005, Mr. Balmer along with the other directors of the company received an average annual salary of about $1.0 million each. As a global company, Microsoft operates in various countries across the world.   The headquarter is located at One Microsoft Way in Redmond, Washington D.C.   Direct competitors of Microsoft include other formidable companies such as Google Inc., International Business Machines Corp. (IBM) and Oracle Corp.   In terms of sales, Microsoft came in second to IBM as at end-June 2005.   However, Microsoft has posted the highest net income as compared to other industry players. Based on the above financial highlights, it can be seen that sales of Microsoft are steadily accelerating as evidenced by the moderate sales growth in the last three years.   In the same way, the income the company generated as at end-June 2005 has recovered from the decline in the previous year.   The sales and income posted by Microsoft are well above the industry average in 2005. Similarly, Microsoft has consistently proven its ability to convert sales into income in the past three years as seen in the company’s net profit margin.   Its 3-year average of 28% is higher than the industry average of only 23.5%. In terms of liquidity, Microsoft is highly liquid since it has more than sufficient current assets to cover its current liabilities.   As such it has a high current ratio that sends a positive signal to investors.

Causes Of The Russian Revolution History Essay

Causes Of The Russian Revolution History Essay Before 1905, Russia was a country that was led by a Czar who held full power and control over the country and its inhabitants. The people of the country suffered greatly under the regime of the many of the Czars through reforms, incompetence and general disregard of the needs of the people. Repression and unrest with the peasants in Russia were the cause on the 1905 Russian Revolution. There were many causes of the 1905 Russian Revolution in which some can be traced back to 1861 under the rule of Czar Alexander II and his series of reforms, such as, the Emancipation of the serfs, and creating the Zemstva1. The Emancipation of the serfs was a reform which allowed serfs the freedom of civil rights and allowed them to own land2. There were many problems with this reform. The peasants paid more money to the monarchy than they did to landlords, and nobles kept the best lands for themselves resulting in the peasants to have land which was difficult to farm3. The reform, which was intended to help the peasants and help industrialize the country, did not actually help the peasants at all but increased their impoverish state. With an increase of population, land prices rose while income wages were kept low4. With the growth of Industrialization, the peasants were forced to find jobs in factories, and with the building of railways they were able to travel great distances for work5. This aided in an increase in literacy as items such as books and news papers were more accessible to peasants. The governmental body, the Zemstava was established in 1864 and held responsibilities such as social welfare6. The Zemstava consisted of intellects such as doctors, teachers, nurses and lawyers who often opposed intellectual values of the state. Some members of the Zemstava even had thought of a constitutional monarchy in place of a ruling Czar7. Due to these liberal changes where elected people we given some power, people began to think they could question the authority of the Czar. These reforms, along with other reforms, were still not solving the problems for the people within Russia. The people were still quite discontented and within intellectual classes and secret societies began to for8. When Alexander II died in 1881, his son Alexander III took the throne. In 1891 a great famine occurred, due to rapid industrial growth. During this crisis the Czar displayed incompetence and ill regard towards the peasants that made up the majority of the Russian population9. The government attempted to deal with the famine and mass starvation, but was slowed down by its bureaucracy and a transportation system that was unable to cope10. Politically, it was a disaster as it presented the government as irresponsible, torpid and incompetent. There were many instances that perceived the government as uncaring, as such; widespread rumors of food deliveries being held back until statistical proof was given11 showing the people were unable to feed themselves, often too late for actual help; relief work schemes set up to employ peasantry who where on their death beds; and the removal and quarantine of people who had contracted cholera, which resulted in riots from the public12. The biggest m istake the government made was the postponement of cereal exports which did not come into effect until late into the crisis. The respite of the ban was seen by the people as the main cause of the famine13. Not only did the government fail to help the people, but it was also forbidden for newspapers to publicly name the problem, even though they printed the stories anyway. November 1891, the government finally issued an imperial order asking for volunteers to help with the crisis they were unable to deal with14. Once the crisis had passed, the people no longer trusted the government as the regime had been discredited with its inability to help the people when the people were suffering. The public began to press for a greater role in the affairs of the nation. Social groups began to reappear with great enthusiasm15. Only Marxism seemed able to explain the causes of the famine and began to become a national ideology. The 1890s seemed to become a decade of social change within the emergence of civil society that opposed the czarist state. This seems to be a condition of the upcoming revolution16. It would also seem that in 1894 when Czar Nicholas II ascended the thrown, he would lead a regime that was doomed to failure with all the problems the nation was having. This was all made worse by the loss of the Russo-Japanese war of 1904, the depression and the beliefs of the people that they were not being treated well17. Under the rule of Nicholas II, the people believed they were not being treated as human beings18 as cities grew rapidly and people were forced to live in daunting and unhealthy conditions Many people suffered from debt they were unable to rise out of, and they were exploited within their jobs. In the early 1900s depression set in and many Russians became unemployed. With the Russo-Japanese war in effect, wheat exports to the far west were stopped and the economy suffered as the Czar refused to change.19 In 1902-1903, peasant revolts became more common as strikes increased. The opposition to the Czarist state, the Social Democratic parties, the Bolsheviks, the Mensheviks and Socialist Revolutionaries, became more organized. However, these groups were often not trusted by the workers who supported mutual aid schemes devised by other workers20. The governmental scheme, the Zubatov movement was successful as it provided workers with a legal platform for protesting and allowing occasional strikes. The success of the movement worried the government about worker loyalty to the Tzar and it was shut down21. However, one still existed in 1904, led by Father George Gapon, The Assembly of Russian Working Men. At first this group was focused on forming clubs and such activities, but as time went on they became more radical. The catalyst, which led to the march on Bloody Sunday, was sparked by four members of Father Gapons association being fired from their jobs22. It expanded to a strike of over 100 000 people stopping work on 7 January 190523. The demands, the right to elect permanent representatives in factories, an eight hour work day, better wages, free medical care and access to education, were typical worker demands. The workers wanted to be treated as people with more equality, justice and dignity within the work place and end issues such as sexual harassment and ill treatment. On January 7 Father Gapon was ordered to put an end to the march. Even if he had wanted to, it would have been impossible as the people were ready to die for this cause24. Bloody Sunday was final blow to the Russian people who after this day fully revolted against the Tsarist state. 150 000 people marched on the Winter Palace. They marched singing Hymns and patriotic songs in a peaceful state of mind.25 The people believed they would present their problems to the Tzar, and the Tzar, having an obligation to the people, would help end their miseries and solve the problems they desperately wanted solved. However, the Tzar was not even at his traditional home as he had left for some quiet time and reflection with his family26. What was intended as the people of the nation coming to their Tzar in peaceful display for help turned into a day of massacre. During the night 12 000 soldiers were dispersed through the city in anticipation of the march and to prevent marchers from reaching the palace. As the marchers approached the Narva Gates, they were faced with the guns of the waiting infantry27. The soldiers fired two warning shots and a third gun was aimed directly at the crowd. The people panicked and some of the marchers dispersed, but most dropped to the ground. The soldiers, who were nervous, also panicked and open fired into the crowd. Estimations of the death toll ranged between 150-200 people, while 450-800 people were estimated as being injured.28 In the middle of the chaos, Father Gapon was heard exclaiming There is no God any longer. There is no Tzar.29 After the display of ill regard towards the peasants during the march, people, much in anger, continued to strike against the regime. In January over 400 000 workers participated in a workers strike across the country. However, without an organized leader, they did not result in much success. It was known by many that that the events of Bloody Sunday where just the beginning as shown in a letter by a student named Kerensky: I am sorry not to have written to you earlier, but we have been living here in such a state of shock that it was impossible to write. Oh, these awful days in Peter will remain forever in the memories of the people who lived them. Now there is silence, but it is also the silence before the storm. Both sides are preparing and reviewing their own forces. Only one side can prevail. Either the demands of society will be satisfied (i.e. a freely elected legislature of peoples representatives) or there will be a bloody and terrible conflict, no doubt ending in the victory of the reaction. 30 Throughout 1905, peasants continued to participate in strikes. May of 1905 is significant within the strikes as it was the the first time a strike committee called themselves soviets.31 70 000 were involved in the strike and and took charge of local military and political operations.32 This was achieved through non-official elections held throughout Russia in the beginning of creating the soviets.33 As the people rebelled, cases of arson on gentry land increased, and land seizures occurred. People from all types of work joined unions that organized massive strikes. The people began to call for a constitution.34 In September unrest continued to escalate. The All Russian Peasant Union to over 100 000 members in 42 provinces. By this time Lenin was an active member and encourage the people to fight an uninterrupted revolution that might convene until socialism was established.35On October 17 1905 the Czar issued the October Manifesto. This reform offered civil liberties, a state Duma an d a cancellation of peasant redemption payments36. As well, a large amount of land was sold to the peasant bank for resale to peasants with easy terms. However, the Manifesto did not seem to help. Provincial leaders began to complain that the peasants took the promises of the Manifesto and seized lands as the peasants still resisted tradition authority37 The people continued to revolt. In November, the country was in full rioting. By December of 1905 army mutinies began to take affect in cities and in Odessa on the Potemkin battleship. However, by this time, the government began to repress the strikes by force. Punishments, such as public floggings and the burning of peasant villages were becoming common. Between October 1905 and March 1906, The number of strikes receded from 450 000 to 50 000 soviet strikes.38 In November, The All Russian Peasants Union met in Moscow. The Union delegates demanded a few things such as a constitutional assembly and the transfer of all landed property. The Financial Manifesto of December 1905 was signed, which called for a mass refusal to pay taxes and a demand by depositors for payments39. The regime responded by arresting the delegates. A congress of Zemstva and Town Duma representatives met and to organize a proposal to the government to restore order to the nation. The proposal was made of agrarian and legal reforms. Soon things began to settle down and people began to lose interest40. There were many causes of the 1905 Russian Revolution as the people suffered under the regime of a Czar. Reforms,such as the Emancipation of the Serfs, creation of the Zemstva aided in the beginning of the road to revolution. Issues were intensified and the Czar showed incompetence and ill regard towards the peasants in the famine of 1891. These issues caused a lot of unrest within the peasant population of the Russian regime. The catalyst of Bloody Sunday and the response of repression through the massacre sent the country into a series of mass revolt that made up the revolution. Czar Nicholas IIs repressive response was met with more rebellion from the inhabitants of the country. It wasnt until the government and Duma officials came a an agreement accepted by the regime and the people that the revolution of 1905 came to an end. However, through all these issues it remains evident that the main cause of the 1905 Russian Revolution was caused by the repression and unrest of the peasa nts. 1 Maureen Perrie, The Russian Peasant movement of 1905-1907: Its social composition and revolutionary significance Past and Present 57 (Nov., 197):123-155 2 Perrie, 123-155 3Perrie, 123-155 4Perrie, 123-155T 5Perrie, 123-155 6Perrie, 123-155 7Perrie, 123-155 8Perrie, 123-155 9Orlando Figes, A Peoples Tragedy: Russian Revolution 1891-1924 (Great Britain: Jonathon Cape, Random House, 1996), 157 10Figes, 158 11Figes, 158 12Figes, 158 13Figes, 158 14Figes, 159 15Figes, 161 16Beryl Williams, 1905 Russia History Today 55.5 (May 2005) : p. 44-48 17Williams, 44-48 18Williams, 44-48 19Williams, 44-48 20Williams, 44-48 21Williams, 44-48 22Williams, 44-48 23Williams, 44-48 24Williams, 44-48 25Williams, 44-48 26Williams, 44-48 27Williams, 44-48 28Orlando, 178 29Orlando, 177 30Orlando, 180 31Eric R Wolf, Peasant wars of the twentieth century (United States of America: First Harper Torchbook, 1969), p.85 32Wolf, 85 33Robert Service, The Russian Revolution, 1900-1927 () p.31-32 34Service, 33 35Esther Kingston-Mann, Lenin and the challenge of Peasant Militance: From Bloody Sunday, 1905 to the dissolution of the first Duma, Russian Review, 38.5 (Oct, 1979) pp. 434-455 36Kingston-Mann, 434-455 37Kingston-Mann, 434-455 38Wolf, 87 39Kingston-Mann, 434-455 40Kingston-Mann, 434-455

Charles Dickens Great Expectations :: Great Expectations Essays

Charles Dickens' Great Expectations When you first meet Heathcliff he is a person that is uncommunicative and difficult to talk to at the age of 8. My impression of him is that he is very shy. He seems to do whatever anyone says, especially his foster parents, they have total control over him, even though his foster parents aren't really too caring about him. His personality, I think, seems odd, he is quiet and boring, but also he has made good friends with Cathy and they soon fall in love. But with everyone else he is quiet, and his slaved for work. The kind of life I think he had before he came to Wuthering Heights, was that his parents abused him, as he sometimes got into trouble and was cheeky to his parents, but then again I think he was the type who had no friends, a loner, just stayed in his room all the time. I don't think his parents cared about him, so they fostered him out. Also he complained a lot, moaned, just what normal kids do, but his parents couldn't stand it. Now that he has foster parents, I don't think he is the kid he used to be, his mean foster parents really bully him - because he seems to be doing lots of work where as the other children aren't, so really they are just picking on him. After Mr Earnshaw died, Hindley decides to recall his old hatred, and he turns into an evil man. He turns Heathcliff into a labourer on the farm. His hatred towards Heathcliff grows, and decides to forbid him seeing his loved one Cathy. I don't think this treatment was fair as he seemed to be nice to Heathcliff and treated him with respect - the reason I think that Hindley decided to awaken his hatred and throw it all towards Heathcliff is because Hindley needed someone who was known by Mr Earnshaw, so it was Heathcliff who was chosen for this punishment, while Mr Earnshaw was alive, also I think that Hindley wasn't the way he was now is because was scared of Mr Earnshaw and since Heathcliff is his son he turned it all on him. But when he did die, Hindleys revived hatred seems to make him want to own Heathcliff. And he cannot do anything about this treatment, except plan his revenge on Hindley. Around Christmas Heathcliff wants to be more responsible, so he tries to not cause trouble, but Edgar is really unfair to him and insults him inadvertently 'I wonder they don't make his head ache.

Personal statement for applying master degree in Finance in the UK Essay

Over the years, I have found that there are so many things that I have started but have never really finished. It was not until a couple of months ago, however, that I had come to realize that I wanted to accomplish so much more and that I was committed to pursuing my career in this field. It was from that moment on that I had decided that I came to a point in life that many people have not. I have made a firm decision to recommit myself to pursuing my dreams. While there are those who believe that with an ounce of luck and a ton of persistence anything can be accomplished, I believe that there is no reason to expend so much energy and rely on luck. I believe in taking hold of my destiny and carving out a future for myself based on the decisions that I make in life. Life is simply too short and too precious to be left to luck alone. That is why the choices that I made in life were all geared towards my intended major in accounting. As a young girl, I have always had a keen interest in accounting. When others wanted to become firemen and doctors, I was intent on being an accountant. There is something about keeping things straight and in order as an accountant that appeals to my preferences. My interests over the years may have spread out to other fields such as marketing and management but the core interest remains in accounting. Coupled with my growing interest in business, however, I have seen that there is no limit to what I can accomplish in the future. The relevance of accounting to myself and the achievement of my personal goals stems from the fact that there have been a number of accounting reforms that have been implemented to address the issue of companies extending certain accounting practices to create a better financial picture of their companies. The Enron and Worldcom scandals have shown that there are indeed ways by which companies can use â€Å"creative† accounting methods to make is seem that their assets are much more than their liabilities. While these events have rocked the accounting world, it cannot be discounted that accounting does indeed play an important role in the managing of any business be it a local store or an international company. As such, I realize that I am in a unique position to not only carry out my dream but also to be part of change in this world. As the world continues to change and the workplace becomes more and more challenging and competitive, it becomes imperative for anyone looking for a successful career to not only have the drive to succeed but also the training and expertise to do so. My numerous experiences in the field of accounting have mostly come through my exposure at work at the Hubei Provincial Cereals Oils and Foodstuffs I/E (Group) Corporation where I needed to learn several accounting concepts in order to perform my jobs satisfactorily. I have also had ample experience as a Tourism Department Director and have been responsible for organizing several trips for Chinese students all over the world. Despite this, however, I believe that I need the experience and training from this course in order to reach my full potential. I believe that this experience and background of mine will help me pursue this dream. While I realize that I am still in undergraduate school at New Castle University, I realize that in the larger scheme of things I can use my education and training here as a means to help others as well. Putting up my own CPA firm and being an accountant will provide me with the financial stability that I need to pursue my other goals in life. As part of the Chinese Society in School and the Accountancy Society, I have had many chances to give back to society and I feel that I can do more with this degree. In the future, I see the fulfillment of my goals as not only as an achievement but as a manner by which I can also help others. That is why I believe that this course is a crucial step for me. My success and my accomplishments here will herald the beginning of the fulfillment of my personal and professional goals. It is said that the one thing that nobody can ever take away from you is your education and that is the one thing that plan to be able to gain for myself. My personality, in my humble opinion, is best suited for this kind of endeavor because of my ability to multi-task. During my past work experiences at Hubei Provincial Cereals Oils and Foodstuffs I/E (Group) Corporation and at the Wuhan HONRN Fashion Limited Company, I have often come across as witty and amiable. Yet, I am no push over when it comes to working in a corporate or business environment. I firmly believe that I can succeed in anything that I want to as long as I work hard at it. I get things done. The job gets done faster and more efficiently as and when the objectives are clear, the strategies acceptable, and the resources are available. Of course, in the real world, these do not always happen. To the extent that they happen and to the extent that I can make them happen, I go after them and manage to get the job done. Being a part of the illustrious alumni of the London School of Economic and being given a chance to be part of this rich history is something that I look forward to. Not only does this School exceed my expectations but it is also enjoys a global reputation of which I would like to be able to contribute to. Given my experiences in life and being a diligent student, I have personally experienced how much good work ethic can contribute to the advancement of one’s dream. I have worked tirelessly in the pursuit of my education because it is said that the one thing that nobody can ever take away from you is your education. I have also learned from my parents the critical importance of the law of giving, and I am both attracted and committed to this model of community service, particularly that â€Å"students apply skills to effect social change. I am confident that my past experiences have prepared me to not only be able to be an instrument by which this change can be affected but also to be able to inspire others to reach for their dreams as well. While I personally believe that â€Å"there is no such thing as a free lunch† and that everything a person has in life must come from hard work and perseverance, I also believe in charity. I believe in helping others who do not have much in life. I believe in helping people regardless of their nation, race or creed. This philosophy is one of the many forces that drive me to pursue my dream of pursuing this career and of becoming so much more in life. The chance to help those who are less fortunate in life, the chance to help others like myself, the opportunity to be of service to humanity; these are the reasons why I have selected this as the profession that I will pursue; for, as Eleanor Roosevelt once said, â€Å"The future belongs to those who believe in the beauty of their dreams†¦Ã¢â‚¬ 

God Is Black: Examine the Uses of Religious Imagery in the Fire Next Time.

‘God is black’ (The Fire Next Time). Examine the uses of religious imagery in The Fire Next Time. The Fire Next Time includes many religious images concerning race, ethnicity and culture. The first essay, My Dungeon Shook, is a letter from James Baldwin to his nephew, in an attempt to â€Å"strengthen [him] against the loveless world. † The second, Down at the Cross, explores the background experiences that shaped his view of the world, and allowed him to give the advice in the previous essay.Throughout Down at the Cross, Baldwin examines the â€Å"white God† of his Christian youth, and the â€Å"black God† preached by Elijah Mohammed and the Nation of Islam. Although Baldwin acknowledges both groups’ achievements, he is ultimately critical of their ideologies. Baldwin becomes disillusioned with his church; he feels the â€Å"slow crumbling of my faith, the pulverisation of my fortress† after practicing as a preacher for 3 years. Simila rly, he rejects the Nation of Islam’s ideology that God is solely for the black community, and that â€Å"the white man [†¦] is a devil. Baldwin uses religious imagery to advocate a policy of acceptance, of love between black and white. He argues that by making God colour-conscious, and by belonging exclusively to one race, each group is guilty of legitimising and strengthening the racial hatred and discrimination of the time. Baldwin makes it perfectly clear that he values the church. He describes his childhood, in which it saved him from the sordid drugs, prostitution and gambling on the street. He describes his time in the pulpit as â€Å"very exciting,† and confesses that nothing else in his life could â€Å"equal the power and the glory† that he felt while leading a congregation.The language he uses to describe the fervor, the experience, of his sermons is remarkably literary. His personal feelings are clearly being recalled here, as he allows himself to be swept up in the â€Å"fire and excitement that [would] sometimes, without warning, fill a church, causing it [†¦] to ‘rock. ’† This imagery is very visual, as Baldwin allows the reader into his personal view of the church. This strengthens his argument, as it gives it authenticity. However, this does not show the full picture. The Church and the street are linked by Baldwin later in the essay when he asks whether heaven is â€Å"merely another ghetto. This could be seen to be a reference to New York’s status as a ‘safe haven,’ away from the lynching and segregation in the Southern states, however in reality New York was crowded and dangerous. It could also be a reference to how the Church itself is not able to help the black population. It connects the Church and the street, and to some extent brings the dangers of the street into the church itself, something that is expanded upon later when Baldwin complains of the â€Å"ugly an d unctuous flirtatiousness† that he experienced in his Church. This sentence defines the Church, with how it promises much but delivers so little.Baldwin understands what he is arguing against, as he spent 3 years of his childhood totally immersed in its ideologies, and it is only now that he can pick apart its restrictions and failures. `It is these restrictions and failures that cause Baldwin to reject his faith. He comes to realise that â€Å"there was no love in the church. It was a mask for hatred and self-hatred and despair. † He starts to see that instead of practicing a message that God loves everybody, the Christian church protects and loves only those that believe the same thing as them. What he found most disturbing was that this love â€Å"did not apply to white people at all. This split between believers and non-believers did not fit with Baldwin’s theory of acceptance and integration, as he saw is as an example of hypocrisy at the heart of the chur ch. This imagery can be seen to mirror that of segregated America, except it is whites who are marginalised and discriminated against. It perpetuates the notion that black and white are different, and cannot co-operate together. Baldwin fears that it is these teachings – that the black community should not attempt to reconcile with the whites, but should exclude and dislike them – that is the first road block on the journey to racial equality.He believes that â€Å"we cannot be free until they are,† as it is black people who must learn to love those that do not show them love in return, before the white oppressors will come to realise, and therefore be free of, their crimes. Baldwin uses religious imagery to reveal the hypocritical behavior of his fellow preachers. He says that he â€Å"knew where the money for ‘The Lord’s work’ went,† indicating not only that he realised that church money was being stolen and spent by preachers on the mselves, but also the use of inverted commas reveals that Baldwin is rejecting that Church work really helps people at all.It gives it an element of sarcasm, by subverting the framework that he used to preach and turning it into a comment on the failure of the Church’s ability to help, Baldwin shows the depth of his disillusionment. Baldwin’s time in the church also helped him come to realise that racism exists even at the heart of Christianity. He states: â€Å"I realised the Bible had been written by white men. I knew that, according to many Christians, I was a descendant of Ham, who had been cursed, and I was therefore predestined to be a slave. [†¦] My fate had been sealed for ever. †¦] It seemed, when one looked out over Christendom, that this was what Christendom effectively believed. † Baldwin uses Christian imagery in order to highlight its flaws. He reveals an institution that offered nothing more than a vengeful God, who did nothing to help b uild constructive relations between black and white people. The refusal to accept white and black together reveals an institution that is bound by parochialism. As B. Pakrasi has said before, â€Å"Baldwin sees the seeds of hatred and acrimony embedded in the dogma of Christianity perpetuating the belief of a white God. †Another facet of religious imagery that Baldwin critiques is the notion that there is a ‘black God. ’ This is part of the ideology of the Nation of Islam, a group led by Elijah Mohammed, but also closely associated with the radical activist Malcolm X. Baldwin expressly praises the Nation of Islam, as he believes they have succeeded where Christianity failed. Mohammed was able to â€Å"heal and redeem drunkards and junkies, to convert people who have come out of prison and keep them out, to make men chaste and women virtuous,† however Baldwin disagrees with one crucial aspect. The Nation of Islam allows for no integration between black and white.Mohammed sees the white population as â€Å"devils,† and links them to being sinners. Baldwin contends this, as he argues that if one is to adopt the theory that all white people are sinners, they open themselves to the â€Å"gates of paranoia,† as they become incapable of distinguishing between an actual threat and an imagined one. In a society that was so hostile towards blacks, Baldwin admits that this is an extremely hard trap to avoid, but he maintains it is necessary to try, because otherwise they will see all whites as an enemy, and will never integrate and build better relationships.Baldwin makes it clear to Mohammed that he has no intention of overthrowing the white population. He says to the table that given the choice between dying with his white and black friends, and living but at their expense, he would choose death. He thinks to himself â€Å"I love a few people and they love me, and some of them are white, and isn’t love more important tha n colour? † Again, Baldwin is using the religious imagery of the devil, the sinners and above all the black God to highlight the weaknesses and hypocrisies in the Nation of Islam’s ideologies.He is pushing forward his own courses of conduct; love and integration with both white and black. He sees no reason why there should not be a black God, but he believes that when a group attaches Him solely to their race, it becomes something else. It gives that God a new meaning, as it encourages His followers to hate the opposing race. He finds this on both sides, both with Christianity and Islam, and is ultimately unable to accept either doctrine. Baldwin sees a mirror image in the Nation of Islam’s treatment of white people, and their treatment of blacks. Harvey G.Simmons sees this, saying that Baldwin rejected the Nation of Islam because â€Å"its methods are infused with the same fanaticism and hatred that the Negro faces in white society. † James Baldwin uses r eligious imagery in The Fire Next Time in order to critique both the Christian church, and the Nation of Islam. He finds them both lacking, as he comes to the conclusion that neither advocates a policy that allows for an increase in co-operation between black and white people. Instead, they are insular, only caring for themselves and are unwilling to truly share the love of God with everyone, black or white.This is what Baldwin wants. He articulates his message in his letter to his nephew, saying that â€Å"you must accept them and accept them with love. For these innocent people have no other hope. They are, in effect, still trapped in a history which they do not understand; and until they understand it, they cannot be released from it. † He is using these essays to attempt to speak to the American public, to urge them to take a stand and speak out against the discrimination. Throughout My Dungeon Shook James uses the personal form of â€Å"I,† giving his letter perso nal emotional ties.It also makes his message more human, and helps establish empathy before his appeal in Down at the Cross. Down at the Cross uses terms such as ‘we Americans’ repeatedly, which shows that Baldwin is attempting to unite everyone, both black and white. For him, religion is short sighted and controlling, it doesn’t follow through with its promise that God loves everybody, because as Baldwin points out; â€Å"If His love was so great, and if He loved all his children, then were we, the blacks, cast down so far? Word Count – 1811 Baldwin, James, The Fire Next Time(London: Penguin, 1964) Bloom, Harold, James Baldwin (New York: Infobase Publishing, 2007) Hardy, Clarence E. , James Baldwin's God: Sex, Hope, and Crisis in Black Holiness Culture (Tennessee: University of Tennessee Press, (2003) Pakrasi, B. , ‘Review: The Fire Next Time by James Baldwin,’ The Journal of Negro History, 50. 1 (1965) ;http://www. jstor. org/stable/2716413 ? amp;Search=yes;searchText=baldwin;searchText=%22the+fire+next+time%22;list=hide;searchUri=%2Faction%2FdoBasicSearch%3FQuery%3D%2522the%2Bfire%2Bnext%2Btime%2522%2Bbaldwin%26acc%3Don%26wc%3Don;prevSearch=;item=1;ttl=312;returnArticleService=showFullText; [accessed 20th November 2011] Simmons, Harvey P. , ‘James Baldwin and the Negro Conundrum,’ The Antioch Review, 23, 2 (1963) ;http://www. jstor. org/stable/4610523? seq=3;Search=yes;searchText=baldwin;searchText=%22the+fire+next+time%22;list=hide;searchUri=%2Faction%2FdoBasicSearch%3FQuery%3D%2522the%2Bfire%2Bnex %2Btime%2522%2Bbaldwin%26gw%3Djtx%26acc%3Don%26prq%3D%2522the%2Bfire%2Bnext%2Btime%2522%26Search%3DSearch%26hp%3D25%26wc%3Don;prevSearch=;item=2;ttl=312;returnArticleService=showFullText;resultsServiceName=null; [accessed 20th November 2011] ——————————————– [ 1 ]. James Baldwin, The Fire Next Time (London: Penguin, 1964) [ 2 ]. Baldwin, p. 15 [ 3 ]. Baldwin, p. 62 [ 4 ]. Baldwin, p. 62 [ 5 ]. Baldwin, p 37 [ 6 ]. Baldwin, p. 60 [ 7 ]. B. Pakrasi, ‘Review: The Fire Next Time by James Baldwin,’ The Journal of Negro History, 50. (1965) p. 61 [ 8 ]. Baldwin, p. 35 [ 9 ]. Baldwin, p. 37 [ 10 ]. Baldwin, p. 36 [ 11 ]. Baldwin [ 12 ]. Baldwin, p. 58 [ 13 ]. Baldwin, p. 40 [ 14 ]. Baldwin, p. 41 [ 15 ]. Baldwin, p. 18 [ 16 ]. Baldwin, p. 39 [ 17 ]. Baldwin, p. 38 [ 18 ]. Pakrasi, p. 60-61 [ 19 ]. Baldwin, p. 64-65 [ 20 ]. Baldwin, p. 60 [ 21 ]. Baldwin, p. 61 [ 22 ]. Baldwin, p. 64 [ 23 ]. Harvey G. Simmons, ‘James Baldwin and the Negro Conundrum,’ The Antioch Review, 23, 2 (1963) p. 252 [ 24 ]. Baldwin, p. 16-17 [ 25 ]. Baldwin

Minnesota Iron Range Dialect Essays - Dialect, Language, Lexicology

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Contribution of Facebook to Egypt revolution Research Paper

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Contribution of Facebook to Egypt revolution Research Paper

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Charles Darwin & theory of evolution Essay Example for Free

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Congestive Heart Failure Introduction Of Patient Nursing Essay This cases study was conducted on February 13th, 2012. This patient will be identified by the initials AH throughout this paper. AH is a 91-year-old Caucasian female. Her mood is as expected for her age and culture. This patient agreed to work with me during her hospital stay and continuation of follow up information after discharge. AH was admitted to the hospital on February 09th, 2012 onto the medical floor. This patient was brought into the emergency department by her son, DH, at approximately 9:00 a.m. on February 09, 2012. AH stated she had an increase of shortness of breath, weakness throughout her body, and her ankles were swollen. When asked about the history of these symptoms, AH stated these symptoms have been present since Sunday February 05, 2012. AH went into the doctors office in her hometown and was told to go into the emergency department at the hospital by the physician. On assessment at the emergency department, AH had a temperature of 96.9 degrees Fahrenheit, a pulse of 130 beats per minutes, respirations of 20 breaths per minute, blood pressure of 192 systolic over 105 diastolic, and a pain level of 0 out of 10 on the pain rating scale. Assessment findings were crackles, bilaterally with auscultation, a non-productive cough occasionally, irregular heart rate, 3+ pitting edema bilaterally in lower extremities from the knee down and in feet. This patient had a delayed capillary refill and neck vein distension. AH also had palpable pulses with upper extremity pulses being strong and lower extremity pulses being weak. This patient was admitted with congestive heart failure and atrial flutter with rapid ventricular response. This patient has a history of hypertension, arthritis, hard of hearing, occasional urinary tract inf ections and had a myocardial infarction in 1990. AH had two previous surgical procedures in her life. She has had a left hip replacement in 2006 and a right hip replacement in 2007. AH denies any significant family health history. She also denies any current use or history of alcohol consumption, tobacco use, or drug use. She is not on any supplemental oxygen at home. AH was able to state name, dose, and reason for home medications. These medications are Bumex water pill 1 MG orally taken daily, Clonidine blood pressure pill 0.1 MG orally taken three times a day, Metoprolol blood pressure pill 50MG orally taken daily, and Nitroglycerin for heart 2.5MG orally taken two times a day. I was able to do a total head to toe assessment on February 13, 2012. AH is 182.90 pounds, 60.00 inches tall, and has a body mass index of 35.72. AH is categorized as obese with this body mass index result. This patient is alert and oriented to person, place, and time. This patients pupils are equal, responsive, and reacts to light upon inspection. AH does have slight pitosis of the right upper eyelid. This patient does wear eyeglasses to read. Her total Glasgow Coma Scale is rated at a 15 out of 15. This is a perfect score and shows no impairments. This patient communicates verbally with no problems. AH has full movement in all four extremities and has intact circulation, movement, and sensation. When asked about history of falls, AH stated she had no current or past falls. Her skin is pink, warm, and dry without diaphoresis but has slight purplish discoloration bilaterally on shins from knee to ankle. When assessing AH respiratory status, she stated that she was not experiencing an y distress or shortness of breath currently but does experience this with exertion. AH is not on any supplemental oxygen. Her oxygen saturation was at 94% on room air. Upon auscultation this patients lungs were clear bilaterally in upper lobes and diminished bilaterally in lower lobes. Her respirations were at 16 breaths per minute. Her chest configuration is symmetrical. I did observe a weak non-productive cough occasionally during this assessment. During the cardiovascular assessment, apical pulse was 84 and her radial pulse was 80. This showed a pulse deficit of 4 beats per minute, which could be due to the irregular heartbeat (atrial flutter) with the rapid ventricular response. Patient was on telemetry to monitor for abnormalities during admission. S1 and S2 were heart upon auscultation. AH had a blood pressure of 167 systolic over 82 diastolic on her right upper extremity. AH did have distended neck veins upon inspection, which is a sign of congestive heart failure. AH denied any chest pain. This patient does not have any implanted cardiac defibrillator or pacemaker. This patients abdomen was soft and non-tender with bowel sounds active in all four quadrants. She is on a low sodium diet and states that she does follow the diet restrictions but when asked about exact amount of allowed sodium intake patient did not know. During her hospital stay AH was on a fluid restriction of 1.5 liters per 24 hours. Patient was able to adhere to fluid restriction but states she is on no fluid restriction at home. AH is continent of stool and urine but had Foley catheter in place per physician orders. AH is full weight bearing and has a steady gait but does use a walker for an assistive device while at the hospital. AH states she uses a wheelchair at home. AH has active range of motion and shows no limitations or discomfort within normal limits. AH was under no precautions or isolation. She had five different medications that I administered to her during her admission to the hospital that ranged from antibiotics, hypertension medications, to diuretics. These will be discussed individually in the following systems breakdowns. When asked about cancer screenings, AH denied any annual appointments. AH stated that she was not worried about this currently. AH also does not obtain influenza or pneumococcal vaccines annually and her last tetanus vaccine was unknown. From observation, this patients health promotion is low and patient may need education on importance to her health. When assessing this patients home life, AH stated she has never had any physical or emotional abuse. AH lives at home with her son DH. Her husband passed away several years ago so she arranged for her son to come live with her. DH provides transportation and assistance with activities of daily living for AH. She has a loving relationship with her son and he assists her with medical decisions. She states she is not afraid of her living situation. AH complied with medical regimen and asked questions when she was not sure of the situation. When asked about the history of her congestive heart failure and length of time she has been diagnose d, AH did not understand that she had congestive heart failure and did not know how long she has had this condition. She stated she would speak with her new physician. She will be set up with a new primary physician since she does not currently have one. With this information, this indicates an need for additional information about primary condition due to deficient knowledge stated by patient. Pathophysiology of Congestive Heart Failure The heart, blood vessels, and blood are components that make up the cardiovascular system. The pumping action of the heart consists of contraction and relaxation of the myocardial (muscle) layer of the heart. Each contraction and relaxation that occurs consists of one cardiac cycle. During diastole (relaxation), the ventricles fill with blood. Systole (ventricular contraction) then occurs, which propels the blood out of the ventricles and into the circulation. Cardiac performance can be calculated by measuring the cardiac output. Cardiac output is the amount of blood moving through either systemic or the pulmonary circuit per minute. (Huether McCance, 2008) Cardiac output is calculated by multiplying stroke volume (volume of blood ejected per beat during systole) and heart rate. The amount of blood a ventricle ejects during the cardiac cycle is called ejection fraction. Ejection fraction is calculated by stroke volume divided by end-diastolic volume (blood left in the blood after di astole). The normal ejection fraction is from 50%-70%. A decrease of ejection fraction is a hallmark sign of ventricular fraction, such as left-sided heart failure. The factors that determine cardiac output are preload, afterload, contractility, and heart rate. Preload is the volume and associated pressure generated in the ventricle at the end of diastole (ventricular end-diastolic volume). Preload is determined by the amount of venous return to the ventricle and the blood left in the ventricle after systole (end-systolic volume). Afterload is the resistance the heart has to overcome to eject blood from the left ventricle. Heart failure is a term for the inability of the heart to work effectively as a pump. It results from different acute and chronic cardiovascular problems. The major types of heart failure are left-sided heart failure, right-sided heart failure, and high-output heart failure. The focus of this case study will be on left sided heart failure. Most heart failure starts out with failure of the left ventricle and progresses to both ventricles failing. Typical causes of left-sided heart failure are hypertension, coronary artery, and valvular disease. Decreased tissue perfusion from poor cardiac output and pulmonary congestion indicate left ventricular failure. Left-sided heart failure is also known as congestive heart failure; however not all cases of left ventricular failure involve fluid accumulation. Left-sided heart failure can be further broke down to systolic heart failure and diastolic heart failure. (Ignatavicius Workman, 2010) Systolic heart failure happens when the heart is unable to contract forcefully enough during systole to eject sufficient amounts of blood into the circulation. Preload increases with decreased contractility, and afterload increases as a result of increased peripheral resistance in the vascular spaces (hypertension). The percentage of blood ejected from the heart during systole (ejection fraction) drops from the normal range (50%-70%) down to 40%. As this percentage decreases, tissue perfusion decreases and blood backs up into the pulmonary vessels. This creates symptoms of systemic and pulmonary congestion. Diastolic heart failure occurs when the left ventricle cannot relax enough during the rest period. When the ventricle cannot relax enough, stiffening of the ventricle occurs and prevents the ventricle from filling up with sufficient blood to ensure adequate cardiac output. This ventricle becomes less compliant because more pressure is needed to move the same amount of volume compa red to a healthy heart. (Ignatavicius Workman, 2010) When cardiac output is unable to meet the demands of the body, other areas of the body start to increase their workload to improve cardiac output. Theses mechanisms start off helping cardiac output increase but eventually have a damaging effect on the function of cardiac pumping. The compensatory mechanisms of heart failure are stimulation of the sympathetic nervous system, activation of the renin-angiotension system, release of pro-inflammatory cytokines, release of natriuretic peptides, release of vasopressin, and myocardial hypertrophy. (Ignatavicius Workman, 2010) These compensatory mechanisms will be discussed further in the appropriate body systems throughout this case study. There are many presenting signs and symptoms of heart failure that a patient may have. Signs and symptoms of left-sided heart failure are restlessness, confusion, orthopnea, tachycardia, dyspnea with exertion, fatigue, cyanosis, cough, crackles, wheezes, blood-tinged sputum, and tachypnea. AH has several of these problems. She has tachycardia, dyspnea with exertion, fatigue, orthopnea, occasional cough, tachypnea, and crackles heard with auscultation. These problems make AHs activities of daily living hard to perform at times. She does not use any supplemental oxygen during any of these times. AH is also showing signs and symptoms of right-sided heart failure that could indicate that her condition is progressing. These symptoms are distended jugular veins, and dependent edema. These symptoms of right-sided heart failure can be due to her history of a myocardial infarction, which could have caused the right ventricle to try and compensate for the increase in pulmonary circulation. Thi s leads to the right ventricle to dilate and begin to fail. This is the cause of the distended jugular veins and edema because the systemic venous circulation increases with the compensation of the right ventricle. Treatment of these symptoms is managed with the treatment of left-sided heart failure. (Huether McCance, 2008) There are several risk factors that put a patient at risk for heart failure. Common risk factors that put a patient at risk for heart failure are hypertension, coronary artery disease, cardiomyopathy, substance abuse with alcohol and tobacco use, dysrhythmias, cardiac infections and inflammations, diabetes mellitus, family history, obesity, and conditions such as hyperthyroidism. (Ignatavicius Workman, 2010) AH has several of these risk factors. She has a history of hypertension, obesity, atrial flutter (dysrhythmia), and past myocardial infarction. All of these have a negative affect on the cardiovascular system and lead to the worsening this patients heart failure. Lifestyle modifications can be made to decrease how some of these risk factors affect this patient. Dietary changes such as watching weight, low sodium, and balanced meals could reduce this patients obesity and hypertension. Also, adhering to medication regimen assists with controlling hypertension and removing retained water from the body. Chest x-rays can be helpful in the diagnosis of left ventricular failure. The problem with chest x-rays is that it may lag behind the clinical findings as much as 24 hours. You may see that the heart is enlarged (cardiomegaly) which can be due to hypertrophy and dilation. AH had a chest x-ray done on February 08, 2012. The reason this was done was because of dyspnea. Results obtained from physician were trachea midline, mild prominence of interstitial markings in bilateral lung fields without lobar consolidation, basilar atelectasis, elevated left hemidiaphragm, no evidence of pneumothorax or pleural effusion, mild cardiomegaly, ectatic aorta with vascular calcification and degenerative changes involving shoulder joints. Echocardiograms are considered the best tool in the diagnosis of heart failure. You can see changes in the valves, fluid accumulation in the pericardial space (pericardial effusion), chamber enlargement, and ventricular hypertrophy. This test can also determine eject ion fraction, which shows how bad the ventricular hypertrophy is decreasing the amount of blood ejected from that ventricle. An electrocardiogram may show ventricular hypertrophy, dysrhythmias such as atrial flutter with AH, and any degree of myocardial injury but is not helpful in determining the presence or extent of heart failure. (Ignatavicius Workman, 2010). This test would be helpful for this patient due to the fact of having a dysrhythmia and also have a past myocardial infarction. Laboratory assessments can also be helpful in diagnosis of heart failure. Electrolyte imbalances may occur from heart failure or because of side effects of medications, especially diuretics such as Bumex with AH. Regular assessments of sodium, potassium, magnesium, calcium, and chloride, are obtained. Any impairment of renal function resulting from inadequate perfusion causes the patients blood urea nitrogen and serum creatinine to be elevated and a decrease in creatinine clearance levels. A urinalysis can show if there is an increased amount of protein present in the urine and an elevated specific gravity due to the kidneys not adequately working. Hemoglobin and Hematocrit levels should be obtained to check to see if the heart failure is from anemia, which is a low level of red blood cells. This can be caused from the kidneys not creating enough erythropoietin, which regulates red blood cell production. B-Type natriuretic peptide (BNP) is used for diagnosing heart failure in patient s with dyspnea. An increase in BNP helps determine whether it is dyspnea from heart failure or lung dysfunction. Patients with atrial dysrhythmias and renal disease may also have elevated BNP levels. (Ignatavicius Workman, 2010) AH does have an atrial dysrhythmia (atrial flutter), which could cause an elevated BNP level even without the heart failure. Arterial blood gases could show if the patient is hypoxic due to the low oxygen level from fluid filled alveoli. Respiratory alkalosis could occur because of hyperventilation, respiratory acidosis could occur because of the carbon dioxide retention, and metabolic acidosis could be present from accumulation of lactic acid. (Ignatavicius Workman, 2010). AH did not have arterial blood gas values drawn to look at any abnormalities. TEST RANGE DATE: 02-08-12 DATE: 02-11-12 DATE: 02-13-12 WBC 5,000-10,000 mm3 8.89 mm3 10.00 mm3 RBC 4.2-6.1 X10 / g 4.70 5.11 HGB 11.5-17.5 g/dl 13.8 g/dl 14.8 g/dl HCT 40-52% 43.7% 46.8 % PLATELETS 150,000-400,000 mm3 194,000 mm3 207,000 mm3 NEUTROPHILS 55-70% 78.0% 78.8 % LYMPHOCYTES 20-40% 10.3% 9.5 % MONOCYTES 2-8% 8.7% 9.2 % EOSINOPHILS 1-4% 1.7% 1.5 % BASOPHILS 0.5-1.0% 1.3% 1.0 % SODIUM 135-145 mEq/L 142 mEq/L 138 mEq/L 13 mEq/L CHLORIDE 98-106 mEq/L 105 mEq/L 98 mEq/L 93 mEq/L POTASSIUM 3.5-5.0 mEq/L 5.5 mEq/L 5.0 mEq/L 4.2 mEq/L CO2 24-30 mEq/L 28 mEq/L 28 mEq/L 35 mEq/L MAGNESIUM 1.3-2.1 mEq/L 1.9 mEq/L CALCIUM 9.0-10.5 mg/dl 7.7 mg/dl 7.8 mg/dl 7.3 mg/dl BUN 10-20 mg/dl 45 mg/dl 68 mg/dl 68 mg/dl CREATININE 0.5-1.2 mg/dl 1.29 mg/dl 1.58 mg/dl 1.52 mg/dl GFR 39 37 39 GLUCOSE 70-110 mg/dl 108 mg/dl AST 0-35 U/L 47 U/L ALT 4-36 IU/L 112 IU/L BNP 952 361 TROPONIN I 0.10 0.07 Treatments for heart failure are a combination of pharmacologic and non-pharmacologic therapies. Treatment often focuses on a combination of afterload-reduction with angiotension-converting-enzyme (ACE) inhibitors, reduction of catecholamine surges with beta blockers, and preload reduction with diuretics. ACE inhibitors reduce the production of angiotension II, which is a potent vasoconstrictor, from angiotension I. This will allow the patients blood pressure to lower to a normal range by vasodilation and also prevents ventricular remodeling (alteration in the structure and function of the heart). These medications are recommended for all patients with heart failure with lowered systolic function. With these medications you need to monitor for adverse effects such as dry hacking cough, hypotension, and renal dysfunction. AH was given Lisinopril 10MG tab QD during her hospital admission. Beta blockers protect the heart from the harmful effects of norepinephrine and epinephrine which a re circulating neurohormones released as a compensatory mechanism. This is aimed to reverse ventricular remodeling. Beta blockers help reduce mortality when combined with ACE inhibitors. This combination is referred to as the cornerstone of heart failure treatment. AH was given Lopressor 100MG tab BID to inhibit beta 2 adrenorecpetors of bronchial and vascular smooth muscle. (Jones Bartlett, 2010). This medication helps lower blood pressure and relieve patient of symptoms of heart failure. Diuretics are a key aspect in the relief of dyspnea and signs of sodium and water retention. This helps reduce blood pressure by removing extra fluid in the circulation. Also, putting the patient on sodium restriction decreases the resistance of diuretics. These medications can also be the first line of treatment for older adults with heart failure and fluid overload. AH was administered Bumex 1MG tab BID. This is a loop diuretic, which means it inhibits reabsorption of sodium and chloride in the ascending Loop of Henle and enhances potassium excretion. (Jones Bartlett, 2010) With this medication you must monitor the patients labs to prevent hypokalemia. Another treatment option for heart failure is cardiac glycosides. These drugs increase intracellular calcium, which increases contraction of the heart. Their function results from an increased cardiac output by increasing the force of contraction of the heart. (Jones Bartlett, 2010). Digoxin was the cardiac glycoside administered to AH during her hospital admission. AH received 125MCG tab QD. Potential benefits of this medication are increased contractility, reduced heart rate, slowing of conduction through the atrioventricular node and inhibition of sympathetic activity while enhancing parasympathetic activity. (Ignatavicius Workman, 2010). Monitoring potassium levels is very important for this medication due to lower levels causing patients to be more sensitive to digoxin, which can cause digitalis toxicity. These sign s and symptoms are also vague and nonspecific and include; anorexia, fatigue, changes in mental status and dysrhythmias. Watch for a loss of the P wave on an electrocardiogram. Also, you must monitor apical pulse and heart rhythm on these patients. You must make sure the heart rate is above 60 beats per minute. Any drug that increases the workload of the heart will also increase its oxygen demand. Patients should be monitored for chest pain while taking digoxin. Non-pharmacological interventions for heart failure are ventilation assistance, energy management, and nutrition therapy. Ventilation assistance is an important aspect of treatment for heart failure patients. This allows the patient to have adequate oxygen and carbon dioxide exchange in the lungs. Depending on the patients oxygen saturation and dyspnea, they may need supplemental oxygen prescribed by the physician. Positioning the patient in a high Fowlers position, and keeping the head of the bed elevated over 45 degrees will minimize respiratory efforts. AH did not receive supplemental oxygen, but maintained adequate ventilation by sitting in a bed side chair most of the time during her admission. She was unable to sleep in the hospital bed due to complaints of orthopnea so she also needed to sleep in the chair. (Ignatavicius Workman, 2010) Energy management will help prevent fatigue and perform activities of daily living to the best of their ability. Steps to take to promote ener gy management is monitor patient response to activity, determine patients physical limitations, encourage alternate rest and activity periods, arrange physical activities to reduce competition for oxygen supply to vital body functions, encourage physical activity, monitor patients oxygen response, and teach patient techniques of self-care that will minimize oxygen consumption. (Ignatavicius Workman, 2010) AH was able to ambulate to the bathroom when needed, but was unable to ambulate larger distances. She maintained adequate oxygenation with adequate rest periods when she became short of breath. AH is able to identify when these rest periods need to be taken on her own. Nutrition therapy is also a key aspect in the treatment of heart failure. This treatment targets sodium reduction and water retention. Physicians may prescribe sodium restrictions to decrease fluid retention. Since sodium follows water, a decrease in sodium allows for a decrease in retained water. AH was on a sodium restricted diet but was unable to state the exact amount of allowed daily sodium. All she could state was that she was not allowed to add extra salt to meals. Some patients are also placed on fluid restrictions. This allows for the body to excrete retained fluid in the body without having work harder with additional fluid intake. The restriction depends on the patient and the extent of the heart failure. AH was put on fluid restrictions by her physician. She was allowed 1.5 liters of fluid per 24 hours. AH was able to comply with this restriction. Assistive personnel need to be accurate in measuring intake and output for these patients. Weighing these patients daily is a key factor for heart failure. This allows seeing if the patient is retaining extra fluid which could cause congestion and result in worsened heart failure. 1 kilogram of weight gain or loss equals 1 liter of retained or lost fluid. The same scale should be used everyday at the same time of day (morning) wearing close to the same amount of clothing for the most accurate assessment of weight. (Ignatavicius Workman, 2010) Cardiovascular The heart, blood vessels, and blood all make up the cardiovascular system. The hearts pumps the blood through a network of blood vessels and delivers oxygen, carbon dioxide, and nutrients to the cells and tissues of the body. This circulatory system also removes waste products of cellular metabolism. (Huether McCance, 2008). The blood is carried away from the heart by arteries that branch into capillaries and provide the body with all the nutrients needed to properly function. Veins carry the blood from the capillaries throughout the body back to the heart where the system starts the process over. Since AH has congestive heart failure (as described above), hypertension, atrial flutter, and previous myocardial infarction, her cardiovascular system is greatly affected. One compensatory mechanism that occurs in the cardiovascular system due to congestive heart failure is myocardial hypertrophy. This is enlargement of the myocardium and can be with or without dilation of the chamber. The heart walls thicken to provide more muscle mass. This results in more forceful contractions. This further increases cardiac output. Often a hypertrophied heart is slightly oxygen deprived. All the compensatory mechanisms contribute to an increase in consumption of myocardial oxygen. When the demand for oxygen increases, and the reserve of the myocardium has been exhausted, manifestations of heart failure develop. AH has a history of hypertension. Hypertension is a consistent elevation of systemic arterial blood pressure. It is defined as a sustained systolic blood pressure of 140 mm Hg or greater systolic pressure or a diastolic pressure of 90 mm Hg or greater. (Huether McCance, 2008) There are four different classifications of hypertension. These are normal, prehypertension, stage 1 hypertension, and stage 2 hypertension. AH is categorized in stage 2 hypertension with her systolic blood pressure ranging around 167 mm Hg. This stage of hypertension puts her at risk for damage to target organs such as her brain, kidneys, and heart. Since systolic hypertension is the most significant factor causing target organ damage, this puts AH at an even higher risk. AH also has an elevated diastolic blood pressure ranging around 82 mm Hg. She would be categorized as prehypertension with this value. When a patient has hypertension both by systolic and diastolic measurements, they are diagnosed with primar y hypertension. A specific cause for primary hypertension has not been identified but it is found that a combination of environmental and genetic factors can be the cause of development. Factors associated with primary hypertension are family history, advancing age, gender (more common in women after age 55), black race, high dietary sodium intake, glucose intolerance, cigarette smoking, obesity, heavy alcohol consumption, and low dietary intake of potassium, calcium, and magnesium. (Huether McCance, 2008) AH has several of these factors which are a family history of hypertension, advancing age, female gender, obesity, and poor nutritional status. Many of these factors are also risk factors for other cardiovascular disorders. With AH, the history of myocardial infarction and congestive heart failure all accumulate to poor cardiovascular effects. Pathophysiologic mechanisms mediate these effects that include; the sympathetic nervous system, the renin-angiotension aldosterone system, and natriuretic peptides. The systemic arterial pressure is made up of cardiac output and total peripheral vascular resistance. Total peripheral vascular resistance is the resistance of blood flow in systemic blood vessels. Cardiac output is determined by multiplying stroke volume and heart rate. Stroke volume is the amount of blood ejected by the ventricle with each beat of the heart. Control of peripheral vascular resistance (dilation or constriction) is controlled by the autonomic nervous system (sympathetic and parasympathetic) and circulating hormones (epinephrine and norepinephrine). Any factor that affects peripheral vascular resistance, heart rate, or stroke volume affects systemic arterial pressure, which affects the patients blood pressure. If all increase, blood pressure will increase. If all decrease, blood pressure will decrease. Four control systems play a major role in maintaining blood pressure; the arterial baroreceptor system, regulation of body fluid volume, the renin-angiotension aldosterone system and vascular autoregulation. The arterial baroreceptors monitor the arterial pressure and counteract a rise in arterial pressure by mediated cardiac slowing and vasodilation. (Ignatavicius Workman, 2010) Changes in fluid volume and renin-angiotension aldosterone system will be discussed further in the renal system. Patients with hypertension are often asymptomatic, however patients may have headaches, dizziness, fainting, facial flushing. AH had no complaints of any of these symptoms, but I did observe facial flushing. AH stated that she has had blood pressure issues for quite some time now. AH is on several medications to help assist the body in lowering her blood pressure. She is taking Lopressor 100 MG tab BID (beta blocker), Digoxin 125 MCG tab QD (cardiac glycoside), Lisinopril 10 MG tab QD (angiotension converting enzyme inhibitor) and also Bumex (loop diuretic). All of these medication help lower her blood pressure which will decrease the workload of the heart which assists in compensating in the effects of her congestive heart failure. Atrial flutter is a rapid depolarization occurring at a rate of 250 to 350 times per minute. This rapid depolarization is caused from the electrical current circulating in a small circle within the atria instead of moving from one end to the other. This current travels in a circle because conduction is slowed due to heart damage and the myocardial cells are unable to activate. (Huether McCance, 2008). This is considered a supraventricular tachycardia due to the fact that it is above the ventricle. The atrioventricular node (between the right atrium and right ventricle) in the heart blocks the number of impulses that reach the ventricles as a protective mechanism. (Ignatavicius Workman, 2010). Atrial flutter has many causes but two causes that are related to AH are ischemic heart disease (myocardial infarction), and heart failure. Symptoms are palpitations, weakness, fatigue, shortness of breath, nervousness, anxiety, syncope, angina, and signs of heart failure. AH has several of th ese symptoms but they also could be due to her heart failure. The patient with a normal ventricular rate is usually asymptomatic. Due to her left ventricle conducting at a slower rate, she is at risk for having these symptoms. With these