Summary of chapter 3 In the sixteenth century, Sir Thomas More coined the term utopia to signify an imaginary society of perfect harmony and happiness. More’s Utopia was a subtle attack on the ills of English society under Henry VIII. The first important attempt to define the “perfect” political order, however, had been made by Plato in The Republic. Four works stand out as representative of utopian thought in the history of Western political philosophy. In The Republic, Plato sought the just society through philosophical inquiry. In the seventeenth century, Francis Bacon’s New Atlantis demonstrated how the human condition could be elevated through modern science. Karl Marx later propounded the view that only through the radical reorganization of economic relationships within society could true justice and an end to human misery be achieved. The ultimate aim of Marx’s theory of social transformation is the creation of a classless society. Finally, in B. F. Skinner’s Walden Two, a prime example of a contemporary utopian scheme, behavioral psychology holds the key to utopia. The form and content of the just society were of less concern to Skinner than the methods for bringing such a society into existence. Thoughts of utopia have been inspired by idealism and impatience with social injustices. However, its presumed desirability conflicts with its practical possibility. The principal obstacle to utopian society is the unpredictability and selfishness of human nature, which utopian thinkers commonly have sought to control through eugenics programs, compulsory education, and the abolition of private property. Utopian visionaries often blame politics for the failure to improve society. As a result, in many utopian blueprints, the role of politics in bringing about desired change is either greatly reduced or eliminated entirely. This leaves most utopian schemes open to criticism, for they could easily become blueprints for totalitarianism. Such blueprints often take shape in writings about dystopias—utopias that turn into nightmares. Summary of chapter 4 In constitutional democracies, governments derive authority from the consent of the governed. Popular election, in theory, ensures that all viewpoints and interests will be represented. Such representation is the defining principle of a republic. Constitutions are designed to place limitations on what governments can and cannot do. There is no one universally accepted model or theory of liberal democracy. The type of liberal democracy we choose implies a particular view of the basic nature of human society and the main threat(s) to peace and stability. The idea of America is synonymous with representative democracy in the minds of people all over the world. For inspiration, the Founders drew upon the writings of political thinkers who lived and wrote from the time of the Renaissance to the Enlightenment and who were themselves inspired by classical political philosophy, particularly the writings o.

1. Summary of chapter 3
In the sixteenth century, Sir Thomas More coined the
term utopia to signify an imaginary society of perfect harmony
and happiness. More’s Utopia was a subtle attack on the ills of
English society under Henry VIII. The first important attempt to
define the “perfect” political order, however, had been made by
Plato in The Republic.
Four works stand out as representative of utopian thought in the
history of Western political philosophy. In The Republic, Plato
sought the just society through philosophical inquiry. In the
seventeenth century, Francis Bacon’s New
Atlantis demonstrated how the human condition could be
elevated through modern science. Karl Marx later propounded
the view that only through the radical reorganization of
economic relationships within society could true justice and an
end to human misery be achieved. The ultimate aim of Marx’s
theory of social transformation is the creation of a classless
society. Finally, in B. F. Skinner’s Walden Two, a prime
example of a contemporary utopian scheme, behavioral
psychology holds the key to utopia. The form and content of the
just society were of less concern to Skinner than the methods
for bringing such a society into existence.
Thoughts of utopia have been inspired by idealism and
impatience with social injustices. However, its presumed
desirability conflicts with its practical possibility. The principal
obstacle to utopian society is the unpredictability and
selfishness of human nature, which utopian thinkers commonly
have sought to control through eugenics programs, compulsory
education, and the abolition of private property.
Utopian visionaries often blame politics for the failure to
improve society. As a result, in many utopian blueprints, the
role of politics in bringing about desired change is either
greatly reduced or eliminated entirely. This leaves most utopian
schemes open to criticism, for they could easily become

2. blueprints for totalitarianism. Such blueprints often take shape
in writings about dystopias—utopias that turn into nightmares.
Summary of chapter 4
In constitutional democracies, governments derive authority
from the consent of the governed. Popular election, in theory,
ensures that all viewpoints and interests will be represented.
Such representation is the defining principle of a republic.
Constitutions are designed to place limitations on what
governments can and cannot do.
There is no one universally accepted model or theory of liberal
democracy. The type of liberal democracy we choose implies a
particular view of the basic nature of human society and the
main threat(s) to peace and stability.
The idea of America is synonymous with representative
democracy in the minds of people all over the world. For
inspiration, the Founders drew upon the writings of political
thinkers who lived and wrote from the time of the Renaissance
to the Enlightenment and who were themselves inspired by
classical political philosophy, particularly the writings of Plato
and Aristotle from the time of ancient Greece. “The architecture
of liberty” grew out of the new science of politics developed by
the Founders. That new science was designed to prevent tyranny
by compartmentalizing the functions of government (separation
of powers) and ensuring that each of the compartments
(branches) would have the means to defend itself against
encroachment by the others (checks and balances).
We trace three distinct models of American democracy to the
ideas of Thomas Jefferson (majority rule), James Madison
(balanced government), and John C. Calhoun (brokered
government). A fourth model of strong central government is
associated with Alexander Hamilton. These early leaders
disagreed about how much democracy was too much. Jefferson,
for example, favored broad individual liberties and narrow
limits on government, whereas Hamilton and others emphasized

3. the need for an energetic national government. Madison falls
somewhere between Jefferson and Hamilton. He recognized the
danger of governmental paralysis, as well as the need for
“energy,” but he argued that the best way to achieve freedom
and stability was by encouraging a vigorous pluralism, or
competition among rival interests. Calhoun was a proponent of
states’ rights—his views contrasted most sharply with
Hamilton’s and were closer to Jefferson’s.
The concept of popular control through majority rule is central
to the creation of a responsive government and holds that the
wisdom and interests of the majority are preferable to those of
the minority. However, constitutional democracies also place
limits on the powers of the government. Protection of individual
rights, the rule of law (constitutionalism), and federalism are
the principal strategies used to prevent the tyranny of the
majority. Finally, we looked at four contemporary models of
democracy and looked into the future of democracy in the light
of globalization. A cosmopolitan model of democracy that has
practical appeal is yet to be found, but there is no question that
technology and globalizing forces have an impact on
governments of all types, including democracies.
STANDARDIZED PROCEDURE PEDIATRICS 2
STANDARDIZED PROCEDURE PEDIATRICS 11
Standardized Procedure Pediatrics
Name
ABC University
Primary Health of Acute Clients/Families Across the Lifespan

4. Course
Dr. Maria Luisa Ramira
July 4, 2016
Running head: STANDARDIZED PROCEDURE PEDIATRICS
1
Standardized Procedure for Nurse Practitioners: General Policy
I Purpose
A. To establish a standardized procedure, in compliance with
the California Board of Registered Nursing (BRN) and the 11
components of the BRN’s guidelines for Nurse Practitioners
(NPs) to perform specified functions without the immediate
supervision of a Physician.
II Development and Review
A. All standardized procedures are developed through the
collaborative efforts of the members of the organization’s
established interdisciplinary committee (IDC). The IDC will
consist of physicians, nurse practitioners, registered nurses and
administrative representatives of the organization.
B. All standardized procedures will be approved through the
IDC made readily available and contain signed and dated
approval sheets of all professionals covered by the procedures.
C. All standardized procedures will be reviewed every 3 years
or more often as necessary by the IDC.
D. All NPs and their supervising physicians will signify
agreement to the standardized procedures upon hire, annually
and with changes as needed as evidenced by a signed and dated
approval sheet.
E. Signature on the statement of approval and agreement
implies the following: Approval of all procedures in the
document, intent to abide by the procedures and willingness to

5. maintain a collegial and collaborative relationship with all
parties. The signed statement of approval and agreement form
will serve as the record of those NPs who have been authorized
to perform the procedures. The signature page will be kept on
file and readily available together with Standardized
Procedures.
III Scope and Setting
A NPs may manage those functions outlined in the
standardized procedures, within their trained area of specialty
and consistent with their experience and credentialing. Such
functions include assessment, management and treatment of
acute and chronic illness, contraception, health promotion and
overall evaluation of health status. Additional functions
include the ordering of diagnostic procedures, physical,
occupational, speech therapies, diet and referral to specialty
care as needed.
B NPs are authorized to practice standardized procedures in
the organization’s Outpatient Clinics.
IV Education and Training/Qualifications
A NPs must have the following
1 Current California registered nurse (RN) license
2 Certification by the State of California, BRN as
an NP
3 Board certification from the American Nurses
Credentialing Center
4 NP furnishing number
5 DEA registration number
6 Current Health Care Provider Card from the American
Heart Association
7 Credentialed by the organization’s medical staff
B In addition to the required education and training all NPs
will be required to complete competency validation upon hire
and annually. The supervising physician is charged with
observing the NP and documenting competency validation. The
competency validation checklist is managed, maintained and
made available by the Office of Medical Staff as a component

6. of the privilege process. Checklist will be reviewed and
updated annually by the IDC.
V Supervision and Evaluation
A NP is authorized to implement the approved standardized
procedures without the direct or immediate observation or
supervision of a physician unless otherwise specified within a
particular procedure.
B Supervising physicians will conduct a weekly case review
of a minimum of 10% of each NPs cases for the week. The
review will be documented within the electronic medical record
and must be completed within 30 days of the visit selected for
review. Cases will be selected randomly unless a request for
review is received by a medical professional.
C No single physician will supervise more than 4 NPs at
any one time.
VI Consultations
A Physician consultation is to be obtained as specified in
individual procedures or when deemed appropriate.
VII Patient Records
A NPs will be responsible for the documentation of a
complete electronic medical record for each patient
contact/encounter in accordance with existing clinic and
medical staff policies.
Protocol:
Croup initial visit in the outpatient clinic setting
I Rationale
To assist Nurse Practitioners in the outpatient clinic
setting in the differentiation between
croup and other upper airway conditions and to establish
guidelines for the management of croup in this setting.
II Definition
Swelling and erythema of the upper airway resulting in
narrowing of these airways, usually as a result of viral infection
and in some instances bacterial. Most cases are usually mild
and self-limiting however, children can be seriously ill or at
risk for rapid progression of disease leading to further

7. narrowing of the airways and respiratory compromise.
III Epidemiology
A Typically occurs in children between the ages of 6 months
to 6 years, with a peak
incidence between 6 and 36 months.
B Most often occurs in the fall and is usually but not limited
to parainfluenza type 1 viral infection.
C Cases occurring in winter are usually but not limited to
influenza A and B viruses
D Risk factors include familiar history, parental smoking and
male gender.
IV History
A Symptoms of upper respiratory infection for several
days.
B Rhinorrhea
C Cough
D Low grade fever
E Symptoms occurring most often at night
F Sore throat
G Stridor
H Intermittent barking, seal like cough
V Physical Exam
A Barking seal like cough, stridor
B Tachypnea
C Use of accessory muscles for respiration
D Tachycardia
E Wheezing
F Low grade fever however, can be elevated to 104F
G Visualization of mouth and epiglottis normal
VI Diagnostic tests
A Diagnosis typically made based on clinical
presentation
B Plain imaging of soft tissue of the neck may display classic
pattern of subglottic narrowing (steeple sign) on posteroanterior
view.

8. C Pulse oximetry
D Laboratory tests are not necessary for the diagnosis of
croup however, may be used to assist with differential
diagnosis.
1 CBC
2 Viral Serology
3 Tissue culture
VII Differential Diagnosis
A Epiglottitis
B Foreign body aspiration
C Retropharyngeal or peritonsillar abscess
D Compression due to tumors, trauma or congenital
malformations
E Angioedema
F Asthma exacerbation
G Bacterial traceitis
VIII Management – According to severity of disease by means
of the Westley Croup Score based on the presence or absence of
stridor at rest, degree of chest wall retractions, air entry, the
presence or absence of pallor or cyanosis and the mental status.
A Mild croup (Westley croup score of ≤2)
No stridor at rest (although stridor may be present when upset
or crying), a barking cough, hoarse cry, and either no, or only
mild, chest wall/subcostal retractions.
B Moderate croup (Westley croup score of 3 to 7)
Stridor at rest, has at least mild retractions, and may have other
symptoms or signs of respiratory distress, but little or no
agitation.
C Severe croup (Westley croup score of ≥8)
Significant stridor at rest, although the loudness of the stridor
may decrease with worsening upper airway obstruction and
decreased air entry. Retractions are severe (including indrawing
of the sternum) and the child may appear anxious, agitated, or
pale and fatigued.
D Impending respiratory failure (Westley croup score of ≥12)
Fatigue and listlessness

9. Marked retractions (although retractions may decrease with
increased obstruction and decreased air entry)
Decreased or absent breath sounds
Depressed level of consciousness
Tachycardia out of proportion to fever
Cyanosis or pallor
E Treatment
Mild Croup:
1 Single dose of dexamethasone 0.15 to 0.6 mg/kg orally or
parentally to a max dose of 10mg.
2 Disposition home with the following instructions:
a Fever management with acetaminophen 15mg/kg po every
4-6hrs as needed not to exceed 75mg/kg/day.
b Anticipatory guidance of potential worsening and
instructions on when to seek care.
c Use of humidified air, cool mist or hot stream
d Return for follow-up next day.
Moderate Croup
1 Follow mild croup guidelines
2 Observe patient for up to 4 hours
If improved
3 Disposition home following instructions for mild croup
If no improvement
a Consult with supervising physician and prepare
to administer
b Inhaled racemic epinephrine 0.05 ml/kg per dose
(maximum of 0.5 ml) of a 2.25% solution diluted with normal
saline for a 3ml total volume via nebulizer.
c If pulse oximetry is <92% provide supplemental oxygen at
a rate to maintain 02 Sat < 92%
d Refer or disposition child via emergency transport to
emergency department
Severe croup and impending respiratory failure
a Activate 911 and provide the following until emergency
transport arrives:
b Ensure open airway

10. c Administer supplemental 02 to maintain 0s sat 92%
d Single dose of dexamethasone 0.15 to 0.6
mg/kg parentally.
e Inhaled racemic epinephrine 0.05 ml/kg per dose
(maximum of 0.5 ml) of a 2.25% solution diluted with normal
saline for a 3ml total volume via nebulizer.
f Notify supervising physician of need for emergency
transport
IX Development and Approval of the Standardized Procedure
This standardized procedure was developed and approved
through the organization’s Interdisciplinary Committee and will
be reviewed and approved every 3 years or more often as
needed.
Revision Date_____________ Review
Date______________
X Standardized procedure was approved by the following
members of the Interdisciplinary Committee.
_______________________________
Date_______________________
Pediatric Department Chair
_______________________________
Date_______________________
Supervising Physician
_______________________________
Date_______________________
Director of Nursing Practice
_______________________________
Date_______________________
Administration
XI Practitioners authorized to function under this
standardized procedure:
This list of Nurse Practitioners will be maintained on file in the
department in which Nurse Practitioners practice and hospital
administration.

11. References
An explanation of standardized procedure requirements for
nurse practitioner practice. (1998). Retrieved from
http://www.rn.ca.gov/pdfs/regulations/npr-b-20.pdf
Bjornson, C., & Johnson, D. (2015). Croup. Retrieved from
https://online.epocrates.com/diseases/68111/Croup/Key-
Highlights
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., &
Blosser, C. G. (2013). Pediatric Primary Care (5th ed.).
Philadelphia, PA: Elsevier.
Ferri, F. F. (2016). Ferri’s Clinical Advisor. Philadelphia, PA:
Elsevier.
Woods, C. R. (2015). Croup. Retrieved from
https://www.uptodate.com/contents/croup-approach-to-
management?source=see_link&sectionName=Respiratory+care&
anchor=H91700#H1
Zoorob, R., Sidani, M., & Murray, J. (2011). Croup: An
overview. Retrieved from
http://www.aafp.org/afp/2011/0501/p1067.html