Respiratory Distress Syndrome Case Study

Respiratory Distress Syndrome Case Study
Introduction:
Respiratory distress syndrome (RDS) which is presented by higher respiratory rate than normal range for age and other clinical symptoms and signs
including grunting, nasal flaring, retraction and cyanosis [5] have a variety of causes in newborn infants and other pediatrics. The main causes of RDS
in newborns including lack of pulmonary surfactant in preterm neonates, transient tachypnea of newborns, Meconium aspiration syndrome, infections,
pneumothorax due to artificial ventilation and congenital heart disease [5]. Moreover, RDS due to Alveolar surfactant deficiency in preterm neonates
considered as the most important cause of death between this group age during first 28 days of life, and it is the main responsible ... Show more content
on Helpwriting.net ...
Since last three decades, surfactant administration for immaturity–related respiratory distress syndrome considered as a main therapy for preterm
neonates [3][6]. Different researches and studies have been conducted about the efficiency of applying exogenous surfactant on reducing the morbidity
and mortality rate and improving the survival rate in early preterm neonates (28–34 gestational weeks), late preterm neonates (34–37 gestational weeks)
and other infants and pediatrics.
Theme 1: Surfactant therapy in early preterm neonates (28–34 gestational weeks)
A: Effectiveness of ST in early preterm neonates
Point #1: Increasing the gestational has a positive influence on alveolar pneumocystis maturation which are responsible for producing Alveolar
surfactant [4].
Point #2: Surfactant therapy significantly reduce mortality rate in early preterm neonates [3][5].
Point #3: Surfactant therapy in early preterm neonates declines not only mortality rate but also the rate of morbidity and subsequent lung complications
in early preterm neonates [1][3][5].
B: Comparison between early and late treatment of respiratory distress syndrome by exogenous surfactant
Point #1: Early treatment is performed during first 2 hours of
... Get more on HelpWriting.net ...

Exposure To Prenatal Distress
It has been said that exposure to prenatal maternal stress can have lifelong consequences resulting in problems with child cognitive development and
motor skills as young as the age of 16 months. The researchers that conducted this study hypothesized that the severity of objective hardship and
subjective stress reactions would predict different aspects of child development.
U70100955 S17
They anticipated that relationships with child development would be moderated by timing and sex. And lastly, they hypothesized that a cascade of
maternal stress reactions would link flood exposure with child development, with higher flood exposure related to worse development. In order to be
eligible for this study, participants were part of the QF2011 already; ... Show more content on Helpwriting.net ...
The participants were tested and asked questions on their reactions to the flooding using a five–point scale ranging from 0 (not at all true) to 4
(extremely true). Parenting stress was also measured 16 months after the child was born using the Parenting Stress Index which is a 36–item
questionnaire that measures stress within the parent– child system and three subscales. The Parental Distress subscale measures perceived competence,
conflict, social support and role stress. The Parent–Child Dysfunctional Interaction subscale (PSIDI) measures the extent to which the child meets the
parent's expectations, and the level of reward associated with interactions. The Difficult Child subscale measures the parent's perception of the child's
temperament, compliance and demands. The last measure tested was child development. The Cognitive and Motor scales of the Bayley Scales of Infant
Development were administered to children at 16 months of age by researchers who were unaware to the mother's stress

Respiratory Distress Syndrome Essay
Respiratory distress syndrome (RDS) is a breathing disorder that affects newborns. RDS rarely occurs in full–term infants. The disorder is more
common in premature infants born about 6 weeks or more before their due dates. It usually develops in the first 24 hours after birth. RDS is more
common in premature infants because their lungs aren't able to make enough surfactant. Surfactant is a liquid that is produced from the alveolar type
two cells and coat the inside of the lungs. It breaks up the surface tension found within in the alveoli. Without enough surfactant, the alveoli will stick
together and the lungs will collapse, which means the infant has to work much harder to be able to breathe. He or she might not be able to breathe in
enough oxygen to support the body's organs. The lack of oxygen can damage the baby's brain and other organs if proper treatment isn't given.
According to an article titled "What is the Respiratory Distress Syndrome" by the National Heart, Lung, and Blood Institution, states that "In fact,
nearly all infants born before 28 weeks of pregnancy develop RDS (2012, p. 1)." This paper will discuss the pathophysiologic problems, ... Show more
content on Helpwriting.net ...
In adults, there are ventilation strategies such as the pressure control ventilation (PCV) and airway pressure release ventilation (APVR) that are
commonly used. The PCV is designed to prevent ventilator–associated lung injuries. Kacmarek et al. mention that "although there is not enough data
showing that this machine improves the outcomes in ARDS, they have been successful in improving patient comfort (2014, p.615)". Breathing support
or oxygen therapies are all designed to help increase the oxygen flow throughout the body. These machines and types of therapy are needed since the
cardio–respiratory system is failing to achieve its primary function, which is to deliver oxygen to the lungs and in turn the rest of the

Essay On Acute Respiratory Distress Syndrome
For the past 50 years acute respiratory distress syndrome or better known as ARDS, has been an issue in hospital intensive care units all around the
world. The first "documented published scientific description dates back to 1821 when Laennec described the gross pathology of the heart and lungs
and described idiopathic anasarca of the lungs; pulmonary edema without heart failure in a treatise on diseases of the chest."1 Cardiac and non–cardiac
issues were not taken into consideration as part of the cause at that time. The first definition dates back to Ashbaugh and colleagues in 1967.2 Though
modern medicine has been around for hundreds of years, it wasn't until hospitals designed intensive care units and began using mechanical ventilation...
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Though many advances were made & multiple research done, in 2012 the medical community once again got together. An expert panel agreed that
ARDS is a type of acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability, increased lung weight, and loss of
aerated lung tissue. "The clinical hallmarks are hypoxemia and bilateral radiographic opacities, associated with increased venous admixture, increased
physiological dead space, and decreased lung compliance. The morphological hallmark of the acute phase is diffuse alveolar damage (ie, edema,
inflammation, hyaline membrane, or hemorrhage)."3 It was at this conference that the Berlin definition was put into existence. Though it is to note
that most research to date has been done using the AECC definition, the Berlin definition removed what was known as acute lung injury. Under the
new Berlin definition patients with a PaO2/FiO2 ratio of 200–300 while on a PEEP of +5 would now be classified as mild ARDS, while patients with a
PaO2/FiO2 ratio of 100–200 would be classified as moderate & anything under 100 would be classified as severe. With pulmonary capillary wedged
pressures under 18mm HG. The Berlin definition defined acute stating that the maximum period between risk factor exposure and ARDS

Acute Respiratory Distress Syndrome
Introduction
Acute respiratory distress syndrome, also known as ARDS, is the abrupt collapse of the respiratory system. It can advance in anyone 1 year and older
who is critically ill. An individual with ARDS has accelerated breathing, difficulty getting adequate air into the lungs and decreasedblood oxygen
levels. ARDS normally develops in people who have major injuries or already ill with another disease. ARDS is usually a hospital acquired disease.
ARDS is normally grouped with an almost indistinguishable condition called acute lung injury, but people with ARDS have much decreased oxygen in
their blood, the condition is more dangerous. ALI can progress into ARDS if the oxygen levels continue to decrease.
What causes ARDS?
No one is certain about exactly what triggers ARDS, but it normally happens when you are previously ill or severely injured. Examples of conditions
that may cause ARDS include: drug overdose, bacterial infection in the blood (sepsis), pneumonia, aspiration, near drowning, breathing in poison,
multiple blood transfusion and severe injury. ARDS usually develops very rapidly, normally within 12 to 48 hours after the circumstance that caused it
(Mancini, 2013).
Signs and Symptoms of ARDS
Initial symptoms of ARDS may include: low blood pressure, confusion, loss of consciousness, fatigue or extreme tiredness, anxiety or a feeling of
impending doom, fever caused by infection, faster breathing, severe respiratory distress, agitation and rapid heart rate. ARDS

No Apparent Distress Summary
Pearson's storytelling method in No Apparent Distress is very effective in describing a complex system and problem that causes heated discussion.
After an anecdote about injustices towards people due to race or class, the author supports any claim she makes with facts. She would then end the story
with a firm, solemn sentence that made you think about the system as a whole. Throughout the book, Pearson made the connection between class, race
and medical care very clear.
For example, when Jimmy has to die because he can't afford the treatment, the author struggles with how to deal with his wife, Vanessa. The author
feels terrible and outraged about what Vanessa has to go through. She calls Vanessa to Saint Vincent's to help Vanessa fill out all of the paperwork.
Despite the complicated paperwork, Vanessa knows what she needs from experience. As she helps Vanessa fill out the paperwork, Pearson rejects the
idea that she is acting as a doctor by helping her fill out paperwork instead of helping her grieve. Pearson also highlights the unjust system from how
the caregivers treat patients. Jimmy's only hope for treatment was that he is a "RANDO, or 'resident ain't never done one'" patient. If he had insurance,
or a better healthcare system, he may have survived or received more ... Show more content on Helpwriting.net ...
She highlights her errors, and the errors of her peers, to show that the system takes advantage of people. The author tells a story of how she messed
up helping a delivery with Dr. Leuke. However, the important part of the story is that the mother didn't have a say as to what happened to her during
her treatment because "she had no way to refuse." Her delivery was also "old–school" which is usually more uncomfortable for the mother, but more
convenient for the doctor. This shows how while making mistakes is a part of the learning process, the way the system allows these mistakes to
happen is clearly

Observational Distress
The purpose of this study was to compare music with standard care to manage pain and distress in a Pediatric Emergency Department. The study found
evidence that children who listen to music had a drastically decreased in pain and fear during medical procedures than those that did not listen to music.
On the primary outcome patient distress was measured using the Observational Scale of Behavioral Distress. There was a decrease in distress for the
music group than the non music group. Children identified as ethnic minority had less increase in distress. Researchers believed the reason for a
decrease anxiety in ethnic minority may be due to cultural differences in experience, perceptions, or expectations.
On the secondary outcome measuring, children's

Distress Across Cultures
Distress Across Cultures
The article "Expression and Communication of Distress Across Cultures" by Lena Andary et al. talks about the Western assumptions about the
expression of distress, how people from different cultures can experience and express distress differently, and how this can influence on the medical
treatment they receive. Language is a very element of a culture, which can affect the communication among individuals who come from two or more
different cultures.
Clients of non–English speaker background may have difficulties on receiving the medical treatment that they should due to Western medical
assumptions about distress. This could cause the doctor to misunderstand the client's medical problem, which can result on the incorrect ... Show more
We could not assume that emotion concepts are universal. It is well known that many idioms may or may not translate from one language to another
because of the culture's vocabulary. This is the same for emotion concepts. A word in English like "sad" or "happy" can have a slightly different
meaning in another language. According to Andary et al., "This has direct implications for psychiatric assessment, during which the process of
reaching a diagnosis depends partly on eliciting individualistically oriented self–statements" (56). Language barriers can definitely interfere with the
adequacy of the information that the clinician is trying to gather in order to help the patient. In the Western culture, feeling hopeless can be one of
symptoms of a depressive person, and sometimes the feelings of a suicidal person, but in other cultures it has a different meaning and value.
According to Andary et al. in the Iran culture "... a sad person with a tragic life is regarded as being someone with a depth of inner self; while a
happy person may be regarded as being shallow and socially incompetent" (58). The way that the Iran culture sees sadness and happiness is very
different from how the Western culture sees

Reasons Why Couples Choose Not To In-Person Therapy
Many couples experiencing relationship distress choose not to seek therapeutic help. "Recent estimates founded that only 19% of intact couples seek
any type of counseling or therapy for their relationship and that only 37% of divorced couples sought any couple therapy prior to divorcing" (Cicila,
Georgia, & Doss, 2014). Reasons why couples decide not to seek treatment are because of the perceived stigma associated with therapy, financial
burden, and logistical concerns, such as difficulty scheduling appointments or finding transportation to appointments (Cicila et al., 2014). These
findings show couples would rather keep issues between themselves than talk to a therapist who has the skills and expertise in marital discord. As an
alternative ... Show more content on Helpwriting.net ...
A limitation to this intervention is that it may not be efficient for distressed couples. Especially for couples dealing with long–term issues in their
relationship. For couple participating in this form of intervention may not get enough out of the program. they may need more support and guidance.
An internet–based intervention does not provide the same level of therapy as in–person therapy. couples may benefit from in–person therapeutic
intervention more than the on–line program. Couples struggling with the online program may get frustrated which can escalate the distress in their
relationship. Another limitation is due to the fact that therapy is online, couples may not take the program seriously and not be fully committed. This
leads to the program having a low completion rate and may not be seen as an effective form of therapy. A limitation of the OurRelationship.com
program is that most of the activities are done individually. If couples are having problems in their relationship, it would make sense if they
performed activities together. If there were a few activities that are required to be done individually that would be okay. But requiring activities to be
done individually does not seem like it would benefit the couple. activities presumed together allows couples to communicate and actively work on their

Acute Respiratory Distress Syndrome ( Ards )
According to the American Lung Association, "Acute respiratory distress syndrome (ARDS) is a rapidly progressive disease occurring in critically ill
patients." ARDS is an extreme manifestation of a lung injury that can be associated with an acute medical problem. This occurs as a result of direct or
indirect trauma to the lungs. With nearly 200,000 cases in the United States each year, ARDS is not extremely common ("Acute Respiratory Distress
Syndrome"). Most people who acquire this disease are critically ill patients within the hospital. The most common predisposing medical problems of
ARDS consist of: shock, trauma, pulmonary infections, sepsis, aspiration, and cardiopulmonary bypass (Ignatavicious, 2013). ARDS is a severe
syndrome and even with prompt and aggressive medical treatment, almost fifty percent of those diagnosed do not survive. Those who survive have a
longer hospital stay along with recurring hospital admissions throughout their lifetime ("Acute Respiratory Distress Syndrome"). Acute respiratory
distress syndrome is a rapidly progressive disease which requires thorough assessment, rapid diagnosis, and emergency treatment measures in order to
successfully respond to the disease process.
ARDS is acute respiratory failure with persistent hypoxemia, decreased pulmonary compliance, dyspnea, noncardiac–associated pulmonary edema, and
dense pulmonary infiltrates on the chest x–ray. The main site of injury within the lung is the alveolar–capillary membrane

A Life Of Distress And Terror
A life of distress and terror lead the largest ethnic group in Ethiopia to start a protest movement for their rights and faced critical challenges within
it. The ethiopian government needs to end cracking down Oromo protest with violence and mistreating the ethnic group simply because they are
different. The Ethiopian government has a blueprint to expand the lands in the capital, sounds like a great idea for the counties eco and a
profitable goal but that plan comes to contact with the Oromos treasured land and coastline. News and protest broke out, placing the Oromos in a
position of scares from the government but also help them put their position spread in Ethiopia and America. Ethiopia is the birthplace of the oldest
human "lucy" and also the place I was born. I came to the U.S at age four and have family and friends from all corners of Ethiopia so I am in a
position to defend all including the Oromos and anyone who comes to conflict with this issue. The Ethiopian government is using savagery action and
targeting Oromos for their better good which is leading the Oromos to lose their rights as citizens of the country. Thus making it wrongful and
injustice for the people of Oromo and the government needs to stop the trouble it 's causing. The Oromos and Amharas have experienced hatred and
discrimination when they were colonized in the 1900's and violence grew towards them because they are so large in population, have a far and
different language and creed then the rest

Legal Memorandum on Intentional Infliction of Emotional...
Memorandum of Law
Statement of Assignment: You have asked me to prepare a legal memorandum on the question of whether our client can gain relief from intentional
infliction of emotional distress occurring from witnessing a friend¡¦s child being injured by a vehicle that is out of control due to being
driven at a high rate of speed through a school zone. Pursuant to your request, this memo includes an analysis of the relevant state and federal law.
Issue: Under Kentucky tort law, does intentional infliction of emotional distress occur when a person suffers severe insomnia and anxiety as a result of
witnessing a friend¡¦s child being injured by a vehicle that is out of control due to being driven at a high rate ... Show more content on
Helpwriting.net ...
She noticed that the car involved was local Bob Barton¡¦s who had had several complaints and speeding tickets against his behavior.
After recognizing the car, Ida then noticed that two children playing on the seesaw were injured, one of whom is her best friend,
Karen¡¦s son, Tim. Upon realizing this she became extremely upset and has since suffered from severe insomnia and extreme anxiety.
Her doctor prescribed medication for her nerves and to help her sleep, and he recently referred her to a psychologist.
Analysis:
The issue in this case as it relates to the Kentucky tort of negligence is governed by rules or principles established by the courts. The elements of
negligence are a duty the defendant owes to the plaintiff, a breach of that duty by the defendant, a causal connection between the breach and the
plaintiff's injury, and actual injury. In the absence of any one of these elements, no cause of action for negligence will lie.
The relevant case law for this situation comes from several cases from Kentucky: 761 S.W.2d 625, 597 S.W.2d 141, 147 S.W. 742, 112 S.W. 600, and
77 S.W. 361 among others. However, those are the only cases that will be discussed. They are substantially relevant to our situation and provide a
clear picture as to the route we should take in regards to Ms. Carry.<p>,,±Wilhoite v. Cobb, 761 S.W.2d 625 (Ky. Ct. App.

The, And Caregiver Moral Distress
Whose decision is it anyway? Patient 'autonomy' and caregiver moral distress
Dana Bergman
250 348 937
Western University
9 October, 2014
The value placed on the autonomy, well–being, and social justice for all participants in health care interventions is biased towards the patient and
family, sometimes to the detriment of health care providers who are obliged by professional ethical commitments to continue to provide care. The
principles guiding ethical healthcare practices were birthed from a genuine need to protect people against harmful medical interventions and
experimentation (the Belmont Report, 1978). The autonomy and authority of the patient or her substitute decision maker (SDM) is currently valued
above other guiding principles central to nursing and biomedical ethics, namely beneficence, non–maleficence, and justice (Beauchamps & Childress,
2013; Canadian Nurses' Association, 2008). The primacy of autonomy and patient or SDM choice is also reflected in recent legal precedents in
Ontario (Cooper, Chidwick, & Sibbald, 2011). Whether such decisions are in fact an exercise in autonomy is debatable. The end result is an
imbalanced provision of care, and subsequent moral distress for health care providers. Nurses are particularly vulnerable to the ill effects of
participating in care they see as unethical for a number of reasons, including perceived futility of outcome, prolonged patient suffering, or the untoward
results of decisions made based on unsound or

Separation Distress And Traumatic Distress
on these facts, I intend to have Gary do two different empty chair exercises by placing both Chris and himself in the chair at different points during
his therapy. As important as it is for Gary to experience and work through the emotions associated with Chris's death, I do not believe that this alone
will be enough to help him work through his grief. Matthews and Marwit (2004) suggest that complicated grief is a pattern of non–normative behavior
triggered by the loss of a loved one. The authors argue that complicated grief may resemble depression while often also including symptoms relating to
separation distress and traumatic distress, illustrated by Gary's feelings of loneliness and rumination over his relationship with Chris in addition to his
anger, guilt, and social isolation. This article describes how, traditionally, it was thought that a bereaved person needed to go through "grief work" by
confronting and processing emotions associated with the loss of a loved one. However, this confrontation of emotion may not be enough and recovery
may also require addressing the cognitions of the bereaved person. In addition, the authors of this study suggest a dual–process model in which the
bereaved person oscillates between confronting various types of stressors, then taking a break from those stressors. By utilizing EFT, Gary will
essentially be doing grief work by experiencing the emotions associated with loss. Experiencing his feeling of guilt may trigger cognitions such

Acute Respiratory Distress Syndrome and Primary Care...
1. A physician is called to the intensive care unit to provide care for a patient who received second– and third–degree burns over 50 percent of his
body due to a chemical fire. The patient is in respiratory distress and is suffering from severe dehydration. The physician provides support for two
hours. Later that day the physician returns and provides an additional hour of critical care support to the patient.
2. A 23–month–old infant with a heart condition presented to the ED. The physician examined the infant and , after reviewing the patient's history of a
heart condition, ordered a transport to a specialty cardiac hospital. This specialty hospital is 150 miles away from the current hospital. The physician
accompanies the patient in ... Show more content on Helpwriting.net ...
The patient complained of right lower quadrant pain and of feeling faint. Dr. O'Donnel documented a chief complaint, a brief history of present illness,
and a systemic review of the gastrointestinal system and respiratory system. Dr. O'Donnel also documented a complete examination of all body
systems, which included all required elements. Medical decision making was of moderate complexity. 7. A full–term baby girl was born at a local
community hospital on 07/08, at which time the infant's APGAR scores were 9 and 10 and the normal infant was examined prior to her admission to
the nursery. On the second day of admission (07/09), the normal newborn was discharged home with her mother. Code the discharge.
8. Dr. Williams treated a 9–month–old new female patient in the office for diaper rash. An expanded problem focused history and exam were
performed, and MDM was straightforward. 9. A 72–year–old patient with a history of breast cancer has a suspicious mass in her uterus. A biopsy was
done. The determination was that the patient had a carcinoma in situ of the uterus. The physician who conducted the surgery called a face–to–face
meeting with his fellow surgeons, the patient and the patient's family and discussed the case and the patient's outcome for 30 minutes.
10. Dr. Martin provided 1 hour and 20 minutes of critical care services to Jack Smithton, age 64, who is in the Intensive Care Unit with acute respiratory
distress syndrome

Symptoms And Symptoms Of Neonatal Respiratory Distress...
Outline
I.Introduction
II.Continuous Positive Airway Pressure (CPAP)
a.History
b.Physiological Effects
c.Types of CPAP Delivery Devices
i.Nasal Masks ii. Nasal Prongs iii. Nasopharyngeal Prongs
III.Bubble CPAP System
a.Understanding How it Works
i.System Setup ii. Nebulization of Drugs iii. Cost iv. Difficulty of Use
IV.Indications for Bubble CPAP in Neonatal Patient
a.Neonatal Respiratory Distress Syndrome (RDS)
i.Definition of Neonatal RDS ii. Characteristics of RDS in Different Gestational Ages
1.Diagnosis
2.Causes
3.Risks
4.Clinical Management
5.Morbidity
b.Idiopathic Respiratory Distress Syndrome (IRDS)
i.Definition
1.Diagnosis
2.Causes
3.Risks

5.Morbidity
c.Meconium Aspiration
i.Definition
1.Diagnosis
2.Causes
3.Risks
5.Morbidity
d.Pulmonary Hypertension of the Newborn
i.Definition
1.Diagnosis
2.Causes
3.Risks
5.Morbidity
V.Complications
a.Failure of NCPAP
b.Pneumothorax
c.Nasal Trauma
d.Agitation
VI.Treatment with Bubble CPAP
a.NCPAP level
b.Monitoring
i.Cardiorespiratory Monitor ii. Pulse Oximetry iii. Blood Gas Analysis
c.Effect of Body Position
d.Length of Therapy
VII.Weaning from NCPAP
a.Titration of NCPAP Level
b.Monitoring
i.Cardiorespiratory Monitor ii. Pulse Oximetry iii. Blood Gas Analysis

VIII.Treatment followed by NCPAP
a.Oxygen via Low Flow Nasal Cannula
IX.Summary
Abstract
Continuous positive airway pressure (CPAP) is

Intentional Infliction of Emotional Distress
MEMORANDUM
RE: Intentional Infliction of emotional distress Relevant Facts
George worked for the Charlotte Bobcats based in Charlotte, NC. George has a contract that guarantees his employment with the Bobcats for a
period of 5 years. Jerry, who is George's boss, wants to get rid of him NOW. Jerry resolves to using tactics to make conditions with the Bobcats
uncomfortable for George to entice him to quit. George eventually quits after Jerry turned off his air conditioner in mid–July and convinced others to
not speak to George. Jerry also tapped George's phone and played his personal conversations over the loud speaker. George sues Jerry forIntentional
infliction of emotional distress.
Issue Presented
Under North ... Show more content on Helpwriting.net ...
In our case, the plaintiff wouldn't be granted compensation for the intentional infliction of emotional distress because he didn't prove that the behavior
of the defendant caused him severe emotional distress.
Conclusion
In conclusion, under NC law, George is not entitled to compensation for intentional infliction of emotional

Financial Distress : A Company
Financial distress can have many different meaning, however in a corporate world it refers to a circumstance where a company struggles to pay off
financial obligations to the creditors. In order for a company to become distressed that means their fixed cost are extensive and all their assets are
liquid. This happens when the cash flows could not fulfill and meet its obligations financially. The results of being in financial distress means an
increase in non–invigorated workers, economic cost and exclusive financing. They would have to borrow additional capital in order to make ends
meet, which makes it harder for them to pay off. To ensure short term obligation the company might decide to go with opportunity's that will benefit
them in the future. The employees are also affected by financial distress as a result, they might have lower self–esteem and a higher stress load. The
employees who work for a company that is in financial distress know that the company can go bankrupt at any time. Meaning they would be out of
work, with such worries on their mind constantly the workers might not be as productive. As long as a company takes the right precautions while in
financial distress it will not go bankrupt and end up liquidating everything. This situation may arise because of the economy which is having an
unfavorable effect on the company. Reducing or removing the risk of financial failure, which come from many things and leave firms in a hard spot, is
an important

Symptoms And Treatment Of Infant Respiratory Distress...
Overview of Disease
Each day there are thousands of babies born, and families wait for their new loved ones to enter the world. However, there are also many
complications that may occur with child birth. "Approximately 50% of neonates born at 26–28 weeks ' gestation develop respiratory distress syndrome,
whereas less than 30% of premature neonates born at 30–31 weeks' gestation develop the condition" (MedScape). Infant Respiratory Distress Syndrome
, or IRDS for short, is a restrictive lung disease that commonly occurs in premature babies. A common cause is a lack of surfactant that is commonly
found in developed lungs. Surfactant is a liquid that uses proteins and lipids to help decrease the surface tension between the alveoli to create ... Show
more content on Helpwriting.net ...
Pathophysiology
When premature babies are born they do not have fully developed lungs because the lungs are one of the last organs in the body to be produced. The
alveoli in the baby's lungs have not yet started making surfactant, which is typically produced when the baby is 34–36 weeks' gestation. When the
alveoli do not have surfactant, the alveoli want to naturally collapse. Surfactant helps to keep the alveoli open and create more surface area for gas
exchange. If you were to look at the infant's lungs using a microscope, you can see that lungs look as though they are solid from the areas where the
alveoli have collapsed, also known as atelectasis. To try to compensate for the atelectasis, "the respiratory bronchioles, alveolar ducts, and some of the
alveoli dilate to decrease airway resistance and increase gas exchange" (Jardins 476). As the disease worsens, the walls of the alveoli become lined
with a hyaline membrane that is made up of dead cells and proteins that make it nearly impossible for gas exchange to occur. It makes the lungs stiff
and much harder to ventilate. With the lungs being noncompliant, the baby starts to become hypoxic. When the infant becomes hypoxic, blood is
shunted away from the other organs in the body and venous return and cardiac output are decreased. "Hypoxemia is common in pulmonary
hypertension (PH) and may be partly related to ventilation/perfusion mismatch, low diffusion

Case Study of an Eighteen Month Old Toddler In Respiratory...
As a respiratory therapist at a local hospital, I was called to the Emergency Department to await the arrival by ambulance of a 32 lb. (14.54 kg.),
eighteen–month old male toddler with a history of coughing, congestion, fever, and runny nose for the previous five days. He is currently taking
prescribed medication, by his pediatrician, consisting of acetaminophen to control fever as well as cough syrup to lessen his cough, congestion and
runny nose. He has been on this medication for the past two days but suddenly, within the past hour, has developed an audible wheeze and cyanosis
around his lips. This change in condition alarmed his mother and she called 911 to have an ambulance come to her home. While in route to the
hospital, the EMS... Show more content on Helpwriting.net ...
I would choose pressure controlled – continuous mandatory ventilation (PC–CMV) for this patient. I would set up the ventilator with the following
settings: initial PIP of 20 cm H2O and once patient is attached, I would adjust the PIP to 10 cm H2O above the determined plateau pressure, tidal
volume at 90 ml (patient's IBW is 14.5 kg and the recommended VT is 5 – 8 ml/kg), frequency at 30 (recommended is 20 – 35 for a toddler), FiO2 at
100%, PEEP at the recommended pressure of +5 cm H2O, and inspiratory time of 0.6 seconds (recommended is 0.6 – 0.7) (Walsh 335). I would also
add heated humidity to the circuit via a heated pass–over humidifier set at 37 degrees Celsius. The alarm settings would be the following: humidifier
high temperature alarm at 38 degrees C. and low temperature alarm at 30 degrees C., high pressure alarm set to 10 cm H2O above PIP and low
pressure alarm set to 5 – 10 cm H2O below PIP, low exhaled tidal volume alarm set to 80 ml (10 – 15% below set tidal volume), high PEEP set to 7 cm
H20 and low PEEP alarm set to 3 cm H2O (2 – 3 cm H2O above and below set PEEP), high respiratory rate alarm set to 42 and low respiratory rate set
to 18 (40% above and below the set rate) (Cairo 106–109). To assess the appropriateness of the ventilator settings, I would first assess the patient by
listening to breath sounds, monitoring heart rate, respiratory

Damsel In Distress Archetypes
Marisa Knorr
English 802
Brad Windhauser
February 12, 2015
"The Damsel in Distress" An archetype is defined as typical character or action that represents a universal pattern in human nature. When used
throughout films they help to portray a message and represent a stereotypical characteristic that is familiar to everyone and is repeated in multiple
movies. The "damsel in distress" is a common archetype that has been seen in many movies throughout history. When someone thinks of thecharacter
playing the damsel in distress they think about the female that is always in trouble because of the male hero and in the end needs "saving". This is
exactly what happens to Belle in Beauty and the Beast, but is not necessarily the case for ... Show more content on Helpwriting.net ...
This particular movie of the trilogy was released late in 2014. Katniss Everdeen, the main female character, wakes up in District 13 after making it
through her second Hunger Games. She was retrieved along with several other competitors of the games when the 75th Hunger Games had
finished. Katniss and the other competitors were taken to District 13, which was previously destroyed and was rebuilt underground in hopes of
striking a rebellion. Katniss is then asked to become the symbol of this mass rebellion and is known as "The Mockingjay." She is now known as
the face of the rebellion against the Capital, the head power over all 13 districts. Her true goal and only condition of becoming the Mockingjay is
that no matter what they save her partner and portrayed lover, Peeta Mellark, and other remaining tributes, who after the most recent Hunger
Games had been taken captive by the Capitol. Peeta becomes the Capital's ransom, in hopes to prevent the rebellion and destroy District 13. They
do this because they know Katniss will do whatever possible to save Peeta. After a series of events, Peeta is retrieved from the Capitol. But little do
the people of District 13 know that Peeta has been "hijacked" by the Capital, which means in his mind he needs to kill Katniss. The only way to keep
him from doing this and returning to normal is by keeping him in isolation, away from Katniss and the other people of District

The Negative Effects Of Stress
Stress, what is it, how it Affects you and How to Deal With it
Riley C. Keim
Culver–Stockton College
Stress, what is it, how it Affects you and How to Deal With it
Stress can have both positive and negative effects on your body. Stress is what gives a person that last burst of energy in a competition.Stress is what
keeps people up at night, what makes them stray from their normal diet and it can even go as far as making someone physically ill.
What is stress? Stress is one's body's natural response to threats and pressure. Athletes feel stress during any game or race, students feel stress before
a big test or exam. Workers feel stress when they are assigned to a big project or up for a promotion. Stress causes feelings of nervousness, low energy,
and even tenses us up and makes us feel on–edge and easily irritable. When a person is stressed out their adrenal gland kicks into overdrive causing
high levels of adrenaline in the brain.
Distress is negative stress in a person's life. Examples of distress may include,
The death of a family member
The death of a lifelong friend
Separation from your spouse
The end of a long relationship Having money issues
If distress is not handled correctly it can lead to the feelings of hopelessness, irritability, and even getting physically ill.
Eustress is the good stress in a person's life. Eustress can be caused by events such as
Entering into big tournaments
Being up for a promotion at work
The holiday seasons
Going on

Acute Respiratory Distress Syndrome (ARDS)
Acute respiratory distress syndrome (ARDS) is a life–threatening lung condition that prevents enough oxygen from getting to the lungs and into the
bloodstream. According to Kacmarek, Stoller and Heuer, " it has been proposed that ARDS can develop via different mechanisms and the risk factors
for ARDS should be categorized either by direct injury to the alveolar space or indirect injury initiated by systemic disease (2014, p. 601)". Common
direct injuries to the lungs can include pneumonia, lung transplant, trauma, septic shock and aspiration among others. Without enough oxygen, an
individual's brain and other organs can be severely damaged. The brain is what controls the rate and depth of respiration. ARDS can lead to a buildup
of fluid... Show more content on Helpwriting.net ...
The individual may experience an absence in breathing, also known as apnea. Rapid labored breathing or hyperventilation, a decrease in blood
pressure, and unusual movements such as chest retractions while breathing may also be present. Mennella and Schub state in a recent work, that signs
and symptoms of ARDS include hyperventilation, agitation, cough, joint stiffness, lethargy followed by obtundation (i.e., diminished sense of
awareness), pain, and apnea (2014, p. 2). A thorough exam of the lungs may reveal brief, popping or bubbling like lungs sounds known as coarse
crackles. A lack of communication from an adult patient may also be present, depending how much pain or discomfort they are experiencing. Physical
signs from the patient may also include nasal flaring, moist and cyanotic skin, and extreme

Acute Respiratory Distress Syndrome Analysis
Acute respiratory distress syndrome is a disease process that requires specific, intensive care to increase the odds of patient survival. Due to the rapid
and significant decline in a patient's ability to maintain their respiratory status, ventilation techniques in treating acute respiratory distress syndrome are
specific and unique. Multiple techniques have been studied extensively and a few stand above the rest in changing the mortality rate. High frequency
percussive ventilation and high frequency oscillatory ventilation may be good options for ventilating some of the most critical patients.
Understanding acute respiratory distress syndrome (ARDS) is a critical aspect of managing a patients ventilatory needs. The definition of ARDS is "the
... Show more content on Helpwriting.net ...
The oscillate trial reported a 35% conventional ventilation mortality rate compared to 41.1% mortality rate in the Oscar trial. Both trials demonstrated
that mortality rates in utilizing HFOV is higher, 47% in the Oscillate trial and 44.1% in the Oscar trial. The Oscar trial patients who were randomized
to the HFOV had a closer margin of mortality to the conventional group with only a difference of 2% favoring conventional ventilation, compared to
the Oscillate trial which concluded with a difference of 12% also favoring the conventional ventilation

Distress Thermometer
Distress is an unpleasant emotional experience of a psychological, social and/or spiritual nature that might interfere with the ability to cope effectively
with cancer, its physical symptoms and the treatment that occurs, before, during and/or after the diagnosis (NCCN, 2003). In the Psychosocial aspect of
cancer patients and their diagnosis, the distress thermometer is a tool that can help both the patients and staff in beginning a conversation with each
other about difficulty going on before or after a cancer diagnosis. People who are at a higher risk of heightened distress, are people with subordinate
cancer diagnosis, in reoccurring cancer patients, in younger patients, and in married people.
There are many potential consequences that can occur when patients are not screened for distress. Consequences are and not limited to poorer
faithfulness to management advices, worse satisfaction with care and worse quality of life (Jacobsen & lee, 2007). However, the benefits of using a
distress thermometer with cancer patients is that psychosocial technicians can see the amount ... Show more content on Helpwriting.net ...
If a patient scores 5–7 the score indicates that the patient is experiencing some sort of distress that might be affecting the quality of life and needs to
use the additional resources to assist them and if a patient scores 8–10 the score indicates that the patient is suffering from high levels of distress and it
can become difficult for the person to make decisions and should be referred to rigorous treatment immediately to heighten the quality of life. In my
opinion, the cutoff score for distress should stay the same for now until because psychosocial resources are so limited that it should only be presented
to people who are really in need for the help. The cutoff score should also stay the same until there is a certain way to limit the number of false
positives that

Surfactant Replacement in Neonates with Respiratory...
Surfactant Replacement in Neonates with Respiratory Distress Syndrome Type The innovation of surfactant replacement therapy in the treatment of
respiratory distress syndrome has proven to increase the survival and minimize the complications of the premature neonate. Replacing surfactant has
lessened time on ventilators, and allowing the neonate and parents an opportunity to grow together earlier outside of intensive care. This paper will
discuss the etiology of respiratory distress syndrome type I, the treatment options and nursing care of the neonate during surfactant replacement.
Respiratory distress syndrome type I is a decrease production of surfactant, a noncelluar chemical produced in the type II alveolar in the lungs... Show
more content on Helpwriting.net ...
These include maternal hypertension, gestational diabetes excluding classes D, F, and R, intrauterine growth restriction, preterm labor, and drug abuse.
The neonate high risk factors are birth prior to 32 weeks, weighing less then 1300 grams and laboratory data suggesting poor lung maturity discussed
later. (Bower, Barnhart, betiti, Hendon, Masi–lynch, & Wilson, 825) The highest risk factor for RDS type I is an insulin dependent diabetic mother,
because boluses of insulin injections severely decrease the fetus production of surfactant. (Porth, 1306)) Chronic hypoxic events during pregnancy
associated with mild to moderate maternal hypertension have shown however to sometime accelerate fetal lung maturity and surfactant production
leading to a decrease in neonatal respiratory complications. (Kim, Vohr, & Oh, 39) This due to cortical steroid secretion that stimulate an increased
production of surfactant in response to the stresses of hypoxic events. (Porth, 1306) The symptoms of oncoming RDS may at first not be present in a
fetus greater then 28 weeks since they have produced enough surfactant to thrive outside of uterine life for a short time. However the high initial
pressure to breathe the first breath remains constant with each subsequent breath causing extreme effort for

The Ventilation Strategies For Acute Respiratory Distress...
The purpose of this assessment is to critique a related pair of published papers surrounding the ventilation strategies for Acute Respiratory Distress
Syndrome (ARDS) within the Intensive Care Unit (ICU).
My role as an Advanced Critical Care Practitioner (ACCP) involves me working with patients with multi–organ failure and more often respiratory
failure following prolonged periods of ventilation and lung insult. ARDS has been studied in a variety of settings since it was first introduced by Dr
Ashbaugh (Ashbaugh et al, 1967), at which time mortality was between 60% and 70%, however, the most effective way to ventilate patients with
ARDS is still being researched. Despite this ongoing research into the management of ARDS, mortality remains at 35–40%. It is thought this is linked
to lack of knowledge and evidence regarding the pathological process of ARDS.
ARDS can be defined as an acute decrease in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F) 30% surface area burns or
any other condition which had a >50% 6–month mortality. Although there are significant differences in each of these papers exclusion criteria they
are clearly identified, which is good practice and not always done (Van Spall et al, 2007). However, these extensive exclusion criteria can impair
generalisability of the trial results in the ICU.
Sample sizes required to show
Critique the sample sizes – look at sample size representivity.
INTERVENTIONS – drafted and critique

Examples Of Damsel In Distress
Sonia PiД…tek
CHAPTER I: TYPES OF REPRESENTATION OF WOMEN IN VIDEO GAMES
1.1. Damsel in distress One of the most widely used clichГ©s in video games is Damsel in distress. The word comes from French demoiselle, which
means ''young lady''. Demoiselle en detresse translates into "damsel in distress". "As a trope the damsel in distress is a plot device in which a female
character is placed in a perilous situation from which she cannot escape on her own and must be rescued by a male character, usually providing a core
incentive or motivation for the protagonist's quest."
First known example of the Damsel in distress can be seen in the myth about Perseus and his wife Andromeda, who is chained naked to a rock by the
sea as a sacrifice, and is then ... Show more content on Helpwriting.net ...
The protagonist Booker DeWitt, is sent there to find a young lady called Elizabeth, who has been held captive by her father Zachary Comstock in
a tower for most of her life. The scenario sounds to be the classic example of Damsel in distress, but when Booker reaches the tower, he realizes
that she is not so gentle, helpless and defenseless as he thinks. "She is unlike any character that I have seen in a game, especially when you play
through the entire thing and you see how she evolves." DeWitt manages to rescue Elizabeth and they both get involved in the city's conflict, during
which she shows her strange, but strong superpowers. Her character is well rounded. Her backstory is interesting and complex. Her flaws and the way
she expresses emotions makes her more real and human. "She's resourceful and quick–witted, with the ability to break codes and pick locks like they're
nothing (being locked in a tower with nothing but books means she's got a lot of hobbies)." Elizabeth has no experience with shooting and fighting,
but she effectively helps Booker. She looks for ammunition and health kits and provides them to the main character. Her participation plays a vital
role during battles. Elizabeth even saves Booker life few times. "That time Elizabeth gave him CRP on the beach when he almost drowned, or that
time she caught him with a blimp to save him from falling off the city, or that time she gave herself up to Songbird to save his life." Elizabeth is
essential to succeed. There is also no sexual undertone in her relationship with Booker. Creative director of Irrational Games, said that "In terms of her
body type, I think certainly people on the Internet have spent way more time thinking about Elizabeth's chest than I have," he said. "It's something I've
barely thought about." Levine said it becomes "disappointing" for him when Elizabeth's measurements become the topic of conversation, because this
was

Neonatal Respiratory distress syndrome reflective practice...
This assignment describes my own reflective experience while caring for a sick neonate with Respiratory Distress Syndrome (RDS) in the neonatal
unit. This has enabled me to explore the meaning and significance of my clinical practice and to recognise the complexities within it. The experience
raises a number of issues frequently encountered in daily nursing practice. Within this assignment, I will be discussing a particular pre term baby with
RDS and critically analyse the use of nasal continuous positive airways pressure (NCPAP) and surfactant therapy and possible effects on baby's
outcome. Pseudonyms will be used to maintain patient confidentiality in order to keep in with the nursing and midwifery council code of conduct.
(NMC 2004)The... Show more content on Helpwriting.net ...
To understand whether the actions carried out was rational or whether it did more harm or good, it is necessary to review the development of RDS in
a preterm baby. Neonatal RDS is a condition of increasing respiratory distress commencing at or shortly after birth (BAPM–2006). It's the single most
important cause of morbidity and mortality in preterm infants (Greenough, et al 2004). Typically RDS affects preterm infants with the incidence
being inversely proportional to the gestational age (Stewart 2005) Approximately 60% of those born before 28 weeks gestation are affected (Fraser,
et al 2004) Incidence also increases in infants of diabetic mothers those born via elective caesarean section (Fraser, et al 2004) and perinatal asphyxia
(Rodriguez, 2003). RDS is characterised by tachypnoea, nasal flaring, intercostal and sub costal in drawing with sternal retraction and a predominantly
a diaphragmatic breathing pattern and a characteristic expiratory grunt or moan and cyanosis without oxygen, all persisting within 4–6 hours of
delivery. Diagnosis can be confirmed by history, blood gases showing impaired respiratory function and an X–ray film showing ground glass
appearance and air bronchograms (Fraser, et al 2004) RDS is caused by a defective or delayed production of surfactant in structurally immature lungs.
Surfactant is a complex mixture of phospholipids and proteins secreted by the type

Respiratory Distress Syndrome Essay
Respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD), is a disease that predominantly affects premature neonates. It
is due to a deficiency in surfactant which is vital in increasing lung compliance, preventing atelectasis at the end of expiration, and promoting the
recruitment of collapsed alveoli by reducing surface tension. Its other name, HMD, is derived from the characteristic histological findings in early
post mortems of premature babies, hyaline membranes were observed, which did not occur in stillborns (Halliday, 2008). RDS is the most common
cause of respiratory distress in the neonate. Over 90% of RDS is seen with preterm births. The incidence is much higher in males, at approximately
66%. It is... Show more content on Helpwriting.net ...
Although mice studies have demonstrated morbidities in SP–A and SP–D deficiency, no cases have been reported in humans (Serrano et al., 2006).
With insufficient surfactant, the lungs have an increased critical pressure, causing atelectasis. Increased pressure and oxygen toxicity results in damage
to the endothelial and epithelial cells within the alveoli. This results in an exudate that forms a fibrous hyaline matrix. SP–B deficiency (SFTPB gene)
has been identified in full term infants who demonstrate hyaline membrane–like disease on x–ray. It is usually fatal. Thirty–four mutations have been
described in this deficiency, with over two–thirds having the c.397delCinsGAA mutation (121ins2) in exon 4. The result of this mutation causes a
frameshift, leading to a premature termination signal which ultimately leaves the individual completely SP–B deficient. SP–B deficiency further causes
a lack of lamellar bodies (Figure 3) in alveolar type II pneumocytes which are responsible for the storage of surfactant proteins, thus reducing the
amount of SP–C. SP–C mutations have also been identified (SFTPC gene) in the cause of interstitial lung disease and emphysema in the older patient
(Kurath–Koller, 2015). Another genetic mutation identified is the ABCA3 mutation. It has been demonstrated that this mutation is more common than
SP–B deficiency (Somaschini et al., 2007) This gene encodes the ATP–binding cassette protein A3. The protein is highly

Use Of Ecmo Versus Conventional Ventilation Patients With...
The Use of ECMO Versus Conventional Ventilation In Patients With Acute Respiratory Distress Syndrome
Travis Day
Northwest Technical College
Extracorporeal Membrane Oxygenation is a medical modality that provides life support for patients experiencing pulmonary failure, cardiac failure,
or both. ECMO is able to maintain oxygenation and perfusion to the body until the native lungs or heart function can be restored. According to Maj
(1990) "ECMO is a long term heart and lung bypass technique that has been successfully used since 1975." ECMO can be divided into two categories;
Veno–venous ECMO (VV ECMO) which supports the lungs by oxygenating the blood and returning the oxygenated blood to heart. This ... Show more
It is important to recognize that ECMO is not a therapeutic intervention. ECMO provides cardiac or respiratory support so that the patient is spared the
harmful effects of mechanical ventilation such as high airway pressure, high oxygenation, and perfusion impairment while reversible pathophysiologic
processes are allowed to resolve either by natural means or by medical or surgical intervention.
One prospective randomized trial compared the effectiveness of ECLS with conventional mechanical ventilation (CMV) in full–term newborns with
severe respiratory insufficiency. This was a randomized prospective study performed by O'Rourke (1989) which demonstrated a significant difference
in survival between neonates managed with ECLS (97%) and those managed by conventional means (60%). Other studies have demonstrated a
significant increase in survival among pediatric respiratory failure patients managed with ECMO when compared to matched patients managed with
CMV.
The neonatal ARDS disease processes result in lung pathophysiology associated with pulmonary hypertension and poor oxygenation. Conventional
mechanical ventilation, surfactant administration, and nitric oxide administrations are the first modalities used in order to increase the tissue perfusion
and respiratory insufficiency. When these interventions fail, ECMO will allow for lower ventilator settings, preventing lung injury caused by the
ventilator.
For optimal timing of

Symptoms Of Acute Respiratory Distress Syndrome
There are many diseases all around the world that affect our loved ones. One in particular that is common among many hospitals is Acute
Respiratory Distress Syndrome, also known as ARDS. Originally it was called Adult Respiratory Distress Syndrome but realized that was not
accurate because it not only affects adults but children also. ARDS is defined as "the acute onset of respiratory failure, bilateral infiltrates on chest
radiograph, hypoxemia as defined by a PaO2/FiO2 ratio в‰¤200 mmHg, and no evidence of left atrial hypertension or a pulmonary capillary
pressure (Fanelli et al., 2013) It can also include cyanosis, tachypnea, dyspnea, reduced respiratory compliance and an arterial blood gas showing
respiratory alkalosis with evidence of hypoxemia. Out of the many pulmonary disorders out there, ARDS is one of the most difficult diseases to
manage and has a high mortality rate that comes with it. For this condition to occur, many things have to take place in the body. First the pulmonary
capillaries and alveoli epithelial tissues become inflamed. This results in absorbency of these layers of tissues which then leads to plasma, which is
abundant in protein, to escape out of the capillaries and into the alveolar space. After the trauma to the alveolar lining occurs, this allows fluid into the
alveoli, which then results in pulmonary edema. During this whole process damage to two different types of cells is being done. Type I and II of the
alveolar epithelial cells. Type II

Acute Respiratory Distress Syndrome ( Ards )
CLINICAL CLARIFICATION o Acute respiratory distress syndrome (ARDS) in neonates is a heterogeneous syndrome most often caused by
pulmonary surfactant deficiency in the lungs. [1,2] CLASSIFICATION o Acute respiratory distress syndrome can be classified into three exclusive
categories based on the degree of hypoxemia: [1]
п‚§Mild (200 mm Hg < PaO2/FiO2 в‰¤ 300 mm Hg)
п‚§Moderate (100 mm Hg < PaO2/FiO2 в‰¤ 200 mm Hg)
п‚§Severe (PaO2/FiO2 в‰¤ 100 mm Hg) DIAGNOSIS CLINICAL PRESENTATION History o Most commonly affects prematurely born infants (<
7.35 o Hypoxemia: [1]
п‚§Mild: 200 mm Hg < PaO2/FiO2 в‰¤ 300 mm Hg
п‚§Moderate: 100 mm Hg < PaO2/FiO2 в‰¤ 200 mm Hg
п‚§Severe: PaO2/FiO2 в‰¤ 100 mm Hg
Other diagnostic tools
п‚§Not applicable DIFFERENTIAL ... Show more content on Helpwriting.net ...
oDiagnosis based on chest x–ray which shows hyperinflated lungs with streaky perihilar markings. [2]
п‚§This gives the appearance of a shaggy heart border with a clear periphery of the lungs. [2]
п‚§Fluid is often seen in the lung fissures. [2]
п‚§Other conditions to exclude include: o Persistent pulmonary hypertension o Aspiration o Pulmonary edema o Congenital cardiopulmonary anomalies
Diagnostic groups
п‚§Not applicable TREATMENT GOALS o The goal of management is to provide immediate intensive care and early ventilation support. [1]
DISPOSITION
Admission criteria o All infants with breathing problems should be cared in hospital setting at birth.
Criteria for ICU admission o All infants who are premature or at high risk need to be treated at birth at the NICU by specialists. [3] Recommendations
for specialist referral o A medical team that specializes in newborn breathing problems should be consulted or should be involved in care. [3]
TREATMENT OPTIONS o Treatment remains supportive and is aimed at improving gas exchange and preventing complications. [1]
Drug therapy

п‚§Surfactant therapy: o Intratracheal surfactant therapy may be helpful but more research is needed. [1, 3] o Requires endotracheal intubation, which
also may be necessary to achieve adequate ventilation and oxygenation. [2] o Early surfactant therapy (within 20 to 30 min after birth) is associated
with: [2]
п‚§Decreased duration of mechanical ventilation
п‚§Lesser incidence of air leak

Distress Simulations
The purpose of this study was to determine differences in levels of distress (as measured by self report pain scores, physiological measurements, and
behavioral distress) experienced by children during venipuncture when assigned to one of four treatment groups – (Group A) positioned supine and
receiving a distraction intervention during the procedure, (Group B) – positioned supine and not receiving a distraction intervention during the
procedure, (Group C) positioned on the parent's lap and receiving a distraction intervention during the procedure, (Group D) – positioned on the parent's
lap and not receiving a distraction intervention during the procedure. The impact of gender, age, and temperament on pain response were also
addressed. Subject demographics will be presented as well as significant findings related to the research questions. . Forty four preschool and school
age children admitted to the pediatric unit of a large urban medical center and meeting study criteria (appendix ) were enrolled in the study (Table ).
Children admitted as outpatients for sedation during radiological procedures comprised the majority of the sample (40/44). The remaining 4 subjects
were admitted for dehydration and lab testing. The type of... Show more content on Helpwriting.net ...
The remaining three were inserted between 3 and 5pm. Thirty five of the 44 venous cannulations (79.5%) were performed by the same RN.. The mean
duration of insertion overall was 248.98 seconds, for preschoolers – 243.54 seconds and for school age children 255.50. The mean difficulty of
insertion score (appendix ) completed by the IV nurse was 1.25 overall, for preschoolers – 1.08, and for school age children 1.45. Thirty five of the 44
catheters were inserted in the left hand and 9 in the right hand. An attempt was made when possible to always insert the cannula in the nondominant
hand to allow optimal

Respiratory Distress Syndrome Analysis
Respiratory distress syndrome (RDS), "is a developmental deficiency in surfactant synthesis accompanied by lung immaturity and hypoperfusion"
(Blackburn, 2013, p. 342). Based on the above scenario, there are so many factors that could lead to surfactant deficiency and I would like to discuss
on three factors like preterm birth, poorly controlled diabetes, and cesarean section as the reasons for RDS. First factor that places this infant at risk for
RDS is being a preterm infant. Normally the lungs mature at about 35 to 36 weeks (Blackburn, 2013, p. 318). Here the newborn is born at 34 weeks
gestation, and the lungs are not mature enough to function effectively, thus being one of the reasons to develop RDS. Pulmonary surfactant is a
lipoprotein ... Show more content on Helpwriting.net ...
Choline and cortisol incorporation into the PC is decreased in case of hyperglycemia and hyperinsulinemia. Lamellar bodies of the type II
pneumocytes cell produce PC (Blackburn, 2013, p. 312) and this production is delayed when hyperinsulinemia is present (Blackburn, 2013, p. 318).
High Insulin level delays the morphological lung maturation and inhibits the gene transcription of surfactant proteins (SPs) (Blackburn, 2013, p. 318)
namely SP–A, SP–B, SP–C, and SP–D (Blackburn, 2013, p.314). Surfactant synthesis gets mature, when the glycogen is depleted from the lung and
liver. High Insulin level may inhibit the breakdown of glycogen and decrease the substrate needed for the synthesis of PC. Glucocorticoid plays an
important role in the synthesis of surfactant, by increasing the depletion of glycogen and increasing the synthesis of phospholipids . When glycogen is
depleted, the walls of alveoli get thinner and increase in size. In diabetic mothers, Insulin prevents the breakdown of glycogen, thereby decreasing the
substance needed for the production of phospholipid and inhibits the synthesis of surfactant production (Blackburn, 2013, p.

An Intentional Infliction Of Emotional Distress
Question Presented Does Samuel Taylor, the former member of the Local 718 Teamsters Union, have a cause of action against Ronald Murray, Local
718 business representative, who repeatedly harassed Taylor for about four months and intentionally inflicted emotional distress which resulted in
Taylor's loss of twenty pounds, extreme nervousness, loss of his union membership and his job? Brief Answer Probably yes. Under Massachusetts law,
a plaintiff has a claim for an intentional infliction of emotional distress if all of the following elements are satisfied: (1) the defendant intended, knew
or reasonably have known that his conduct will result in the emotional distress; (2) the defendant's conduct was extreme and outrageous, beyond all
possible limits of decency and utterly intolerable in a civilized community; (3) the defendant's conduct is the cause of the plaintiff's distress; and (4)
the plaintiff's emotional agitation was so severe and of a nature that no reasonable person could withstand. Here, Murray intended to inflict emotional
distress by harassing Taylor so he would cooperate with the union, it was of extreme and outrageous manner, when he threatened Taylor's and his
wife's life, and caused the emotional agitation so severe, which no person could be reasonably expected to endure, and as a result, Taylor withdrew his
membership, quit his job,

The Damsel In Distress Trope
In the mini–series of three twenty–three to twenty–six minute episodes, Anita Sarkeesian explains in full, attentive detailing, the tropes embedded in
video games since the very beginning of the Video Game era. The mini–series uses a systemic, big picture outlook to ultimately examine the plots and
designs in video games to explain why women have always been objectified in video games. The most well–known way the female character is
objectified is through a video game is by placing her in a Damsel in Distress position, woman in the refrigerator position, or any other position that
creates a trope. In the mini–series description, Sarkeesian also states that even though critical analysis of the video games will be done, it is certainly
probable ... Show more content on Helpwriting.net ...
Because the female is normally involuntarily taken due to her inability to do anything but just be there in the game, waiting rescue while in the view
of the male, he is even more compelled to save her (incentive/motivating force). In other games, the male protagonist is sometimes restrained, but
unlike the Damsel, he can free himself for the sake of his heroic Sarkeesian believes this is a problem because a female in that situation is not able to
do the same for irrational reasons. Sarkeesian claims this works because the disempowerment of the female is traded to empower the

Quantitative Review : Moral Distress Experienced By Nurses
Quantitative Review: Moral Distress Experienced by Nurses
Data Sources:
A literature review was performed using the following databases: MEDLINE, Embase, CINAHL, PsychInfo, Web of Science and Cochrane Library
for articles published between January 1984 and December 2011 on nurses' moral distress. This review was inclusive of studies that featured: empirical
research with a quantitative study design, addressed moral distress experienced by nurses, based on a conceptual framework of moral distress as
defined by Jameton, Wilkinson, or Corely, and published in English (Oh and Gatsmans, 17). This was the criterion required to screen the studies for
inclusion in the review.
Procedure:
The sampling procedure was performed through 3 phases. In Phase 1, researchers carried out the search to find all relevant articles (979 articles).
All articles were then screened by title. All that were found to be irrelevant were then excluded from the study. Remaining articles (543 articles)
were sent on to Phase 2. During phase 2, the remaining articles were had their abstracts evaluated for relevance. 465 articles were excluded, which
passed 78 onto Phase 3. During phase 3, the remaining 78 articles were read for inclusion criteria. Irrelevant texts (47 articles) were excluded along
with qualitative studies (13 articles). A final total of 19 article were included in the study.
Results
The review included 19 different articles. Studies were conducted in 7 different countries, which

Definition And Definition Of Counselling
Definition of Counselling British Association for Counselling & Psychotherapy (BACP), an international counselling body, defined Counselling as:
1.A contractual arrangement when a counsellor meets a client in privacy and confidence to explore a difficulty, distress they may be experiencing,
perhaps their dissatisfaction with life or loss of a sense of direction or purpose; and
2.An umbrella that cover a broad range of taking therapies, delivered by trained practitioners who work with people over a short or long term to help
them bring about effective change or enhance their wellbeing. (as quote by Sarah Bolitho, 2013)
In layman's term, we can say that counselling is giving advices to resolve a problem.
There is a formal way of counselling which referred to as therapy or psychotherapy. According to Christine Wells Dip.Hum. N.D., counselling is
"talking confidentially to a trained professional about your difficulties, past or present, in a safe, non–judgmental, private and supportive environment."
To be able to offer this service, the person must fulfil academic requirements. People with serious emotional conflicts which sometimes resulted in
health issues are those usually consume the service. The person who receives counselling is called a client or a patient. ... Show more content on
Helpwriting.net ...
Approaches of Counselling According to Sanders 1997, the following are some of the approaches of counselling:
Counselling skills may be used by (1) a helping service professional like qualified counsellor, psychotherapist or psychiatrist, (2) a voluntary
counsellor who has been trained to use counselling skills, (3) a person who use counselling skills as part of their work like a teacher or doctor, and
(4) an Informal counsellors such as friends and family
A helping relationship
A repertoire of interventions, determined by the specific orientation and approach of the

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