Effects of Orphanhood on Child Development

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3. REVIEW OF LITERATURE



“A solid family environment is essential in paving the way for the realization of future dreams and aspirations of children.”

—Nelson Mandela



“The suffering of children is not in itself what is revolting, but the fact that it is undeserved…… if we cannot make a world in which children no longer suffer, at least we can try to reduce the number of suffering children”

– Albert Camus: “L’ Homme Revolte”.



“Children must be protected not because they are innocent but because they are powerless”

– Mason Cooley

A research literature review is a written summary of the state of existing knowledge on a research problem. The task of reviewing research literature involves identification, selection, critical analysis, and written description of existing information on a topic.

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The various attributes of orphans, orphaning and orphanages are considered in separate sections

1. DEFINITIONS OF ORPHANS AND VULNERABLE CHILDREN

The word “orphan” is derived from the Latin word ‘

orbus’

meaning bereft or to suffer the loss. Today, it applies to a child who’s either or both of the parents are dead.

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According to UNICEF the definition of an orphan is anyone between the ages of 0 and 17 years who has lost at least one parent or both the parents.

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Vulnerable children are those who belong to high-risk groups who lack access to basic social amenities or facilities. “Vulnerable” is analogous to the word “affected”. They include street children, orphans, child prisoners, child laborers, the children of sex workers and, confusingly, children who are orphaned by AIDS or have an HIV-positive parent

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. Historically such orphans have been reared by close relatives or in institutions meant for other deprived children like them.

India’s commitment to the cause of children is an old as its civilization. The child is believed to be a gift of the Gods, which must be nurtured with care and affection, within the family and the society Unfortunately, due to socio-economic and political factors, the incidence of neglect, abuse and deprivation, particularly in the poverty afflicted sections of the society, has gradually increased .

The category of ‘socially handicapped’ children includes within it those children who are ‘destitute’, ‘abandoned’, ‘deprived’, ‘neglected’, ‘victimized’, ‘vagrant’, and even ‘delinquent’ children observes.

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Khandekar feels that the term ‘deprived children’ implies deprivation of many aspects, such as economic, social, familial, emotional and moral.

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Bose opines that the category of children in need of care and protection s a wider scope which includes children whose parents are extremely poor, children of working women with low income, exploited, runaway children, child beggars, vagrants, delinquents, etc.

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Thus we see a little agreement on the specifics of who can be include into the category of orphan children. Bose vehemently advocates that the juvenile delinquents too be included the class of orphan children. They have even been called neglected juveniles and described as one who is a destitute, who is left alone, abandoned, forsaken, in utter want, without resources, deprived, in a state of extreme poverty, being without food, shelter etc.

The working group appointed by the

Department of Social Welfare, Ministry of Human Resources Development, Government of India in 1969

listed the following circumstances to define orphans, although there are other terms such as

‘socially handicapped’

used interchangeably:

a) a child, whose parents are not able to look after with proper care and control.

b) a child, without any living parents, who is not being looked after by any other near relatives on whom there is a moral or social obligation to look after.

c) a child who has no home or settled place of abode, without any ostensible means of subsistence.

d) a child whose surviving parent is a lunatic.

e) a child deserving special protection, from parents who indulge him / her in prostitution, drunkenness or anti-social behavior.

f) a child whose parents have forced him into beggary, acrobatics or performing tricks for the purpose of earning or any other kind of child labor.

g) a child who is uncontrollable.

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Further the

Planning Commission of India

in the 10th Five year plan has brought all these children under a common category called as —

“children in difficult circumstances”

and included under this category are street children, abandoned children, orphaned children, child laborers, children who have been physically or sexually abused, children in conflict with law, children with HIV/AIDS, children of terminally ill parents, children of parents serving prison terms, children victims of natural disasters, terrorist attacks, immigration etc, for the purpose of devising need based policies and welfare programmers.

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2. BURDEN OF ORPHANHOOD IN INDIA

The estimated number of orphans who need care and protection in India would give a better perspective of the magnitude of the problem on our hands .Though the exact quantum of dependent children is not known, approximations are available.

In India 31 million children have become orphans due to all causes as by 2009.

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Every 2.2 seconds a child loses a parent somewhere in the world. By 2015, It is projected that there will be 400 million orphaned children worldwide.

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Moreover, it would be difficult to estimate the number of children who are abandoned, neglected, deprived of parental or family care due to innumerable other reasons such as family feud, parental desertion, illegitimate pregnancy, natural disasters.


3.

CAUSES OF ORPHANING

3.1 BROKEN HOMES, PARENTAL DISHARMONY , PARENTAL LOSS / DEPRIVATION

BROKEN HOMES, PARENTAL DISHARMONY

A large proportion of delinquent and neglected children come from broken homes. Desertion, divorce, illegitimacy, cruelty, drunkenness and drug abuse by the parents are some of the common denominators among the neglected children.

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Broken Home is one which is rendered incomplete by the absence of one or both parents Parental separation or divorce often have an altogether different aspect where in the child is presented with a conflict of loyalties which is sometimes played upon usually by the contesting parents introduces new problem of adjusting to step parents and their attitudes.

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There is also a type of home which is thoroughly noxious without being ‘broken’. The members of the family go on living together, a life punctuated by quarrels, hatred, brutality, alcoholism, irresponsibility etc and emotional turmoil resulting from domestic discord, parental neglect or rejection may drive the child to retaliatory aggression.

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Ganga et al in their study of 225 inmates of an orphanage in Thanjavur documented that in 43.5% of the children, father had more than one wife, and father had left home in 14.6% while mother had left in 12.9%.

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Manjushree and Srinivasan noticed that of the 73 neglected children, in 8 children frequent quarrels between father and mother was observed.25 Thilagaraj in his study of neglected children documented that 37.5% of the parents were unhappily adjusted, parental separation/ desertion was seen in 12.6%. In 10% each, either both the parents had died or one parent had died and there was remarriage or there was no remarriage.

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Singh and co-workers while studying parental image in delinquents observed that in all cases of their study sample, parents had cordial and harmonious relationship.

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PARENTAL LOSS / DEPRIVATION




The presence of a human figure is essential



to develop



social responsiveness. Because, if the child is



constantly exposed to



inanimate means of stimulation, the feelings of attachments



to



inanimate objects might generalize to human figure.





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The effects of long-term or permanent separation form one or both parents are complex. When the separation occurs as early as three months after birth, the infant’s emotional upset seems to be primarily a reaction to the environmental change and strangeness, and he /she usually adapts readily to a surrogate mother-figure. But once attachment behavior has developed, the emotional hurt of separation may be deeper and more sustained. The child may go through a period of bereavement and have greater difficulty in adjusting to the change. It would appear that the age at which the infant is most vulnerable to long term separation or loss is from 7 months to 5 years.

The long term consequences of such a loss appear to depend not only on the time of its occurrence, but also on factors such as the child in question, his previous relationship with parent and the quality of subsequent parental care.

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MATERNAL DEPRIVATION :

In a pioneering study,

Bowlby

(1960) summarized the effects of maternal separation on children from 2 to 5 years of age who were hospitalized for prolonged periods.

He cited three stages of their separation reaction:

1) Initial protest characterized by increased crying, screaming and general activity

2) Despair which included dejection, stupor, decreased activity and general withdrawal from the environment, and

3) Detachment following the children’s discharge from the hospital and re¬union with their mothers in whom the children appeared indifferent and sometimes even hostile towards their parents.

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According to Howells separation and deprivation are not synonymous terms. He states that “separation” of the child and parent, means that the child is physically parted from its parents and has an existence independent of them. On the other hand, ‘deprivation’ is a term which indicates that a loss is suffered, and when applied to the child, it is used in the following two senses:

1) Occasionally it is used to denote that the child suffers the loss of its parents, or permanent parent substitute. This usually coincides with physical separation of parent and child (to prevent confusion with the term ‘separation’ the usage deprivation should be avoided).

2) Frequently it is used to denote that the child is deprived of the necessary care for its emotional growth and so suffers the loss of parenting


“Separation

“, then involves the physical absence of the parent, but not necessarily of parenting.

“Deprivation”

involves the loss of parenting but not necessarily of parents. Thereby, he has drawn a distinction between parents as an entity from parenting, that is, the emotional care given by them to the children.

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Bowlby

comments that “in the young child’s eyes father plays second fiddle, but is of an indirect value as an economic and emotional support to the mother.

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True enough, this is the impression carried over by the social, psychological and psychiatric literature. The facts however may be different. The father may share parenting, often equally, sometimes pre-dominantly and sometimes subordinately. Few facts are available.

Nevertheless, the available literature indicates that the father has an important role to play in maintaining the stability of the family group and in supporting the role of the mother. He has also a significant influence on the psychological development of boys and girls.

The father’s masculine model (aggressiveness, leadership and objectivity) is necessary for the boy if he is to emancipate himself from the feminine model prevailing at home and develop the qualities of maleness that will make him acceptable to his peers.

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The various causes for parental loss described in the various studies, parental deaths due to a number of causes, outnumber all other causes. Fosteer G and colleagues in their study observed that 12.8% of children under 15 years old had a father or mother who had died; 5% of orphans had lost both parents.

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Bhagath and Fraser in their study on neglected children found that paternal death was discovered in 40% whereas maternal loss was seen in 15%.

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Presley et at reported parental loss in 49. 2% of 140 neglected children, with 21% maternal loss and 25% had lost both the parents.

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Approximately 23% entering the foster care in the United States of America have lost one or both the parents in a survey carried out by Simms M D et al.

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describe similarities and difference between evaluation and research

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describe similarities and difference between evaluation and research

 

Introduction and learning outcomes

On completion of this weeks activities, students should be able to:

describe similarities and difference between evaluation and research
assess barriers to evaluation
examine methods for conducting an evaluation

Monitoring and Evaluation

An important component of being a reflective educator is program evaluation. There are many similarities between program evaluation and research methods, however evaluation is not necessarily research nor vice versa.
Text reading

Boland, D. L. (2015). Program Evaluation. In M. H. Oermann (Ed.), Teaching in nursing and role of the educator (pp. 275-302). New York: Springer Publishing Company.

There are three additional readings on curriculum evaluation approaches in the reference list available through eReserve (Hall 2014; Kesting 2015; Lindemann & Lipsett 2016) . Please review these if you are interested in building on your knowledge of the field of evaluation.

Boland (2015 p278-9) cites Wandersman et al’s (2012) nine principles associated with empowerment that educators should incorporate into their program evaluations. This raises some great principles to consider when planning and conducting program evaluations. Boland (2015 p285) then presents a list of things that need to be considered when developing and doing a program evaluation:

identify and engage stakeholders
clarify goals of the evaluation
assess resources needed for evaluation
design the evaluation
determine appropriate methods of measurement and procedures
develop a work-plan, budget, and timeline for evaluation
collect the data using agreed upon methods and procedures
process and analyse data
interpret and disseminate the results
take action

Given the purpose of undertaking a program evaluation is to judge the worth and value of a program, and its ability to meet the intended aims, it is vital that results be actioned, meaning it must lead to a modified curriculum as required.

Drawing on similar points of view, the following reading is another look at curriculum evaluation, but with a focus on technology enhanced learning.

1.Introduction of civil right and health care reform 2. What is affordable healthcare act? 3.What does health care reform mean to uninsured and underinsured? 4.What is the implication of limited access to vulnerable population 5. what can nursing do to help awareness on civil rights

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1.Introduction of civil right and health care reform
2. What is affordable healthcare act?
3.What does health care reform mean to uninsured and underinsured?
4.What is the implication of limited access to vulnerable population
5. what can nursing do to help awareness on civil rights

1.Introduction of civil right and health care reform
2. What is affordable healthcare act?
3.What does health care reform mean to uninsured and underinsured?
4.What is the implication of limited access to vulnerable population
5. what can nursing do to help awareness on civil rights

Describe additional strategies for assisting patients in becoming informed consumers of online health information that could employ to improve the health literacy of patients

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Describe additional strategies for assisting patients in becoming informed consumers of online health information that could employ to improve the health literacy of patients

 

 

PLEASE ADDRESS/ANSWER THESE QUESTIONS AS THE CONTENT OF MY ASSIGNMENT:
1. Your assessment of the nurse’s role in improving the health literacy of patients.
2. Consider the many ways patients access health information, including blogs, social media, patient portals, websites, etc.
3. Reflect on experiences you have had with patients who self-diagnose using online medical sources.
4. Identify the resource you would recommend to patients for evaluating online health information and why it would be beneficial.
5. Describe additional strategies for assisting patients in becoming informed consumers of online health information that could employ to improve the health literacy of patients
6. Conclusion about Health Literacy
*Kindly follow APA format for the citation and references! References should be between the period of 2010 and 2016.
*Make heading each question, so I need 6 headings that address the 6 questions above.
Background information of this assignment: HEALTH LITERACY
In order to effectively manage their own health, individuals need to have competencies in two areas—basic literacy and basic health literacy. What is the difference? Basic literacy refers to the ability to read, even simple language. Health literacy is defined as, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (National Coalition for Literacy, 2009). Unfortunately, according to a Department of Education report on health literacy, only 12% of adults aged 16 and older are considered to have a proficient level of health literacy (U.S. Department of Education, 2006). Acquiring health literacy skills has become more complicated with the explosion of online health information, some credible and some misleading.
In this Discussion, you focus on how to help individuals find credible information on the Internet and develop strategies nurses can use to increase the health literacy of their patients.
REQUIRED RESOURCES
Readings
· McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge(Laureate Education, Inc., custom ed.). Burlington, MA: Jones and Bartlett Learning.
o Chapter 20, “Supporting Consumer Information and Education Needs”

This chapter explores health literacy and e-health. The chapter examines a multitude of technology-based approaches to consumer health education.
o Chapter 21, “Using Informatics to Promote Community/Population Health”

In this chapter, the authors supply an overview of community and population health informatics. The authors explore a variety of informatics tools used to promote community and population health.
o Chapter 22, “Informatics Tools to Promote Patient Safety”

The authors of this chapter present strategies for developing a culture of safety using informatics tools. In addition, the chapter analyzes how human factors contribute to errors.
· Health literacy: How do your patients rate? (2011). Urology Times, 39(9), 32.

The authors of this article define health literacy and emphasize its poor rates in the United States. Additionally, the authors recommend numerous websites that offer patient education materials.
· Huff, C. (2011). Does your patient really understand? H&HN, 85(10), 34.

This article defines hospital literacy and highlights the barriers that prevent it from increasing. It also emphasizes the difficulties created by language and financial costs.
· The Harvard School of Public Health. (2010). Health literacy studies. Retrieved fromhttp://www.hsph.harvard.edu/healthliteracy

This website provides information and resources related to health literacy. The site details the field of health literacy and also includes research findings, policy reports and initiatives, and practice strategies and tools.
· Office of Disease Prevention and Health Promotion (n.d.). Health literacy online. Retrieved June 19, 2012, from http://www.health.gov/healthliteracyonline/

This webpage supplies a guide to writing and designing health websites aimed at increasing health literacy. The guide presents six strategies that should be used when developing health websites.
· U.S. Department of Health and Human Services. (n.d.a). Quick guide to health literacy. Retrieved June 19, 2012, from http://www.health.gov/communication/literacy/quickguide/Quickguide.pdf

This article contains an overview of key health literacy concepts and techniques for improving health literacy. The article also includes examples of health literacy best practices and suggestions for improving health literacy.
Media
· Agency for Healthcare Research and Quality (Executive Producer). (2012a). Interview with Rachelle Toman, M.D. Ph.D. Rockville, MD: Author. Retrieved fromhttp://www.ahrq.gov/legacy/questions/video/06clinician/

In this interview, Dr. Toman discusses the importance of asking patients questions to ensure they have been able to sufficiently communicate their concerns.
· Agency for Healthcare Research and Quality (Executive Producer). (2012b). The waiting room video.Rockville, MD: Author. Retrieved from http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/videos/waitroom/index.html

This video addresses the importance of communication in the patient-health care professional relationship. It highlights the need to ask meaningful questions to the patient to fully understand issues and concerns.

An Analysis on the Consequences of Substance Abuse

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Substance abuse takes a toll on the entirety of a person. From broken relationships to cancerous tumors, the aftermath of addiction can take many forms. Researchers are continuously working to determine all the effects that drugs can have on an individual, ranging from physical health to emotional wellbeing. While understanding the side effects is useful in general, it is especially necessary to determine which of these consequences one can recover from after sobriety and which are permanent. Understanding the differences between the severity of each consequence will assist clinicians in creating focused treatment plans that will reap the most benefits for the patients. According to the literature, it seems that the emotional, interpersonal and social consequences of substance abuse are reversible while the physical consequences are for the most part permanent.

To begin, the consequences of substance abuse can be severe but they are not always permanent. One aspect often altered by addiction is the user’s emotional health. In an epidemiological study across Europe, it was determined that there is a strong positive correlation between anxiety and substance abuse disorders as well as between depression and substance abuse disorders. There also seemed to be a direct relationship between the severity of the substance abuse and the number of comorbid disorders (Merikangas et al, 1998). These results have been verified by other sources as well. In 2011, the National Institute of Health found that  27.6 % of mentally ill adults in that year were also diagnosed with alcohol abuse disorder (Abuse, 2014). This data indicates that substance abuse is highly correlated with mental illness, however it does not give information on if the mental illness is curable once sobriety is reached. There is a lot less information in the literature on this topic compared to the comorbidity during abuse, however it is clear that there is a possibility of reversing the mental and emotional impacts of substance abuse. The strategies to achieve this coincide with normal mental health treatment. In fact, most treatment programs for comorbid substance use and mental illness focus on both disorders simultaneously. In a meta-analysis comparing dual vs individual treatment programs, there seemed to be greater success when the substance abuse and mental illness are treated simultaneously (Drake, Mercer-McFadden, Mueser, McHugo, & Bond, 1998). In general, individuals with more than one psychiatric disorder take longer to recover than those with just one, however there is the same success rate for recovery (Rohde, Clarke, Lewinsohn, Seeley, & Kaufman, 2001). Overall, substance abuse does often coincide with poor emotional and mental health, however this side effect can be reversed with a focused treatment plan that looks at both disorders at once.

To continue, substance abuse disorders are known to have a negative impact on the user’s interpersonal relationships. In a literary review, substance use was deemed a cause for divorce in around 11% of the participants. In fact, it was the third most common reason for divorce after infidelity and incompatibility (Amata & Previti, 2003). Aside from divorce, substance abuse takes a large toll on parent-child relationships as well. A 2018 study found that parental substance abuse is correlated with “child adversity” as well as adolescent substance abuse (McGovern et al, 2018). The fact that addiction can impact relationships in such a negative way is disheartening, yet these changes are not always permanent. The concept of mending broken relationships is incredibly subjective and difficult to study, so it is hard to “prove” that they are mendable with scientific facts. Despite this, it does seem to be of common knowledge that relationships are capable of being recovered, no matter the cause of their brokenness. In general, the damage that addiction can cause to relationships is reversible, but not always easy.

Substance abuse disorder can have many social consequences as well. In this context, “social” indicates the relationship of the user with larger society, specifically in terms of occupation and social standing. Those struggling with addiction often have difficulty maintaining their careers and not letting their disorder interfere. In a 2018 study, dependence on alcohol was found to significantly increase one’s risk of unemployment. This relationship held true for marijuana dependence as well (Boden, Lee, Horwood, Grest & McLeod, 2017).  In addition, a meta-analysis of the literature from 1990 to 2010 found clear evidence that substance abuse “increases the likelihood of unemployment and decreases the chance of finding and holding down a job” (Henkel, 2011). It is important to note that this relationship is two-sided. While substance abuse can often lead to unemployment, unemployment can drive individuals to abuse substances as well (Compton, Gfroerer, Conway & Finger, 2014). This trap of addiction can be detrimental, as users often need money to get back on their feet yet they struggle to maintain any job they are offered. Without a sustainable income, obtaining drugs of abuse can also be very difficult for users. Securing money for these drugs can lead to theft and even violence, hurting not just the user but those around them (Stevens, Trace & Bewley-Taylor, 2005). These actions lower the social standing of the user and hurt their chance of maintaining a healthy life, yet it is not impossible to recover what has been lost. There are many programs that help those recovering from substance abuse reintegrate into society. The process is difficult but not impossible. For example, many successfully transition back into society through Alcoholics Anonymous’ twelve step program. Through a mentoring approach, Alcoholics Anonymous has been found to be a relatively effective in transitioning users back into a sober lifestyle (Moos & Moos, 2006). The literature indicates that a healthy transition is possible, but the process can be undermined if the drug is still being abused (Ginexi, Fox & Scott, 2014). The social consequences of substance abuse are indisputable but can be reversed with the right treatment.

While there are many side effects of addiction that can be reversed, the physical consequences of drugs on the body are often permanent. The negative impact of drugs on the body can vary from initial nausea or dizziness, to long-term alterations in functioning. The short-term consequences would not be deemed irreversible, however many of the late-onset side effects are. For example, those who abuse cigarettes often do not realize the impact of the chemicals on their body until they receive a lung cancer diagnosis decades after they achieved sobriety. According to the Center for Disease Control, around 80% of lung cancer deaths are associated with cigarette smoking. They also stated that there is still an increased for those who had quit smoking compared to those who had never started, indicating that there are some biological consequences of cigarette use that users cannot change (“What are the…,” 2019). Another interesting example is that of chronic cocaine use on the heart. Cocaine is a stimulant that can be toxic to heart tissues through various processes. As a result, cocaine users have an increased risk for cardiovascular diseases and myocardial infarctions. These effects are due to the chronic cocaine use but that does not necessarily indicate the individual is using at the moment of their cardiac episode (Stankowski, Kloner, & Rezkalla, 2015). While these are only two examples, many drugs have the potential of creating irreversible damage on the body.

To summarize, the consequences of substance abuse are severe but they do not always last. The emotional, interpersonal and social changes that occur due to addiction can alter all facets of the user’s life, including their marriages, careers and families. Amidst all this darkness, there is the incredible reality that recovery is possible with the right treatment. On the other hand, the physical consequences of drug abuse are not so easily fixed. These side effects, reversible or irreversible, are important to understand for the sake of users and practitioners alike. As scientific research continues, greater treatments will be developed to reverse these negative consequences. There is hope for those grappling with addiction; may research advance to give user’s the tools to rebuild their lives.


References:

  • Abuse, S. (2012, November). Results from the 2011 national survey on drug use and health: mental health findings. In

    United States. Department of Health and Human Services; United States. Substance Abuse and Mental Health Services Administration

    . United States. Department of Health and Human Services; United States. Substance Abuse and Mental Health Services Administration.
  • Amato, P. R., & Previti, D. (2003). People’s reasons for divorcing: Gender, social class, the life course, and adjustment.

    Journal of family issues

    ,

    24

    (5), 602-626.
  • Boden, J. M., Lee, J. O., Horwood, L. J., Grest, C. V., & McLeod, G. F. (2017). Modelling possible causality in the associations between unemployment, cannabis use, and alcohol misuse.

    Social science & medicine

    ,

    175

    , 127-134
  • Compton, W. M., Gfroerer, J., Conway, K. P., & Finger, M. S. (2014). Unemployment and substance outcomes in the United States 2002–2010.

    Drug and alcohol dependence

    ,

    142

    , 350-353.
  • Drake, R. E., Mercer-McFadden, C., Mueser, K. T., McHugo, G. J., & Bond, G. R. (1998). Review of integrated mental health and substance abuse treatment for patients with dual disorders.

    Schizophrenia bulletin

    ,

    24

    (4), 589-608.
  • Ginexi, E. M., Foss, M. A., & Scott, C. K. (2003). Transitions from treatment to work: Employment patterns following publicly funded substance abuse treatment.

    Journal of Drug Issues

    ,

    33

    (2), 497-518.
  • Henkel, D. (2011). Unemployment and substance use: a review of the literature (1990-2010).

    Current drug abuse reviews

    ,

    4

    (1), 4-27.
  • McGovern, R., Gilvarry, E., Addison, M., Alderson, H., Geijer-Simpson, E., Lingam, R., … & Kaner, E. (2018). The association between adverse child health, psychological, educational and social outcomes, and nondependent parental substance: a rapid evidence assessment.

    Trauma, Violence, & Abuse

    , 1524838018772850.
  • Moos, R. H., & Moos, B. S. (2006). Participation in treatment and Alcoholics Anonymous: A 16‐year follow‐up of initially untreated individuals.

    Journal of clinical psychology

    ,

    62

    (6), 735-750.
  • Stankowski, R. V., Kloner, R. A., & Rezkalla, S. H. (2015). Cardiovascular consequences of cocaine use.

    Trends in cardiovascular medicine

    ,

    25

    (6), 517-526.
  • Stevens, A., Trace, M., & Bewley-Taylor, D. (2005). Reducing drug-related crime: an overview of the global evidence.

    The Beckley Foundation Drug Policy Programme. Retrieved March

    ,

    10

    , 2008.
  • What Are the Risk Factors for Lung Cancer? (2019, September 18). Retrieved from https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm.

HIV Screening for Pregnant Mothers | Research

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INTRODUCTION


“There is such a special sweetness in being able to participate in creation”


– Pamela S.Nadev

“Passing the disease to a new born is a human rights violation. This should stop and all of us must try to make this a success,” Oscar Fernandes (Head of Forum of parliamentarians on HIV/AIDS) reportedly said when asked about HIV screening among pregnant women.

Pregnancy is what make our life on earth keeps going. Making a healthy progeny, would help the existence of our species in our natural GOD given form. If the progeny is not good, who knows, man might again turn to be monkeys as by Darwin’s theory. But that’s not what we are going to discuss here. As Oscar Fernandes says, giving a disease is a serious human rights violation, which I would call a great sin.

India has a low HIV prevalence of 0.34 percent while in terms of individuals infected, India is home to the third largest number of people living with HIV in the world. Nearly 5% of infection are attributable to parent to child transmission. National AIDS Control Organisation estimated that 2.39 million people live with HIV/AIDS in India in 2008 – 2009, a more recent investigation by the Million Death Study Collaborators in the British Medical Journal (2010) estimates the population to be between 1.4 – 1.6 million people. In the last ten years 50% decline has been seen in the number of new HIV infections. (

British Medical journal 2009

)


Pandey et al., (2008-2009)

updated the adult HIV prevalence and number of people living with HIV in India for the year 2008-2009. It revealed that the estimated number of people living with HIV is 2.4 million (1.93 – 3.04 million) in 2009, of which, 39% are women, children under 15yrs of age account for 4.4% of all infections. NACO had estimated that there was 0.31% of HIV prevalence among adults (15yrs & above).

According to

UNICEF

, it is estimated that there are between 22,000 and 61,000 HIV pregnant women living with HIV in India. Although the percentage of pregnant women tested for HIV increased from 2% in 2005 to 23% in 2010, testing coverage is still low. The more recent National AIDS Control Organisation data, India has demonstrated a reduction of 57 % in estimated annual new infections from 0.274 million in 2000 to 0.116 million in 2011, and the estimated number of people living with HIV was 2.08 million in 2011. A study to determine seroprevalence of HIV in pregnant women in a tertiary care hospital (Kurnool Medical College) India was conducted in 2011. Out of 11,671 pregnant women, 53 were found to be positive for HIV (0.45%). (

Devi R.A., Shyamala R. (2011)


Alvarez-Uria G., Midde M., Naik K.P. et al.,

(2011) suggested that the HIV prevalence in young pregnant women reduced from 1.22% in 2007 to 0.35% in 2011. A reduction in HIV prevalence was seen in all subgroups except in women from forward castes. Women whose job was not related to agriculture and women who had only completed primary education were more likely to be HIV- infected.

According to

NFHS-II

figures, overall HIV prevalence was higher among urban than rural populations. However some states had a slightly higher HIV prevalence among rural populations than urban populations namely Punjab, Tamilnadu and Uttar Pradesh. In 2006, HIV prevalence among mothers attending antenatal clinics is more than 1% in 118 districts. 81 districts have an HIV prevalence of >5% in one or more of the high risk groups.

In Tamilnadu, NFH survey II found, HIV prevalence at antenatal clinics was 0.88% in 2002 and 0.5% in 2005, though several districts still have rates above 1%. The general population survey of 2005-2006 found a rate of 0.34% across the state. According to recent National AIDS Control Organisation data, there was 0.25% of antenatal clinic HIV prevalence 2007.

Infochange India.


Dash M., Mohanty I., Sahu S., Narasimham M., Padhi S., Panda P. (2012)

reported that among 18,905 pregnant women counselled, 15,853 (83.85%) were accepted for HIV testing. From the total 15,853 testing in 61/2 years, 0.66% women were found to be HIV seropositive. The mean age of HIV positive women was 24.31 years (SD ± 3.9yrs). The HIV seroprevalence rates showed a declining trend from1.53% in 2006 to 0.34% in 2012. Among seropositive women majority (43.8%) were in the age group of 25-29years.


UNAIDS

found that mother to child transmission is the largest source of HIV infection in children below the age of 15yrs and the estimates of children living with HIV in 2012 was 3.3 million. The joint technical mission on PPTCT (2006) found that out of 27 million annual pregnancies in India, 1,89,000 occur in HIV positive pregnant women. If not intervened timely, an estimate of 56,700 infected babies will be born annually.

(NACO)


Kaushal A., Udadhyay Y. (2007)

stated that children of today are the youth of tomorrow. Human immunodeficiency virus affects this very precious generation and bear grave consequences to our future, our nation, the continent and the world at large. It will adversely impact the health statistics, economic growth and above all the morale of nations. The main thrust areas include the newborn component of prevention of parent to child transmission (PPTCT), follow up of the HIV exposed infant, counselling mothers to decide the right infant feeding choices and appropriate diagnosis of infected children


Nanavati R., Mondkar J., Kabra N.(2006)

found that in the pandemic of HIV infection, mother to child transmission accounts for over 90% of HIV infections in children below the age of 15yrs. With approximately 27 million babies born in our country every year and given 0.7% prevalence rate of HIV infections in pregnancy, the estimates are about 1,89,000 HIV infected women deliver in India and as per the NACO 2005 estimates, approximately 60,000 HIV infected infants are added to the existing load each year.

Almost 10% of world’s burden of vertical transmission of HIV infection comes from India. Unfortunately, less than 4% of pregnancies avail – prevention of PTC transmission services, less than 7% of such exposed mother- baby couples are put in – prevention of mother to child transmission (PMTCT)- regimen of single dose of NVP and less than 3.5% of such babies are actually prevented from getting infected from their mothers. This is far less than United Nations General Assembly Special Session (UNGASS) goals of 20% reduction in MTCT, which was to be achieved by 2005. It is equally important to provide support to those, who are infected inspite of best efforts. This is huge task for a country like India.

(National Neonatology Forum)


NEED FOR THE STUDY

Screening for HIV has been imposed mandatory in India because of the increased threat of child being born with HIV. Thousands of babies are born with HIV positive status as they acquire the virus while in their mother’s womb. So now our government of India has imposed mandatory HIV testing for all pregnant women. Though there is much of advancement in knowledge, people still widen their eyes on sound of the word ‘HIV’ itself. People just don’t want to acquaint with HIV in any way, even for testing. And some who have this doubt, about the possibility of acquiring HIV are worried about confidentiality.

“India must produce a generation without HIV. This is possible if we go for detecting the virus in every single pregnant women before delivery.” –(UNAIDS executive director)Michel Sidibe said.

This decision of the government was not very much welcomed because of the lack of awareness among the primi mothers.

According to USPSTF (U.S. Preventive Services Task Force) 2013, the goal of bringing end to AIDS starts with diagnosis of individual people. Current treatment has made HIV infection a chronic disease by prolonging survival and preventing further transmission. Bringing the epidemic to end will be very tough and only effective screening can make it possible. For any screening guideline and protocol to be effective, awareness about its seriousness must be known to people.

(Das,M., Volberding,P. (2013).

In September 2013 BBC Health NEWS, said that researchers at Keeleuniversity found HIV was still widely seen as a disease of young people. They said older women, in particular, fear they will be seen as undignified or sexually irresponsible. Many in the study also expressed fears over the uncertain impact of the disease as they moved into old age. Dr.Dana Rosenfeld, who led the project used focus groups, surveys and life history interviews with 76 older people in the London area living with the virus. She says there was an “immense knowledge gap” in this field. She continued that it has revealed a sense of anxiety about how they may be perceived.

(Brimelow,A. (2013)


Addo,N.V.(2005)

conducted a descriptive study to assess the knowledge about HIV/AIDS and attitudes to VCT among 334 antenatal attendants at KomfoAnokye Teaching Hospital (KATH). The study summarizes that about 50% of respondents said a HIV positive woman could transmit HIV to her baby before birth but had no idea of any means to prevent this.


He,N., et al. (2009)

conducted a descriptive study on knowledge, attitudes and practices of voluntary HIV counselling and testing among rural migrants in Shangai, China. A questionnaire was administered face to face. Among 2,690 participants, 78% had lifetime sexual intercourse with 41.3% of singles, 9.2% had multiple sex partners in the past year, only 19% had always used condoms and only 2.3% had ever had HIV testing. As far as this report is concerned, effort should be made to improve the awareness among public so as to increase usage of voluntary counselling and testing centres.


Ekabua J.E., Oyo-ha A.E., Oquji D.S., Omuemu V.O. (2005)

conducted a descriptive multi-centric study of 400 antenatal attendees in Calabar, using pre-tested, semi- structured and interviewer – administered questionnaire for data collection. The study states that out of 96.7% women with knowledge of HIV infection, 41.2% were assessed to have excellent knowledge of the mode of transmission. Awareness of antenatal HIV screening was observed in 96.2% women; while 93.7% approved of antenatal HIV screening. Awareness and approval of antenatal HIV screening was significantly related to age and educational status.

In a developing country like India, where HIV screening is made mandatory for all antenatal mothers, there is a foreseen risk of developing negligence in imparting awareness to the public. A test like this can also be done without much emphasize on knowledge regarding HIV, its screening, prevention and treatment availability. In situations like this, we find it important to evaluate or assess the knowledge and attitude aspect of the Indian antenatal women regarding HIV screening. The goal of reaching a HIV free generation will not be possible unless everyone of our nation cooperate and participate. There arise the need to know the awareness among primi mothers and their attitude regarding routine HIV screening.


STATEMENT OF THE PROBLEM

A study to assess knowledge and attitude regarding HIV screening among primigravida mothers in selected Maternity centres, Coimbatore


OBJECTIVES:

  • To assess the knowledge regarding HIV screening among primigravida mothers.
  • To assess the attitude regarding HIV screening among Primigravida mothers.
  • To associate demographic variable with knowledge and attitude scores towards HIV screening.
  • To associate knowledge and attitude regarding HIV screening among primigravida mothers.


OPERATIONAL DEFINITION


ASSESS

This term refers to evaluate or estimate the knowledge and attitude regarding HIV screening among primigravida mothers.


KNOWLEDGE

Refers to the familiarity and awareness of primigravida mother to the transmission of HIV, purpose of its screening and its importance


ATTITUDE

Refers to the expression of favour or disfavour feeling towards HIV screening among primigravida mothers


HIV SCREENING

Refers to the Anti HIV1 and 2 (rapid) done for Primigravida mother to detect human immunodeficiency virus that causes acquired immunodeficiency syndrome.


PRIMIGRAVIDA MOTHER

This refers to a woman who is first time pregnant and is in her first trimester and have not had an abortion previously.


CONCEPTUAL FRAMEWORK

Conceptual framework of the study had been developed from Nola J.Pender, Health Promotion Model (revised). The Health Promotion Model (revised) deals how the individuals are motivated to engage in behaviors directed towards the enhancement of health. The components of the HPM (revised) include,

  • Individual characteristics and experiences
  • Behavior – specific cognitions and affect
  • Behavior outcome

Health promotion is defined as “behavior motivated by the desire to increase well-being and actualize human health potential. Predicting factors are prior related behavior, personal factor, biological, psychological and sociocultural factors. Influencing factors are perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity related affect, interpersonal influences and situational influences. Competing factors are immediate competing demand and preferences. Factor favoring action is commitment to a plan of action which ultimately leading to health promoting behavior.

This model is useful in assessing knowledge and attitude, which favours the health promoting action- the HIV screening. In our nation, HIV screening is made mandatory, but the willingness to take up the action among the pregnant women is what assessed using this conceptual framework. Health teaching could be initiated in order to remove ignorance and misconceptions about HIV screening.

The first component dealt is individual characteristics and experiences. This component is very unique to each person and is divided into prior related behavior and personal factors. Prior related behavior is more of predictive of future action or behavior and is linked to gathered information about HIV screening, taken HIV screening prior to marriage, Initiated HIV screening of the partner before marriage. Personal factors are those that are unique and would influence behavior or action. It includes Age, Religion, Education. Biological factor is linked to sickness of the past. Psychological factor includes fear of HIV, while sociocultural factor include stigma.

In this study, the second component behavior specific cognitions and affect is influenced by perceived benefits of action such as early medical approach and early intervention to prevent mother to child transmission of HIV; Perceived barriers to action such as perceived no risk, social stigma and poor attitude regarding HIV screening. Perceived self-efficacy includes ability to take up HIV screening; Activity related affect includes result- oriented ambiguous feelings of uncertainity. Interpersonal influences include learning from others; situational influences such as public motivation to HIV screening and access to health care; Immediate competing demands include fear of needles and preferences include postponding HIV screening; commitment to a plan of action include initiation to take HIV screening by approaching health services at specific time and place.

In this study, the third component health promoting behavior is influenced by asking for HIV screening related information, taking up HIV screening, convincing spouse to take up HIV screening and propagating information regarding HIV screening to others.


































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What are examples of integrated teaching and learning between or among disciplines?

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What are examples of integrated teaching and learning between or among disciplines?

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A software company has a high turnover rate. What staffing strategy would be most appropriate? HRMD 630 – Mid-Term Exam

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A software company has a high turnover rate. What staffing strategy would be most appropriate?
HRMD 630 – Mid-Term Exam

This is an open book exam that must be completed as an individual assignment. There are 20 multiple-choice questions (1.5 points each = 30 points), 5 short-answer (5 points each = 25 points), and 3 essay questions (15 points each = 45 points).

Please submit your test paper through the Assignment module.

Due date: July 2, 2017 at 11:30 pm

Multiple Choice Questions

Prepare an answer sheet with numbers 1 – 20. Place the letter of the correct answer next to the number of the corresponding item. You may choose only one answer for each item.

Each question is worth 1½ points.

A software company has a high turnover rate. What staffing strategy would be most appropriate?
A) hiring people with the potential to be promoted over a period of years
B) hiring people quickly even if their skills are not as high as required
C) slowing down the hiring process to try to find better recruits
D) filling vacancies quickly with people who are able to perform with minimal job training

An FTE is defined as:
A) a full-time equivalent employee
B) an independent contractor working at least 36 hours per week
C) an applicant that is searching for work on a full time basis
D) a plan for recruiting full-time workers

Janson Engineering has found it difficult to recruit experienced project managers to lead its many projects. Which of the following would be a proactive action that may help close current and future gaps?
A) adjusting the mix of employees versus contractors
B) working with local universities and colleges to create courses that focus on project management skills
C) source candidates from similar industries with project management skills
D) all of the above
E) A & B only

4.) Which of the following is not a step in workforce planning?
A) look at internal and external factors to estimate job demand
B) calculate the replacement need
C) look to the future for redundancies
D) conduct a strategy meeting to analyze selection methods
E) all of the above are steps in workforce planning

5.) Employment-at-will is an employment relationship which ________.
A) allows either the employee or employer to terminate the employment at any time
B) offers blanket protection to employers for all employee discharges
C) allows an employer to terminate employment only for a just cause
D) offers employees a contract for a definite term of employment

6.) Which of the following examples would qualify the company to hire the intern as an unpaid employee?
A) a local college engineering student is hired to help with filing and data entry for a small engineering firm.
B) an accounting student is given an opportunity to shadow one of your company’s accounting employee’s prior to starting work with the company in the fall.
C) the local university has an internship requirement for their Computer Science majors. The internship is for six weeks and the student must report weekly to their advisor to review their progress.
D) your organization is hiring college students whose parents work at the company for the summer.

7.) Which of the following is the first step in the typical workforce planning process?
A) identifying the firm’s business strategy
B) articulating the firm’s strategic staffing decisions
C) developing and implementing action plans
D) conducting a workforce analysis

8.) The job analysis technique that uses worker oriented job elements is the ________.
A) task inventory method
B) job elements method
C) position analysis questionnaire
D) structured interview method

9.) In analyzing a job of a stenographer that is to be advertised as a vacancy, an employer found that the ________ for the job was rapid typing skills.
A) bona fide occupational qualification
B) employee value proposition
C) desirable criteria
D) essential function

Advanced Pathophysiology Across Lifespan

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Advanced Pathophysiology Across Lifespan

Advanced Pathophysiology Across Lifespan

Question 1.

A community health nurse practitioner is teaching a group of female high school students about the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that which of the following items underlies the rationale for this teaching?

The active substitution of normal cells in the cervix correlates to cancer risk.

Undifferentiated stem cells are an early indicator of cervical cancer.

Cancer of the uterine cervix develops incrementally at a cellular level.

Dysplasia in the connective tissue of the cervix is a strong precursor to cancer.

Question 2.

A patient who has a diagnosis of lung cancer is scheduled to begin radiation treatment. The NP providing pretreatment education is explaining some of the potential unwanted effects of the treatment. Which of the following statements by the nurse is most accurate?

“Some patients experience longer-term irritation of skin adjacent to the treatment site.”

“Sometimes you might find that your blood takes longer to clot than normal.”

“The changes that you might see are normally irreversible.”

“The unwanted effects will be limited to the exposed portions of your skin.”

Question 3.

Which of the following patients of a primary care nurse practitioner would not require extra screening for cancer?

A 51-year-old woman whose grandmother died of breast cancer

A 48-year-old man who takes immunosuppressant drugs following a kidney transplant

A 50-year-old male who is obese and has a low-fiber, high-fat diet

A 38-year-old female with Down syndrome and congenital scoliosis

Question 4.

A nurse practitioner is educating a patient with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the cell in order to provide energy for the patient. The nurse practitioner knows that which of the following processes allows glucose to enter body cells

Osmosis

Facilitated diffusion

Active transport

Diffusion

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Reflective Analysis of Viva Voce

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Introduction

Viva voce and a reflection, both a requirement for successful completion of the course. For somebody not used to this form of assessment process, it is just but normal to ask oneself what? , why? and how?. Although a brief and complete orientation, description and information was provided in the early part of the curriculum, it is only in the end that I have fully understand its significance to my learning. Through the viva voce and a reflective writing that I was able to evaluate myself in terms of what I have learned? (Knowledge), what I can do? (Skills gained), and what I have become? (Attitude)… A competent practitioner. A highlight that I have to address in the Intensive Care Course. For it is in a reflective practise that we gain new understanding and appreciation (Mann et al. 2009).


Description

This is a reflective piece about my viva voce that revolves around my care of a 73 year old male referred to as Mr X, 6 hours post Coronary Artery Bypass Graft. As he became hemodynamically compromised, I have discussed Mr. X’s assessment in relation to a normal physiological compensatory mechanism involve and the care given.

Review of Mr. X history sheet and assessment details found in appendix 1, was suggestive of hypovolemic shock as further supported by his clinical symptoms. Clinically, it can be classified as mild, moderate or severe (Kelly, 2005).

This leads to organ hypoperfusion characterized by tachycardia, hypotension, oliguria, decrease cardiac output and high Systemic Vascular Resistance (SVR) as a result of hypovolaemia. It can be due to excessive fluid loss such as haemorrhage, vomiting, diarrhoea, burns or inadequate fluid intake (Adam and Osborne, 2005).


Strengths and Areas for Development

Stress and anxiety, is always a major predicament that I had been most worried about. I have tried to alleviate this from reading, rehearsing and any other form of preparation needed one would have conceived about. In the end, the anticipation that your next, was the most gruelling.

I believe, I was in its entirety at best well prepared, organized and chronological in my presentation of points and information with some hiccups along the way but acceptable although can be overall improve given the situation.

Upon presentation of Mr. X’s assessment details and laboratory result, and concluded hypovolaemia as a cause of haemodynamic compromise based on supporting evidences, I, at some point, preceded in the discussion of physiological responses as a result of decrease in cardiac output. This is due to decrease in circulating blood volume. His Haemoglobin level was acceptable and there is no signs of active bleeding. During my discussion, I have mentioned about how low circulating blood volume results in decrease End Diastolic Volume (EDV). This stimulates the baroreceptors located at the aortic arch and carotid sinuses to send signal to the medullary centre of the brain which in turn causes the release of adrenalin and noradrenalin by the action of the adrenal medulla (Jevon and Evens, 2008). This supported why Mr. X is tachycardic.

The human body compensates in various ways through the involvement of different organ system working together to establish haemostasis. In renal response I have mentioned the involvement of the Renin Angiotensin Aldosterone System. Not to be exhaustive with information, this involves the release of renin through the action of the juxtaglomerular cells stimulated because of decrease renal blood flow , which in turn is converted to angiotensin 1 by angiotensinogen. Angiotensin 1 is then transformed by the Angiotensin Converting Enzyme (ACE) predominantly found in the lungs to Angiotensin II, a potent vasoconstrictor. Furthermore, the release of aldosterone from the adrenal cortex causes increase in renal sodium and water retention. A surge in osmolarity in the blood stimulates the release of Antidiuretic hormone (ADH) or vasopressin from the posterior pituitary gland. This results in the reabsorption of solute free water in the distal tubules and collecting system of the kidneys and further stimulates peripheral vasoconstriction (McGloin and McLeod, 2010). With the reabsorption of sodium and water, coupled with vasoconstriction the circulating blood volume is improved thus, result in the increase in the end diastolic volume. This improves muscle contraction of the heart and overall the cardiac output. Hence Mr. X low urine output.

Although I felt satisfied about my presentation of cardiac and renal responses to a decrease in cardiac output, my explanation in regards to metabolic acidosis more specifically in the aspect of cellular anaerobic metabolism was somehow lacking in its content.

Glucose being a major carbohydrate, is a fuel used by cells in our body. Its metabolism travels through a pathway called glycolysis with the end product referred to as pyruvate, a three carbon acid. Inside the cell with mitochondria and oxidative metabolism, this is converted completely into Co2 and water known as aerobic glycolysis (Baynes, n.d.). In contrary, lactic acid is the end product of anaerobic breakdown of glucose in the tissues during persistent oxygen deprivation secondary to an insult caused by decrease circulating blood volume, and owerwhelming of the bodies buffering abilities (Gunnerson et. al. 2013). These explains why Mr. X lactate shows an increasing pattern with a base excess noted at – 5.9.

Familiarity and consistency in my opinion is my area of development. I need to continually update myself with the ever changing needs of the client more so, of the profession. This includes current research based guidelines and policies. From reading books, journals, articles, new discoveries or trends in the field of critical care. More importantly, to continue to look after haemodynamically compromised patients to help facilitate maintain and improve a level of my competency and skills in Intensive care nursing.


Implication for Practice

With the knowledge and skills that I have gained from the viva voce and looking after clients with haemodynamic instability, supported with theory during lectures and mentoring, I am better able to understand what is happening inside the body as is tries to compensates to maintain haemostasis. More importantly, act upon the needs of the patient, and anticipates interventions with rationales for doing so. With the knowledge and skills that I will be bringing back to the unit, I will be able to help enhance the standard of care through mentorship.


References

Adam, S. K. and Osbourne, S. (2005) Critical Care Nursing: Science and Practice. Second Edition. Oxford: Oxford University Press.

Baynes, J. W. (n.d.) Anaerobic Metabolism of Glucose in the Red Blood Cells [online] Available from:

http://molar.crb.ucp.pt/cursos/1º e 2º Ciclos – Lics e Lics com Mests/MD/1ºANO/2ºSEM/12-UBA5/TPs/TP1/Baynes Cap11- Metabolismo da Glucose.pdf

[Accessed12/12/13]

Jevon, P. and Ewens, B. (2008) Monitoring of the Critically Ill Patient. Second Edition. Oxford: Blackwell Publishing

Kelly, D. M. (2005) Critical Care Nursing. Volume 28, no. 1 pp 2-19. Lippincott. Williams and Williams, inc.

Gunnerson, K et al. (2013) Lactic Acidosis[online] Available from:

http://emedicine.medscape.com/article/167027-overview

[Accessed12/12/13]

Mann, K., Gordon, J. & MacLeod, A. (2009) Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Practice, 14(4), 595-621. doi: 10.1007/s10459-007-9090-2

McGloin, S. and McLeod, A. (2010) Advance Practice in Critical Care – A Case Study Approach. Oxford. Blackwell Publishing


Appendix 1

On the start of the shift , received a patient in ITU who is 73 years of age, now 6 hours post CABG. He has been weaned off sedation and now ready for extubation. Pre operatively his echo showed good LV. Upon review of his chart showed a blood pressure of 140/60 mmhg. Now fully awake, proceeded with extubation at 20:30. His risk factors are; prev. MI, HTN, DM type 2, high Cholesterol, smoker and TIA x2. At 22:00 his assessment findings are:

HR 110- 120 bpm

BP 85/55 mmhg

MAP 55-60 mmhg

CVP 2

Temp. 36.5

Urine output 25mls/ hr ( Weighs 85kg)

GCS : E4V4M6

Mediatinal drain 25mls –serosanguineous

Bloods:

K+ 4.9 mmol/L

Na 143 mmol/L

Urea 8 mmol/L

Creatinine 80 umol/L

Hb. 9.0 g/L

Hct 35%

WBC 8.4 k/ul

ABG’s

pH 7.29

pCO2 5.54 kPa

pO2 18.4 kPa

HCO3 19.4 mmol/L

BE -5.9 mmol/L

Lactate 1.9 mmol/L

He is on maintenance fluids of 85ml/hour 5% Dextrose, 2L of geloplasma cautiously given against CVP and eventually started on Noradrenaline to achieve a MAP of 70mmhg.