Life Goals Essays - Computer Literacy, Digital Divide, Literacy

Life Goals My future long-term career goal is to become a part of the governments defense counsel, either by becoming a legal secretary or an attorney. I would need to attend college, pass the bar exam and become board certified in order to become an attorney. In reference to becoming a legal secretary I believe I've developed those skills through several years of hard work, and I feel I've gained enough experience to pursue this field. I believe I will be successful in becoming an attorney. I am determined to finish high school with the academic excellence required to obtain a good professional direction in the law field. I have several years of expierence in Law, Speech, Acting, and Debate. These qualities will help me to pursue questioning, and feel comfortable in the courtroom. It was difficult to find information on my career goal. I found several job opportunities, but I could not find information on the academic requirements needed to attend a 4 star law school on the internet. I had to research my information through word of mouth, and the results I received from the "job search" worksheet we did gave me a lot of needed information. My current job skills relate to my future career goals in several ways. My knowledge of computers are very useful in todays society. I am experienced in several aspects of the computer. I am literate of several computer programs such as Peachtree Accounting, Microsoft Word and Works, and Power point among several others. I have several years of experience with the internet. I took 4 years of computer classes, and I've built my own web-site. Furthermore, I consider myself very computer literate, and in todays career fields literacy is required, and a fast typing speed is encouraged. Communication and social skills are very important when dealing with customers. The happiness and satisfaction of the customer is what companies thrive their business on in order to profit, and keep up with supply and demand. Maintaining a professional attitude is very I, important when dealing with clients. Whether the client is happy or night, the needs of the customer are the most important. In High School I took several communications classes. My favorite was Law class. We had Mock-Trials, which was role playing for the students in order to get the feel of a real courtroom. I received an A in Law Class. I took Speech, Acting, Children's Theatre, Drama. I worked for a large insurance company that dealt with insurance claims, and I was surrounded by lawyers. I learned the basics of handling insurance claims, but I'd still like to be on the defense counsel. Job Comparisons "Large Downtown Firm" My current job skills relate to my future career goals in several ways. My knowledge of computers are very useful in todays society. I am experienced in several aspects of the computer.

buy custom Characteristics of the U.S. Health Care System essay

buy custom Characteristics of the U.S. Health Care System essay Both health care delivery and health services refer to the act of providing health care services to the affected citizens. The United States being one of the developed countries has a unique system, whereby they have national health insurance programs chaired by the government and financed by the general taxes collected. Each citizen to receive health care services what is referred to as the universal access but not routine basic health care services. On the other hand though the county has evolved in terms of cost it has not been able to provide these services at an affordable cost. External factors such as political climate, level of economic development, technological advances, social cultural values, physical environment, demographic factors, and the shape which the health has been taking for the last previous years. Characteristics of the U.S. health care system No central governing agency and little integration and coordination The U.S. system lack centrally controlled having variety of payments, insurance, and delivery of health care is financed both privately which predominantly hold much of the country employment with the larger percentage of 55% leaving the rest 45% to the public. Technology-driven delivery system focusing an acute care Growth of science and technology make patients assume that the best has best care and the p Factors which have served to shape the U.S. Health Care System physicians want to try the latest gadgets. Also hospitals compete for the latest modern equipment which are more expensive and consequently lead to high cost in providing the health care services. Workers lack over time extension on insurance, forcing the insurance companies to lower their premiums. Due to the limited resources to invest in the health sectors before investing in high technology should be evaluated. The investment should be done in both low and high technological meicine. High cost, unequal in access, average in outcome. More than any developed country U.S. spend so much on health care ( 13%) of the nations gross domestic products but population do not get access to the health care services. One has to have health insurance through their employers, covered by under a government health care program, can afford to buy insurance with their finances, and is able to pay their bills privately. If one is not able to meet any of the above conditions waits until the condition gets worse where one can get treatment free in hospital emergency department. Delivery of health care under imperfect market condition In the United States provision of health care services do not meet basis of a free market where buyers (patients) and sellers (providers) act independently. Patients should be able to choose their providers based on the quality of the services they offer. There must be also competition in the provision of the health services but since the power of health sector is the hands of the private hands they try to maximize profits rather than the provision of the good health care services. Patients should be aware of the costs which will be incurred in their treatment ahead of time, if this is not disclosed patients are not aware of the costs to be incurred leading to poor budgeting. Legal risks influence practice behaviors In the United States unlike other developed countries health care services are dominated private sectors. This reliance of individual of individual limits the power to the national government and the only role left to it is just filling the gaps which have been left by the private investors. This could be issues such as environmental protections care for the poor citizens, support in training and research. Market justice vs. Social justice: conflict throughout health care Market justice places the responsibility for the fair distribution of health care on the market forces in a free economy where medical care is provided on willingness and the ability to pay by the people. On the other hand, social justice is concern with the well-being of the society other than that of individual hence failure to get treatment for lack of resources is unjust. Distribution of the resources should always be based on the need other than the ability to buy them in the market. Market justice consequently should be based to unequal allocation of the health care services, leaving out the critical humans. Multiple players and balances of power In the many players; physicians, administrators of health, service institutions, insurance, large companies, large employers and the government. Among all these players each has got its own self-interests which are often not in line bringing conflict in the system. Its only advantage is that these players protect any of the above to dominate the system. Quest for integration and accountability Today, in the United States there has been the call for organizing the switch to continuous and coordinated health services which review the patient-provider relationship and how health of each individual can be improved strengthening the entire population. It have gained its popularity through the expansion of well managed care but slowed down before reaching its full purpose. Conclusion As some of the characteristics of the health care services in the United States, has led to the system being unsuitable to some citizens and some making the system look bearable to even the less fortunate citizens. In comparison to other developed countries, the United States is lagging behind since it has been left to the hands of private sectors that are most centered in maximizing of profits other than provision of better and affordable services. 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Head-to-Toe Assessment Complete 12-Step Checklist

Head-to-Toe Assessment Complete 12-Step Checklist SAT / ACT Prep Online Guides and Tips Need some info on conducting a head-to-toe assessment? Whether you are just looking for a quick head-to-toe assessment cheat sheet or a total guide to conducting a nursing head-to-toe assessment in a clinical setting, we’ve got you covered! We’ll start with a brief overview of the assessment process, then a quick head-to-toe assessment checklist. After that, we’ll do a deep dive on all the assessment steps, and wrap up with some example videos. What Is a Head-to-Toe Assessment? A head-to-toe nursing assessment is a comprehensive process that reviews the health of all major body systems (from â€Å"head-to-toe,† hence the name). head-to-toe assessments are usually performed by nurses as part of a physical exam, although physician assistants, EMTs, and doctors also sometimes perform head-to-toe assessments. Nurses and other clinicians may not perform a head-to-toe physical assessment for every single patient, depending on the setting they work in. They are typically a key part of primary care visits and annual physicals, but less common when the patient presents with a specific complaint or issue. Quick Head-to-Toe Assessment Checklist In case you’re just looking for a head-to-toe assessment cheat sheet, we’ve created a brief list here of the major things to check for. You can click on each of the body systems to be taken to a more in-depth description with instructions for that part of the head-to-toe assessment. Or maybe you’re looking for a nursing head-to-toe assessment form that you can print out and write on? We have that, too! Just click on this link for a PDF: Head-to-Toe Assessment Checklist Note that different health systems (or professors, if you’re a nursing student!) may have slightly different expectations for all of the specific tests you will perform as part of the head-to-toe assessment. While the below nursing head-to-toe assessment cheat sheet can function as a guide, be sure to comply with the specifications of your place of work or school. Also note that assessments for different sub-populations (like a pediatric head-to-toe assessment) may have different procedures. This is a general adult nursing head-to-toe assessment guide. So this is not a guide to head-to-toe assessment for cats and dogs. Assessment Tools Penlight BP cuff Thermometer Tongue depressor Stethoscope Sterile sharp object (like toothpick or pin) Sterile soft object (like cotton ball) Something for patient to smell (could be an alcohol swab) Vital Signs, Stats, and Neurological Indicators Oriented x 3 Assess temperature Measure blood pressure Assess heart rate Assess respiratory rate Height and weight Head/Face Check distribution and condition of hair Check scalp for bumps, nits, lesions, etc Palpate skull for tenderness Check for symmetrical facial movements Assess sharp and dull sensation on face Eyes Assess symmetry Eyebrow and eyelash distribution Check state of conjunctiva Check sclera Assess state of patient’s cornea PERRLA Check the six cardinal positions of the gaze Assess patient vision with Snellen Charts Ears Inspect and palpate auricle for lesions, tenderness Look inside ear; assess ear discharge and tympanic membrane Tuning fork tests (Weber’s Test, Rinne Test) Assess patient hearing with whisper test Nose Palpate nose and assess symmetry Check septum Check inside nostrils Verify that patient can breathe through each nostril Verify patient sense of smell is intact Palpate sinuses Mouth and Throat Moistness and color of lips Inspect teeth and gums Assess buccal mucosa and palate Examine tongue Look at uvula Look at tonsils Palpate jaw joint Neck and Shoulders Check neck range of motion Check shoulder shrug with resistance Palpate lymph nodes of the head, face, and neck (and under the arms) Palpate neck and trachea Check for JVD Lungs and Thorax Listen to lung sounds front and back Assess respiratory exclusion level Palpate thorax Assess spinal curvature Ask about coughing, respiratory issues Circulatory System Palpate carotid and temporal artery bilaterally Listen to heartbeat and heart valves Gastrointestinal System Inspect abdomen Listen to four quadrants of abdomen for bowel sounds Palpate four quadrants of abdomen for pain/tenderness Ask about problems with bowel or bladder Arms and Hands Assess range of motion and strength in arms/hands Check all pulses in arms Cap refill test on fingernails Check skin turgor Assess sharp and dull sensation on arms Legs and Feet Assess range of motion and strength in legs and ankles Check cap refill on toenails Check pulses of legs and feet Assess sharp and dull sensation on legs Assess gait Genitourinary Exam Check pubic hair for lice and nits Check for tenderness, lumps, lesions Breast Exam Palpate breasts Let's get started! In-Depth Guide to Conducting a Head-to-Toe Assessment Here’s our in-depth guide to conducting a head-to-toe assessment, complete with explanations and linked videos. We’ll start with some general principles to keep in mind throughout the assessment and then move on to a more detailed look at each of the tasks you’ll need to complete for each area/system of the body. 4 General Principles for Head-to-Toe Nursing Assessments Here are four general principles to keep in mind as you conduct your head-to-toe assessment. #1: Documentation Is Important Remember that head-to-toe assessment documentation is a critical part of the process. If you don’t write down your findings, how will you remember them all to translate patient needs into a comprehensive care plan? Many people use nursing head-to-toe checklists or forms to make sure they remember everything and to document patient results. #2: Communicate Throughout Be sure to communicate clearly with your patient throughout the assessment. Always ask before you start touching the patient, and explain what you are doing as you do it. Additionally, ask patient about how they have been feeling. They are the expert on their own body! #3: Keep an Eye on Bilateral Symmetry The human body is, in general, bilaterally symmetrical (i.e., the left side is the same as the right side). When you are examining a patient, make note of any unusual asymmetry. If a patient is weaker on one side than another, or has limited range of motion, or one side seems limper or otherwise different from the other side, there could be an underlying neurological or musculoskeletal issue. #4: Assess Skin Throughout The skin is a great barometer of overall wellness. Note if patient’s skin seems unusually pale, flushed, cold, hot, clammy, or dry anywhere throughout the exam. Also not any lesions, abrasions, or rashes. You might not have a barometer, but you definitely have skin. Step 1: Check Vital Signs and Neurological Indicators The first things you'll want to check are patient vital signs and overall neurological status. Oriented x 3 Is patient alert and responsive? Ask if they can tell you their name, if they know where they are, and what day it is. If yes, patient is â€Å"alert and oriented x 3.† Assess Temperature Take patient temperature and assess whether it is in the normal range. Record whether the temperature was taken orally, rectally, in the ear, at the forehead, or in the armpit as these methods have differing accuracy levels. Measure Blood Pressure In professional settings, you may have an automatic blood pressure cuff or you may need to take blood pressure manually. (As a student you’ll likely need to demonstrate that you can take blood pressure manually). To measure blood pressure manually: First find the brachial pulse, on the inside of the patient’s elbow. Tightly secure the cuff about one inch above the elbow bend (you should be able to fit about two fingers between the cuff and the patient’s arm). Place your stethoscope (diaphragm or bell) over the pulse. Verify that you can hear the brachial pulse. Inflate the cuff until the gauge reads at about 180 mmHg. You should no longer hear the brachial pulse through the stethoscope. Allow the cuff to deflate gradually. The systolic BP is the measurement of the gauge the moment you hear the brachial pulse again. The diastolic BP is the measuring of the gauge when you stop hearing that pulse. Here’s an in-depth guide to taking manual blood pressure with a video. (There’s a briefer video with all the vital signs below). Assess Heart Rate When you measure the heart rate, you’ll count the beats per minute over a patient pulse point with two fingers (not the thumb, which has its own pulse and can mess up the reading). You’ll usually assess at the radial pulse (wrist) or the carotid pulse (neck). Normal adult BPM is about 60-100, although athletes can have lower heart rates. In a patient with a regular heartbeat, you can take the pulse for 30 seconds and just multiple by two, but if the beat seems irregular, go for at least a full minute. Assess Respiratory Rate Respiratory rate is the number of breaths per minute, which you can tell from the rise and fall of the patient’s chest. If you tell a patient you are assessing their breathing, they may actually change their breath rate, so it’s best to assess this surreptitiously after you take the pulse rate. 12 to 20 breaths per minute is the normal adult range. Here’s a quick video guide to checking all the vital signs. This video includes oxygen saturation, which you may or may not need to assess. Height and Weight You may also take patient’s height and weight as part of a head-to-toe assessment. Sadly, "number of puppies seen recently" is not a vital sign. Step 2: Examine Head and Face These steps will have you check the overall condition of the head and face. Subsequent sections will be devoted to the eyes, nose, mouth, and ears. Check Distribution and Condition of Hair Is hair healthy? Evenly distributed? Is it thinning in places? Note any abnormalities, like unusual brittleness or uneven thinning. Check Scalp for Bumps, Nits, Lesions, Etc. Part hair in several places on the scalp to check for bumps, sores, or scabs on the skin. Assess dryness and dandruff. Also check if there are lice or nits present in the hair. Palpate Skull for Tenderness Palpate the skull to determine if there are any tender or sore areas. Check for Symmetrical Facial Movements Have patient smile, frown, raise eyebrows, and puff out cheeks. If patient can move face at will, movements are symmetrical, and there are no involuntary movement, cranial nerve VII is intact. Assess Sharp and Dull Sensation on Face This test assesses the state of cranial nerve V. Hold a sterile, sharp object (like a needle or pin) in one hand and a soft item (like a cotton ball or q-tip) in the other. Ask patient to close eyes and identify whether the sensation they are feeling is sharp or dull. Gently touch the patient’s face in different places with the sharp item or the dull item, varying the order. His head doesn't look so good to me. Step 3: Inspect Eyes When checking patient eyes, you'll assess both patient vision and the health of the eye tissues like the conjunctiva, sclera, and cornea. Assess Symmetry Verify that eyes are symmetrical, that the palpebral fissures are equal and there is no ptosis. Have patient blink; make sure that eyes close completely Eyebrow and Eyelash Distribution Assess state of eyelashes and eyebrows; should be symmetrical and evenly distributed. Check State of Conjunctiva You can assess the conjunctiva by gently applying downward pressure to the skin below the patient’s eyes. Conjunctiva should be pinkish and free of lesions. Unusually pale conjunctiva can be a sign of anemia, and inflammation or infection can cause red conjunctiva. Check Sclera Gently hold patient lids open and examine whites of the patient’s eyes (can be done simultaneously while assessing conjunctiva). They should be white in color with some capillaries visible. There may be some spots of pigmentation but there should not be lesions or yellowness. Assess State of Patient’s Corneas You can examine the cornea by shining your penlight indirectly across the patient’s eye (so not directly into their eyes but shining from the side). This will illuminate the cornea, which should be smooth and clear. The features of the iris should be clearly visible through the cornea. Additionally, patient should blink when cornea is touched gently with something sterile (the corneal reflex). PERRLA PERRLA is an acronym that means that pupils are equal, round, reactive to light and accommodation. This can be tested with a penlight and assesses the state of cranial nerves II and III. You should first look at the pupils to ensure that they are round and equal in size (PER). To check that they are reactive to light, dim the room and move the penlight back and forth between the eyes. Both pupils should constrict equally in response to the light (direct and consensual response). To check that they accommodate, move your finger (or the penlight) slowly closer to the patient’s face. The patient’s pupils should constrict as the object comes closer. Here is a how-to video for checking PERRLA. Check Six Cardinal Positions of the Gaze Hold your penlight or finger about one foot in front of patient’s face. Ask them to follow the movements of your penlight or finger with their eyes only (without moving the head/neck). Move the penlight or finger out to the six cardinal positions of the gaze, moving back into the center before proceeding to the next one (like you are drawing out a compass rose). The patient should be able to hold their gaze at each of the six cardinal positions without any jerking (nystagmus). This test assesses the health of cranial nerves III, IV, and VI. Assess Patient Vision with Snellen Chart Ask patient to stand the appropriate distance away from the Snellen Chart. (Distance from a standard chart is 20 feet, but your health care setting may use a special chart where the patient should stand a different distance away.) Have them first cover one eye and read the smallest row of letters that they can. Have them repeat with the other eye. If the patient wears glasses or contacts, test both with and without vision correction so you can assess the adequacy of the vision correction. Here’s some info on interpreting Snellen Chart results. If the eyes are the window to the soul, you'll be seeing a lot of souls. Step 4: Evaluate Ears As with the eyes, you'll assess both the health of the ear tissue and sensing function (i.e. hearing). Inspect and Palpate Auricle for Lesions, Tenderness Skin of the auricle (and behind) should be intact. Cartilage should be firm with no tenderness on palpation. Auricles should be roughly symmetrical. Look Inside Ear; Assess Ear Discharge and Tympanic Membrane Pull the pinna/auricle upwards and backwards to straighten the ear canal and examine the tympanic membrane in adults (pull down and back in children). Some yellow or brown cerumen (earwax) is normal. Tympanic membrane (eardrum) should be a translucent pearly gray color; note abnormal color or rupture. [picture of tympanic membrane from wikimedia commons] Tuning Fork Tests (Weber’s Test, Rinne Test) The Weber and Rinne tests both check for different kinds of hearing loss. For the Weber test, strike the tuning fork and then place the base of the fork on the center of the patient’s forehead. Sounds should be equal in both ears. If sound is stronger in one ear or the other, indicates possible hearing loss. For the Rinne test, strike the tuning fork and place the base against the mastoid process. Start a stopwatch. Tell the patient to tell you when they stop hearing the sound of the tuning fork. When they stop hearing the sound, move the tuning fork so the forks are in front of the ear (and note the time on your stopwatch). Tell them to tell you when they stop hearing the sound again. Patient should hear the sound of the tuning fork through the air (in front of the air) 2x longer than through the bone. Repeat on the other ear. Assess Patient Hearing with Whisper Test Stand next to and a little behind patient (about 2 feet away) so they cannot read your lips. Ask patient to cover opposite ear. Whisper a two-three syllable word and ask patient to repeat it back to you. Repeat with the other ear (and a different word!) Are you ready to get out your trusty tuning fork? Step 5: Check Nose You'll be checking the nose both externally and internally. Palpate Nose and Assess Symmetry Gently palpate nose for any tenderness. Make sure nose is in midline and symmetrical. Excessive flaring of the nostrils may indicate respiratory distress. Check Septum Use penlight to illuminate septum to check that it is midline and not perforated. Check Inside Nostrils Shine penlight in each nostril. Check that membranes are pink and that there is no discharge or lesions. Turbinates should not be swollen. Verify Patency of Nares Have patient close one nostril with fingertip and breathe in and out through that nostril. Repeat with other nostril. If patient cannot exhale through each naris, the nasal passage is occluded. Verify Patient Sense of Smell is Intact Ask patient to close eyes. Hold easily scented item (like coffee beans, cinnamon, or even an alcohol-soaked cotton ball) under the nose and ask patient to identify scent. Palpate Sinuses Gently palpate patient frontal and maxillary sinuses. Frontal sinuses are palpable over patient eyebrows. Maxillary sinuses are palpable on the cheek just outside the nares. Patient should not feel tenderness to pressure. "Ma'am, I'm going to have to ask you to remove your fingers from your nose so I can examine it properly." Step 6: Probe Mouth and Throat Again, like the nose, you'll assess the health of the mouth and throat both externally and by looking inside. Moistness and Color of Lips Lips should be colorful, pinkish, roughly symmetrical, and free of lesions. Very cracked or chapped lips could be a symptom of a number of issues, from dehydration to wind exposure to autoimmune conditions. Inspect Teeth and Gums Assess patient teeth for number (28 in children, 32 in adults), color, and alignment. Note any cavities or chips. Assess gums for bleeding, puffiness, or retraction (the pulling of the gum away from the tooth, which can give teeth an â€Å"elongated† appearance). Also note presence of halitosis; gum disease and oral infection are some of the most common causes of bad breath. Assess Buccal Mucosa and Palate The membranes of the mouth and cheek should be pink, moist, and free of lesions. Examine Tongue Tongue should be midline, pink with white taste buds, and free of lesions. Patient should be able to move tongue without difficulty. Look at Uvula Patient uvula should be in the midline, pink or reddish in color, and free of swelling or lesions. When the patients says â€Å"ah,† uvula should move forward and up. (This tests cranial nerve X.) Look at Tonsils Depress tongue to inspect tonsils for inflammation, infection, swelling and tonsil stones. Infected tonsils are often red and puffy with white or yellow patches. Palpate Jaw Joint Palpate the jaw joint (the temporomandibular joint) while patient’s mouth is closed, and then again while it is open. Patient should be able to open and close mouth without pain and there should be no pain on palpation. What plentiful mouths you have! Step 7: Examine Neck and Shoulders In the neck and shoulders, you'll primarily assess musculoskeletal function, but you'll also assess the lymph nodes and a few other things. Check Neck Range of Motion Ask patient to look up, down, left, and right to assess that they have full range of motion in the neck. Ask if there is any pain (should be painless). Check Shoulder Shrug with Resistance Ask patient to shrug shoulders. Movement should be symmetrical and painless. Then, place hands on shoulders and ask patient to shrug again. Apply resistance. Patient should still be able to shrug with about equal force on each side. Palpate Lymph Nodes of the Head, Face, and Neck (and Under the Arms) Using the first two or three fingers (using the flat pads as opposed to the fingertips), you’ll palpate the following lymph nodes by moving the skin over the area in a circular motion: the occipital, posterior auricular, pre-auricular, sub-mandibular, sub-mental, anterior cervical chain, posterior cervical chain, and the supraclavicular lymph nodes. You may also wish to palpate the axillary lymph nodes, under the arms. Here is a video of lymph node palpation. Observe/Palpate Trachea and Neck Palpate neck to feel for any lumps, deviations, or tenderness in the neck, especially the trachea area. You may also wish to palpate the thyroid, which requires a glass of water and can be done from the front (anterior approach) or behind (posterior approach). Check for JVD Jugular Venous Distension refers simply to an abnormally full or bulging jugular vein in the neck. It can be a sign of serious heart disease. To assess JVD, you’ll want to lay the patient down with the head of the hospital bed at a 45-degree angle. If you can see the bulging jugular vein in the side of the neck, the patient has JVD. Here’s a video so you can see what JVD looks like and how it is diagnosed. It would take a long time to palpate a giraffe neck. Step 8: Assess Lungs and Thorax When examining the chest area, you'll primarily be assessing respiratory function. Listen to Lung Sounds Front and Back You’ll be listening to the lungs up and down each lung, front and back, with your stethoscope to assess for any irregular breathing sounds. Here’s an in-depth video guide to lung auscultation as well as a guide to regular and irregular lung sounds. Assess Respiratory Expansion Level To assess respiratory expansion, place your hands on the patient’s mid-back with thumbs at midline. Ask them to take a deep breath. Both sides of the chest should expand equally with breath. Palpate thorax Palpate the thorax for any areas of tenderness, lumps, asymmetry, lesions, etc. Assess Spinal Curvature Spine should appear vertical when viewed from the back (with no scoliosis). Should exhibit normal curvature from the side. Ask About Coughing, Respiratory Issues Ask patient if they are experiencing any coughing or other respiratory problems. If they are coughing, is it a dry cough or a wet cough? Lungs or alien heads? You decide! Step 9: Check Circulatory System Function Assessing the circulatory system is something you'll actually be doing throughout the exam as you assess various pulses. but as you are assessing the chest, you'll want to examine the heart. Palpate the Carotid and Temporal Pulses Bilaterally Using index and middle fingers, feel the carotid pulse (at the side of the neck) and the temporal pulse (at the temple). Since you already checked pulse rate, you don’t need to listen for a whole minute; just verify that the pulse is palpable and regular in rhythm. Listen to Heartbeat and Heart Valves You’ll need to listen to the patient’s heart in four places with your stethoscope: the aortic valve, the pulmonic valve, the tricuspid valve, and the mitral valve. You’ll be listening for any irregularities in rhythm or irregular sounds during valve closures. Here’s an in-depth video describing how to find and listen to all of these valves, an overview of heart sounds, and a short video showing how to auscultate the heart if you just need a quick refresher. These hearts don't circulate blood very well. Step 9: Review Gastrointestinal System You'll assess the gastrointestinal system by examining the abdomen and asking the patient questions. Inspect Abdomen Inspect patient abdomen for any visible lumps, lesions, or distension or concavity. Listen to 4 Quadrants of Abdomen for Bowel Sounds Visually dividing the abdomen into four quadrants with the belly button as the midline, listen to bowel sounds in each quadrant. Judge if sounds are hypoactive, hyperactive, or absent. If you do hear sounds, you may only need to listen for several seconds in each quadrant. However, you should listen to each quadrant for five minutes before you determine that there are no bowel sounds. Here’s a video. Palpate 4 Quadrants of Abdomen for Pain/Tenderness After you listen to the sounds, palpate the four quadrants of the abdomen for any pain, tenderness, or lumps with your fingers. Here’s a video showing how to do it. Ask About Problems With Bowel or Bladder Ask patient when their last bowel movement was. Also ask if appetite, bowel movements, and urination have been normal. Aren't you glad that humans don't actually have transparent skin? Step 10: Inspect Arms and Hands In the extremities, you'll assess musculoskeletal function, sensory function, circulation, and tissue perfusion. Assess Range of Motion and Strength in Arms Have patient demonstrate range of motion in arms and hands. They should be able to roll shoulders, show flexion and extension of the elbow joint, circle the hands around the wrist joint, and demonstrate full flexion and extension of the wrist without pain. Also have patient squeeze push against your hands, pull your hands towards them, and squeeze your fingers to assess strength, which should be equal bilaterally. Here’s a video showing this process. Check All Pulses in Arms There are two major pulses in the arms: the radial pulse (at the wrist) and the brachial pulse (in the inner elbow). If you already checked the radial and brachial pulses while you were taking vitals, you can skip this step. It’s most important to check that the pulses are palpable and regular in rhythm. Cap Refill Test on Fingernails To check tissue perfusion, pinch one of the patient’s fingertips, applying pressure to the nail. When you release the fingertip, the nail bed should return to a normal color within 3 seconds. Check Skin Turgor On the back of the hand or forearm, pinch skin. It should immediately snap back to position upon release without â€Å"tenting† (remaining pinched upright). Tenting indicates dehydration or fluid volume deficit (link). However, note that this is not an effective test of skin turgor on elderly patients, as lower skin elasticity means their skin often tents regardless of their fluid levels! Assess Sharp and Dull Sensation on Arms Take your sterile, sharp object (like a needle or pin) in one hand and your soft item (like a cotton ball or q-tip) in the other. Ask patient to close eyes and identify whether the sensation they are feeling is sharp or dull. Gently touch the patient’s arms in different places with the sharp item or the dull item, varying the order. The hands are fine, but where's the rest of you? Step : Examine Legs and Feet You'll perform most of the same examinations on the lower extremities that you did on the upper extremities. Assess Range of Motion and Strength in Legs and Ankles You should test range of motion of the lower extremities with the patient lying down. Patient should be able to flex and extend the ankle joint, and circle the foot. Patient should also be able to bend the knee and then move leg outward (to test hip ROM) on each side. There should be no pain. To assess strength, patient should push against your hands on the top of their feet, push down against your hands on the bottom of your feet, and push up against your hand on their shin. Strength should be equal bilaterally. Here’s a video of these tests (she starts with strength and then tests ROM). Check Cap Refill on Toenails Perform the cap refill test on one of the patient’s toenails. After applying pressure, the patient’s nail bed should return to a normal color by 3 seconds. Check Pulses of Legs and Feet There are four major pulse points on the legs and feet: femoral (hip/groin), popliteal (behind knee), posterior tibial (ankle) and dorsalis pedis (top of foot). Palpate the pulses of the legs and feet with your middle two or three fingers (not the thumb, which has its own pulse!) As you’ve already taken the pulse rate at this point, it’s not necessarily the rate that’s critical here but the regularity and strength of the pulse. Pulse should be palpable and regular. Assess Sharp and Dull Sensation on Legs Repeat the sharp and dull sensation test on the patient’s legs. Take your sterile, sharp object and your soft item. Ask patient to close eyes and identify whether the sensation they are feeling is sharp or dull. Gently touch the patient’s legs in different places with the sharp item or the dull item, varying the order. Assess Gait Observe patient gait (can be done when patient gets up to complete Snellen chart). Should be symmetrical, regular, and balanced. I bet they have complete range of motion and strength in their lower extremities. Optional Step 1: Complete Genitourinary Exam You may not always perform a genitourinary exam as part of a head-to-toe assessment. However, if you do, here are the main things you’ll be checking for: Check Pubic Hair for Lice and Nits Assess for presence of lice or nits in pubic hair. Check for Tenderness, Lumps, Lesions Check for any unusual tenderness, lumps, or lesions on the external genitalia. For men, this will involve lightly palpating the penis and testicles. Optional Step 2: Perform Breast Exam You may or may not need to perform a breast exam in your head-to-toe assessment- sometimes it’s advised to only perform them on symptomatic men or older women. However, here’s an in-depth guide to palpating the breast and feeling for unusual lumps. I almost made a melon joke, but then I decided it was low-hanging fruit. Heads So you can get an idea of how the entire process plays out in real time (and also how it may vary from institution to institution), we’ve gathered a few videos that are useful head-to-toe assessment examples. If you’re looking for more examples, you can find lots of example videos of student assessments on Youtube (just type in â€Å"head-to-toe assessment nursing†). However, be aware that every student is going off of a different professor’s rubric, and not everything may be 100% correct! Student Head This example video shows a nursing student performing an efficient but thorough sample assessment. Florida State College at Jacksonville Student Example This head-to-toe assessment video shows a particularly detailed assessment procedure performed by a nursing student. This video is particularly helpful because the student clearly describes what each step indicates about body function. Capital Community College Assessment This head-to-toe nursing assessment video is useful because it presents the assessment in a realistic-seeming care setting with a patient who asks questions. It also shows the nurse asking questions about the patient’s life quality, and closely explaining every step of the assessment so that the patient knows what’s happening. We made it all the way from head to toe! Time for a nap. Review: Completing a Head-to-Toe Assessment In this guide to the head-to-toe physical assessment, we provided the resources you need to complete a comprehensive head-to-toe nursing assessment! We have a nursing head-to-toe assessment form for you to use as a guide as well as in-depth guidance to every step of the assessment process. We also included several head-to-toe assessment videos so you can see the whole process in action! What's Next? If you're looking for more information on clinical care, we have guides to making care plans for decreased cardiac output and fluid volume deficit. We have a complete list of ICD-10 codes for diabetes and for abdominal pain. Want more information about heart positioning? Or about blood pressure readings? We've got you covered. Considering going into healthcare administration instead? We have a list of the top programs and what degrees you'll need for which jobs in this article.

Managing through information (finance exam) Essay

Managing through information (finance exam) - Essay Example However, the major point of concern is the Gearing Ratio, which has dramatically increased from 0% to 36.1446% in a year due to the long-term loan, this increases the risk of investment, and in addition the Dividend Payout Ratio has also decreased from 40% to 21.28%, which is a bad signal for the shareholders. In 2008 no interest had to be paid, but in 2009 interest also needs to be paid from the reserves, thereby reducing reinvestment into the company. Johnsons Ltd. should focus upon clearing the debt as early as possible, and clarify to the investors that it is for the betterment of the company. Furthermore, it should try to reduce the gearing ratio by increasing ordinary shares, either through new issuance or issue of bonus shares. Financial ratios aid in analyzing, controlling and improving the performance of a company, it also helps in attaining loans from banks, it can provide sufficient information to analyze the liquidity and performance of the firm, and points out the areas requiring improvement. However, ratios have certain limitations as well, for larger companies it is difficult to make comparative analysis as it becomes extremely complicated, firms set their targets at average instead of following market leaders, hampering the efficiency of the company. The major drawback of ratio analysis is that it does not account for inflation and therefore can mislead the managers. Apart from inflation, seasonal variations can create distortions in the results as well, furthermore many valuations used in the ratios such as depreciations, inventory, bad debts etc are approximates and can thus affect the end result. The user of these ratios must know how to differentiate between wrong results and should be capable of adjusting to various situations (Besley and Brigham, 2008, 68). It is obvious from the calculations that none of the three proposals is good, since they give fewer profits than the current system, Proposal A

Injectronics Essay Example | Topics and Well Written Essays - 1500 words

Injectronics - Essay Example The initials IM stand for innovative mechatronics. This was the new name that was taken up since the year 2012. The merger involved four organizations namely RAE ignition and sensors, DAT equipment, Injectronics and MAP- mechatronic auto parts. Initially, Injectronics used to remanufacture and repair automotive products for resale. They then started manufacturing of automotive equipment and also embarked on extensive testing equipment to ensure they have the widest range of products in stock ready for sale. They were the first automotive company in the southern hemisphere to be given ISO 9001 accreditation. The IM group has lived up to the same expectations regardless of the mergers and still remains the only automotive organization in the southern hemisphere that is ISO certified. The remanufacturing process follows the step of a customer trading in already used automotive equipment or perhaps even a car. This equipment will be remanufactured and then the customer will be able to pu rchase the remanufactured equipment or new equipment depending on their choice. The MAP (mechatronic auto parts) is a new and exciting brand that was recently added to the IM group; it is aimed at providing unique and high quality automotive products to the southern hemisphere. ... These key rubbers usually do not have a replacement but the MAP products effectively do the trick. These products come with a duly explained replacement user manual thereby making it easy for the user to change. RAE ignition and sensors is another branch of the IM group, which deals with ignitions and sensors. They present different ignitions for various makes of vehicles in the industry, which are ISO certified. These are also replacements for defective or faulty ignitions and sensor systems. The Injectronics branch of IM group continues the initial trade of the original Injectronics. This is the initial business of buying of used automotive parts and selling of new automotive parts. DAT equipment is yet another branch of the IM group that deals with automobile diagnostics. Such equipment includes gadgets that show faults or confirm the state of vehicle parts and their efficiency. Equipments are electronically tested, with ignition spark tester being an excellent example. This elect rically checks for the ignition sparks performance. All the above products of the IM group have played a big role in finding the break -even point for the firm thereby making it continuously viable. The emergence of the above subsidiaries led to a lot of change in the market share for the firm; this played a big role in making top-level management to change the company name from Injectronics to the name Innovative mechatronics. The name innovative mechanics well suits the organization as it only deals with a very special niche in the automotive field. Not many automotive companies are exploiting the above niche, which is well favored by the Australian population. IM group however, also exports her products to other countries. This is also another avenue of

The World Of Hair :: essays research papers

In The World of Hair Throughout time, the world of hair, and now the well-known field of cosmetology have raisin and fell. I can remember the time when black women were wearing Afros and Caucasian women short cuts and now things have evolving into all these long flowing hairstyles and not to mention the current health these days on our hair. Seems like the days on juices and berries were hairs happiest time. Now going thur how we manage our hair is tricky but here are some great ways of staying on top of every strand. Knowing that mornings or the worst time for all of us here is the rule to keeping a well-groomed and healthy crop on hair. If you have short hair of any type than this is the beast stagy for it, a good shower wash before you start that steamy shower. And wash twice to insure that there will be no oil build up because old can slow a hairstyle down or even stop a style right in its tracks. Next you would want to apply and good protein based conditioner such as, cholesterol and allow it to remain on the hair form root to tip of the duration of your shower and when you rinse than your hair rinses this method saves time and work. Now that your hair is all-clean and you need and quick method of drying it; and before we get the drying part lets stop and think bout how we want to where our hair, now seeing as we have a short bobbed length with about 8 inches of hair to work with we need to apply a styling aid and that would be in the form of a lotion or cream. I prefer the lotion myself, so apply the setting lotion to the hair this will act as a fixative that will lock the style in place. Next we are ready to blow with a handheld blow dryer; this process will take twenty to twenty-five min. After blowing the hair dry we are ready to style the hair. Now that we have decided that we want some bounce and curl in our hair for the day here is how we will get the results needed for a day at the office and an evening on the town. You will need a medium to large curling iron (a heat motivated instrument) and a light styling spray.

Page-by-Page Analasis of John Marsden’s “A Prayer for the 21st Century” Essay

This book, entitled â€Å"Prayer for the 21st Century†, is by famous Australian writer, John Marsden. It is an illustrated, poetic ballad, filled with metaphors and complex issues, written to send messages of hope and warning intended for the people of this new century, especially those that will shape it (our children), about the lessons learnt from the past, the importance of today, and the wonders of the future. The font of the text on the front cover, and throughout the book for that matter, is in an untidy scrawl that is both important – in that it is in a bold font and is a demanding colour (either black or white) – and is informal, imperfect, personal and human – in that it is handwritten. These aspects combine to show the picture-book nature of the book; that the text is really part of the art in the illustrations themselves, and that the two cannot be isolated on their own and singled out as visual or written text. This motif is continued throughout the book. The front cover of this book has a spray-patterned, blue background, which has calm connotations. The blue also serves the purpose of increasing the salience of the bright orange picture of the boy in front of it, because the picture contrasts violently with the background, and reducing that of the soft green lines of scrawled writing that fade into the blue of the background (the writing in the background is another example of where the line between visual and written text is unclear). The boy is the clear focal point of the page, and stands out from the rest of the cover, making the lines of the poem hardly noticeable in comparison. This is to make the point that words, like those in the poem, are not nearly as strong as actions – especially the actions of those who, like the child on the cover, will shape the 21st century. The title page has an earthy coloured, frond-patterned background with two hand prints surrounding the text of the title and author’s name. These handprints have aboriginal connotations, and seem to hold some sort of wisdom from past ages. These visual elements combine with the lines in the text to reveal the nature of the poem; that this is not truly a prayer to a god, but a command, request, and message of hope for this new generation. It  is a culmination of wisdom from the past centuries, for this new century, and a reminder to the newer generations to remember the lessons of the past. â€Å"May the road be free for the journey.† These words make up the first line of the poem and introduce us to the first idea of the poem, that life must be free. The idea of freedom being the main message in this first line is emphasised by the word â€Å"free† in large, lowercase font, placed directly above the line of the poem. This is a motif effective at showing the main point of the page, and is repeated throughout the book (the main idea being emphasised by a large fronted keyword place in the background) which is effective in emphasizing the main idea in the text. The background is a gravel-brown colour, emphasising the comparison of life to a dirt road, a free road, a road that could lead anywhere. The picture on the left page continues this idea of an unknown future, by comparing life itself to a river, natural laws to banks, and the individual as someone travelling along a river in a boat. In this stream of life, no one knows what is around the next bend, except that around one of them, eventually, is the sea (death). The picture also continues the theme of abstract metaphors and symbolism, in that the picture is not really boats, just freehand drawings of them. However, whether life is a road or river, the point remains, it must be free. The next page has a very similar layout to the page before it; and indeed to every page in the book, with a line of text, a textured background, and a picture (sometimes more than one) upon a double page spread. The text on this page, â€Å"May it lead where it promised it would†, makes the point that life must deliver the reward it offers. The blue in the background of the second page is associated with hope and promise, and this promising blue is again used in the illustration. In the illustration, is a Queen, symbolising success and all of the glory that was promised to come with it. The theme of promised success and the associated rewards that come as a result is continued in the picture of the map – which appears to be from a time of discovery and conquest of new lands. The various scientific diagrams are there in order to make the point that there will be an answer to all of our  questions if we work hard, further emphasising the idea of effort leading to the mu ch deserved and promised success. Upon the set of pages, two lines instead of one are written. These are; â€Å"May the stars that gave ancient bearings Be seen, still be understood.† These lines urge people to remember the knowledge of the past, and be able to understand it. The picture itself is easy to link to the line (it is a picture of stars) however, due to the fact that it is done in the Aboriginal style, the picture’s full meaning cannot be understood, except by someone whom knows how to interpret and understand the ancient symbolism of Aboriginal art. This introduces the idea that, for the knowledge of the past to be fully realised, it must be understood. The next page now returns to the idea of life as a journey, by calling the individual a traveller, introducing the concept that life should be safe for all, and that the â€Å"safe† people must find those whom have been lost, and help those whom have been forgotten. It does this in the lines, â€Å"May every aircraft fly safely, May every traveller be found,† The concept of safety in life is emphasised by the colour of the background; a calm, soft green. In the illustration, the audience is placed in the point of view of someone inside of a safe aircraft, who is looking out of the window. Directly outside of the window, the sky is a serene blue; but around the window’s red, orange, and yellow – colours with â€Å"danger† connotations – edges, another scene forms. A lonely traveller, who could be anyone due to its ambiguous colour and unknown gender, stands lost and alone, unsafe and helpless upon the aircraft’s wing; surrounded by a da rk sky with the only hope of help being from the person in the plane, who is the viewer of the picture. This calls upon the viewer, as a traveller of life safely within the walls of the aircraft, to help the lost person, to find the traveller; and puts the viewer in the spotlight, making the point that; if you won’t, who will?Upon the next page, the two lines read; â€Å"May sailors in crossing the ocean Not hear the cries of the drowned.† The same layout as before is used, except on this page, two pictures instead of one, are used. The background is blue, which has links to tears (â€Å"cries†), feeling â€Å"blue†, the ocean, and the uniform of a sailor. The first picture appears to be asymbolic representation of someone battling against life’s troubles (i.e. a sailor crossing the ocean), fish call from the sea as spirits of the drowned, the dark sea thrashes and churns, while the yellow sky swirls above a small boat riding the crest of a wave. In the next picture, one of life’s traveller’s has heard the cries of the drowned, and joined them. However, in the background of this picture, there is land, showing that even at the worst times, there is still hope. In both of these, the idea of the individual travelling the ocean or river of life, in a boat, is reintroduced. The main point made by the last two lines of this stanza, and their corresponding illustrations, is that life has ups and downs, and not to succumb and relinquish one’s self to despair at one’s lowest points, because, as was stated on the first page, is restated on this page, and is stated again on the last page, no one can know what the future holds. â€Å"May gardens be wild, like jungles, May nature never be tamed,† are the first lines in the next stanza of the poem. The pages have a yellow, earthy-brown, palm-frond-patterned background, which connotates nature and jungles. The picture, with its complete absence of straight lines, and blurred movement, makes the point that nature is never rigid and constrained, but free to do whatever it wishes. This point is reinforced in the bank less waterfalls, and the rounded cliff faces. The people in the picture exist to draw attention to the relationship between nature and people, and says that the people of the 21st century, like those in the picture whom are neither trying to disrupt or control nature, must harmoniously co-exist with it nature, and not try to tame it, but to acknowledge it’s freedom, and grasp the fact that nature is not for humankind to control, but is untameable, it is wild and free. â€Å"May dangers create of us heroes,† reads the next line. The background of this page is a splattered, cameo green, which, along with the mateship displayed in the picture, connotates war. However not all heroes are born of violence, as is shown in the midshot (inviting the viewer into the scene) picture of a boy jumping off the top of a haystack, and his friends cheering him on. The black and white photography, setting, and attire of the people  in the picture appear to be from an old time, a time of simple values, and simple heroics. At first glance, it appears that the boy in the picture is a hero because he did something that was dangerous, but this is not the case. He is a hero because he made people happy by facing the danger. This goes on to show the true meaning of the line. That we must always have people that go out of their way, or face danger, to help others whom are in need. The boy symbolises that anyone can be a hero. That anyone, and everyone, must help th ose in need. â€Å"May fears always have names† reads the next line of the poem. The keyword in the background (â€Å"fear†) is hidden among tendrils of paint, first introducing the concept that, even though the name of the fear may be hidden, it always exists, fears always have names. The illustration is dark, with soft, runny brushstrokes that seem to obscure true meaning. At first, it appears to be a picture of fears, peeping between the trunks and branches of trees, but upon closer inspection, it is revealed that the fears are not fears at all, but people, experiencing that which we fear. The people in the picture are in agony, some cry at the side of a dead loved one, others just cry out in pure pain. Then, finally, the viewer notices a horseman in between the trees and realises two things. The first is the reference to the Myall Creek Massacre and the next was that the fears were created by people, the fears have names, and their name is the evil of humankind. It asks us to remember our evil, and asks the people of this new century not to repeat the evils past committed, or else, like the symbolic dove upon the picture’s left, peace will flee the world. The next page, and its two lines, â€Å"May the mountains stand to remind us Of what it means to be young†, now talk about the impermanence of youth, and the importance of the wise. There are again two pictures. In the first picture – a firm lined photograph – great mountains, symbolizing the vast importance, knowledge, wisdom and experience of the old, stand in the background with rays of light falling upon them; while in the foreground, a vast plane of rocks, younger, smaller versions of the mountains that dwarf them in comparison, stand to show the true importance of the memories of the old, in comparison to the inexperience of the young. The second picture is a  soft lined painting (symbolizing the impermanence of being young) of two youths embracing and in love. They are shown next to a shell, which puts them on a symbolic scale. It makes the point that, if these two youths are dwarfed by a shell, and a shell will be dwarfed by a rock, such as those seen in the picture on the opposite page, how tiny they are, how fleeting their time as youth if they are to grow into the giant mountains, how petty their memories and experiences in comparison to the mountains. It is through this symbolic scale that the illustrations remind us of what it means to be young. The final lines of this stanza reads; â€Å"May we be outlived by our daughters, May we be outlived by our sons.† This line is different from the rest of the poem in that its meaning is straightforward and obvious, and that this line is actually a prayer for the long and happy lives of our children. The pictures add to the text, in that they are pictures of people from different ethnic groups, and that they join united at the edge of each picture, showing that it refers to the entire people of the 21st century, they are not our children in a literal sense, but are the children of humanity. It prays that, even though there will be hardships in life, as is mentioned many times before and is symbolised by the black and white colour scheme of the older children, the new generation, as with the generations before them, must live through them, and continue – as is symbolised in yellow colour of the background of the page – to shine on like the sun, outliving those befo re us. History’s importance is again brought up in the final stanza, with the opening line being: â€Å"May the bombs rust away in the bunkers, May the doomsday clock not be rewound,† The lines ask the new century not to use mankind’s evil, even though they do and always will exist; they then ask humanity not to repeat past mistakes, even though we will always have the potential to. The background is patterned by gears, and the emphasised keyword this time is â€Å"rewound†, displaying that the main idea of these lines is to make the point that we must never repeat our past mistakes. The gears are also part of the â€Å"doomsday clock†, which is simply referring to time and history itself. The picture shows text from what appears to be newspaper  articles, which refer to injustices throughout history to the indigenous peoples of Australia, which hold some of the greatest evils of this country’s history. The many pictures at the top of the image show the faces of the many sufferers of evil, from a small child, to a grown man. The theme of war is again brought up with the word â€Å"bombs† in the first line, and the image of a man from Picasso’s â€Å"Guernica†, a painting about the suffering of innocents as bombs dropped on their city. For many people, that day was their doomsday. It once again brings up the issue that humankind itself is what causes people the most pain and suffering. Overall, the pages ask the people of the 21st century never to use humankind’s evil again. The next page continues the theme of war, with a reference to the bombing of Hiroshima and Nagasaki in the Second World War. The line reads â€Å"May the solitary scientist working, Remember the holes in the ground† and the single, hand drawn illustration, is of a large and powerful solitary scientist in his own solitary world, admiring and awestruck of his solitary discovery; while behind him his discoveries explode over a desolate plain on which the only survivors are a small, helpless man and woman, silhouetted against the bleak white light thrown across a vast landscape, and upon them from evil inventions that exist to destroy. It asks the people that will shape this new century to remember that every single action has consequences, and that knowledge can just as easily be used for the evil of bombs, as it can be used for the good of curing cancer. It tells people to look into the past, in order to shape the new century’s future for the better. â€Å"May the knife remain in the holder, May the bullet stay in the gun,† These penultimate lines continue the theme expressed in the first stanza, that even though we have the potential and the means to carry out evil, the people of the 21st Century must never do so. The page is extremely straightforward in relation to the pictures – the bullet is being put into the gun and must remain there and the skeleton has been skinned with a knife – however, in the skeleton picture, the body is made up of many different cut up body parts, making the new point that we should not use evil upon anyone, indiscriminate of who they are, or what they believe in. The final lines of this prayer are as follows: â€Å"May those that live in the shadows Be seen by those in the sun†. Upon the pages surrounding these lines, are two pictures, one of footsteps on a beach with a man’s shadow crossing their path; the other of a silhouetted man running along a beach with a beam of sunlight floating on the waves of the sea. Both pictures are in black and white, emphasising the ideas of shadows and sun. The blue background is the same textured blue as at the very first page of the poem, and is sea-spray like in appearance. The theme of these final two pages, is very simple, to help others, and this idea can be seen throughout the illustrations. The picture of the footprints, reminds of the Christian story of how Jesus carried the man over the sand, and through life’s shadows. This makes the point that, sometimes, others need to be carried through hard times. The shadow crossing the path of the footsteps represents a dark time in the l ife of the person that made them but this shadowed part is only a mere fraction of the whole, a symbolic representation that life does have deep darkness, but for the most part, it is light. The next picture across, the one of the runner, continues this idea; and also adds to it. This time, the sea is used s a metaphor for life, and, as first mentioned on the page about sailors, the sea can be in many states. The repetition of the motif of both light and shadows making up life is displayed on the surface of the sea, where the thick beam of light shines and glistens, while at the edges, shadows and darkness can be seen. However, yet again, there is more light in the picture than there is shadow. The illustration of the silhouetted man running along the beach, making his own path in the sand, appears – at first glance – to show that he himself is in a shadowed stage in life. However, on close inspection something appears to be in his arms, if you look very closely, you can see that he is carrying something. This man is not the Christian Messiah; this man is an ordinary person, showing simple, yet powerful heroics as mentioned earlier in this book. He further demonstrates that we all can be heroes, even without obvious physical dangers, just by helping someone. This final line is a hope. It is a hope that maybe, just maybe, in the 21st Century; we can all stand and walk together, in the light of the future. This simple yet honest poem of hope and fear effectively reached out to, and appealed to me, the target audience and a child of the 21st Century. It was deep and complex in some places, yet simple enough to be understood by the intended reader. It is a thought stimulating read to be understood more and more with wisdom and experience. Now it is just a question, first posed in the photograph of the boy on the front cover – one side of his face in darkness, the other in light – as to whether this generation of young rocks will grow up, remember the past, not repeat its mistakes, and one day be tall mountains. Then we will write a new prayer, for a new century. Bibliography: http://www.johnmarsden.com.au/home.htmlhttp://en.wikipedia.org/wiki/John_Marsden_(writer)http://www.judyoz.com/ccp0-display/john-marsden-books-tomorrow-ellie-novels-australian-fiction.htmlhttp://www.fantasticfiction.co.uk/m/john-marsden/