The Suicide Death of Conrad Roy III

On July 12, 2014, Conrad Roy III, 18, killed himself by carbon monoxide poisoning by shutting himself in the cab of his pickup truck in a Kmart parking lot with a running gasoline-powered water pump.​ On Feb. 6, 2015, Roys 17-year-old girlfriend Michelle Carter, who was being treated in a mental facility at the time of his death, was charged with involuntary manslaughter for encouraging him to go through with his suicide plan via a number of text messages and phone calls, including one call while he was dying. Here are the latest developments in the Conrad Roy III case. Judge Upholds Manslaughter Charges in Encouraged Suicide Case Sept. 23, 2015:Â  A juvenile court judge has denied a motion to drop criminal charges against a Massachusetts teenager who encouraged her boyfriend to commit suicide. Michelle Carter will face involuntary manslaughter charges for the death of Conrad Roy III. Judge Bettina Borders pointed to evidence that shows Carter was on the phone with Roy for 45 minutes while he was in his vehicle inhaling the carbon monoxide that would kill him and failed to call the police. Judge Borders also cited text messages that reveal that Carter, 17 at the time, told Roy to get back in the truck when his suicide plan began to work and he became afraid. The Grand Jury could find probable cause that her failure to act within the 45 minutes, as well as her instruction to the victim to get back into the truck after he got out of the truck, caused the victims death, the judge said in her ruling to deny the defense motion to dismiss the charges. The defense plans to appeal Borders ruling. The next pretrial hearing is scheduled November 30. Michelle Carters Attorney Wants Charges Dropped Aug. 28, 2015 - The attorney for an 18-year Massachusetts teen accused of encouraging her boyfriend to commit suicide has asked a judge to dismiss the charges against her because prosecutors are trying to apply manslaughter to speech. Joseph Cataldo, attorney for Michelle Carter, said his client is not responsible for the death of Conrad Roy III. It was his plan, Cataldo told the judge. He is someone who caused his own death. Michelle Carters only role in this is words. Carter, who was being treated at McLean Hospital, a psychiatric facility, at the time of Roys death, has been charged with involuntary manslaughter in New Bedford Juvenile Court. Online Relationship Roy, from Mattapoisett, and Carter, from Plainville, had seen each other only a couple of times in-person, they were mostly online friends, exchanging thousands of text messages over the past two years. Cataldo said that Carter, now 18, at first tried to discourage Roy from killing himself, but when that did not work, she became brainwashed over the weeks leading up to his death to assisting him with his suicide plans. Roy had been hospitalized in a psychiatric facility two years before his death and was on medication for his mental condition, Cataldo said. Roy left suicide notes at his home for his family on the day he died. Romeo and Juliet Pact Rejected Cataldo told the court that just days before he killed himself, Roy sent Carter a text suggesting that they should kill themselves together like Romeo and Juliet. Carter responded to the text with, (Expletive), no we are not dying. Carter tried to help Roy by suggesting that he join her at McLean Hospital, but he rejected the idea, Cataldo said. The government is harping, if you will, on her saying when are you going to do it? When are you going to do it? Joseph Cataldo, Carters attorney said. What they are not harping on are all the times she said dont do it, dont do it. Words Are Harmful But, at the court hearing on the defense motion to dismiss the charges, Assistant District Attorney Katie Rayburn told the court that it is possible to commit a crime with words only. One can be an aider and abettor or an accessory before the fact simply for words, Rayburn told the judge. Her words are not protected, Your Honor. Her words are harmful, offensive and likely to cause an immediate, violent act. The indictment against Carter included text messages she sent other friends after Roys death in which she appears to admit being responsible for his death. Its My Fault It’s my fault. I was talking to him while he killed himself. I heard him cry in pain, Carter texted a friend. I was on the phone with him and he got out of the car because it was working and he got scared and I told him to get back in. In a later text, she explained why she told him to get back into the vehicle. I told him to get back in because I knew he would do it all over again the next day, and I couldnt have him live that way -- the way he was living anymore. I couldnt do it. I wouldnt let him, Carter said. Therapy didnt help him and I wanted him to go to McLeans with me when I went but he would go in the other department for his issues, but he didnt want to go because he said nothing they would do or say would help him or change the way he feels. So I like, started giving up because nothing I did was helping -- and but I should have tried harder, she continued. Like, I should have did (sic) more. Its all my fault because I could have stopped him but I (expletive) didnt. All I had to say was I love you and dont do this one more time, and hed still be here, Carter said. You Just Fall Asleep On Aug. 28, prosecutors released to the media other texts that Carter sent directly to Roy during the time leading up to his death. They included: There is no way you can fail... Youre strong... I love you to the moon and back and deeper than the ocean and higher than the pines, too, babe forever and always. Its painless and quickEveryone will be sad for a while but they will get over it and move on.Do you have the generator? WELL WHEN ARE YOU GETTING IT?You just need to do it, Conrad. The more you push it off, the more it will eat at you. Youre ready and prepared.All you have to do is turn the generator on and you will be free and happy. No more pushing it off. No more waiting.You have everything you need. There is no way you can fail. Tonight is the night. Its now or never.Yeah, it will work. If you emit 3200 ppm of it for five or ten minutes you die within a half hour. You lose consciousness with no pain. You just fall asleep and die. Conviction and Sentencing Carter was freed on $2,500 bond and was ordered by the judge not to use social media. Even in youthful offender court, in Massachusetts, she was looking at the possibility of being sentenced to 20 years if convicted. However, in August 2017 she was sentenced to 15 months in prison, with the sentencing judge ultimately convicting her of involuntary manslaughter due in part to the complexities of criminal responsibility in the case. Source Woman sentenced to 15 months in texting suicide case, CNN.com. August 3, 2017

Going Look At The Stars - 1846 Words

Go look at the stars. Now look at the paper. Now look at the stars. Now look at the paper. Now take one last look at the sky and count the number of visible stars. Not many, right? The problem of being a miniscule part of a vast Universe is our incapability to observe and understand the Universe, especially with the naked eye. Even in ancient Greece, people observed the skies, understanding it in order to locate their relative positions and noticing the movements of the sun and the moon. Many believe that a Greek cosmology does not form until the Pre-Socratic works of 600 B.C.E., but there are signs that point to the Greek tradition of epic poems as a means of communicating astronomical information, the first of which was written down by Homer, who is considered the first epic poet (Hetherington 54, Murnaghan l). Before delving into Homer’s poems, it is important to first understand the history of Greek civilization because his poems reflect several historic periods spanning h undreds of year. After 2000 B.C.E. Greek-speaking people arrived in what we call Greece, establishing the Mycenaean civilization, which thrived, becoming rich with powerful cities that were military strongholds and international trade centers (Murnaghan l). Through their trade with nearby islands, they adopted a â€Å"syllabary† system of writing from the Minoans, who flourished on the island Crete (Murnaghan l). However, the next evidence of Greek writing is not seen until the Phoenician alphabet isShow MoreRelatedWhat It Means to Be a Pop Star968 Words   |  4 Pagespop star A pop star can have a lot of different meanings to many people. An image can make people assume that they know what a pop star is. Some people think a pop star is someone who just gets on stage and performs. However not everyone thinks that’s what a pop star is. Not too many people are able to become a pop star in today’s society. In order to do that you have to be really dedicated, work hard, and you also have to make a lot of sacrifices. One of the more popular teenage pop stars thatRead MoreMovie Analysis : Movie 3 A.m And The Stars Were Out 968 Words   |  4 Pagesand the Stars Were Out Have you ever stopped to think that, â€Å"We’ve gotten a lot more than we ever thought?† Carson and Darnell wonder about that in the short story â€Å"3 A.M. and the Stars Were Out.† Carson is on his way to birth a calf on his best friend Darnell’s farm. They start to look up at the sky and rethink their lives together as friends, and the battles they have fought internally and externally. They were amazed how far they had come in life. 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Speech for Chinese Medicine Free Essays

General Purpose: To inform. Specific Purpose: To inform my audience of an aspect of Chinese culture, which is is traditional Chinese medicine. Thesis: Traditional Chinese medicine is found in nearly all countries today, which I believe would be the result of intercultural communication. We will write a custom essay sample on Speech for Chinese Medicine or any similar topic only for you Order Now INTRODUCTION I. Hello! For my presentation, I am going to talk about a certain aspect of Chinese culture, which is traditional Chinese medicine. A. TCM, for short, is a practice still used in modern China and most of the United States. B. There are two types of TCM treatments commonly used today. National Center for Complementary and Alternative Medicine, 2009) 1. Herbs 2. Acupuncture C. According to the National Center for Complementary and Alternative Medicine (2009), herbs and acupuncture are the most common; however, other practices include 1. moxibustion 2. cupping 3. Chinese massage 4. mind-body therapy 5. and dietary therapy D. For this presentation, I will mainly talk about herbs and acupuncture, since it is the most commonly used forms of TCM. II. Herbs and Accupuncture. A. Both acupuncture and Chinese herbal medicine have been used and studied for a wide range of conditions. National Center for Complementary and Alternative Medicine, 2009) 1. Acupuncture has been used for conditions such as a. back pain b. chemotherapy-included nausea c. depression d. osteoarthritis 2. Chinese herbal medicine has been used for conditions such as a. Cancer b. Heart disease c. Diabetes d. HIV/AIDS III. According to the National Center for Complementary and Alternative Medicine (2009), TCM is considered a form of alternative medicine. A. Alternative medicine is any healing practice that isn’t conventional medicine. B. Alternative medicine may be based on historical or cultural traditions, rather than on scientific evidence. (Hesketh Zhu, 1997) C. Alternative medicine varies from country to country. (Hesketh Zhu, 1997) [I know that culture, especially Chinese culture may differ from town to town in a region as large as China. The main aspects of Chinese culture include its literature, music, cuisine, martial arts, etc. , today I am only going to speak to you about one aspect which is our alternative medicine, but their very own medicine. ) BODY I. China is the only country in the world where Western medicine and traditional medicine are . . . [practiced] . . . alongside each other at every level of the healthcare system. † (Hesketh Zhu, 1997) A. 40% of all health care delivered in China is Traditional Chinese Medicine. (Hesketh Zhu, 1997) II. TCM practitioners use a variety of therapies in an effort to promote health and treat disease. The most commonly used are Chinese herbal medicine and acupuncture. (National Center for Complementary and Alternative Medicine, 2009) A. Chinese herbal medicine 1. The Chinese materia medica (a pharmacological reference books used by TCM practitioners) contains hundreds of medicinal substances- primarily plants, but also some minerals and animal products- classified by their perceived action in the body. 2. Different parts of plants such as the leaves, roots, stems, flowers, and seeds are used. 3. Usually, herbs are combined in formulas and given as teas, capsules, tinctures, or powders. B. Acupuncture 1. By stimulating specific points on the body, most often by inserting thin metal needles through the skin, practitioners seek to remove blockages in the flow of qi. . moxibustion (burning moxa- a cone or stick of dried herb, usually mugwort- on or near the skin, sometimes in conjunction with acupuncture) 3. cupping (appyling a heated cup to the skin to create a slight suction) 4. mind-body therapy (qi gong and tai chi) III. â€Å"In spite of the advent of Western practices, the Chinese have never completely ceased to employ their own art of hea ling, mainly because it continued to fit into their specific philosophy of life, but also because it appears that in frequent cases it was good medicine† (Risse, 1997, p. 7). A. Chinese traditional medicine, the Ayurvedic medicine of India, Tibetan medicine, and other Eastern medical systems evolved, for the most part, independently of Western scientific medicine. B. â€Å"Until the twentieth century the Eastern and Western medical systems were each considered particularly efficacious [,which means, successful in producing a desired or intended result; effective. ] by their own practitioners [ who are people actively engaged in a discipline, or profession, esp. medicine]† (Eisenberg, 1985, p. 2) IV. In an article from the Skeptical Inquirer, Joe Nickell (2012) explains his experience, where he learned about â€Å"Chinese healing techniques. † A. Nickell (2012) explains the origins of traditional Chinese medicine. B. Nickell (2012) learned that TCM is based on the five elements. V. Khalsa (2011) wrote an article titled Ancient Chinese Secrets, which explains the five herbs used in traditional Chinese medicine. A. Ginseng B. Dong quai C. Schisandra D. Ho shou wu E. Astragalus VI. According to a newspaper article titled Chinese herbs that hurt, not heal, traditional Chinese medicine (TCM) is suffering from modern China’s safety troubles and quality control. A. For centuries, traders bringing their Chinese herbs into this town made sure their first stop was the Medicine King Temple. They prayed to the Han Dynasty medical expert Pei Tong, whom the temple was built to honour, asking for their roots, fungus and berries to have the potency to cure the world’s ills. The practice has long ceased, especially after the Chinese Communist Party came to power in 1949. VII. Chinese clamor for herbs to fight respiratory virus- U. N. Doctors inspect Beijing hospital A. Beijing – – The World Health Organization has no evidence to suggest that traditional Chinese medicine can prevent the spread of SARS, but the people in line at Tong Ren Tang Pharmacy don’t care. There’s a two-hour wait to buy herbs. Ever since the popular Beijing Evening News newspaper ran a recipe Tuesday concocted by two experts in traditional Chinese medicine, thousands of people have rushed to pharmacies to buy the supposedly immunity-boosting elixir to†¦ Conclusion I. TCM follows the belief that ancient Chinese followed many years ago, which is the same as the reasoning behind Chinese Universalism. Their reasoning include: 1. the Tao 2. the Yin and the Yang 3. and finally, the 5 elements, which are water, fire, wood, metal and earth. A. Chinese traditional thinking conceives of man as composed of the same elements as the universe. II. The origins of China’s medical history are usually found in legends that come from the tradition of health care over several thousand years. A. nd where contemporary communities promises further insights into the nature of the human response to illness. B. Furthermore, medical historians and medical anthropologists have begun to focus their research on China, where a wealth of written sources permits III. References Eisenberg, D. (1985). Encouners with qi. New York, NY: W. W. Norton Company. Hesketh, T. , Zhu, W. X. (1997). Health in China. traditional Chinese medicine: One country, two systems . British Medical Journal 315(7100), 115-117. Abstract retrieved April 5, 2012 from http://www. cbi. nlm. nih. gov/pmc/articles National Center for Complementary and Alternatice Medicine. (2009). Traditional Chinese Medicine. Retrieved April 5, 2012 from http://nccam. nih. gov Nickell, J. (2012). Traditional Chinese medicine: Views east and west. Skeptical Inquirer, 36(2), 18-20. Retrieved April 5, 2012, from Readers’ Guide Full Text Mega on-line database (H. W. Wilson) Khalsa, K. P. S. (2011). Ancient Chinese secrets. Amazing Wellness, 3(3), 36-38. Retrieved April 7, 2012, from Readers’ Guide Full Text Mega on-line database (H. W. Wilson) Risse, G. B. (1973). Modern China and traditional Chinese medicine. Springfield, IL: Charles C Thomas. MacQueen, K. (2001). The best of both worlds. Maclean’s, 114(11), 44-47. Retrieved April 7, 2012, from Readers’ Guide Full Text Mega on-line database (H. W. Wilson) Academic honesty. (n. d. ). Retrieved December 2, 2005, from University of Saskatchewan website: http://www. usask. ca/honesty Ancient chinese medicine and mechanistic evidence of acupuncture physiology. Medline Database TCM: Made in China. Medline Database Ginseng, Panax. MedlinePlus How to cite Speech for Chinese Medicine, Essay examples

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