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말기 환자관리. different palliative care in indigenous Australian

Palliative care plays an important role to provide patients’ quality of life at the end of their life. Symptom management and comfort care are main aspects in delivery of palliative care. However, due to diverse cultural and spiritual backgrounds of patients, different people have different expectations and needs when it comes to care the end of life. Addressing the varied needs and expectations of palliative patients requires cultural sensitivity and culturally safe practices. Indigenous Australians have specific cultural beliefs and traditions relating to death and dying influenced by communities and regions. Therefore, the purpose of this essay is to explore indigenous Australian cultural practices and this relates to palliative care and the nursing responsibilities when delivering this care. With this view, this essay will describe the Indigenous Australians’ beliefs and traditions by focusing on communication during palliation and post death practice in regards to death and dying.

의/약학| 2017.01.15| 8페이지| 1,500원| 조회(87)

Cultural Sensitivity, 말기환자간호 중요성, 호주 원주민들의..

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congestive heart failure, 심부전

↑L atrial pressure →Atrial dilatation→AFLeft ventricular function fail→↓CO HypoxiaDecreased tissue perfusion PulmonaryvasoconstrictionRAAS activation→ Fluid retention↑pressures in the left ventricle→impair filling, causing congestion, ↑pressures in the pulmonary vascular system→↑fluid movement from the blood vessels into interstitial tissues and the alveoli→↓Lung compliance, V/Q mismatchPATHOGENESIS 1,2,3When the exacerbation of acute left ventricular failure develops, the neuroendocrine responses including sympathetic nervous system and the renin-angiotensin system leading to fluid volume excess are activated to maintain perfusion of the vital organs (Lemone & Burke, 2013). The decreased contractility of the left ventricle causes decreased left atrial pressure and moreover, pressures in pulmonary veins increase. Pulmonary capillary hydrostatic pressures rise, ultimately exceeding the osmotic pressure of the blood (Eugenio, Luna & Mihai, 2010). In other words, left ventricular failure ne & Burke, 2013).Fluid leaks into interstitial space as an exudate from increased pulmonary capillary hydrostatic pressure. As capillary and interstitial pressures increase, tight junctions of alveolar walls are disrupted and the fluid included RBCs and protein molecules enters the alveoli (Lemone & Burke,2013). This result leads to pulmonary oedema, in other words, the accumulation of fluid in the alveolar and interstitial spaces in the lungs causing decreased lung compliance and V/Q mismatch (Joanne, 2010).As effective nursing interventions used to manage pulmonary oedema, a consequence of fluid volume excess, the delivery of higher concentration of oxygen and improving cardiac output with diuretics, vasodilators and other drugs can be main strategies(Craft et al.,2011).For the intervention of impaired gas exchange, a patent airway is vital for pulmonary function including ventilation and gas exchanges. Nurses should monitor changed respiratory status and administer oxygen as orderecation of the causes of the acute pulmonary oedema and these sounds can be monitored(Lemone & Burke,2013). These drugs like morphine, diuretics, vasodilators and bronchodilators can be administered to reduce cardiac work and improve contractility. Input and output should be recorded and fluid restriction is recommended to reduce vascular volume and cardiac work (Lemone & Burke, 2013).Frusemide is the most commonly used loop diuretic. Frusemide acts on the 2Cl-Na- K cotransport in the thick segment of the ascending limb of Henle’s loop of the nephron (Mei-Yi et al., 2014). This blocks the resorption of chloride and sodium ions from the loop into the interstitial fluid. Solute reabsorption is inhibited. This result leads to interstitial fluid becomes hypotonic while lumen of the loop of Henle becomes more hypertonic (Bullock &Manias,2013). Due to this result, frusemide prevents passive reabsorption of water by creating osmotic gradient within the nephron. That means the accumulation of ebe developed. Nurses should monitor the manifestations of dehydration, for example, dry mouth, thirst and oliguria and headache, and measure weigh daily and administer frusemide on an intermittent schedule and minimal effective dose(Lehne, Moore, Crpsby & Hamilton, 2013). Frusemide can cause hypotension due to the loss of volume and relaxation of venous smooth muscle. Nurses should monitor the signs of hypotension, dizziness, lightheadedness and fainting and then monitor blood pressure routinely (Lehne et al., 2013). Through increased secretion in the distal nephron, hypokalemia is developed. Nurses can encourage potassium-rich foods, such as dried fruits, nuts, spinach, citrus fruits and bananas to minimize the side effects of frusemide. Ototoxic drugs can be administered with the loop diuretics to prevent hearing loss (Lehne et al.,2013).ReferencesBarbara, L.C., & Elaine, O.K.(2011).Adult health nursing (6th ed.). Missouri. United States of AmericaBullock,S., & Manias, E.(2013) . Fun Forest, NSW: Pearson Australia.Mei-Yi, W., Nen-Chung,C., Chin-Ling, Su, Yung-Ho, H, Tzen-Wen, C., Yuh-Feng, L.,...& Ka-Wai, T.(2014). Loop diuretic strategies in patients with acute decompensated heart failure: A meta-analysis of randomized controlled trials. Journal of Critical Care, 29(1):2-9. Doi:10.1016/j.jcrc.2013.10.009Concept map references1. Barbara, L.C., & Elaine, O.K. (2011).Adult health nursing (6th ed.). Missouri. United States of America2. Craft, A., Gordon, C., & Tiziani, A. (2011).Understanding pathophysiology (Australia ed.). Chatswood. Australia: Elsevier Australia.3. Eugenio, P., Luna, G.,& Mihai, G.(2010). Why, when and how to assess pulmonary congestion in heart failure: pathophysiological, clinical, and methodological implications. Heart Fail Rev, 15: 63-72.Doi 10/1007/s10741-009-9248-94. Joanne, W. (2010). Cardiovascular and pulmonary physical therapy. (2nd ed.). Missouri. United States of America5. Lehne, R.A., Moore, L., Crosby, L., & Hamilton, D. (2013). PharT2

의/약학| 2017.01.15| 7페이지| 1,500원| 조회(78)

증상, 예방, prevention, Aetiology, 심부전의 저의, 치료. ...

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고지혈증, HIGH cholesterol

High cholesterolContents The definition Importance of cholesterol Types of cholesterol Symptoms of hyper cholesterol Risk factors of high cholesterol Prevention Treatment for high cholesterol PrognosisDefinition Importance of cholesterol Cholesterol is a fatty substance . Role - build the structure of cell membranes - make hormones - oestrogen , testosterone , adrenal hormones - help your metabolism work efficiently EX) to produce vitamin D - produce bile acids- digest fat and absorb important nutrients.T ypes of cholesterol LDL-’bad ’ cholesterol, build-up of plaque in your arteries → coronary heart disease, stroke less than 2 mmol /l HDL- ‘good’ cholesterol , prevent coronary heart disease no higher than 5.5 mmol /lSymptoms of hyper cholesterol Atherosclerosis- the accumulation of cholesterol-rich fatty deposits in arteries Asymptomatic The result can be heart-related chest pain (angina) or other symptoms of coronary artery disease , as well as symptoms of decreased blood supply to the brain (transient ischemic attacks or stroke).Risk factors of high cholesterol •Being a male older than 45 • Being a female older than 55 • Being a female with premature menopause • Having a family history of premature coronary artery disease • Smoking cigarettes • Having high blood pressure • Not having enough good cholesterolPrevention Healthy diet - F ruit - Vegetables and legumes/beans - Lean meats and poultry, fish, eggs, tofu, nuts and seeds, legumes/beans - Grain (cereal) foods, mostly wholegrain and high fibre varieties - Milk, yoghurt, cheese and alternatives, mostly reduced fat. exercising dailyTreatment for high cholesterol lifestyle changes- diet habits cholesterol-lowering medicines , such as statins- lovastatin simvastatin, atorvastatin (Lipitor), rosuvastatinPrognosis diet and exercise can lower LDL cholesterol by about 10 %. Medications can lower LDL cholesterol by another 20% to more than 50%.Things to remember Cholesterol- essential to many metabolic processes. Your body needs cholesterol, but it can make its own ↑ LDL cholesterol in the blood →coronary heart disease. Foods high in saturated fats → ↑ LDL cholesterol.{nameOfApplication=Show}

의/약학| 2017.01.15| 10페이지| 1,000원| 조회(48)

치료, 관리, definition, 타입, 예후, Risk factor, 고지혈증 ..

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한국의 50년전과 지금. how has chaged in korea compared to 50 years ago and now

People have experienced changes and challenges in daily lives. It means that though the passing time, people have been experiencing growth and success. On the other hand, failure and unexpected outcomes have been faced by people too. It is not different in the history of one country. Korea Also has changed in the evaluation of success, growth, failure and unexpected outcomes. In this essay, the changes in Korea’s development in the last half decade will be described in the areas of economic aspects, urbanisation and the family system.Korea has developed in the economic aspect which is called the miracle of Han River. In the past, Korea was one of the poor countries and many people suffered from poverty and hunger. However, Korea, as the 11st largest economy in the world, is entirely different compared with the past 50 or 60 years ago. According to the World Bank Group, the Gross National Product (GNP) in Korea increased remarkably from about 80 US dollars in 1960 to 25,976.95 USD in 2013. Even though there is a lack of natural resources, one of the reasons that Korea has developed economically was government-led industrialization that means many industries such as constructing highway, manufacturing cars and producing consumer goods boomed under the support of the government.Secondly, another important change has been urbanisation. Until 1960, the primary industry in Korea was agriculture and 63% people lived in rural areas. However, with the start of the economic boom in 1963, people who lived in country areas started to move to urban areas, especially Seoul which was developing economic, environment and transportation. As a result of this, the population of Seoul is over ¼ of total Korea population. It was contributed to industrialisation and modernization. Compared with the past, in the industry sector, the present biggest part is the service industry (about 55%) including department stores and supermarkets, and followed by trade and manufacturing sectors. On the other hand, agriculture only contributes a small part of the GDP at approximately 4%. In addition, the percentage of population living in rural areas was recorded at 17.64% in 2014.Lastly, since the 1960s the family structure has changed to the nuclear family system because of the impact of industrialisation and urbanisation. In the past, Korean family structure was the extended family system consisting of grandparents, parents, aunts, uncles and children. They supported each other, worked together in that land and looked after their children with the family- centered approaches. However with the influence of Western culture, industrialisation and modernism, the nuclear family system has popularised and the women’s equal rights have been emphasised. In more daunting aspects, rising divorce rates and the worsening of family relationships are arising big issues to solve.In conclusion, Korea has been changed to one of the richer countries with industrialisation. At the same time, the centralisations of population to the capital cities and decreased and broken family relationships also have occurred during the last 50 years. At this point, the recognition of problems is necessary and practical solutions should be suggested to make a better future.References“AGRICULTURE” HYPERLINK "http://countrystudies.us/south-korea/52.htm" http://countrystudies.us/south-korea/52.htm (01 November 2016)“Economy of South Korea” HYPERLINK "http://www.tradingeconomics.com/south-korea/gdp" http://www.tradingeconomics.com/south-korea/gdp Hyperlink "https://en.wikipedia.org/wiki/Economy_of_South_Korea" https://en.wikipedia.org/wiki/Economy_of_South_Korea (01 November 2016)“Korean Trade and Business - Seoul & South Korea” Hyperlink "http://www.seoulkoreaasia.com/trade-business.htm" http://www.seoulkoreaasia.com/trade-business.htm (01 November 2016)Kwon, T. (1992). Social change and family system in Korea. Korea Institute for Health and Social Affairs Hyperlink "http://www.popline.org/node/323710" http://www.popline.org/node/323710“Population Change and Development in Korea” HYPERLINK "http://asiasociety.org/education/population-change-and-development-korea -(01" http://asiasociety.org/education/population-change-and-development-korea -(01 November 2016)RURAL POPULATION (% OF TOTAL POPULATION) IN SOUTH KOREA Hyperlink "http://www.tradingeconomics.com/south-korea/rural-population-percent-of-total-population-wb-data.html" http://www.tradingeconomics.com/south-korea/rural-population-percent-of-total-population-wb-data.html (01 November 2016)PAGE * MERGEFORMAT2

사회과학| 2017.01.15| 3페이지| 1,000원| 조회(76)

경제, 도시화, 인구변화, 핵가족화, Urbanisation, economic c..

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client service manual

Develop a client service manual. Include in your manual:Definition of client-Clients can be anyone involved my business, specifically landlords, tenants, buyers, sellers, solicitor and trade men. But you need to understand the concept of customer profiling to effective answering the definition of client. Client profiling is made of age, gender, income range, occupation, locality and education of customers. A customer profile seeks to establish a set of characteristics that represent the critical customer group for a business.Client: needs, wants and expectations-When you meet clients, you need to find their needs, wants and expectations for their property. This information gives affects you will provide services for them. To identify clients’ expectations, you need to build a relationship with them. You have to learn effective listening skills, and ability asking something. You also have to treat them with good manners and consideration. After identifying their expectations and needs, rably. For example, in case of a client’s wants; he or she wants sell the property as higher price and quick.Note taking and listening skills-An agent must have note taking skills. When you communicate with client, you have to write important thing. Sometimes, it can be used for evidence. Also, it is the responsibility of legal. To protect you and your business, it is important to write note, and to keep records. Effective listening skills enable to understand clients’ needs, wants, and expectations through building a rapport with them. This is included only hearing the words, but also seeing clients’ point of view involved emotion.Fostering loyalty and repeat business-The agency has to develop any initial contact into a longstanding relationship. This is related a repeat business. To repeat a business, it is important to foster loyalty with clients. Therefore, the agent has to give trust to clients. Trust includes honesty, confidentiality and credibility. Addition, great services givelient satisfaction surveys-To satisfy clients’ services, the agency needs some reviews. The methods of measuring activity services are interview, feedback, and survey reports. When you ask some questions for better services, you can ask as closed questions and hypothetical questions. For example, “is there any comment for improving our services?” Or “Are you satisfied my services?”Customer service for : Individual and team-In reality, a real estate industry is not operated as a team for customer services. But a team can be small group or people with common purposes to deliver better services. A real estate agency should be a market place for customers. Customers can receive various services such as selling or leasing properties as well as finance, legal, management and valuation related property. The team performs better services than individuals, when the task is complex. Tasks are decided into individual tasks. When you distribute the tasks, you need to be specialized every staff. Ong; on the other hand another staff is more excellent for sale.Reviewing policy using performance indicators-After you establish policy, you need to review the policy using performance indicators. If you find the problems, you need to modify the plans. Compared in the past 10 years in Australia, it has been changed too much. Today, Australia is a multicultural society. So you need to change the policy dealing communication skills with clients. You need to be aware that people may approach the negotiation process differently, based on their cultural experiences and customs.Keeping current: agent and client-A real estate industry has too much fluctuation. Economy, politics and Society give impaction to the real estate market. Due to the interest change, the legislation change, immigration policy and so on, a real estate market continues changing. To catching up this, you need to train agents and clients. You can only survive from competitions with others, when you have up to dated knowledcannot not be lazy to read newspaper, to watch news, and to surf Internet. Also due to office meeting, you have to share information with other staffs and also notify clients if necessary through email or letters.Complaints manual-If a client complains, the staff should have to report a manager each department. The manager gives customer services. First the manager gives tea or coffee to the customer and then pays attention his or her words. The manager should respect to the client. Every complaint should be answered to the client as soon as possible. Every complaints report should be kept as a hard folder.10)Implementing change-A real estate industry has changed for long time. Due to the change of legislation, society and culture, real estate agents need to change their skills dealing with clients. To look professionalism, you need to know the change of law and regulation. Also you need to have time management skills to organize something properly. It is important to decide which a toT 4

경영/경제| 2017.01.15| 4페이지| 1,000원| 조회(73)

부동산, 서비스 스킬, client skills, 서비스 관리 매뉴얼

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