Hillcrest Case 7 H&P

HISTORY AND PHYSICAL EXAM Patient: T. J. Moreno Patient ID: 110497DOB: 02/15Age: 44Sex: M Room No. : 502 Date of Admission: 10/09/2013 Admitting Physician: Patrick Keathley, MD Endocrinology Chief Complaint: Left ankle pain. DETAILS OF PRESENT ILLNESS: This is a 44 year old Hispanic male who I was kindly asked to admit by Dr. Max Hirsch. The patient is status post arthrodesis of the left ankle and has newly diagnosed diabetes and hypertension. PAST MEDICAL HISTORY: Pre-op blood glucose was noted to be greater than 200. The patent asked for a medicine consult/admission for further evaluation.Currently he denies chest pain and shortness of breath. No dysuria, or increased urinary frequency. Past history is significant for hearing loss in the right ear subsequent to an assault several years ago. PAST SURGICAL HISTORY: Lower back surgery and a left ankle surgery. SOCIAL HISTORY: Patient admits to drinking beer on the weekends, some tobacco use, but no illicit drug use, is divorced with f our children, is a long haul truck driver, lives with his fiancee. MEDICATIONS: Patient is to provide a list, admits to taking no diabetes meds. PHSYICAL EXAMINATION: VITAL SIGNS: afebrile, BLOOD PRESSURE: 155/98. HEART RATE: 69.In general he is in no acute distress, alert and oriented X4. HEENT: Mucus membranes moist. No facial asymmetry. Left ear : WNL, Right ear: with profound hearing loss. LUNGS: clear to auscultation and percussion bilaterally. CV: Normal. S1, S2 without murmurs or rubs. GI: soft, non-tender, non-distended. No HSM. Positive Bowel sounds. GENITALIA: deferred. EXTREMEITIES: No edema. He has been admitted for left ankle surgery. NEUROLOGIC: intact with the exception on cranial nerve on the right. LABS: CBC within normal range. Pre-op glucose 239. BUN and creatinine of 8 and 0. 5. Pre-op UA with 3+ glucose. (Continued)HISTORY AND PHYSICAL EXAM Patient: T. J. Moreno Patient ID: 110497DOB: 02/15Age: 44Sex: M Room No. : 502 Page: 2 ASSESSMENT AND PLAN: 1) Status post ankle arthrodesis: tolerated procedure well, will continue to monitor. 2) Diabetes: patient with elevated glucose and blood in urine. We will start sliding scale for now. Likely needs Lantus. Possible candidate for Metformin. 3) Hypertension: We will start lisinopril. 4) Pain: we will continue to monitor pain post-op and provide adequate pain control. _____________________________________________________________ Patrick Keathley, MD Endocrinology PH/xx D: 10/09/ T: 10/10

Health Care Careers Diagram and Summary Essay

The role of the Chief Information Officer (CIO) in healthcare has become one of the main lifelines in the industry. The CIO is the most important person within an organization in regards to the collecting, organization, monitoring and securing of data. The CIO is a critical member of the executive leadership team. Charged with developing the organization’s strategy, he or she is responsible for leading the IT staff and ensuring overall compliance with all regulatory requirements. The CIO is also responsible for keeping up-to-date with the latest technology trends as well as threats and being able to adapt the organization’s strategy to mitigate those threats. The CIO also facilities and drives change within the organization (Glaser & Williams, 2010). The CIO is responsible for establishing and maintaining many key relationships within an organization’s leadership team. They work to provide valuable input that helps shape the entire organization’s vision and path to success. The CIO reports consistently on the progress and development of all information technology (IT) projects, issues, and tasks. â€Å"They are the brain of the business-body, monitoring and regulating all the data that passes through. Without CIOs, a healthcare company would collapse under the weight of unprocessed information.† (Becoming a Healthcare CIO (Chief Information Officer), 2012) The CIO focuses on updating and optimizing existing systems while utilizing new systems effectively and efficiently. They are also responsible for updating and maintaining capabilities, strengthening policies and reworking procedures on a daily basis. The CIO is the front line of defense for protecting the organization against fraud and abuse, as well as securing all electronic patient health information (ePHI). The role of the CIO has evolved as the health care industry has faced changes with the dependency on  information technology. Figure 1. Chief Information Officer’s responsibilities within a health care organization. As shown in Figure 1, a health care CIO faces many challenges on a day-to-day basis. These challenges are in the form of maintaining existing systems, optimizing new systems, and protecting PHI. The role of the CIO will continue to evolve as the health care system changes and the dependency and regulations surrounding the role of information technology increase. References Becoming a Healthcare CIO (Chief Information Officer). (2012). Retrieved from HealthcareAdministration.com: http://www.healthcareadministration.com/becoming-a-healthcare-cio-chief-information-officer/ Glaser, J. P., & Williams, R. B. (2010). The Definitive Evolution of the Role of the CIO. Journal of Healthcare Information management, 21(1), 9-11. Retrieved from http://www.himss.org/files/HIMSSorg/content/files/03_column_Leadership.pdf

Bohemian Rhapsody Lyrics Meaning

Wow. I had no idea there were so many interpretations of this song. For me it's always been clear: the song is about an execution. Please bear with me as I construct a detailed argument for this interpretation. Here's the set-up (all of this is proven later): The narrator has committed murder. He might have done this out of malice, or self-defense, or anything in between; we don't know. The fact is that he killed someone, was caught and sentenced, and is now on Death Row. The man is not an important person, so to speak. He is not famous, nor rich, nor anything of the kind.He has no high-priced lawyers and no â€Å"connections† to help him in his plight. The narrator implies that, if he had higher social status, if he had money or fame or whatever, then he would stand a good chance of escaping death. But alas, he is merely a â€Å"poor boy† (aka ordinary person), and has no such power. His family and friends are attending the execution (or have otherwise heard about it), and are very distressed. Conversely, the family and friends of the dead man want revenge and they can't wait to see the narrator executed.The song takes place just prior to the execution, and involves the narrator talking to (or perhaps just thinking about) his mother, just before he dies. If you're still reading, you have my thanks. Here's the line-by-line analysis: *We start with the narrator's thoughts: â€Å"Is this the real life? Is this just fantasy? † *The narrator is overwhelmed by the idea that he's going to die. He almost wonders whether this is all a nightmare or something. â€Å"Caught in a landslide, No escape from reality† Again, he feels overwhelmed, but he can't really deny that he's about to be killed. Open your eyes, Look up to the skies and see,† Looking up to heaven, wondering about life etc. â€Å"I'm just a poor boy, I need no sympathy Because I'm easy come, easy go, Little high, little low† Here he is quoting the common perspective: he's just a poor man (â€Å"boy†), and he doesn't deserve sympathy. Much of the song is about how no one seems to care for the narrator, even though he seems mournful and regretful for his actions. â€Å"Any way the wind blows doesn't really matter to me, to me† Now that he's going to die, nothing more matters. He has no future, no hopes or dreams or goals.He's going to die within the hour, and there's nothing he can do about it. He feels very hopeless, and from his perspective nothing really matters. â€Å"Mama, just killed a man, Put a gun against his head Pulled my trigger, now he's dead† This part is obvious. He committed murder. I don't he's confessing to his mother here, as surely she would already know by the time of the execution. I think that he's really just sadly reflecting on what he's done, and he mentions this to his mother (or perhaps he's just thinking about her) â€Å"Mama, life had just begunBut now I've gone and thrown it all away† He was a young man, in his 20s perhaps. He had the chance to live a meaningful life, but instead he killed a man, thus causing his own death via execution. The narrator laments, noting that he could have saved his own life by choosing not to murder. But now the deed is done, and the narrator will face justice. â€Å"Mama, ooh, Didn't mean to make you cry If I'm not back again this time tomorrow carry on, carry on as if nothing really matters† Again he's sorry for his actions, and regrets that his mother now weeps for him, as he will soon be killed.The execution will take place within the hour, so if he's not back again this time tomorrow, it will mean that the execution happened on schedule, that he failed to escape it via pardon or other means. The narrator tells his mother that, even if he dies, she should carry on living, almost as if his death didn't matter to her. â€Å"Too late, my time has come† The execution is imminent. â€Å"Sends shivers down my spine, body's aching all the time† These are symptoms of his intense fear. â€Å"Goodbye, ev'rybody, I've got to go† He says a final farewell to his family and friends. Gotta leave you all behind and face the truth† The truth is that he killed a man, and now he faces strict justice. He will die. â€Å"Mama, ooh, I don't want to die I sometimes wish I'd never been born at all† This much is obvious. He doesn't want to be killed, and indeed he wonders if it would have been better never to have been born in the first place. A new voice starts singing; this voice represents his friends and family who are (or have been previously) protesting his execution. â€Å"I see a little silhouetto of a man† The narrator seems so poor and pitiful, â€Å"a shadow of what he once was†, so to speak Scaramouche, Scaramouche, will you do the Fandango† Honestly, I don't know what this means â€Å"Thunderbolt and lightning, very, very fright'ning me† Both he and them are afraid that he'll be killed. The â€Å"lighting† part might indicate that he's to be killed with the electric chair, or it might just be symbolic. â€Å"(Galileo. ) Galileo. (Galileo. ) Galileo, Galileo figaro† Galileo was unfairly persecuted by the authorities of his time. Granted, Galileo didn't commit murder, but the narrator's advocates still draw a parallel, insisting that he doesn't deserve the punishment he's receiving. â€Å"Magnifico.I'm just a poor boy and nobody loves me† The narrator repeats the common belief. â€Å"He's just a poor boy from a poor family Spare him his life from this monstrosity† His friends and family argue that, because he's a poor boy, he deserves sympathy and compassion, not death. â€Å"Easy come, easy go, will you let me go† Here the narrator pleads for his life. He basically says â€Å"You don't seem to care about me; I'm ‘easy come, easy go'. You don't really care if I live or die. So, if you don't re ally care whether I live or die, can't you just let me live? Can't you grant me a pardon or something? â€Å"Then the opposite group, the friends and family of the dead man (and/or the execution authorities) respond to these pleas. â€Å"Bismillah! No, we will not let you go† The other group wants the narrator to be executed. â€Å"(Let him go! ) Bismillah! We will not let you go (Let him go! ) Bismillah! We will not let you go (Let me go. ) Will not let you go (Let me go. ) Will not let you go. (Let me go. ) Ah No, no, no, no, no, no, no. † The two groups have a spirited argument. â€Å"(Oh mama mia, mama mia. ) Mama mia, let me go† Here the chorus of friends and family says â€Å"let me go†, but I really think they mean â€Å"let him go.Don't kill the narrator† â€Å"Beelzebub has a devil put aside for me, for me, for me† Beelzebub means Satan. The narrator feels (or speculates) that Satan is out to torment him by leading him to such a sa d fate. After all, it was probably a devil that tempted him to commit murder in the first place. Likewise, his family feels Satan is tormenting them as well, by killing the narrator to make them feel sad. Perhaps even the dead man's family joins in on this chorus; they feel that it was Satan who told the narrator to commit murder in the first place, and now they insist that execution is the only holy esponse to such a sin. Throughout this, the narrator has been lethargic and morose. But right before the end, he has a sudden burst of passion. â€Å"So you think you can stone me and spit in my eye? So you think you can love me and leave me to die? Oh, baby, can't do this to me, baby Just gotta get out, just gotta get right outta here! † I'm not sure if he's talking to anyone specific here, or if he's just ranting with passion, screaming at everyone and everything involved. As I imagine it, the narrator throws off his guards and fights to escape from his shackles.In the ensuing musical piece, he struggles with the executioners, knocking the room into disarray. The two families watch closely, but everyone knows it's a useless struggle; there's simply no way for the narrator to escape. And the end of the musical piece, he is beaten down and finally subdued. Once again he become morose and dispirited, and the executioners drag him to his place of death (electric chair, perhaps). In his last few moments before death, the narrator resumes his previous state of mind. Nothing really matters, Anyone can see Nothing really matters Nothing really matters to me† Again, because he's about to die, nothing really matters to him. He has no purpose, no hope, nothing. â€Å"Any way the wind blows†¦ † This is an allusion to the begining of the song, where this image was used along with â€Å"nothing really matters† So†¦ yeah. I think that's a pretty thorough interpretation. Bohemian Rhapsody is about a remorseful murderer as he's about to be ex ecuted. Questions? Comments? Did anybody even read all that?

Nietzsche and the Superman

The philosophy of Friedrich Nietzsche has four themes: nihilism, morality, the will to power, and eternal recurrence. It is important to know and to understand first these themes so as to comprehend the value of Nietzsche proclaiming the struggle to be a superman. Nietzsche perceives nihilism as the product of an accelerating corrosion of religious and cultural beliefs at the heart of European civilization at the end of the 19th century. Thinkers during the Enlightenment period, who uphold the supremacy of reason over faith, challenge supernatural truths, demanding explanations of the afterlife, the soul, and God that are amenable to human logic and the senses. This mode of thinking seriously challenge and influence to undermine the basic tenets of Christianity and European culture. The statement of Nietzsche, â€Å"God is dead,† is the greatest expression of nihilism. From a viewpoint that God is none existent, Nietzsche sees man’s life as characterized by an aimless relativity that is experienced by him in every sphere of reality – cultural, political, historical, and philosophical. God, considered to be a supreme value, no longer exists. When the highest values consequently become devalued or rejected, nihilism emerges. A case in point, if a supreme value is non-existent, what is there that serves as basis for the existence of things? Man is therefore incapacitated to arrive at certainty about knowledge of reality or of his world. The highest values become devalued not in the sense that man knowingly confronts an eternal abyss in fear and trembling, but the highest values simply no longer exist. These values no longer exert influence. Man accepts this event not with stoic resignation but in total unawareness (Magnus, 1978: 11). Man lives in a society, and is bound by its conventions. When he is born, given to him are his race or ethnicity, status, and role to fulfill in society. Man takes these things and lives his life according to these, often done unconsciously. The second theme of Nietzsche’s philosophy is the master and slave morality. The master morality is born out of higher qualities inherent in the greatest men. Moral judgments are made according to the qualities of the person and not to his actions. A noble statesman is always deemed good, someone who is worth emulating. On the one hand, slave morality is an almost unconscious condition that holds sway over the vast majority of men. The moral standard is that which is useful or beneficial for the many or for the community. The noble statesman, who is deemed good by the standards of master morality, is judged as vile according to the standards of slave morality. Majority of men are suspicious of the leaders that rule over them, and are influenced not immediately because their actions but by their role of ruling over the majority. This value system is an unfortunate vestige of millennia-old social and religious systems, which perpetuate outdated and corrupt moral values such as humility, sympathy, and the like (Magnus, 1978). Nihilism is a life without depth. It is a life of endless wandering, moreover with the fact that man is often unconscious of it. Man hence has to be made to see that this nihilism is the form of life that he has become. He has become a slave, who is one among the many. He must come to know that he lives a passive nihilism, submitting to the fate of the many, and must overcome this, which is to become a master. He must overcome himself. Indeed to change man’s nihilistic idea, he has to change his habitual way of viewing the world. He has to transform his way of understanding religions, moral behavior, language, and political and social institutions of which he is a part (Magnus, 1978: 12). This is where the superman of Nietzsche gains significance. Since the highest values no longer exert influence, Nietzsche proclaims that men have to struggle to become the superman. The superman represents ascending to life, self-overcoming, self-possession, and is to be contrasted with decadence, decomposition, and weakness. As an idealized type, he represents the highest possible integration of intelligence, strength of character and will, autonomy, passion, taste and perhaps even of physical prowess (Magnus, 1978: 34). The task of the superman is to become individuated in an extreme degree and thus to rise high above morality and the herd morality. Man has to question conventional truths that have been accepted by society, and for him to in fact rise above these truths. He has to formulate those high values for himself, and thus end his aimless wandering. There are three steps that Nietzsche espouses in struggling to become a superman. In his book Thus Spoke Zarathustra, Nietzsche portrays this struggle as the metamorphoses of the camel, the lion, and the child.   First is that one must exert a will to power which is demonstrated in that person’s extinguishing of his nihilism and in a profound reevaluation of traditional moral ideas and the creation of radical new concepts. For this to be realized, one has to be immersed as an active agent with the structure in which one finds himself. Referring to the camel, it submits to burdensome labor. It offers itself to be employed in order for society to attain its good. In doing this, the camel realizes itself and acknowledges its value in that society. Upon realizing that one’s value or worth is endowed by society instead of emanating from oneself, the will to power must also manifest itself destructively in the form of an abhorrence and total rejection of the moral and social ideas hitherto believed by mankind. â€Å"In the loneliest desert, however, the second metamorphoses occurs, here the spirit becomes a lion which would conquer its freedom and be master in its own desert. Here it seeks out its last master: it wants to fight and its last god; for ultimate victory it wants to fight with the great dragon.† (Nietzsche, 2006: 14) Referring to the lion, it projects pride, strength, autonomy, and passion to assert and to distinguish itself among the many. It strives to dominate or to be above the rest. â€Å"My brothers, why is there a need in the spirit for the lion? †¦to create new values†¦that is within the power of the lion. The creation of freedom for oneself and a sacred â€Å"No† even to duty – for that my brothers the lion is needed.† (Nietzsche, 2006: 15) Last is that one must perpetually involve himself in an act of self-overcoming. The will to power is a struggle both against oneself and other men that have adhered to conventions in society. Referring to the child, he is free from internal constraints. He is emancipated from the cares of this world. â€Å"†¦my brothers, what can the child do that even the lion could not do?†¦A child is innocence and forgetting, a new beginning, a game, a self-propelled wheel, a first movement, a sacred Yes. For the game of creation, my brothers, a sacred â€Å"Yes† is needed: the spirit now wills its own will, and he who had been lost to the world now conquers his own world.† (Nietzsche, 2006: 15) A child creates and possesses his own values and sees the world according to these values. To become a child, to have a freedom like his, this is man has to struggle for. The last theme in Nietzche’s philosophy is eternal recurrence. This is his central and most famous philosophical idea. This his conviction that at some time in the future another individual would be born with precisely the same thought-processes and experiences as himself. Furthermore, Nietzsche’s principle of love of fate is purely antithetical to religion: rather than live your life in preparation for such supernatural illusions as heaven, one must rather embrace this life and wish every feature and moment of it to be repeated forever, since only this life exist and none other. This idea may be horrifying and paralyzing for most people but it is a necessary conviction for the attainment of full individuation. II The struggle to become a superman arises from an external force, that is social structures, and from an internal force, that is emanating from the individual. Man is born free, yet he is situated in a massive and oppressive social structure, which limits and alienates his activities. He lives with a set of beliefs and values that influence his thoughts and actions. But are these beliefs and values that he adheres to are instilled consciously by him? Not all, and even most of these beliefs and values are already present when he was born. He is born in a family, baptized or inducted into a particular religion, taught with customs and traditions of his native place, bounded to the laws of his people or nation, and the like. As he matures, he takes these beliefs and values into himself without much evaluation since these are what he got to grow up with and such are the conventions that his society got used to live with.   He is born a peasant or a working class. He would be taught or trained to be a worker; would have a family and would pass his learning to his children. He would unfortunately die a peasant or a working class. This is what usually happens to man. This is the curse of the many. Is man totally free then? The answer is that an individual has the capacity to go beyond the present, to move toward the future. Man has the capacity to choose and decide for himself.   What he does ought to be determined by him and not by the social laws or larger social structures wherein he is situated. Though he lives in a society, he is not bounded by its conventions. Man has the prerogative for transcendence, the surpassing of the given. Freedom however demands that man be responsible for it. It is simply to take the consequences of choice. People are free to choose for themselves or to decide for their lives. They are responsible for everything they do. They have no excuses for the outcomes of their choice. And that is the staggering responsibilities of freedom, which cause anguish to some while a source of optimism to those who see their fate in their hands. The struggle to become a superman involves that anguish because due to the staggering resonsbilities of freedom. Friedrich Nietzsche in his work, Thus Spoke Zarathustra, has wrote: â€Å"The Superman is the meaning of the Earth. Let your will say: The Superman shall be the meaning of the Earth! I conjure you, my brethren, remain true to the Earth, and believe not those who speak unto you of superearthly hopes! Poisoners are they, whether they know it or not. Despisers of life are they, decaying ones and poisoned ones themselves, of whom the earth is weary: so away with them!† (Nietzsche, 2006:4) It is a challenge to question a universal system of thought that reveals what is true, right, beautiful, and so on that led to the closure of philosophy and the human sciences. It is to challenge convention. â€Å"Man is a rope stretched between the animal and the Superman – a rope over an abyss. A dangerous crossing, a dangerous wayfarign, a dangerous looking-back, a dangerous trembling and halting. I love him who lived in order to know, and seek to know in order that the Superman may hereafter live. Thus seek he his own down-going.† (Nietzsche, 2006: 6) Life is a theatre, and we are the actors. We can choose to play our own roles, and not be determined by the roles that are given to us by society. That is the Superman. REFERENCES Magnus, Bernard (1978). Nietzsche's Existential Imperative. United States: Indiana University Press. Nietzche, F. (2006 ed.) Thus Spoke Zarathustra. Cambridge University Press, Cambridge.      

Nursing research Essay Example | Topics and Well Written Essays - 250 words - 17

Nursing research - Essay Example In line with this, the process of change involved a number of principles as guided by Lewin’s principles of process of planned change. The principle of unfreezing as advocated by Lewin improved the chances of success. In this case, Lewin advocated for proper and efficient planning of the change process in a detailed manner that clarifies and identifies the problem while suggesting the change process (Keele 236). In this case, this principle helped the facility change the thoughts, attitudes, and behavior of the nurses regarding the old and conventional method of bedside handovers. In effect, the new process of change was set to be effective since all nurses were aware of the new method of bedside handover. In addition, the principle of unfreezing, which involves encouraging people on the need for process of change was instrumental in ensuring that the change process was successful (Keele 236). In this case, unfreezing involved building relationships with the nurses who were to implement the planned

Whether we should ban the use of internet and social media in schools Thesis

Whether we should ban the use of internet and social media in schools - Thesis Example As the Internet and social media started its active development, concerns over its negative influence on the general population, and especially on children, has been present and widely discussed. Among the most disturbing issues has been the fear that as an endless source of information and opportunities for connecting with diverse people, social media creates versatile threats for the young individuals, their normal emotional health and development. (Wallace) Namely, there are concerns that students are in danger of accessing â€Å"inappropriate matter on the Internet† that can be expressed by both â€Å"harmful content or harmful contact†. (Varlas) Subsequently, the problems of cyberbullying and online harassment are commonly discussed while talking about social media usage by children and teenagers. (OKeeffe, and Clarke-Pearson 800-804) As a result, some educators tend to explain that it is more effective and easy to ban the usage of social networking than to control the way students use them. Apart from harmful influences that social media can produce, much has been said in relation to its distracting effect. At present, it has already become a norm to spend a significant percent of time in front of the monitor, communicating, sharing information and photos, or other. (Varlas) It follows that, often, the computer is a substitution of the real-life activities, such as face-to-face communication, sports, going out and having good time with friends, everything that can be considered a part of the normal process of maturing and social development. For instance, specialists revealed that spending too much time online, adolescent are at risk of developing â€Å"Facebook depression†, which is both a result and root of â€Å"social isolation leading to risky behavior.† (OKeeffe, and Clarke-Pearson 800-804) In addition, social media is also sometimes blamed

Criminal Justice Research Methodology Term Paper

Criminal Justice Research Methodology - Term Paper Example It is also practical in the sense that it covers a long process over determining what a research needs in particular as it can be modified and take the form of interviews, questionnaires, or a combination of both. In a survey-interview, for example, it allows a researcher to observe the subject and modify questions if the subject seems confused by them. Survey is a good method to consider specially if there is a long range of respondents involved and the researcher needs to collate more uniformed answers in a given period of time (example, respondent-reactions due to the changes brought about by a recent ordinance created). Unlike plain interview that answers brought about by open-ended or close ended questions may vary and sometimes complex in their meaning, survey-questionnaires can eliminate the possibility that the researcher can influence the subject by is or her facial expressions, e.g., unconsciously frowning at an answer making unnecessary body language. Of course, there is a lways a danger that subjects may give misleading answers in order to make themselves â€Å"look good† but the researcher can always modify the questions in several different ways to detect this as well. Surveys are also ideal to use when concerns for safety is involved. It has been tested and experience through time that when safety is concerned, it is highly difficult to get willing respondents that will be open for research. There are two ways to ham ­per successful data gathering through face-to-face interviews. First, potential re ­spondents may refuse to be interviewed because they fear the stranger-interviewer specially if the subject for the research is a sensitive one. Second, the interviewers themselves may be in danger given that in some studies to be conducted, a need to expose researchers in a dangerous situation is inevitable (Maxfield, and Babbie, 2008). Social desirability is known to be one of the common problems that plague self-report crime questions in