According to Schmidt and Mandel Essay Example for Free

According to Schmidt and Mandel Essay Sepsis is an inflammatory systemic response to infection. The symptoms are produced by the host’s defense systems rather than by the invading pathogens (Schouten et al. , 2008). Sepsis is a frequent cause of admission to intensive care units (ICUs) and it is one of the leading causes of death among hospitalized patients (Alberti et al. , 2003). It is a public health concern and it continues to be a burden on the healthcare system (Ely, Kleinpell and Goyette, 2003). Despite advancing medical technology, the rate of patients in intensive care units diagnosed with sepsis is continually increasing. According to Schmidt and Mandel (2009), even when optimal treatment is provided, morbidity due to severe sepsis or septic shock is approximately 40 percent and can exceed 50 percent in the most critically ill patients. Early recognition of sepsis and sepsis-associated infections is essential to treating and controlling it from escalating to advanced stages that are associated with higher mortality rates (Lukaszewski et al. , 2008). Unlike other diseases or trauma, the initial signs and symptoms of sepsis are subtle and can easily be missed by health care practitioners. See more: Homeless satire essay Sepsis involves the activation of the coagulation cascade along with downregulation of anticoagulant systems and fibrinolysis (Schouten et al. , 2008). This cycle becomes exaggerated because inflammation induced coagulation produces further inflammation. Sepsis is associated with hypovolemia, hypotension and endothelial dysfunction. The following report will examine a patient’s course of illness during her stay in the ICU at XXXX. This paper will provide a discussion on the patient and her past Running Head: Sepsis medical history, the pathophysiology of sepsis, the clinical manifestations of sepsis, the patient’s clinical course, and finally, a summary and critique of the case management. Patient Information Mrs. E is a 73 year old female with an extensive past medical history. According to her medical chart, her history includes type II diabetes mellitus, obesity, hypothyroidism, dyslipidemia, hypoglycemia, chronic kidney disease (due to hypertension and diabetic nephropathy), hyperuricemia and gastritis. She has a history of breast and uterine cancer. As a result, she has undergone a left lumpectomy and she has had a hysterectomy. Mrs. E. is an ex-smoker and she has been diagnosed with chronic obstructive pulmonary disease (COPD). In June 2009, Mrs. E. was being investigated for transaminitis, and an MRI in the same month suggested a periampullary mass. She underwent Endoscopic Retrograde Cholangio Pancreatography (ERCP) on August 26, 2009 at Trillium Health Centre in Mississauga. The ERCP results indicated papillary fibrosis and stenosis; however no masses or stones were discovered. Mrs. E. presented to the emergency department at Trillium Health Centre on August 27, 2009 in septic shock due to an intra-abdominal source. She was then taken to the operating room for a laprotomy for cholecystitis. It was discovered during surgery that Mrs. E. had a gangrenous gallbladder. The surgery team drained a supraphrenic abscess, sutured the intestine and repaired a ventral hernia. She was then admitted to the intensive care unit (ICU) at Trillium Health Centre. During her stay in the ICU, cultures were taken on successive days that confirmed Klebsiella, pneumonia, and sepsis. She was treated with ceftriaxone and flagyl. Mrs. E’s renal function progressively worsened and her creatinine steadily rose. She developed thrombocytopenia due to sepsis. Mrs. E. began to become less responsive to furosemide treatments and was diagnosed with acute renal failure. As a result she was transferred to xxxxxx for hemodialysis. Upon arrival to xxxxxxx, Mrs. E was intubated, ventilated and sedated. On initial examination, her heart rate (HR) was 88 BPM, blood pressure (BP) was 189/59 mmHg, temperature was 36. 7 degrees celsius, her respiratory rate (RR) was approximately 22 bpm, and her oxygen saturation was 97%. Mrs. E. had generalized pitting edema throughout her entire body. She also presented with periods of paroxysmal atrial fibrillation and as a result was given amiodarone. The amiodarone infusion helped to bring Mrs. E back to normal sinus rhythm. On assessment, Mrs. E. had inspiratory crackles with decreased breath sounds to the left lower lobe of her lung, and ecchymosis of her upper extremities. Based on the evidence she presented with, including laboratory evidence, Mrs. E. was diagnosed by the renal physician at The Credit Valley Hospital with acute on chronic renal failure. The acute component was determined to be secondary to sepsis and hypertension perioperatively. Disease Process Pathophysiology Sepsis is a clinical condition that complicates a severe infection and is characterized by systemic inflammation and widespread tissue injury (Neviere, 2009). When coupled with acute organ dysfunction, sepsis can lead to severe life-threatening complications, including death (Lukaszewski, 2008). Individuals suffering from sepsis display signs of inflammation at tissue sites remote from the original insult such as vasodilation, increased microvascular permeability and leukocyte accumulation. During sepsis, the inflammatory response causes extensive damage to an individual’s microcirculation (Neligan, 2006). According to Schouten et al (2008), sepsis involves the activation of the coagulation cascade coupled with down-regulation of anticoagulation and fibrinolysis. An intricate link between inflammation and coagulation exists within the body (Neligan, 2006). When a pathogen is present in the bloodstream or when tissue injury occurs, an inflammatory response occurs. The response causes a stimulation of the immune system to produce interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF? ) (Neligan, 2006). These cytokines are the main catalysts of the inflammatory response and cause the release of several agents including, interleukin-8, histamine, kinins, serotonin, selectins, and neutrophils. When the above compounds are activated, local vasodilation occurs, cytotoxic chemicals are released and the invading pathogen is destroyed (Neligan, 2006). The inflammatory response can be excessive at times and causes local cellular destruction (Neligan, 2006). In septic patients, damage to their own tissues occurs throughout the body in the vasculature and endothelium. The release of the proinflammatory cytokines, specifically IL-6, causes activation of the coagulation cascade (Neligan, 2006). Coagulation can be activated by either the intrinsic or extrinsic pathway following a particular tissue damaging event (Neligan, 2006). The intrinsic pathway is the slower of the two pathways and it requires that all factors are present within the blood for clotting to occur (Marieb Hoehn, 2007). However, when blood is exposed to a factor that resides under the damaged endothelium, called tissue factor (TF), the extrinsic pathway is activated (Marieb Hoehn, 2007). The extrinsic pathway is shorter than the intrinsic pathway as it bypasses several steps of the intrinsic pathway. Each clotting pathway 6 requires ionic calcium and involves a series of procoagulants, and eventually forms a common factor X (Marieb Hoehn, 2007). Within the extrinsic pathway, tissue factor binds to activated factor VII. The complex that results activates factors IX and X (Marieb Hoehn, 2007). When factor X has been activated, it complexes with calcium ions, PF3 and factor V to form prothrombin activator (Marieb Hoehn, 2007). Prothrombin activator catalyzes the transformation of the plasma protein prothrombin to the thrombin, an active enzyme. Thrombin catalyzes the formation of fibrinogen and eventually into fibrin (Marieb Hoehn, 2007). Thrombin, in the presence of calcium ions, activates factor III in order to bind the fibrin strands closely together (Marieb Hoehn, 2007). The last step in the normal clotting cascade is fibrinolysis. Fibrinolysis is responsible for removing clots once the healing process is complete (Marieb Hoehn, 2007). Without fibrinolysis, vessels have the potential to become completely blocked because clotting occurs continuously (Marieb Hoehn, 2007). Plasmin, a digesting enzyme, is responsible for breaking clots (Marieb Hoehn, 2007). It is produced when the plasma protein plasminogen is activated. Plasminogen is incorporated into a forming clot, however it remains dormant until it is activated by an appropriate signal or tissue plasminogen activator (tPA) (Marieb Hoehn, 2007). Activated factor XII and thrombin can also activate plasminogen. In a septic patient, the fibrolytic system is inhibited (Neligan, 2006). Cytokines and thrombin stimulate the release of plasminogen-activator inhibitor-1 (PAI-1), from platelets and the endothelium (Marieb Hoehn, 2007). Thrombin is an activator of inflammation and an inhibitor of fibrinolysis. Thrombomodulin, a modulator of fibrinolysis that activates protein C, is also impaired by inflammation and endothelial injury.

Traditional Values :: Personal Narrative

Traditional Values Traditional values can sometimes sway us to do wrong things parallel to our own personal beliefs. People, places, and things shape these values and cause us to surrender to situations that neither influence nor hold our interest. This is a scary concept: What if one of these situations put our life or someone else’s life in danger? This is a question that crossed my mind when I thought about conformity in my life. One memory in particular involves my football team. As did Langston Hughes in his experience with conformity, I too felt pressure from my peers to do something I didn’t want to do. During my sophomore year, my teammates wanted to take part in hazing a younger freshman football player. They asked me to help them take all of his equipment out of his locker, find him, and beat him up. This went against my personal beliefs. In no way did I want to take part in something that had to do with the humiliation of another teammate. Also, when I was younger, I had to go through the same thing, and it hurt me deeply. Then and now, I looked at my own embarrassment as something I don’t ever want to see someone else go through. Before I gave my answer to my teammates, other consequences rolled through my head; hazing is illegal, and if convicted, the offender would be prosecuted to the fullest extent of the law. I was doing well both on and off the field, so why mess it up? So I devised a plan. I would agree to help my teammates, but I would also agree to help the young freshman find his equipment and help him elude a vicious beat-down. â€Å"Well are you gonna help us or not?† the quarterback of my team impatiently asked.â€Å"Yeah sure†¦Ã¢â‚¬  I said, â€Å"Just let me take care of everything ‘cause I really don’t like this kid.† He looked at me and smiled. â€Å"There you go, Taylor!† He turned to the posse of football players, â€Å"We got a sophomore that’s stepp’n up!† It was like I killed two birds with one stone and saved both my butt and the kid’s in one throw.

Students, faculty struggle with plagiarism in Internet era

In the postmodern society we have today, Internet-access Is a natural part of the everyday life. Not only have the Internet almost taken over people's lives, but apparently also their schoolwork and education. Due to the easy access to everything on the Internet, faculty at schools have trouble find-inning a dividing line, between what is cheating and what is not. An example of this was seen in a chemistry-class at the University of Wisconsin, where 42 students were accused of plagiarism. While all the students protested, none of the students seemed to know the seriousness of the situ-tool.This leads to the question: when Is something plagiarism? And what can one do to fix the cheating? Journalist, Todd Effeminately wrote the text â€Å"U students, faculty struggle with plagiarism in In-tern era† in 2010, and it was published in â€Å"the Capital Times†- newspaper. The sender of the art-clue, want to Inform the reader of the present Issue: plagiarism. The sender simply wants to notify the reader that plagiarism Is Illegal and wrong. This leads to the unknowing students, who tempt to take the short cut and use other people's work.The scary thing is that most students don't see the series- scenes of this problem – they simply don't consider it cheating. As Donald McCabe, professor at Rutgers University and co-founder of the International Center for Academic Integrity, explains it: â€Å"You're almost to the 50-50 mark right now, where almost half the students we survey don't see this as ‘moderate' or ‘serious' cheating. And the number that's growing Is the half who don't con-slider It cheating. † This quotation-use by the writer, appeals to the readers pathos: how come so many students don't see this wrongdoing?What have society done wrong to make this happen? Not only does Effeminately appeal to pathos, but he also appeals to ethos, which strengthens his reliability. HIS ethos Increases, with both the use of statistics and experts to comment on the Issue, for an example: â€Å"Donald McCabe, has been researching academic misconduct for 20 years, and he says Logos is also a penetrating form of appeal. It is used throughout the entire text, when Effeminately tries to convince the reader that plagiarism is an increasing crime.Because, of course plagiarism is wrong, and he proves it by referring to the majorities opinion: â€Å"most me to agree with the notion that plagiarism – taking the work of others and presenting It as your own – Is wrong†. Another appeal to logos Is his use of connectives in the text. Connectives make him look sure of his case, for an example when he uses â€Å"of course† in the end his contention: â€Å"Students who cheat are nothing new on college campuses, of course†. All of the examples above are all signs of hidden argumentation.Hidden problem, and agree with him at the same time. With the use of hidden argumentation, the reader is influence d in the wanted direction, most likely without ensign any form of manipulation. The signs of hidden argumentation is seen in the text, when the writer refers to experts, the majority of people's opinions and if the writer is general-sizing, which is all seen in this text. The way of the composition makes the text very floating – there is a good balance between claim and evidence in the argumentation.At the same time there is a perfect comprehensive use of experts to support the argumentation. Because of the formal and high-flown language used in the article, it is to conclude that the target roof for the text must be most suitable for the academic educated people. At the same time it is not unthinkable that the text also is meant for college-students around the world. Because of the theme and the conclusion in the text, you must assume that the text's purr-pose is to enlighten the students about the serious matter of the problem: plagiarism.One of the scary things to think ab out is the fact that young students cheat because they have doubt in themselves. Either, they don't realism how smart they are, or maybe they are Just scared of hard work and failure? In reality, the main reason why students cheat is because they: â€Å"didn't think they could accomplish what they wanted to any other way'. But is the goal really accomplished, when it is accomplished with fraud? Plagiarism is so common that some people even write papers in ex-change for money.As it is told in the article: â€Å"Professor Donald Downs (†¦ ) met a man who â€Å"told me he felt like he had taken my courses. † A puzzled Downs asked the man what he meant. â€Å"He told me, ‘Vive written about 20 papers for your In conclusion, what can one do to fix the cheating? According to the article the main season to fix cheating is by talking about it, even though the topic is sensitive: ;legalism is a very difficult conversation to have because nobody quite wants to talk about it,† (†¦ You can't work on this issue unless you talk about it. † The important thing is to enlighten students about this issue, because if the students really speak the truth: then how can it be considered cheating, if they truly don't know what plagiarism is? Enlighten is also the main purpose of this article: enlighten the world about plagiarism. Set a stop to plagiarism and accomplish your goals by yourself.

Actuellement Is a French False Cognate

Mistakes will always be made in French, and now you can learn from them. French and English have hundreds of cognates, which are words that look alike or are pronounced the same in both languages. There are true cognates (similar meanings), false cognates (different meanings) and semi-false cognates (some similar, some different meanings). The French adverb actuellement looks an awful lot like the English word actually, but looks can be deceiving.  Its really the  case of a  false cognate, because these two words mean completely different things: Actuellement means at the present time and should be translated as right now or currently.  Actually means in fact and should be translated as  en fait,  Ãƒ   vrai dire  or vraiment. Still, many people have not assimilated this lesson, and  actuellement  is mistakenly used to mean actually so often that  you  have to read the sentence two or three times to decide what the person actually means. How to Remember Which Is Which If you need a memory device, keep this in mind: Actualità ©Ã‚  refers to a  current event.  If you can remember this, you shouldnt have trouble remembering that actuellement and actually are false cognates with different meanings. Or you can remember the etymology. The root word of actually is actual, which means real or true. (Depending on the context, actual can be translated as  rà ©el,  vrai,  và ©ritable,  positif, or  concret.)  By extension then, actually means in fact. Meanwhile, the French root word for actuellement is the French adjective actuel, which means current or present. So actuellement  naturally refers to time as well and, by extension, means currently or right now. Examples of Correct Usage Je travaille actuellement. (I am currently working.)Le problà ¨me actuel (The current/present problem)Actually, I dont know him. (En fait, je ne le connais pas.)The actual value (La valeur rà ©elle)