Impact of Stroke Case Study

Impact of Stroke Case Study Introduction Jithra is now 68 years of age. Her family consists of husband, daughter, nephew and nephews wife. She has been living with left side hemiplegia caused by stroke since she was 64. As this interview went, Jithra was holding her daughters hand and slowly elaborated her word by word experience in tears. Before an episode of stroke damaged the right side of her brain and put her in bed for the rest of her life, Jithra was living a life of a healthy person. She stated that poverty and debt were the most important factors that motivated her to wake up at 4:30 am on regular basis in order to prepare food and beverage for her respective customers who kindly supported her small restaurant. A strong belief that she did not have any health issue strengthened by the fact that an annual physical check-up was so expensive disguised Jithra from realising how essential it was to have her blood pressure and blood glucose level regularly monitored when she aged. As now that she spends her activities of daily living in bed, pressure sore has become the main concern for both Jithra and her family. Though Jithra does not complain of soreness, redness on skin does indicate that some areas need attention. This essay will provide an overview understanding of stroke and its negative effects posed on Jithra. Furthermore, this essay will emphasise on the intervention and prevention of pressure ulcer in depth. Understand Stroke According to World Health Organization (2014), stroke occurs when there is an interruption of the blood supply to a part of the brain. Stroke can be divided into two major types. The first type is called haemorrhagic stroke. This type of stroke accounts for approximately 13 percent of all strokes (Brown Edward, 2012). It results from bleeding into the brain tissue. The bleeding caused by a rupture of blood vessels results in the leakage of blood into the brain impairing the delivery of oxygen and nutrients. Haemorrhagic stroke can be caused by a number of disorders affecting the blood vessels. Some of which are long-standing high blood pressure and cerebral aneurysms, a thin or weak spot on a blood vessel wall. The weak spots that cause aneurysms are usually present at birth. The development of aneurysms happens over a number of years and don’t usually cause detectable problems until they break (Stroke Foundation, 2014). Jithra’s daughter stated that Jithra complained of headache and nausea approximately 48 hours, especially during periods of activity, before an episode of stroke occurred. Headache particularly distinguishes haemorrhagic stroke from ischaemic stroke. Its other symptoms also include nausea, vomiting, decreased level of consciousness, neurological deficits and hypertension (Brown Edward, 2012). The second type is called ischaemic stroke. It accounts for approximately 85 percent of all strokes. According to Brown and Edward (2012), this type of stroke occurs as the result of partial or complete obstruction, caused by a blood clot, of a blood vessel that supplies blood to the brain. This leads to an insufficient of oxygen supply and glucose needed for cellular metabolism. A clot may be formed by means of embolism or thrombosis. Both types of clotting formations can be differentiated by their characteristics. The term embolism in relation to stroke is characterised by a condition where an embolus is created in one part of the brain or the body, circulates in the bloodstream, and eventually blocks the flow of blood through a vessel in another part of the brain (Crosta, 2009). This is called embolic stroke. On the other hand, the term thrombosis is characterised by the formation of a clot resulted from fatty deposits or plaque blocking the passage of blood through the artery. Th is type of clot remains in one area of blood vessels without being carried throughout the bloodstream. This is called thrombotic stroke (Brown Edward, 2012). Stroke risk factors There are multiple risk factors associating with stroke as according with (Brown Edward, 2012). The risk factors can be classified into non-modifiable risk factors and modifiable risk factors. Non-modifiable risk factors include age, gender, race and heredity. Modifiable risk factors include diabetes mellitus, heart disease, atrial fibrillation, heavy alcohol consumption, hypercoagulability, hyperlipidaemia, hypertension, obesity, physical inactivity, sickle cell disease and smoking. Jithra, at 68, was diagnosed with hypertension or high blood pressure and diabetes mellitus. Age, hypertension and diabetes mellitus have played a key role in contribution to stroke. ‘Stroke risk increases with age, doubling each decade after age 55 (Brown Edward, 2012, p. 1622).’ The rate of atherosclerotic development is usually increased by the stress of a constantly elevated blood pressure. The term atherosclerosis is referred to as hardening of the arteries resulting from the formation of fatty deposits or plaques. The narrowing of the blood vessels is its consequence. The carotid artery in the neck is a common site where these plaques develop and tend to break away and lodge in the vessels of the brain (Sander, 2013). Likewise, diabetes mellitus increases tendency towards the dysfunction of the inner linings of the blood vessel walls leading to an increase in the tendency towards the development of plaques. In addition, high cholesterol and triglyceride levels are highly likely among people with diabetes mellitus (Brown Edward, 2012, p. 863). Impact of Stroke According to Brown and Edward (2012), stroke is a leading cause of serious, long-term disability. Jithra has been living with left side paralysis since she was 64 as a consequence of stroke. Immobility and the weakness in Jithra’s right arm and leg are the key limitations. She relies greatly on her family members when repositioning in bed is attempted and a combination of self-care abilities and activities of daily living, such as eating or drinking, are performed. Dysarthria, a disturbance in the muscular control of speech, is also experienced. Impairment may involve pronunciation, articulation and phonation. This helps explaining why Jithra feels uncomfortable communicating with strangers. As the interview went, a sudden change in emotion was spotted. Persons who have had a stroke may have difficulty controlling their emotions. Emotional responses may be exaggerated or unpredictable (Brown Edward, 2012, p. 1628).The daughter said that Jithra sometimes cried without any reas on. The interchanging between laughing and crying took only minutes to do so. Besides pressure, shearing force, friction and excessive moisture contribute to pressure ulcer formation (Maklebust Sieggreen, 2001). As mentioned above that Jithra is bed-bound and greatly relies on her family members when repositioning is attempted, manual handling is used in order to lift and move her around the bed. However, the incorrect techniques combined with non-supportive equipment, such as sliding sheet, have put the maintenance of Jithra’s skin integrity becomes much more difficult. Pressure Ulcer According to Sydney South West (2008, p. 4), pressure ulcers are defined as â€Å"any lesion caused by unrelieved pressure when soft tissue is compressed between a bony prominence and an external surface for a prolonged period.† Factors that influence the development of pressure ulcers include the intensity of the pressure; the length of time the pressure is exerted on the skin; and the ability of the tissue to tolerate the externally applied pressure. Intrinsic factors that put Jithra at risk in developing pressure ulcers consist of advanced age, malnutrition and diabetes mellitus. Extrinsic factors include pressure, shear and moisture Sydney South West (2008). Intervention Although the skin remains intact, the appearance of persistent redness, particularly in sacrum, followed by itchy sensation indicates that stage one pressure ulcer has already developed. Stage one pressure ulcer can be intervened as referred to pressure ulcer intervention guidelines (Jones, 2013) by strictly maintaining the skin integrity. This can be done by relieving the externally applied pressure, protecting fragile skin and bony prominence, preventing friction and shearing and protecting skin from moisture. In relieving the externally applied pressure, a regime of repositioning combined with the use of pressure relieving devices has already been utilised by Jithra’s daughter. However, it might not be enough in terms of the frequency. The frequency of repositioning depends on the ability of the tissue to tolerate the externally applied pressure. In this case, Jithra should move or be repositioned frequently enough in allowing reddened area of affected skin to recover from the effects of pressure. A turn clock may be a helpful reminder of correct body positions and appropriate turning times. Additionally, a 30-degree side lying position may well be utilised for Jithra as it diverts pressure from the sacrum. Maintaining a 30-degree side lying position can simply be done by using pillow or foam positioning wedges. However, lying on the side may increase pressure on extremities, especially knees and ankles. Placing pillows between the legs helps preventing opposing knees and ankles fr om exerting pressure on one another (Maklebust Sieggreen, 2001). In protecting fragile skin and bony prominence, an appropriate support surfaces shall be used and yet its cost has to be taken into consideration. Poverty and debt make it very difficult for Jithra to afford buying or renting them. ‘Charges can range from $24 to purchase a foam overlay to a daily rental fee of $125 for a highly technical therapy bed (Maklebust Sieggreen, 2001, p. 75).’ Regardless of the variations in price, There is no scientific evidence that one support surface consistently works better than any others. Nevertheless, pressure points require protection whether at risk persons are in a bed or on a chair. Using pillows to bridge vulnerable areas, again simple, is an effective way to eliminate pressure. A regime of repositioning, together with the use of pillows has proved to be highly effective in protecting fragile skin and bony prominence. In preventing Jithra from friction and shearing, a family education on how friction and shearing occur and correct usage of manual handling techniques and appropriate equipment shall be provided. Shear is greatest when a caregiver drags an at risk person along the surface of the sheets during repositioning or allows the person to slide from high-fowler’s position. In order to minimise shearing force, the head of the bed shall not be raised exceeding a 30 degree angle, unless the patient is eating. Furthermore, friction, a precursor of shear, is commonly caused by pulling a patient across the bed linen. Rubbing the protective layer of skin away increases the potential for deeper tissue damage. Excessive moisture may be the result of sweating, wound drainage, soaking during bathing and faecal and urinary incontinence. Moist skin is five times as likely to become ulcerated as dry skin. The intervention guidelines suggested that protecting skin from moisture can be done by using continence management systems, using barrier skin cream to prevent skin maceration and keeping the site clean and dry. Living in a hot and humid country like Thailand may put Jithra at a higher risk of developing pressure ulcer due to sweating. Thailand normally has its temperature sitting at around 30 degree Celsius. Two fans, together with the application of baby powder are used in maintaining the dryness of Jithra’s skin. Recommendation According to Jones (2013), it is highly recommended that risk assessments must be done on Jithra by using the Waterlow scale. In doing so, her body mass index is required. The scale will give a score which helps identifying if Jithra is at risk, high risk or very high risk in developing pressure ulcers. Therefore, repositioning regime can be precisely arranged in order to ensure optimum pressure redistribution. Manual handling, together with the use of equipment such as hoists or slide sheets, effectively helps avoiding shear and friction. Education on the use of the mentioned equipment shall also be provided. A dietician shall be involved in discussing knowledge of healthy diet and considering the need for food fortification and nutritional supplements. Make sure that Jithra consumes adequate fibre and well hydrated as she is more prone to constipation due to immobility. Conclusion This can be concluded that the maintenance of skin integrity plays a key role in avoiding the development of pressure ulcers. Being rich or poor might not be the factors in treating and preventing pressure ulcers. This essay has shown how beneficial it is to have carers or family members who strictly put pressure ulcer intervention and prevention guidelines into practice to look after Jithra. The mattress that Jithra lays her body on might not be the best that the family can afford but frequently turning and maintaining dry skin have proved in lowering the risk of developing pressure ulcers. Only stage one pressure ulcer developed though, Jithra has been suffering from disability for 4 years. References Brown, D., Edwards, H. (Eds.). (2012). Lewiss medical-surgical nursing: assessment and management of clinical problems. NSW, Australia: Elsevier Australia. Crosta, P. (2009). What Is Embolism? What Are The Different Types Of Embolism?. Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/153704.php Jones, D. (2013). Pressure ulcer prevention in the community setting. Nursing Standard, 28 (3) 47-55. Retrieved from http://web.a.ebscohost.com.ezproxy.holmesglen.vic.edu.au/ehost/pdfviewer/pdfviewer?vid=3sid=87c6951d-c6be-44c5-8985-c35d1918eb04%40sessionmgr4004hid=4207 Maklebust, J., Sieggreen, M. (2001). Pressure Ulcers: Guidelines for Prevention and Management (3rd ed.). Pennsylvania, USA: Springhouse Corporation. ONeill, P. A. (2002). Caring for the Older Adult: A Health Promotion Perspective. Pennsylvania, USA: W.B. Saunders Company. Sander, R. (2013). Prevention and treatment of acute ischaemic stroke. Nursing Older People, 25(8), 34-39. Scott, K., Webb, M., Sorrentino, S., Gorek, B. (Eds.). (2006). Long-term care assisting: Aged care and disability. NSW, Australia: Elsevier Australia. Stroke Foundation. (2014). Types of Stroke. Retrieve from http://strokefoundation.com.au/what-is-a-stroke/types-of-stroke/ Sydney South West Area Health Service. (2007). Pressure Ulcer Prevention and Management. Retrieved fromhttp://www.sswahs.nsw.gov.au/pdf/policy/pd2008008.pdf Watkins, C., Leathley, M. (2010). Setting the scene. In Williams, J., Perry, L., Watkins C. (Eds.), Acute Stroke Nursing (pp.1-16). Retrieved fromhttp://0-onlinelibrary.wiley.com.alpha2.latrobe.edu.au/store/10.1002/9781444318838.ch1/asset/ch1.pdf?v=1t=ht43cw4ls=1791526b00be208b196d718b1c2189904267ad40 World Health Organization. (2014). Stroke, Cerebrovascular Accident. Retrieved from http://www.who.int/topics/cerebrovascular_accident/en/

Main Causes of the US Automobile Industry Crisis Essay

Recent happenings in the US automobile industry point to an industry that is steeped in a crisis of monumental proportions, one that it has never had the misfortune of staring at since the advent of the automobile as we know it today. Sales at the Big Three motor companies (Ford, GM, and Chrysler) have touched historic lows, not only pushing industry profitability levels down with them, but also triggering off a rare spectacle characterised by all the largest American carmakers bleeding in red ink. Writing for one of the premier automotive media, Krebbs and Visnic (2009) adduce data fresh from the oven that point to as much. According to Krebbs and Visnic (2009), the American industry posted the lowest levels of sales in sixteen years in the year just past. While GM witnessed a drop in sales of 23%, Ford saw its sales revenues shrink by a massive 20%, and Chrysler posted sales that were 30% lower than the previous year. Other automakers in the country such as Hyundai, Toyota, and Nissan did not fare any better. On average, the industry shed off some 3 million units in lost sales, which translates into a contraction of 18%. With such massive declines in sales, the Big Three have become deeply steeped in debt, and are staring bankruptcy right in the face in spite of the massive bailout packages tailored for the industry by the Obama administration. As a matter of fact, GM (which is the largest of the Big Three) and Chrysler have already filed for Chapter 11 bankruptcy protection. As the Wall Street Journal (2009, p.A1) points out, GM went under in June under a massive debt of $172 billion (against assets of only $82 billion) in what has been described as the second largest industrial bankruptcy filing in the US. After 84 years, the icon of American industry had its name struck off the Dow Jones, hot in the heels of Chrysler which had filed for bankruptcy just months earlier. It is not just dwindling sales and profitability that have afflicted the three largest American carmakers, they have also been steadily losing market shares and particularly to their more fleet-footed Asian rivals who include Toyota, Nissan Honda, and Hyundai. For example, GM, Chrysler and Ford had market shares of 23.8%, 12.9% and 15.5% respectively in 2007, which fell to 22.6%, 11% and 15.1% respectively in 2008. In contrast, the market shares of Honda, Nissan and Toyota increased from 9.7%, 6.6% and 16.3% respectively to 10.8%, 7.2% and 16.8% respectively over the same period. This is an indication that the US carmakers are losing out to other foreign carmakers (Krebbs and Visnic, 2009). Various factors have been cited as being behind the poor performance of the US automobile industry, but there are three main reasons that stand out. These include the meltdown in the US economy that was largely triggered off by the sub prime mortgage crisis, the failure by American carmakers to respond adaptively to the dictates of the external environment, and a poor business model characterized by factors such as huge legacy costs. Economic meltdown: One of the major causes of the declining fortunes of the US auto industry is the meltdown of the US economy which is mainly attributed to the sub prime mortgage crisis. The sub prime mortgage crisis occurred when banks and other financial institutions made out loans for the purchase of homes to a segment of the market that is considered risky due to its poor credit history and low ability to repay given their low income levels (this segment of the market is what is referred to as the sub prime segment). These loans were made out at the height of the boom in the real estate industry with expectations being that the boom in the industry would continue and that the buyers of the homes given the mortgages would be able to refinance their homes and pay back the loans. With the unexpected and sudden burst of the real estate bubble however, the sub prime borrowers were unable to refinance their homes due to plummeting values of real estate, leading to huge defaults that triggered off massive foreclosures never before witnessed in US history (Zeese, 2008; Rasmus, 2008). This caused banks and financial institutions to write off billions of dollars in bad debts, leading to a huge liquidity crisis and credit crunch that hit the economy and caused the current recessionary conditions being witnessed in the US and in much of the world. It also brought about a sharp and dramatic spike in unemployment rates which have affected demand for cars. The economic crisis has had the effect of drying up credit, which has made many potential car buyers unable to access car loans, a factor that has in turn triggered a massive decline in the demand for cars. Additionally, car makers have been unable to access debt finance for investment and working capital requirements, which has also impacted them negatively (Zeese, 2008; Rasmus, 2008; Borade, 2009). Failure to adapt to the external environment: Firms operate in an external environment in which its operations are affected either positively or negatively by political-legal, economic, socio-cultural, and technological forces. The role of the company therefore is to scan the external environment for opportunities or threats which these forces may present, and to implement strategies that will help the organization to either capitalize on the opportunities or avoid the threats (Saloner, Shepard, and Podolny, 2008). The troubles afflicting the US automobile stem in part on the failure of the US carmakers to assess changes in their external environment and to respond adaptively. Over much of 2008, oil prices soared at one tine time touching all-time highs of $147 per barrel. The rise in oil prices triggered a corresponding rise in gasoline prices (to a high of $4 a gallon), which pushed the commodity out of reach for many Americans, and especially those with large fuel guzzling vehicles such as trucks (e.g. GM’s hugely popular Hummer) (Krebbs and Visnic, 2009; Zeese, 2008). Concomitant with the rise in the price of oil and gasoline has been an increasing consciousness towards the need for environmental protection, which has caused the rising popularity of cars that have higher fuel efficiency. These two factors contributed a great deal in shifting consumers’ tastes and preferences away from large fuel-guzzling cars such as trucks towards smaller more fuel efficient models. Unlike Asian car makers which recognized these trends and moved towards the manufacture of small models and green vehicles, all the Big Three firms continues producing large fuel guzzling cars such as SUV’s (Zeese, 2008). The result of this is that SUV and truck sales plummeted, hitting hard the revenues and bottom lines of the American firms, as consumers shifted their purchases to the smaller models manufactured by the Asian carmakers. Krebbs and Visnic (2009) write that as a result of these trends, car sales surpassed those of trucks in 2008, the first time that has ever happened since 2000. An example of   how hard SUV and large vehicle sales were affected as a result of these trends is given by the case of GM and its Hummer brand, which Hummer, which â€Å"suffered the biggest decline of all GM’s brands with sales plummeting 51 percent — its lowest sales level since 2002† (Krebbs and Visnic, 2009, p.2). Poor business model: The third factor that has contributed to the dramatic decline of the US auto industry’s fortunes is the fact that the industry has a poor business model. The US automobile industry is unique among all car industries worldwide due to the fact that it is saddled with huge and unbearable healthcare costs which produces one of the highest cost structures that makes American made cars uncompetitive against Asian made cars, for example (Zeese, 2008). According to Zeese (2008), failure by successive US administrations to reform the country’s healthcare system has resulted in car manufacturers paying healthcare costs for their employees to the tune of billions of dollars. Zeese (2008, p.1) writes that â€Å"It would not be unfair to describe General Motors as a health insurance provider who happens to make cars. GM spends $5 billion annually on health care for 1.2 million people – only 150,000 of whom work for the company. GM, Ford and Chrysler have a combined unfunded retiree health care obligation of more than $90 billion. Health care adds $1,500 to the cost of each vehicle.† With the American carmakers saddled by such huge costs, it is little wonder that their products are uncompetitive when compared to cars made by foreign manufacturers such as Toyota (which has one of the most admired lean manufacturing systems that keeps costs very low). Conclusion: The US automobile industry is in a big crisis. Other than declining sales and profitability, the industry is losing out to foreign car makers and particularly Asian rivals such as Toyota, Honda and Nissan. This has been brought about by three main reasons, which include the meltdown in the US economy triggered off by the sub prime mortgage crisis, a poor business model adopted by the industry, and failure by the US car industry to respond adaptively to changing environmental conditions. References: Borade, G. 2009. US economic crisis: impact on automobile industry. Retrieved on 11 July 2009 from http://www.buzzle.com/articles/us-economic-crisis-impact-on-automobile-industry.html King, N and Terlep, S. 2009, June 2. â€Å"GM Collapses into Government’s Arms.† Wall Street Journal. Retrieved on 11 July 2009 from   http://online.wsj.com/article/SB124385428627671889.html

American Culture The People s Way Of Life Essay

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Innovator Speculation And Its Effect On The Body And For...

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For in many cases—for example, in the challenges inherent in the DISAPPEARING BIRTHRATE in the developed countries, or inRead MoreImpact of Working Capital Management on Cash Holdings25344 Words   |  102 Pagesthese companies is therefore on the agenda of governments around the world. Purpose: To describe the situation facing seed stage investing venture capitalists. I will emphasize difficulties and evaluate venture capitalists ability in addressing them. Effects of the difficulties in form of access to financing for entrepreneurs and a possible need for government intervention will be examined. Method: Empirical information from seed stage investing venture capital organizations have been collected in theRead MoreOperational Strategy in Nestle24176 Words   |  97 Pagesmanagement? In a traditional set up operations were related to the day-to-day activities while strategy addresses the issues involving long time planning. In the present set up the way a company handles its day-to-day operations has had increasing effect on its long-term performance thus developing the field of operation strategy. In the not so far past the issues related to operations were not given their due importance. With the introduction of new ideas such as Total quality management (TQM), ISORead MoreRastafarian79520 Words   |  319 Pagesin Africa and rejects the European values that have oppressed a society. But prior to the advent of popular culture and especially the music recording business in the late twentieth century, its apparatus of cultural formation was controlled fully by the elite who, to a large extent, ran the educational apparatus and the economic system. But much of the country was beginning to question in earnest the structure of colonial society by the early 1930s. The emergence of Rasta during that period corresponds