Sinusitis Care Plan Essay Example for Free

Sinusitis Care Plan Essay This therapeutic care plan will utilized the â€Å"I can treat and prescribe framework† to ensure that appropriate patient treatments are selected using a step by step approach, including assessment integration, drug and/or disease related problems, therapeutic goals, therapeutic alternatives and indications, plan of care and evaluation (OPHCNPP, 2012). By going through each step of this framework, and including or excluding treatment options based on individual patient factors and strong clinical evidence, this clinician will arrive at the most suitable treatment plan for the patient. H.K (32 year old male) presented with persistent facial pain for 7 days. He reported having a headache (6/10 on a pain scale) upon bending forward and awakening, occasional tooth pain, no nasal drainage, and no cough. H.K denied fever or chills but admitted to feeling â€Å"run-down†. His past medical history included varicella zoster at age 5 years, seasonal allergic rhinitis (pollen), viral respiratory tract symptoms 2 weeks ago (now resolved), and no recent antibiotic use over the past 3 months. He is married with two children who are not in daycare (ages 8 and 9). H.K is a supermarket manager, non-smoker, and denied substance abuse. The patient reported having private prescription drug coverage but was only taking Advil cold and sinus (2 tablets orally every 6 hours as required) with good effect. H.K’s vitals were taken (temp. 37.5 °C tympanic, HR 74 reg., R 12 reg. and equal). His head and neck examination revealed that his sclera were clear and his pupils were r ound, reactive to light with accommodation. There was tenderness to palpation of the frontal and maxillary sinuses. Transillumination of the right and left maxillary sinuses revealed an opaque surface. His nares were erythematous and edematous with no obvious discharge. There was cobblestoning of the pharynx with slight erythema. His tonsils were two plus in size with no exudates. His neck examination revealed the absence of lymphadenopathy, the thyroid was non-palpable, and his chest examination revealed clear lung fields. The diagnosis of acute sinusitis was made based on H.K’s presenting signs and symptoms. The two most common predisposing events for acute bacterial sinusitis are acute viral upper respiratory infections and allergic inflammation (80% and 20% of bacterial infections, respectively) (Desrosiers et al., 2011). Complications of sinusitis are very rare and are estimated to occur in 1 in 1,000 cases (Hwang, 2009). In complicated sinusitis, the orbit of the eye is the most common structure involved and is usually caused by ethmoid sinusitis (Hwang, 2009). Patients who present with visual symptoms (diplopia, decreased visual acuity, disconjugate gaze, difficulty opening the eye), severe headache, somnolence or high fever should be evaluated with emergent care suspected (H.K had none of these symptoms) (Hwang, 2009). Most adult patients diagnosed with acute sinusitis become well or nearly well after 7 to 10 days, but 25% are still symptomatic after 14 days (Worrall, 2011). H.K had no untreated medical conditions contributing to his acute sinusitis (not pollen season). A primary health care nurse practitioner can effectively diagnose, treat and manage adults who have symptoms like H.K according to the Nurse Practitioner Practice Standard of Ontario (CNO, 2011). His condition was not life threatening and did not necessitate a referral to a physician, specialist or transfer of care. H.K was taking Advil cold and sinus, a drug that was appropriately dosed (1-2 tablets orally every 6 hours as required to a maximum of 6 tablets in 24 hours), which is clinically indicated for sinus pain in adults and is not too complex (CPA, 2013). This drug was deemed safe for him after a review of contraindications, including hypersensitivity to the agent, nonsteroidal anti-inflammatory drug-induced (NSAID) asthma or urticartia, aspirin triad, pre-operative coronary bypass surgery, coronary artery disease, monoamine oxidase inhibitor use within 14 days, uncontrolled or severe hypertension, and urinary retention (Epocrates, 2013). For H.K, the oral route of medication administration was most appropriate, the least invasive and the easiest way for an adult to take drugs (Brophy et al, 2011). Advil cold and sinus is not a cytochrome P450 system inhibitor, which is the main (or partial) cause for large differences in the pharmacokinetics of other drugs (Rx Files, 2012, Epocrates, 2013). The patient was not taking borrowed prescriptions, using drugs from previous occurrences of the condition, or experiencing any adverse drug events/reactions to Advil cold and sinus. Also, he was not being double dosed or experiencing therapeutic duplication of drugs belonging to the same pharmaceutical class. H.K had no untreated medical conditions (other than his new acute sinusitis), was not taking drugs prescribed by other clinicians and there were no other factors (communication errors, non-adherence, financial restrictions) influencing his ability to receive medication. Antibiotic therapy should be reserved for patients with acute bacterial sinusitis as defined by a complete history and physical examination (AMA, 2008). A â€Å"wait and see† approach has been suggested in recent Canadian guidelines as a means of differentiating bacterial sinusitis from a viral respiratory tract infection (Desrosiers et al., 2011). Initiation of treatment should take place 7 to 10 days after persistent symptoms or when signs compatible with acute sinusitis occur (Desrosiers et al., 2011). Since H.K’s facial pain had lasted for 7 days, the decision was made with the patient to treat. Goals of care were established (with the patient) including maximizing symptom relief (especially drainage of congested sinuses), eradication of infection, and prevention of re-occurrence and complications (Fryters Blondel-Hill, 2011). Five drug choices were selected and scrutinized as potential treatment options for H.K, including first and second line therapies (appendix 1) (ARP, 2012). The primary bacterial pathogens involved in the development of acute sinusitis for adults are Streptococcus pneumonia and Haemophilus influenzae (AMA, 2008). Canadian antimicrobial resistance data of S. pneumoniae describes that penicillin resistance rates range from 14% to16% in Central Canada (Powis et al., 2004). Amoxicillin is a first line drug therapy that remains active against S. pneumoniae with the rate of resistance under 2% (Brook et al, 2006) and also retains the best coverage of oral beta-lactam agents against S. pneumoniae (AMA, 2008). It is available in a capsule, chewable tablet or powder for oral suspension (H.K had no dysphagia and preferred to take capsules) (CPA, 2013). Amoxicillin should not be prescribed to a patient more than once in a 3-month period (H.K had not taken it in the last 3 months) (ARP, 2012). This drug is acid resistant, rapidly absorbed after oral administration, and is stable in the presence of gastric acid allowing for adequate systemic concentr ations (H.K was not taking drugs that affect gastric acid production) (CPA, 2013). Pertinent adverse affects of the drug are diarrhea, nausea, headache, vomiting, abdominal pain, anaphylaxis, anemia, AST/ALT elevation, mucocutaneous candidiasis, rash and pseudomembranous colitis (Medscape Reference, 2013). Amoxicillin is contraindicated with anaphylaxis reaction to penicillins or cephalosporins (Epocrates, 2013). Several cautions to consider when prescribing amoxicillin to H.K include him having clostridium difficile infection, infectious mononucleosis (result is skin rash), bacterial/fungal superinfections, allergy to cephalosporins, and carbapenems, (Medscape Reference, 2013). Also, serious drug interactions include bcg/typhoid vaccine live, doxycycline, minocycline, probenecid and tetracycline (Epocrates, 2013). H.K did not have any of the contraindications, cautions, or potential medication interactions relevant to taking amoxicillin, so it was deemed safe for him to take. Amoxicillin was selected as a treatment option for H.K (appendix 1). The three times a day (500 mg) option was selected to ensure simplicity, when compared to the 875 mg twice a day option that would require H.K to take two possibility identical capsules (a 500 mg and a 250 mg), increasing the likelihood of medication error (Epocrates, 2013). A primary concern for individuals infected with H. influenzae is ampicillin resistance, mediated by the production of a beta-lactamase, which is produced by approximately 19% of the bacteria (Zhanel et al, 2003). H. influenzae remains predictably susceptible to amoxicillin-clavulanate (a second line therapy) which possesses the added benefit of stability against beta-lactamases and cephalosporins (Tristam et al, 2007). Amoxicillin-clavulanate is also effective against most penicillin-resistant S. pneumoniae (MacGowan et al., 2004). It has enhanced gram positive activity and should be used in patients where risk of bacterial resistance is high, consequences of failure of therapy are greatest, or for patients not responding to first-line therapy (DeRosiers, et al, 2011). Common side effects of this drug are nausea, vomiting, diarrhea, rash and uticartia (Poole-Arcangelo Peterson, 2013; Rx Files, 2013). Higher rates of diarrhea and other gastrointestinal side effects occur with amoxicillin-clavulanate than with amoxicillin alone (Burns et al., 2009). It is also considered a more costly sinusitis treatment (ARP, 2012; Rx Files, 2012). Amoxicillin-clavulanate was added as a treatment option for H.K (see appendix 1). The clinician selected the two times a day option (875 mg) because the clavulanic acid daily dose is less, resulting in a decreased likelihood of the patient experiencing adverse effects co mpared with a more frequent dosing schedule option such as every 8 hours (Rx Files, 2012). As a result of activity against beta-lactamase–producing H. influenza and S. pneumonae (Zhanel Lynch, 2009), cefprozil and cefuroxime axetil have a second line treatment role in acute sinusitis (ARP, 2012). With the expanded spectrum of activity, ability to achieve adequate concentrations in tissues, suitability for twice-daily dosing, favorable toxicity profile, and proven tolerability of cephalsporins, they are a safe alternative for treatment (Poole-Arcangelo Peterson, 2013). However, they have a broader range of activity and are more costly than amoxicillin (Rx Files, 2012; ARP, 2012). Second line drugs cefuroxime axetil and cefprozil were added as treatment options for H.K (see appendix 1). The 250 mg dose was selected for both drugs due to ease of use (smaller pills, easier to swallow), patient related factors (H.K was not immunocompromised) and disease related factors (H.K’s sinusitis had no complications). In beta-lactam-allergic patients, a second line therapy such as trimethoprim-sulfamethoxazole (TMP- SMX) may be substituted for penicillin (ARP, 2012). The TMP-SMX resistance reported from Canadian laboratories is approximately 14% (Desrosiers et al., 2011). Increased pnuemoncoccal and H. influenza resistance rates make TMP-SMX a less desirable agent, however it is one of the most cost-effective options for patients with financial constraints (not an issue with H.K) (ARP, 2012). The most common side effects of this drug are rash, fever and gastrointestinal symptoms (Poole-Arcangelo Peterson, 2013; Rx Files, 2012). Drugs containing sulfa (such as TMP-SMX) potentiate the effects of warfarin, phenotoin, hypoglycemic agents and methotrexate (Poole-Arcangelo Peterson, 2013). Since H.K is not taking these drugs, TMP-SMX was selected as a treatment option (see appendix 1). One double strength tablet was selected over two single strength tablets for simplicity of administration. The general approach to the non-pharmacological management of acute sinusitis requires utilizing adjunctive therapies. Decongestants, intranasal corticosteroids (INCS), antihistamines, mucoltylics and analgesics are treatment options. A decongestant may be used to reduce mucosal edema and facilitate aeration and drainage (Desrosiers et al., 2011). Oral decongestants have been shown to improve nasal congestion and can be used until symptoms resolve. (Desrosiers et al., 2011). Topical decongestants are controversial and should not be used for longer than 72 hours due to the potential for rebound congestion (ARP, 2013). INCS reduce inflammation and edema of the nasal mucosa, nasal turbinates, and sinus ostia (Desrosiers et al., 2011). INCS are minimally absorbed and have a low incidence of systemic adverse effects (Desrosiers et al., 2011). Adverse effects include transient nasal irritation, epistaxis, pharyngitis, rhinitis, headache, and changes to taste, smell and voice (Rx Files, 201 2). A Cochrane review evaluating three INCS drugs for acute sinusitis found limited but positive evidence for INCS as an adjuvant to antibiotics (Zalmanovici Yaphe, 2009). Antihistamines are often used to relieve symptoms because of their drying effect, however there are no studies to support their use in the treatment of acute sinusitis (Desrosiers et al., 2011). Guaifenesin is a mucolytic that has been used to thin mucus and improve nasal drainage, however because it has not been evaluated in clinical trials, it was not recommended as an adjunct treatment for sinusitis (Rosenfeld et al, 2007). Selection of analgesics should be based on the severity of pain. Tylenol or an NSAID given alone or in combination with an opioid is appropriate for mild to moderate pain associated with sinusitis (Rosenfeld et al, 2007). Recent Canadian guidelines suggest that limited evidence exists supporting the beneficial effects of saline irrigation in patients with acute sinusitis (Desrosiers et al., 2011). Despite limited evidence, saline therapy, either as a spray or high-volume irrigation, has seen widespread use as adjunct therapy (Desrosiers et al., 2011). Although the utility of saline sprays remains unclear, the use of saline irrigation as ancillary therapy is based on evidence of moderate symptomatic benefit and favourable tolerability (Desrosiers et al., 2011). Some additional comfort measures for patients with symptoms of acute sinusitis include maintenance of adequate hydration and application of warm facial packs. No high quality trials have demonstrated that these comfort measures are effective (Worrall, 2011). As viral infections predispose individuals to acute sinusitis, strategies (such as handwashing) that focus on patient education of reducing viral transmission help to reduce the incidence of bacterial sinusitis (Desrosiers et al., 2011). Educating patients about common predisposing bacterial sinusitis factors may be considered as a preventative strategy (Desrosiers et al., 2011). Prophylactic antibiotics are not effective in preventing viral episodes or the development of subsequent bacterial sinusitis, and are not recommended (Desrosiers et al., 2011). Also, there is no evidence that influenza or pneumococcus vaccinations reduce the risk of contracting acute sinusitis (Rosenfeld et al, 2007). Recent reviews have found limited evidence for alternative and complementary medicine (Scheid Hamm, 2004). Alternative practices that have failed to show efficacy include acupuncture, chiropractic, naturopathy, aromatherapy, massage and therapeutic touch (Desrosiers et al., 2011). Vitamin C preparations and zinc lozenges are also felt to be controversial (Scheid Hamm, 2004). Studies of zinc lozenges for the common cold have produced mixed results (Desrosiers et al., 2011). One recent meta-analysis of echinacea preparations has shown some positive effects in reducing duration of respiratory tract symptoms (Barrett et al, 1999). However, the widespread use of echnichea in the treatment of acute sinusitis is not well supported (Desrosiers et al., 2011). A recent Cochrane review found that when antibiotics were given to patients, they increased recovery time from sinusitis symptoms (Ahovuo-Saloranta, 2008). The choice of first-line treatment is based on the anticipated clinical respons e of a patient, as well as the microbiologic flora likely to be present. Also, when selecting an antibiotic regimen for H.K, the clinician considered the medication cost, medication safety profile, adverse effects, and local patterns of bacterial resistance in order to maximize therapy (Hickner et al., 2001). The recommended antibiotic regimen is specific for H.K, who did not have any intracranial/orbital complications or a compromised immune function, and has normal renal function. In the absence of drug allergies and presence of resistant organisms, amoxicillin was selected for H.K as it is a first line therapy, is generally effective against susceptible and intermediate resistant pneumococci (Brophy et al, 2011), low cost (ARP, 2012), high patient tolerability, and relatively narrow antimicrobial spectrum (Aring Chan, 2011). Factors suggesting greater risk of penicillin resistant streptococci include antibiotic use within the past 3 months, chronic symptoms present for longer than 4 weeks, and parents of children in daycare (H.K had none of these risk factors). When antibiotics are prescribed by the clinician, the duration of treatment should be 5 to10 days as recommended by product monographs (Desrosiers et al., 2011). For H.K, the clinician utilized product monographs and other evidence based guidelines for determining the appropriate duration of treatment (CPA, 2013; ARP, 2013). Based on the information and discussion presented in this paper, amoxicillin 500 mg three times a day for 10 days (CPA, 2013) was selected as the most appropriate treatment for H.K (see appendix 2). H.K was instructed by the clinician to take his medication until finished, not share it, and to store at room temperature away from moisture, heat and light (Epocrates, 2013). He was taught about the drug’s side effects and that overdose symptoms may include confusion, behavior changes, severe rash, decreased urination, or seizure (Epocrates, 2013). He was provided health teachings by the clinician, including seeking emergency medical help if exhibiting any signs of an allergic reaction (hives, difficulty breathing, swelling of the face, etc.) or experiencing serious side effects (white patches/sores inside his mouth/lips, fever, swollen glands, rash, itching, joint pain, pale/yellowed skin or eyes, dark colored urine, fever, confusion/weakness, severe tingling, numbness, pain, muscle weakness, easy bruising, unusual bleeding, purple/red pinpoint spots under his skin) (Epocrates, 2013). H.K was provided health teachings regarding reducing the risk of contracting viral infections through hand washing techniques. Complementary therapies, alternative medicines, comfort measures, saline prophylactic antibiotic usage and vaccines were not recommended to H.K. He was also instructed about the role these treatments play in acute sinusitis treatment. Only evidenced-based adjunctive therapies as described in this paper have been selected for H.K, including INCS therapy (see appendix 3), analgesics (Advil cold and sinus) and oral decongestants (Advil cold and sinus). H.K agreed to this treatment plan. Based on H.K’s history and physical exam findings, a follow-up examination would be required if no improvement is seen within 72 hours of antibiotic administration, as this could indicate treatment failure (Derosier et al, 2011). The patient was advised to return in 72 hours if there were no improvements in symptoms. He did not return to the clinic for follow-up. If H.K had deteriorated at any time, the clinician would have reassessed for acute complications, other diagnoses and adherence to treatments (Derosier et al, 2011). If H.K experienced a type 1 hypersensitivity reaction to amoxicillin at any time, other pharmacological options would have been considered. A phone call was placed one week after H.K’s medical visit to conduct a post-visit evaluation, and he reported that his symptoms were nearly resolved (pharmacological and non-pharmacological therapy evaluation). Since H.K demonstrated signs of clinical improvement, a follow-up visit or possible referral to an otolaryngologist was not required (Fryters Blondel-Hill, 2012). The original goals of care for H.K were met. He stated that he was able to manage his symptoms with the treatment plan, was grateful that no complications were experienced, and was more knowledgeable about the prescribed drugs and future prevention strategies. H.K was satisfied with his healthcare experience (self-report) and was able to verbalize non-pharmacological therapies and apply them to his situation. When faced with a similar patient in the future, the clinician will ensure that the â€Å"I treat and prescribe framework† is utilized, as it is a valuable tool for ensuring patient specific treatment. Professional feedback from the course instructor/preceptor will also be integrated into future treatment plans.

Definition Essay - Can Love be Defined? -- Expository Definition Essay

Can Love be Defined? The other day I was babysitting my three-year-old niece, a most conniving little angel. As she sat gawking at my girlfriend's brother, Matthew, who was eating potato chips, she told me that she loved me "so much." She had already devoured her potato chips, but she obviously wanted more. Many more expressions of love proceeded to drip from her lips. Finally, the question came; "Reg, can I have some more chips?" At first, I thought this little show of bribery was cute and funny, but then I started to think about the true meaning of love. What is true love? Poets, philosophers, religious leaders, and the American media all have different definitions for this word. Too often, love is conceived as doing whatever it takes to get your potato chips. However, true love involves much more than personal satisfaction. Our society uses the term "love" far too lightly. Having been guilty of this offense myself, I admit my guilt. I often say, "I love Mexican food," or, "I love my truck." Love, however, is not just a happy feeling we get when something nice pleases us. Love is a verb. Love is the action of giving yourself totally to one person without expecting anything in return. Love is being willing to put aside your own needs in order to meet the needs of others. Giving up your weekend trip to the beach in order to take care of your sick mother is one example of love. A destitute mother giving up her one piece of bread to feed her sick little boy is another example of love. The ultimate expression of love is being willing to lay down your own life in the place of another. Love is giving, not getting. Too often our love is conditional. We often hear, "I will love you if you meet my needs," or, "I will love you... ...n who did just that. Two thousand years ago, on a hill outside of Jerusalem, Jesus of Nazareth was nailed to a cross. Three nails brutally pierced his hands and feet. Being a Christian, I believe that Jesus died on that cross to save me from an eternity in Hell. Jesus laid down his life in my place. This is the greatest love anyone has ever shown me, and my definition of love comes straight from that historical death. Would I lay down my life for anyone? I would consider going to the gas chamber in the place of very few people; this would be the ultimate test of my love. However, there are smaller ways that love can be shown. Washing dishes for my girlfriend, babysitting my niece, or even taking my mom out to eat are three small ways of showing my love. The next time I tell someone that I love them, I will be sure to follow through with the actions to prove it.

Third-Person Effect and Social Networking: Implications for Online Marketing and Word-of-Mouth Communication

Few studies have explored the direct influence of social networking websites related to behaviors. â€Å"One of the most important capabilities of the internet relative to previous mass communication technologies is its bidirectionality. Through the internet, not only can organizations reach audiences of unprecedented scale at a low cost, but also for the first time in human history, individuals can make their personal thoughts, reactions, and opinions easily accessible worldwide. Best known so far as a technology for building trust and fostering cooperation in online marketplaces, such as eBay, these mechanisms are poised to have a much wider impact on organizations. Their growing popularity has potentially important implications for a wide range of management activities such as brand building, customer acquisition and retention, product development, and quality assurance. † This article explains about online marketing and I’m going to incorporate this piece of informa tion into my paper. Few studies have explored the direct influence of social networking websites related to behaviors. â€Å"One of the most important capabilities of the internet relative to previous mass communication technologies is its bidirectionality. Through the internet, not only can organizations reach audiences of unprecedented scale at a low cost, but also for the first time in human history, individuals can make their personal thoughts, reactions, and opinions easily accessible worldwide. Best known so far as a technology for building trust and fostering cooperation in online marketplaces, such as eBay, these mechanisms are poised to have a much wider impact on organizations. Their growing popularity has potentially important implications for a wide range of management activities such as brand building, customer acquisition and retention, product development, and quality assurance. † This article explains about online marketing and I’m going to incorporate this piece of informa tion into my paper.

Essay on Morality

Essay on Morality Being a part of a society every human is trying to follow some moral principles that define what is good and what is bad, what is right and what is wrong. All of these determine our actions made in various life circumstances and shows our moral values as well. This essay will aim to discuss the concept of morality and describe the main issues related to this philosophical question that may be never answered. What is morality? Lots of definitions can be applied to the concept of morality. In short, morality is regarded as an attempt to define who we are from the position of some right and wrong actions we do and thoughts that we think. Throughout thousands of years philosophers have been trying to solve the issue about defining the concept of morality. â€Å"Many man many mind† approach is what can be applied to the problem. Nevertheless, it is possible to try to think over the question and reveal the common sings of morality that can be meaningful for us in a modern society. What is meant by a moral person? Can it be properly interpreted? The concepts with multiform meanings such as morality can be illustrated in the real world on practice and thus possibly defined in some way. Lets assume, you are going back home at midnight and find a purse on the sidewalk with lots of money and some bank cards with a name on it. You can find the person and return the stuff, will you do it? Or will you choose to keep it for yourself and use somebody elses money for your own purposes? Your action in this specific situation defines your morality. Your decision can show whether you act right or wrong. Still, another question arise – is it right to give the purse back to its owner if you are in need yourself? Maybe this is a sign and life supports you when you need it? No one knows the right answer, because it does not actually exist. Each of us defines from our own point of view what is right and what is wrong, and it may has nothing to do with the concept of morality as it is defined by a modern world and other individuals. Are people in a modern society loosing their moral values? Modern society is more likely to lose moral values with the time flow. It happens because of materialism that affects peoples mind and prevails moral values. Technical progress contributes to this as well. People keep on earning money and buying products they need, so they tend to try to buy everything they want. This fact devalues moral characteristics in some way and make people do morally wrong things even subconsciously just because of the materialistic way of thinking. Additionally, public manners influence others actions. Looking at someone doing something in a public place may affect others. Lets take an example with a public smoking. First of all, it is actually forbidden and should be so. Secondly, it has nothing to do with a moral manner when a man is walking with a cigarette in his hands while there are many people around, including children. The bad influence of the Internet on moral values of people is not the exception too. Today it is available all over the world, people have an access to the Internet and spend a lot of time there reading social media, comments to the blogs, political reports, etc. One can easily find a lot of bad things posted there, which harms and abuses other people. Adults may not take care of it, but children should be protected from this in the first place as they see bad words, consider them to be normal and copy the manner of communication. In conclusion People in a modern society tend to loose their moral values, which is influenced by materialism, public thinking and manners, and the Internet as well.

Analysis Of Machiavelli s The Prince - 1592 Words

D.I.Y. Empire In The Prince, Machiavelli discusses ways in which a ruler should obtain power and maintain power, emphasizing the concept of gaining power through virtue versus fortune. Virtue, or virtu in the original Italian, is defined as the masculine quality of power, and not necessarily tied to ideas of morality as it is in the English definition. Gaining power through virtue is the process of gaining power through one’s own ability, while gaining power through fortune is the process of gaining power through means not related to one’s own ability such as wealth or another’s grace. In Chapter 6 of The Prince, Machiavelli discusses principalities gained through virtue and their characteristics. Rulers who wish to gain such†¦show more content†¦His enemies are those of the older order, who did well under it and are reluctant to change to a new order. His allies are those who would do well under the new order but are, as Machiavelli puts it, â€Å"lukewarm† and, therefore, aren’t entirely dedicated. This is in part due to their fear of the new prince’s enemies, those who do not want a new order, and in part due to their skepticism in the ability of the prince to impose this new order. As such, it is very dangerous to impose a new order where one may face attack by hostile forces and have only â€Å"lukewarm† defenders of the new order. It is then necessary to examine how the prince will utilize his virtue. If he is to â€Å"beg† and ask others for help, he is then seen as week and cannot accomplish his goal. The alternative is to use â€Å"force†, to arm themselves, and to literally force those who do not believe in the new order to believe. After all, human nature is changeable and easily changed, but difficult to maintain in a certain persuasion, after which force is necessary to maintain it. And once created through great difficulty, it is then easy to maintain, as under the prince’s rule, the need for force will lessen, since those who would rebel are eliminated and the ruler gains reputation and respect from his subjects. The examples of such principalities and rulers Machiavellie provides are of Moses, Cyrus, Romulus and Theseus. In the first example of Moses, Machiavelli admits that the lines are a bitShow MoreRelatedAnalysis Of Machiavelli s The Prince 1370 Words   |  6 Pagesman. Niccolo Machiavelli and Immanuel Kant are political philosophers who have grappled with these very relationships. Machiavelli wrote The Prince over three centuries before the process of Italian unification had begun. The Italian Peninsula was fragmented and could not stand on its own especially compared to the unified powers like Spain and France. It is from this weak position that the Republic of Florence falls costing Machiavelli his own political power. 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The Prince rest on the principle that, above all, the foundation for a ruler’s success is within verita effettuale—or, the effectiveness of a prince’s rule. Machiavelli urges rulers to focus on acting in ways that will result in Read MoreAnalysis Of Niccolo Machiavelli s The Prince 1625 Words   |  7 Pageswell-known Renaissance thinker, Niccolo Machiavelli, was one of those philosophers whose political views caused an uproar during earlier centuries. His view on effective leadership was rather harsh and not exactly adopted in the Italian society. As a Renaissance citizen, Machiavelli proved his writing skills through a number of works such as short stories, plays, and histories. 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The Process Of Aging And Metabolism - 1259 Words

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Epidemiology for Amoebic Dysentery and Cancer- myassignmenthelp

Question: Discuss about theEpidemiology for Amoebic Dysentery and Cancer. Answer: A Notifiable disease can be any disease that has a legal obligation to be reported to the government/ public health authorities, when it is diagnosed since the disease can be potentially harmful to health (Gibnet et al., 2016). It is also known as reportable disease. Collected reports of this disease can allow its monitoring, and provide an early warning if an outbreak is imminent. Several governments have laws being enacted and enforced that stipulates reporting of diseases in both Humans and Animals (or livestocks). Some of the notifiable diseases (caused by bacteria and viruses) in Australia are: Anthrax, Botulism, Brucellosis, Cholera, Diphtheria, Leprosy, Leptospirosis, Pertussis, Plague, Salmonellosis, Shigellosis, Syphillis, Tetanus, Tuberculosis, Typhoid fever, AIDS, Arbovirus infections, Hepatitis, (A-E), HIV, Influenza, Measles, Poliomyelitis, Rubella, Small Pox and Yellow Fever. Other disease includes: Amoebic Dysentery, Cancer, Dysentr, Malaria, Giardiasis and Trichinosis , to name a few (Gibney et al., 2017). List of Australian websites that acts as repositories for information related to Notifiable disease: Department of Health, Australia (https://www.health.gov.au/casedefinitions) Department of Agriculture, Australia (https://www.agriculture.gov.au/pests-diseases-weeds/animal/notifiable) Database of notificable diseases, Australia (https://data.gov.au/dataset/national-notifiable-diseases-surveillance-system) Department of Health, Australia (https://ww2.health.wa.gov.au/Silver-book/STI-or-HIV-notification/Australian-national-notifiable-disease-case-definitions) Government of South Australia (https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/health+notifications/notifiable+disease+reporting) Northern Territory Government (https://health.nt.gov.au/professionals/centre-for-disease-control/cdc-programs-and-units/notifiable-diseases) Federal Register of Legislation, Australian Government (https://www.legislation.gov.au/Details/F2008L00800) Department of Agriculture and Fisheries, Australia (https://www.daf.qld.gov.au/animal-industries/animal-health-and-diseases/notifiable) Livestock Biosecurity Network, Australia (https://www.lbn.org.au/farm-biosecurity/notifiable-diseases/) Signs and symptoms of Tuberculosis (TB): Tuberculosis is a bacterial disease which can be fatal if not treated properly (Fogel, 2015). The bacterium (Mycobacterium tuberculosis) spreads via tine droplets released while coughing or sneezing, and affects the lungs. However tuberculosis infection can exist in a Latent or Active state. In the Latent stage, the bacteria remain in the body in an inactive and non-contagious stage, and exhibit no symptoms. However, the latent bacterium can become active in the body, causing the onset of symptoms (Getahun et al., 2015). In the Active stage, the bacterium is infective and can spread from person to person. The typical signs and symptoms at this stage includes: Cough that lasts for more than three weeks, discharge of blood during cough, pain in the chest and difficulty in breathing, weight loss, fatigue, fever, nocturnal sweats, chills and appetite loss. Symptoms of primary pulmonary tuberculosis include fever or dry cough, and are often temporary. People suffering from pulmonary disea se from Tuberculosis can develop Tuberculosis Pleuritis. The pleural disease can occur when the diseased area ruptures into the space between the lining of abdominal cavities, chest and lungs, causing chest pains (Khan et al., 2013). The TB bacterium can also spread to different parts of body via blood, in immune-compromised patients, causing military tuberculosis (symptoms: fever, weakness, appetite and weight loss, cough and difficulty breathing). Infections of the upper respiratory system causes symptoms like frequent coughs, with a progressively increasing amount of mucous produced, coughing of blood, fever, loss of appetite and weight, and nocturnal sweats. In rare cases, the bacterium can also develop in other organs like Lymph Nodes, Bones and Joints, Genitourinary tract, Meninges and the lining of GI tract. Disease Burden of Tuberculosis: Studies from 2012 and 2013 shows the rate of TB occurrence in Australian born population at 0.9 to 1.0 per 100,000 individuals. Indigenous Australians have shown to experience a greater burden (4.5 to 4.6 per 100,000 individuals) of the disease, compared to Non Indigenous Australians (0.7 to 0.8 per 100,000), showing an incidence that is six times higher. Compared to to other countries, the disease burden of Tuberculosis in Australia is low (that is, less than 10 reported cases per 100,000) along with Western Europe, USA, Canada and New Zealand (https://www.who.int, 2017). Data collected by National Notifiable Disease Surveillance System showed 1317 reported cases as of 2012 and 1263 as of 2013 (rate of 5.8 to 5.2 per 100,000). The overseas-born Australians however showed a much higher incidence of TB at 19.5 to 18.4 per 100,000 cases. Multi Drug resistant TB also shows a lower prevalence in Australia at 20 cases reported as of 2012 and 22 as of 2013, most of which were reported in t he overseas born Australians. Also, the disease burden of TB tends to be higher among children than healthy adults (Seddon Shingadia, 2014). Overall, Australia shows an excellent and sustained control of TB, and proves its commitment to alleviate the global burden of this disease. Contact Tracing- In the context of epidemiology, Contact Tracing refers to the process of identification follow up and diagnosis of individuals who came in contact with the infected individual(s) (Begun et al., 2013). This is a useful means of controlling infectious disease (like TB, HIV and STDs) and their epidemiologic investigation and surveillance (Sabat et al., 2013). The purpose of contact tracing is to detect the early symptoms in the contacts, monitor and treat them for disease. It can help in secondary prevention (preventing disease in the individuals exposed to it) tertiary prevention (preventing severe outcomes) and prevent or contain outbreaks. Contact tracing is done when mode of contact is direct contact (casual or sexual). A pre-test tracing of contact is needed when there is high level of concern for the patient, and waiting for the laboratory reports can be detrimental. A post test tracing of contact is done after diagnosis have been confirmed, and can reduce adverse effects to the e xposed contacts. Steps of contact tracing: Step 1: Clarifying the reasons to trace contacts- The patients needs to be made aware of asymptomatic infection, possible complications if not tested, risk of infection. This can ensure proper participation from the infected, and uphold the basic human rights. While clarifying the reasons, information must also be justified with currently known knowledge, keeping the individuals up to date. Step 2: Help to identify whos who needs notifications of the disease- The mode of transmission, and the duration of infective stage needs to be discussed. Tracing back of contacts since the relevant time period. This will allow understanding the extent of the spread, and finding ways to control it. Also, depending upon the proximity to those contacts, a proper method to communicate with them must also be devised. The mode of transmission can allow understanding how the infection spreads through the population, so that the risks can be managed. Once the possible infection cases are identified they can be screened to check if they are test positive for TB. Step 3: Explanation of the methods involved and offering choice- Notification of patients can be done by patient or provider referral. Working with patients to identify appropriate methods applicable to each of the listed contacts. Patient referral involves personal notification by the index patient to his/her contacts. Provider referral involves the healthcare providers advising the patient directly or through an agency. Referring the patients can allow the screening of these contacts for exposure and infection. It can also check if any further infection was spread by those individuals. Step 4: Support to the patient, and providing patient referral for future contact. Since the patient undergoing screening and treatment requires medical expertise, and improper treatment can lead to complications or re exposure, it is important to educate the contacts about the right procedures, and provide support to them when needed (https://www.health.gov.au, 2017). Identification of contacts allows identifying the initial case, identifying additional incidents among individuals in contact with the initial case, identifying individuals who might be infected due to contact with the initial case, providing counseling and assessment to those diagnosed with TB. Categorization of the case is needed as per the degree of infectiousness. Also categorization of contacts depending upon the risk of exposure allows identifying the high risk cases. Examination of medium risk cases should follow next if there is any evidence of transmission. Investigation of contacts requires noting down of the history, performing IGRA and/or TST or radiographic investigation when indicated (Balmelli, 2014). All the contacts tested positive for TST or IGRA needs to be referred to healthcare practitioners involved in diagnosis and treatment of TB, and treatment for LTBI should be considered. Young children with a history of immuno-supression and TST below 5 should be referred for TB diagnosis and treatment. Children below 5 years in household contact with individuals tested smear positive should be evaluated for infection. In special cases like in exposure inside Aircraft, schools, hospitals or healthcare centers, or during pregnancy, factors like the infectiousness of the initial or index case should be analyzed. Also the duration of exposure (like the travel time in aircraft, or school hours, or the time admitted in hospital where the infection occurred must be noted). Susceptibility of those who might have been infected must also be taken into consideration. A list of possible consequences that might ensue, must be made and shared with the concerned individuals. Any delay between the infection and screening should be taken into account, as with increased delays, the chances of further exposure also increases. In Australia, contact racing needs to adhere to section 71 of Public Health Act 1991. The sensitivity and circumstances that dictates contact tracing, as well as its scope must be clarified. Advice must also be sought from NSW Department of Health. Next the degree of infectiousness must be noted, based on clinical, bacteriological, radiological and nucleic acid tests. The degrees of infectiousness can be categorized as High Infectiousness (positive for sputum smear/ laryngeal involvement/ x ray of chest/ evidence of transmission to others), Medium Infectiousness (smear negative but positive for sputum culture or nucleic acid test, pleural disease, positive smear for bronchial wash) and Low Infectiousness (negative for sputum smear and culture). Determination of the infective period is important to identify the high risk groups for tracing. The infective period needs to be considered 3 months prior to the TB diagnosis, unless a clear set date of the onset exists. Assigning priority can be done based on naming risk groups (high risk, medium risk and low risk). High Risk groups would be those who have had regular and long contacts inside a closed environment during the infective period, and can include individuals in the same household, close relatives, friends, colleagues who are working closely in a small work area (Gao et al., 2016). Medium Risk groups would be those who would have frequent but lesser time spent with the infected and can include relatives, friends, schoolmates, colleagues, neighbors who are not in high risk group. Low Risk group would be the other contacts in workplace or school or other places that are not in High or Medium Risk groups. Risk groups for Tuberculosis also need to be identified. The chances of TB progressing from latent to infective stage is considerably higher in children who are below 5 years, who are suffering with HIV; people receiving 15mg or more of prednisone (or equivalent) for four or more weeks; people on immunosuppressive medication; people suffering from cancer/ diabetes mellitus/ silicosis/ and kidney failure; and people who underwent jejunoileal surgery or gastrectomy. The high risk contacts are to be screened the first. General Information on TB: Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. The bacterium generally invades the lungs, but is also capable of infecting other organs. In its latent form, TB shows no symptoms, but has a 10% chance of progressing to active or infective form. The most common symptoms include chronic cough, sputum with blood, night sweats and fevers accompanied by loss of weight. The disease spreads via air (by sputum droplets discharged due to cough, sneeze or while speaking) from individuals who have infective stage of the bacterium in their lungs. According to WHO report on Tuberculosis in 2016, a total of 1376 cases (new and relapse) were reported in Australia. The rate of mortality from TB+ HIV were reported at 0.02 (per 100,000), and incidence of TB+HIV at 0.12 (per 100,000). Overall the disease burden of TB is Australia is very low, with the highest reported cases found among Overseas born or Non residential Australians. Infectiousness and Risk Factors of Tuberculosis: Tiny aerosol droplets (0.5 to 5.0 microns) up to 40,000 in number can be discharged while coughing or sneezing. With a small dose of infection (less than 10 bacterium to fully develop the disease), each of the infective droplet can potentially cause or spread the disease. People in constant contact with the infected are at a high risk of developing TB symptoms (Fox et al., 2013). An infected person can potentially spread the disease to an average of 10-15 people or more in a year. Transmission occurs only from only those people who have active TB, and the latent form is not contagious. The chances of the spread of infection depends upon several factors, like the number of infective droplets released, the ventilation condition inside the place where the droplets were released in the air, the length of exposure, the level of virulence of the bacterium (drug resistant/ multi drug resistant) and the immune condition of the individuals exposed. Risk Factors: People suffering with HIV are at the highest risk globally (Sester et al., 2014). Also, the disease is related closely in overcrowded places, especially when people are suffering from malnutrition, thereby making it a disease of poverty. Other risk factors includes people involved in drug abuse, those in contact with or working the infected individuals, economically poor or underprivileged societies, children who are exposed to the pathogen, ethnic minorities, healthcare professionals involved in TB treatment and management (Narasimhan et al., 2013). Chronic lung disease can also increase the chances on TB infection along with Silicosis and tobacco smoking. Certain diseases like diabetes mellitus can also be a risk factor for TB. In addition genetic susceptibility, medications like corticosteroids and alcoholism can increase the prevalence of the disease. High Risk groups: The high risk groups of contact tracing includes those who have had regular and long contacts inside a closed environment during the infective period, like individuals in the same household, close relatives, friends, colleagues who are working closely in a small work area. Foreign nationals who have emigrated from a country with high disease burden of TB in the last 5 years. Residents living in high risk settings (prisons, homeless shelters, nursing home, rehabilitation centers, healthcare centers). Healthcare professionals who are treating infected individuals. Low income groups or other groups who might be under serviced medically and high risk ethnic minorities. Children or infants or adolescents exposed to the disease. Also the risk of the disease progressing from the infective to non infective stage is higher in people with HIV infection, people already infected with TB in the last 2 years (specially infants or young children), people with existing medical conditions, people who were improperly treated for TB previously, and drug users (van Hest de Vries, 2016). Procedures for Household contacts: The Household contacts are at a high risk of developing the disease. Those exposed to highly infectious case needs to be screened in the span of 7 days from diagnosis. Those exposed to low or medium infective cases be screened by 2 weeks from diagnosis. Tracing of TB cases which are extra pulmonary can be done to identify the source or initial case. Contact screening should also be done when the infection is thought to be transmitted in the past. On the first visit, a clinical history needs to be recorded to clarify the risk of exposure, record the vaccination status for BCG, identifying symptoms related to TB, identifying any pre existing medical condition that can increase the risk of the disease, and identifying situations that can interfere with the result of TST. In the current scenario, the following measures are needed to screen contacts of the source case: The family members by screened for TB. Their BCG vaccination status and reported symptoms be noted. Any pre existing medical condition is noted. Rest period and chances of re infection: The patient would need a resting period of 6 months, during which he will have minimal contacts with the outside world, preferably in a private room, with sufficient ventilation. The isolation needs to be continued as long as 3 consecutively negative results occur in sputum smear test. During the resting period, contacts of the index case will still be at high risk, and therefore would have to undergo regular screening for the infection. Once the disease is successfully cured from the index case, there will be no chances of re infection. Therefore teachers and parents need not worry about being reinfected, once the recommended treatment procedure has been complied with (Horsburgh, Barry Lange, 2015). Guidelines for the control of Tuberculosis in Northern Territory and Victoria: The jurisdiction of Northern Territory comprises of Disease Control units in Darwin, Tennant Creek, Alice Springs and Nhulunby. The jurisdiction of Victoria is in the state of Victoria. In the Northern Territory jurisdiction, the cases are first categorized based on infectiousness. After this a list of contacts are obtained from the infected patients and arranged according to their risks. The high risk contacts are next identified, followed by medium and low risk individuals. If the case diagnosis is from an indigenous community, the treating staff needs to travel to such areas and help to educate the community, and assist contacts whenever necessary (https://digitallibrary.health.nt.gov.au, 2017). In the Victoria Jurisdiction, public nurses from The Victorian Tuberculosis Program are responsible for both contact tracing and investigation. The practices follow the protocols set by the Communicable Diseases Network of Australia (CDNA) via a series of National Guidelines, and are endorsed by AHPPC (Australian Health Protection Principal Committee (2013). The index case is identified by clinical presentations, symptom duration, disease site, bacteriological report and radiological report. Once the index case is identified, the high risk contacts are then identified, followed by medium and low risk contacts. The contacts have to then undergo clinical evaluation, tuberculin skin test (TST) or Interferon Gamma Release Assay (IGRA). The TST also needs to be repeated after 8-12 weeks. A chest X ray is done next, followed by contact follow-ups and any special categories also need to be identified (www.thermh.org.au, 2017). So, it can be seen that the northern territory employs an additional role of educating indigenous communities who are at high risk of TB, and providing support to them in their treatment. References: Balmelli, C., Zysset, F., Pagnamenta, A., Francioli, P., Lazor-Blanchet, C., Zanetti, G., Zellweger, J. P. (2014). Contact tracing investigation after professional exposure to tuberculosis in a Swiss hospital using both tuberculin skin test and IGRA.Swiss medical weekly,144, w13988-w13988. Begun, M., Newall, A. T., Marks, G. B., Wood, J. G. (2013). Contact tracing of tuberculosis: a systematic review of transmission modelling studies.PloS one,8(9), e72470. Dean, A., Zignol, M., Mecatti, F. (2015).Guidelines for surveillance of drug resistance in tuberculosis. World Health Organization WHO Press. Fogel, N. (2015). Tuberculosis: a disease without boundaries.Tuberculosis,95(5), 527-531. Fox, G. J., Barry, S. E., Britton, W. J., Marks, G. B. (2013). Contact investigation for tuberculosis: a systematic review and meta-analysis.European Respiratory Journal,41(1), 140-156. Gao, L., Bai, L., Liu, J., Lu, W., Wang, X., Li, X., ... Jin, Q. (2016). Identification of populations at high risk of tuberculosis infection in rural China: a population-based, multicentre, prospective study.The Lancet,388, S16. Getahun, H., Matteelli, A., Chaisson, R. E., Raviglione, M. (2015). Latent Mycobacterium tuberculosis infection.New England Journal of Medicine,372(22), 2127-2135. Gibney, K. B., Cheng, A. C., Hall, R., Leder, K. (2016). An overview of the epidemiology of notifiable infectious diseases in Australia, 19912011.Epidemiology Infection,144(15), 3263-3277. Gibney, K. B., Cheng, A. C., Hall, R., Leder, K. (2017). Sociodemographic and geographical inequalities in notifiable infectious diseases in Australia: a retrospective analysis of 21 years of national disease surveillance data.The Lancet Infectious Diseases,17(1), 86-97. Horsburgh Jr, C. R., Barry III, C. E., Lange, C. (2015). Treatment of tuberculosis.New England Journal of Medicine,373(22), 2149-2160. https://digitallibrary.health.nt.gov.au. (2017).Cite a Website - Cite This For Me.Digitallibrary.health.nt.gov.au. Retrieved 2 November 2017, from https://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/696/4/TB%20Guidelines%20May%202016.pdf https://www.health.gov.au. (2017).Department of Health | Tuberculosis notifications in Australia, 2012 and 2013.Health.gov.au. Retrieved 1 November 2017, from https://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdi3902f.htm https://www.who.int. (2017).Cite a Website - Cite This For Me.Who.int. Retrieved 2 November 2017, from https://www.who.int/tb/publications/global_report/ Khan, A. H., Sulaiman, S. A. S., Muttalif, A. R., Hassali, M. A., Akram, H., Gillani, S. W. (2013). Pleural tuberculosis and its treatment outcomes.Tropical Journal of Pharmaceutical Research,12(4), 623-627. Narasimhan, P., Wood, J., MacIntyre, C. R., Mathai, D. (2013). Risk factors for tuberculosis.Pulmonary medicine,2013. Sabat, A. J., Budimir, A., Nashev, D., S-Leo, R., Van Dijl, J. M., Laurent, F., ... ESCMID Study Group of Epidemiological Markers (ESGEM). (2013). Overview of molecular typing methods for outbreak detection and epidemiological surveillance.Euro surveill,18(4), 20380. Seddon, J. A., Shingadia, D. (2014). Epidemiology and disease burden of tuberculosis in children: a global perspective.Infection and drug resistance,7, 153. Sester, M., Van Leth, F., Bruchfeld, J., Bumbacea, D., Cirillo, D. M., Dilektasli, A. G., ... Gerogianni, I. (2014). Risk assessment of tuberculosis in immunocompromised patients. A TBNET study.American journal of respiratory and critical care medicine,190(10), 1168-1176. Toms C, e. (2017).Tuberculosis notifications in Australia, 2012 and 2013. - PubMed - NCBI.Ncbi.nlm.nih.gov. Retrieved 1 November 2017, from https://www.ncbi.nlm.nih.gov/pubmed/26234258 van Hest, R., de Vries, G. (2016). Active tuberculosis case-finding among drug users and homeless persons: after the outbreak.European Respiratory Journal,48(1), 269-271. www.thermh.org.au. (2017).Cite a Website - Cite This For Me.Thermh.org.au. Retrieved 2 November 2017, from https://www.thermh.org.au/sites/default/files/media/documents/Management%2C%20control%20and%20prevention%20of%20tuberculosis%20-%20Guidelines%20for%20health%20care%20providers%20-%202015.pdf