Haemolytic Transfusion Reactions-Free-Samples-Myassignmenthelp

Question: Describe the Pathophysiology of an Acute Haemolytic Transfusion Reaction. Answer: Pathophysiology of acute haemolytic transfusion reaction A haemolytic transfusion reaction is referred to the complications occurred after a blood transfusion, as a result of harmful reactions between the transfused RBCs with the recipients immune system (Massey, Davenport Kaufman, 2013). Aetiology The lack of compatibility among the donor and receivers blood is the key reason behind the immune reaction. In that condition, the immune cells of the recipients immune system attacks and destroys the incoming RBCs. The 2/3rd of these transfusions related issues are caused by a medical error in identifying the patient, blood sample or blood component and 1/3rd is due to an misconduct by the transfusion service. The key mediators of the immune reactions are the IgM or IgG antibodies or the non-ABO IgG antibodies like Rh, Kell or Duffy (Harmening, 2012). Risk factors Multiparous women, previous blood transfusion history, emergency uncross-matched transfusion, IgA deficiency, volume overload, transfusion of fresh frozen plasma, uncalibrated or poorly maintained blood warmer, mechanical damage of red cells, inadequate patient handling by staffs, inadequate diagnosis, concomitant medications are the key risk factors for developing haemolytic transfusion reaction (Bolton?Maggs Cohen, 2013). Pathogenesis Durring the first phase, the IgM/ IgG antibody of the recipient reacts with the transfused RBCs cell membrane. However, haemolysis occurs, if these antibodies are capable of activating components of complement system, i.e. C1 to C9. In the next phase, the RBCs, the non-hemolyzed RBCs bind to phagocytic cells, through IgG or C3b receptors; thereby stimulate the cytokine production, including IL-8 and TNF alpha. Then through phagocytosis, the bound cells are destroyed. This step is followed by the systematic effects of anaphylotoxins, C3a and C5a, cytokines; which then produce the clinical signs and symptoms of the haemolytic reactions (Bersus et al., 2013). Clinical manifestation The clinical manifestation of the haemolytic transfusion reactions are usually represented within 24 hours. These include the followings: Chills Fever Hypotension Renal failure Back or flank pin Oliguria Epistaxis Disseminated intravascular coagulation (DIC) Decreased fibrinogen Elevated bilirubin Hemoglobinemia Hemoglobinuria Clinical reasoning cycle Consider patients situation The patient, Mr. Ha had a medical history of gastric ulcer, hypertension and was getting tired easily. He was also passing black stool from last 3 years. His haemoglobin count was high, i.e. 89 mmol/l, indicating destruction of RBC. The blood pressure was also significantly low. The patient was prescribed with 2 units of PRBC transfusion. However, the second unit was ceased, when the patient represented symptoms of high temperature, 220/ min pulse rate along with shaking and stiffness. In this context, the following nursing care plan is being developed for the patient. Collection cues The patient had gastric ulcer and hypertension. His initial blood haemoglobin was high, along with the significantly low blood pressure, i.e. 60/90 mmHg. It indicates leakage in blood circulation or destruction of red blood cells. Upon the cessation of his second unit of transfusion, the pulse rate was dangerously high, i.e. 220/min along with high temperature. It has also been revealed that the patients vital signs were not measured through 1.15 hours. Process information Processing the available information, it has been revealed that the key cause of the adverse situation of the patient is lack of frequent monitoring the vital signs. Moreover, the situation is likely to rise as a result of incompatible transduction of blood cells. The high pulse rate, shaking and high temperature also indicate the occurrence of immune reaction or anaphylacytic reaction (Forbes Watt, 2015). The nurses should be more careful to monitor patients vital signs frequently, to prevent these kinds of severe reactions. Identify issues In the current situation, the patient is having high temperature, high pulse rate, losing consciousness and started shaking. Therefore, it is important to prioritise the key issues, which needed to be addressed first. The key issues are: High temperature and shaking High pulse Losing consciousness and haemolytic reactions in blood Establish goals Based on the key issues identified in the case, it is important to establish care goals for the patients. Therefore, the immediate key goals for the patient would be: To reduce temperature and control shaking To reduce pulse rate and control fluctuation of pulse rate To cross-check the patients compatibility to the transfused cells To Monitor vital signs and report deterioration To maintain IV line Take action To control the initial high temperature, the nurse need to report to the physician first and upon consultation, antipyretic medications should be provided. Moreover, to control patients shivering and stiffness, chloropromazine and diazepam could be administered, upon consultation. Intravenous saline solutions should be started to replenish fluid loss (Marcum, 2012). As the patient has undergone the previous situation, as result of infrequent monitoring, nurse should monitor patients vital signs every 5 minutes. To deal with inadequate cardiac output and hypotension, the IV line should be started with 0.9 % saline solution (NaCl) immediately. As the patient is losing consciousness, the nurse should continuously communicate with the patient, to reduce the risk of losing consciousness completely. Urine specimen should be tested for determining the presence of haemoglobin in urine (Alfaro-LeFevre, 2012). Immediately after recognizing the adverse condition, the transfusion should be ceased and patients actual order for the blood type and the administered packet of blood should be cross-checked for any kinds of administration error. To control further deterioration, the nurse should immediately consult with the physician and administer drugs including antihistamines, steroid, vasopressor or fluids to reduce allergic symptoms immediately and reduce the fatal risk (Ahopelto et al., 2011). Evaluate outcomes Evaluating the patients current situation and the interventions implemented for the patient, it can be interpreted that the patient would be benefited from the solutions, as these have been implemented in an evidence-based manner (Alfaro-LeFevre, 2012). Moreover, it can be interpreted that transfusion reactions should be performed upon checking the compatibility more than one time. Reflection Dealing with the case of Mr. Ha, the importance of cross-checking blood component compatibility between donor and recipient has been understood significantly. In addition, the role and accountability of a nurse in case of a patient with transfusion reactions, have also been understood. Reference List Ahopelto, I., Mikkil-Erdmann, M., Olkinuora, E., Kp, P. (2011). A follow-up study of medical students biomedical understanding and clinical reasoning concerning the cardiovascular system.Advances in health sciences education,16(5), 655-668. Alfaro-LeFevre, R. (2012).Applying nursing process: the foundation for clinical reasoning. Lippincott Williams Wilkins. Bersus, O., Boman, K., Nessen, S. C., Westerberg, L. A. (2013). Risks of hemolysis due to anti?A and anti?B caused by the transfusion of blood or blood components containing ABO?incompatible plasma.Transfusion,53(S1), 114S-123S. Bolton?Maggs, P. H., Cohen, H. (2013). Serious Hazards of Transfusion (SHOT) haemovigilance and progress is improving transfusion safety.British journal of haematology,163(3), 303-314. Forbes, H., Watt, E. (2015).Jarvis's Physical Examination and Health Assessment. Elsevier Health Sciences. Harmening, D. M. (2012).Modern blood banking and transfusion practices. FA Davis. Marcum, J. A. (2012). An integrated model of clinical reasoning: dual?process theory of cognition and metacognition.Journal of evaluation in clinical practice,18(5), 954-961. Massey, E. J., Davenport, R. D., Kaufman, R. M. (2013). Haemolytic Transfusion Reactions.Practical Transfusion Medicine, Fourth Edition, 77-88.

Ben Jonsons Epigrams free essay sample

This paper is an in-depth analysis of Ben Jonsons Epigrams containing two basic classes of epigrams those of praise and those of blame. The following paper examines how Jonsons book of epigrams seeks to give each man his due. The writer examines the way in which the positive poems rest on the theory that good men have a duty to do praiseworthy things and that the poet has a reciprocal duty to praise them. The writer discusses how Jonson asserts that his epigrams are not only about how men should act toward one another, but also about what they should be in themselves. These characters can easily be imitated if one follows the attributes Jonson exposes, so one can find their faults and display examples of virtue for emulation. There has to be self-control of one;s senses, creating manly characteristics. Once self-control is obtained, others begin to recognize your standing in society. We will write a custom essay sample on Ben Jonsons Epigrams or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page In order to obtain recognition, there must be firm allegiance of oneself to continue these manly qualities. Once you have been free from deceit, society creates a favorable impression toward your ideal. You then have obtained a high position in society, creating a prominent force. People then think of you as useful with a proposed end in mind. This person becomes highly cherished and attracts others because of their presence. They look for your presence because one is free from corruption. These characteristics are voluntary allowing for happiness inside a character because they keep their goals alive by observance of the moral laws in society. All these qualities are not obtained instantly, but develop into models creating the idea that these characters are not unique. These characters could be imitated by any willing character exposing a free manner for doing deeds fearlessly, frankly and voluntarily.

Negative Effects Global Warming Essay Example

Negative Effects Global Warming Paper The first and most obvious disadvantage is the higher sea levels. Due to the warmer climates many ice caps are melting down which are increasing the sea levels and affecting the low-lying lands. The water is reaching these lands and flooding them over. Many places in the coasts around the world, will disappear if this happens, places such as Shanghai, Holland, Bangladesh, San Francisco, Florida, Tantalum’s, Veracity, Camper etc. This issue brings many other consequent problems such deaths and many diseases from food and evacuations. Another main negative effect is the bad life conditions that many parts of the world will suffer. These bad life conditions may be starvation, malnutrition and increased deaths due to food and crop shortages. Also there will be water shortage in already water-scarce areas and deserts get drier leaving to increased desertification. Human health will be decreasing because of the high levels of air pollution in our environment, and will cause problems such as allergies and asthma. The last disadvantage is the huge negative impact that global warming causes on the weather. Since the temperatures of our planet will begin to rise, there will be more extreme weather. These drastic changes in the climate will cause increased frequency in natural disasters. Many of these severe and catastrophic disasters will be such as storms, avalanches, landslides, heat waves, and acidity of rainfall. All of these disasters will increase diseases, deaths and the extinction of animal and plant species. Human kind can keep thinking we still have plenty of time to make conscience and change, or even think global warming is not an actual problem, but we would all be wrong. We will write a custom essay sample on Negative Effects Global Warming specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Negative Effects Global Warming specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Negative Effects Global Warming specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We have to start taking actions right away and not let more years go by. There are many simple but important actions we can do to help our planet. Some of these actions are, buying energy-saving light bulbs, turn off electric devices when not in use, reduce the use of air conditioners or heaters, try to reduce the use of cars by using bicycles or walking, plant trees, shower with less hot water, separate the trash and recycle. Our planet IS dying with the pass of the years and it is in our hands to do something about it, we must start changing our ways of thinking and start taking actions NOW.

The History of the Telescope and Binoculars

The History of the Telescope and Binoculars Phoenicians cooking on sand first discovered glass around 3500 BCE, but it took another 5,000 years or so before glass was shaped into a lens to create the first telescope. Hans Lippershey of Holland is often credited with the invention sometime in the 16th century. He almost certainly wasn’t the first to make one, but he was the first to make the new device widely known. Galileo’s Telescope The telescope was introduced to astronomy in 1609 by the great Italian scientist Galileo Galilei   the  first man to see the craters on the moon. He went on to discover sunspots, the four large moons of Jupiter and the rings of Saturn. His telescope was similar to opera glasses. It used an arrangement of glass lenses to magnify objects. This provided up to 30 times magnification and a narrow field of view, so  Galileo could see no more than a quarter of the moons face without repositioning his telescope. Sir Isaac Newton’s Design Sir Isaac Newton  introduced a new concept in telescope design in 1704. Instead of glass lenses, he used a curved mirror to gather light and reflect it back to a point of focus. This reflecting mirror acted like a light-collecting bucket the bigger the bucket, the more light it could collect. Improvements to the First Designs   The Short telescope was created by Scottish optician and astronomer James Short in 1740. It was the first perfect parabolic, elliptic, distortionless mirror ideal for reflecting telescopes. James Short built over 1,360 telescopes.   The reflector telescope that Newton designed opened the door to magnifying objects millions of times, far beyond what could ever be achieved with a lens, but others tinkered with his invention over the years, trying to improve it. Newton’s fundamental principle of using a single curved mirror to gather in light remained the same, but ultimately, the size of the reflecting mirror was increased from the six-inch mirror used by Newton to a 6-meter mirror 236 inches in diameter. The mirror was provided by the Special Astrophysical Observatory in Russia, which opened in 1974. Segmented Mirrors The idea of using a segmented mirror dates back to the 19th century, but experiments with it were few and small. Many astronomers doubted its viability. The Keck Telescope finally pushed technology forward and brought this innovate design into reality. The Introduction of Binoculars The binocular is an optical instrument consisting of two similar telescopes, one for each eye, mounted on a single frame. When Hans Lippershey first applied for a patent on his instrument in 1608, he was actually asked to build a binocular version. He reportedly did so late that year.   Box-shaped binocular terrestrial telescopes were produced in the second half of the 17th century and the first half of the 18th century by Cherubin d’Orleans in Paris, Pietro  Patroni in Milan and I.M. Dobler in Berlin. These were not successful because of their clumsy handling and poor quality. Credit for the first real  binocular telescope goes to J. P. Lemiere who devised one in 1825. The modern prism binocular began with Ignazio Porros 1854 Italian patent for a prism erecting system.

Discuss and explain situations where OSHA would be able to enter and Assignment

Discuss and explain situations where OSHA would be able to enter and inspect a worksite without obtaining a warrant or the employers express consent - Assignment Example stances where the employer expressly refused inspection would the OSHA, by virtue to â€Å"Section 5(a)(1) of the Act, known as the â€Å"General Duty Clause,† which requires that every working man and woman must be provided with a safe and healthful workplace† (Occupational Safety & Health Administration, 2002, p. 1), obtain a warrant to inspect. Therefore, the instances or situations where OSHA would be able to enter and inspect a worksite without obtaining a warrant or the employer’s express consent include the following: (1) imminent danger situations that required immediate corrective actions (where the definition of imminent danger is explicitly stated as â€Å"any condition where there is reasonable certainty that a danger exists that can be expected to cause death or serious physical harm immediately or before the danger can be eliminated through normal enforcement procedures† (Occupational Safety & Health Administration, 2002, p. 3); (2) accident investigations, especially when more than three employees have been injured, become hospitalized or caused unfortunate deaths; and (3) when there are complaints for unsafe or unhealthy working conditions were apparently received from any member of the organization or its stakeholders (Occupational Safety & Health Administration,

Terrorism Term Paper Example | Topics and Well Written Essays - 5000 words

Terrorism - Term Paper Example Its history has been long and significant. This paper shall now seek to study and trace the history of terrorism in America. First, a general overview of the significant events in American terrorism shall be discussed. Secondly, a more specific discussion of relevant terrorism attacks in America shall be carried out. Lastly, this paper shall be summarized and concluded with specific points of discussion for future studies. This paper is being carried out in order to establish a clear picture of terrorism in America. It is being conducted as a means of understanding the patterns of attacks as well as the impact of these events in the life of the American people. Body Overview Terrorism in the United States is said to be caused by the various issues and conflicts which exist within and outside its borders. The country is a unique country because of its ability to contain the masses in a state of relative peace and harmony (Kelly, 2012). On further evaluation, terrorism in America is bo rne out of an extreme distrust of the American democratic ideals and of the illusion that people from varied backgrounds can all live loyally under the US political system (Kelly, 2012). In effect, despite significant variations in the expressions of terrorism, terrorism in the US can sometimes be explained as a violent claim on American values. The distrust is based on various expressions from different groups and in different time periods. The earliest manifestation of terrorism was seen in the early republic time period. The Boston Tea Party is an incident which is not considered terrorism in the technical sense (Kelly, 2012). The incident was a staged rebellion launched by colonists as a means of pressuring Britain into shifting its policies on the US (Kelly, 2012). Although this incident is not significantly violent, it can be placed in the category of terrorism as it was an act which sought to secure the goals and styles of national liberation groups. After the Civil War, terr orism came in the form of white supremacy movements and activities. The first form of terrorism seen in the United States was based on the ideals and activities of white supremacists (Kelly, 2012). These supremacists were Protestant Christians who believed that they were superior to other races and ethnicities and that general society must also exhibit such superiority. Before the Civil War, American society displayed such supremacy, especially as slavery was a legal practice (Kelly, 2012). Only after the Civil War ended was slavery made illegal, and white supremacy was soon to emerge. The Ku Klux Klan (KKK) was the most infamous white supremacist group formed. This group used various means of terrorism and harmful activities against African-Americans and other sympathetic whites (Kelly, 2012). This group was later outlawed by Congress and the group branded as terrorists. Various incarnations of the group have become apparent over the years and various similar violent and terrorist acts have been perpetuated by these incarnations. The Ku Klux Klan still exists, but in a less violent fashion, however it has since grown in membership and continues to support its white supremacist ideals, not just against African-Americans, but against other minorities as well, including Asians, Arabs, and Jews. The Bolshevik revolution which later led to the establishment of the Soviet Union had a significant impact on revolutionaries all over the world, including America (Kelly, 2012). The

Considering the Climate of the IT System Essay Example | Topics and Well Written Essays - 500 words

Considering the Climate of the IT System - Essay Example If a system is designed such that it will remove autonomy or authority from the end user and place it in the hands of the system, it is important to plan for that. In an organization that has a traditional management style, workers may be more accepting of relinquishing control to a more bureaucratic system. However, in an environment where the organization is more empowered, failure to consider this can result in resistance to the implementation. A successful system design will involve the organization and not significantly disrupt the hierarchy or alter the perception of control. While it is important that people's perceptions and attitudes be considered, it's imperative to keep in mind that the organization will have to use the system. Any problems in the organization such as arrogance or disinterest will be magnified when implementing a new system. One of the most important factors affecting a new system or modifications to an existing system is employee acceptance. Many system implementations fail because the system designers did not consider the behavioral climate resulting in a lack of acceptance (Headrick and Morgan). It is also important to consider the social environment of the organization prior to implementing a new system.