Case study of a man with parkinsons disease

Case study of a man with parkinsons disease Mr Henderson has arrived in hospital after a history of falls at home and has just commenced a new medication regime. It is very possible that he may be anxious, worried, frightened as a result of falling at home which also may result in loss of confidence. He may also be apprehensive about his new medication regime. Having been diagnosed with Parkinsons for 5 years, he more than likely knowns the importance of getting his medications on time, in reducing the symptoms allowing him to maximise his independence. However, it is not for the nurse to presume this and she/he must sit down, talk to him, allowing him time to talk and express his worried and anxieties. This was help to establish a relationship and Mr Henderson will understand that you are there to support him throughout his journal of care. The nurse should also make sure that all members of the multidisciplinary team are aware of Mr Hendersons condition and if they are not aware of the importance of getting medication on time out with normal drug rounds then they should be informed of its importance and understand the significant consequenc es resulting from not getting the drugs on time such as reduced independence and prolonged hospital stay. As medications are a large part in maximising independence and mobility and it may be suggested that Mr Henderson receives his medications before getting out of bed in the morning. This will allow time for the drugs to work and therefore enabling him to get out of bed more easily. Freezing, a symptom of Parkinsons disease can be distressing for patients. It affects gait initiation, turning and moving through small spaces, such a doors and busy areas. Anxiety can exacerbate freezing and it is vital that the nurse can firstly recognise anxiety, this may be achieve through effective communication and listening skills and secondly developing strategies to reduce anxiety levels such as allowing him time to talk, listening and taking on board his expressions allowing for a trusting relationship to be developed, helping him to build in confidence and preparing him psychologically for going home. Various strategies have been suggested to assist with freezing. Alexander, Fawcett and Runicnan (2006) suggest cognitive techniques in breaking down movement. They suggest breaking down the task of getting out of bed in the morning and describe that patients should bend their knees so that feet are flat on the mattress and they the patient should swing knees in the direction that he wants to turn. The next stage involves clasping both hands and lifting them straight up, straightening the elbows, then turning the head and swinging the arms in the same direction as the legs. Finally the patient can grip the edge of the mattress and adjust his position until comfortable. When Mr Henderson is mobilising then it is important that he does not have any distractions and the nurse or other members of staff should not disturb or interrupt if at all possible as this could lead to freezing. The Parkinsons Disease Society describe cueing strategies as external meaning visual, auditory or preprioceptive or internal meaning cognitive. Visual cues could be stepping over a cue in the floor, for example tape can be placed on the floor in strips to help initiate in confined spaces when freezing has taken place. Tape can also be placed on the edges of stairs. Mr Henderson may also find useful to imagine he is taking steps up stairs and this may prompt movement. The nurse should ensure that the area is clutter free and this can exacerbate freezing. Auditory cues as the name suggests would indicate sound used to enhance movement. Metronomes have been described as a useful tool in support gait initiation. Counting out rhythms or singing and walking in time to this can be beneficial. Proprioceptive cues which means taking a step back before starting to walk; rocking gently from side to side or marching on the stop before stepping. The nurse should ask Mr Henderson if he has experienced falls in the past year and frequency, obtaining as much information as possible about the falls, this can form part of the patients assessment namely a Falls Risk Assessment. Nice (2004) provides clinical guidance on falls risk assessment and suitable referrals should be initiated to the physiotherapist who will help to improve balance and the occupational therapist can help to make Mr Hendersons home safer place to live by attending a home visit and suggesting suitable aids that can improve safety, maximising independence. One of the most devastating consequences of falling in older people is a fractured neck of femur which can have significant impact on independence and quality of life. The nurse may suggest to Mr Henderson about wearing a hip protector, this again can improve confidence and also help to protect the hip if her were to fall. A full explanation as to why this is being suggested should be provided allowing for in formed choice. Falls can be as a result of loss of balance and posture, freezing, only being able to take small steps, or dyskinesia and it is important to use techniques such as cues to minimise the risk of falls. Also physiotherapy input will help with exercise, improving balance and posture. Multidisciplinary collaborating is essential in proving effective care. The nurse can find out what strategies are being taught to Mr Henderson and the nurse can encourage continuation of these exercises within the ward environment. It is important to continue to communicate with Mr Henderson allowing for evaluation in care and understanding what strategies are working and ones that are not. Once evaluated alternative strategies may be considered. Postural hypotension should be monitored/assessed for patients with Parkinsons as this increases the risk of falls as a result of dizziness or fainting in the drop in blood pressure. The patient should be supine for at least 10 minutes before taking a supine blood pressure reading. Then another reading should be taken within 3minutes of him standing up from the supine position. The nurse should be aware the dizziness the patient may experience when standing up should be standing next to him when she does the reading. If there is a significant fall in systolic blood pressure, by 20mmHg or goes below 90mmHg then this would indicate that the person has postural hypotension. Strategies can be adopted to improve the deficit before considering pharmacological methods such as recommending gradual compression stockings to improve venous return and therefore blood pressure. For them to work efficiently they much be measured and fitted to ensure the correct pressure is applied to the legs and ensuring that Mr Henderson is achieving recommended fluid intake of 1500-2000ml per day. If Mr Henderson is in a bay of beds for example 6 beds, then his location within the room should be considered in relation to the toilet. The bed should be relatively close to the toilet, if his fluid intake perhaps is being increased then frequency to micturate will potentially be increased. Mr Henderson is experiencing reduced mobility then bed position should be definitely considered to minimise the risk of unnecessary bowel or bladder incontinence. A commode may be considered and placed discretely closer to his bed for the evening or provision of urine bottles and buzzer placed in a position that is easily available. Appropriate footwear should be consider, the nurse should ensure that the are well fitted and not falling off increasing the risk of falls. The nurse should also check his feet or ensure there are no problems such as ingrown toe nails or blisters. The nurse should also ensure that Mr Hendersons vision is examined or glasses should be worn at all times if required as this could result in unnecessary falls. 1299 words Parkinsons Disease Question 2b Within the substantia nigra and basal ganglia there is progressive degeneration of cells which produce the neurotransmitter dopamine. The substantia nigra is a strip of dark pigmented cells located in the midbrain and the basal ganglia are collections of nerve cells located in near the base of the cerebrum. When motor impluses are initiated in the motor cortex, they need to be modified by the basal ganglia and substantia nigra by modifying motor activity, posture and making fine adjustments to movement. This is contained within the extrapyramid motor system and within the system there is normally a fine balance of neurotransmitters dopamine and acytylcholine. Dopamine is inhabitory and acytylcholine is excitatory. Due to the reduction in dopamine there is excess of the excitory neurotransmitter acytlecholine resulting in excitable muscle tone and the symptoms associated with Parkinsons disease. Mr Hendersons has begun a new medication regime using co-careldopa used to regain and maintain the balance between dopamine and acytlecholine. Dopamine cannot be given on its own as it will fail to cross the blood-brain barrier (BBB). The BBB is a physiological barrier that prevents substances from getting across from the blood stream and into the brain. Instead of dopamine, the drug levadopa is used which can cross the blood brain barrier and is then converted into dopamine. The dopamine then acts on dopamine receptors in the extrapyraminal motor system to maintain the neurotransmitter balance and therefore control the Parkinsons disease symptoms. When levadopa is administered it is broken down in the gut and liver by an enzyme called dopa decarboxylase, therefore combined with levadopa is a drug that inhibits the enzyme from breaking down levadopa is used which will lengthen the effects of levadopa meaning that less drug is required. This drug is called dopa decarboxylase inhibitor (cardidopa) This combination of levadopa can be provided as a preparation of one drug called co-careldopa or Sinemet (the brand name) There may be side effect such as nausea and vomiting, postural fall in blood pressure, constipation, and red stained urine. Mr Henderson must be made made aware of these side-effects and should inform the nurses when he is experiencing them. Domperidone can be used as an anti-emetic to stop the side-effects of nausea and vomitting. Blood pressure should be monitored for signs of postural hypotension and if required a medication review may be required, the nurse may ask the patient not to sit up or stand up too quickly. Parkinsons Disease 2c

Luxury Brand Engagement Research Write Up Essay

Brand Management is a function of marketing that uses techniques to increase the perceived value of a product line or brand over time. Effective brand management enables the price of products to go up and builds loyal customers through positive brand associations and images or a strong awareness of the brand. Developing a strategic plan to maintain brand equity or gain brand value requires a comprehensive understanding of the brand, its target market and the company’s overall vision. Brand engagement is a term loosely used to describe the process of forming an attachment (emotional and rational) between a person and a brand. It comprises one aspect of brand management. What makes the topic complex is that brand engagement is partly created by institutions and organizations, but is equally created by the perceptions, attitudes, beliefs, and behaviours of those with whom these institutions and organizations are communicating or engaging with. Brand engagement between a brand and its consumers/potential consumers is a key objective of a brand marketing effort. In general, the ways a brand connects to its consumer is via a range of â€Å"touch points† — that is, a sequence or list of potential ways the brand makes contact with the individual. Examples include retail environments, advertising, word of mouth, online, and the product/service itself. It can be broadly classified into two areas- Internal and external. Internal refers to the company’s employees, franchisees, etc while external refers to the end consumers. All the consumer behavioural factors like attitudes, beliefs, society, culture and trends are studied and form an interesting part of the study unlike many other areas of research. All these factors are psychological yet emotional and drive consumer behaviour towards brands ultimately leading to sales and higher revenues. Getting there requires convincing less conscious consumers that they can have their cake and eat it too (drive positive change and indulge their needs), and teaching them to choice-edit for the most personal, planetary and societal impact. Customer involvement starts from the personal basic perspectives of goals, values, and self-awareness. Depending on the relevance of these to individuals, they are reflected in decision-making behaviours. Different product attributes cause different degrees of involvement in consumer minds. These differences of involvement result in differences when consumers make purchase decisions. Therefore, when consumers perform consuming behaviours, the extent of their involvement affects purchase intention and this is only reflected when a deeper understanding of their psychological and emotional factors is attained. It relates at an emotional level and ensures long term sustainability, revenue and growth for the brand. One of the most significant sectors where brand management plays an even more important role is Luxury. Luxury as a concept is defined within the scope of socio-psychology as a result of its connection to a culture, state of being and lifestyle, whether it is personal or collective. When linked to brands, it is characterised by a recognisable style, strong identity, high awareness, and enhanced emotional and symbolic associations. It evokes uniqueness and exclusivity, and is interpreted in products through high quality, controlled distribution and premium pricing. These core factors have led to the development of a $180 billion global industry with an uninterrupted growth for over two decades. These elements have also led to the summarisation of luxury as a ‘dream’, leading to justifiable curiosity and interest. Luxury good manufacturers offer high quality products at higher prices. At times, the quality of the actual product may not actually be very different from the low cost one, however, the brand value attached to it is high. It is for this reason that the branded product still sells at a higher price. The customer, though buys the product, actually pays for the brand. He pays for the emotional/ psychological/ physiological need that he has been able to satiate through this purchase. Also, it is worth noting that building a luxury brand can be a very tough task. It has to have the right value of consumer behavioural/ attitudinal compatibility mix for it to achieve its purpose owing to the high costs. Brand Managers for luxury products cannot over advertise their product (devalues the image) and not under advertise their product (loss in enquiries/ revenue). This interesting amalgamation of business drivers and human behaviour forms a motivating and challenging topic for research studies. Brand value measures the economic asset value of a company or product brand. It details how much of the company’s operating income and free cash flow is derived from the brand, the influence of the brand within each consumer purchase decision driver, and the associated brand risks. By linking the brand to the economics of the business at a detailed level, brand value opens the door to a number of useful applications like proving that branding offers real value, justify a proposed marketing budget, align the commercial organization, evaluate acquisition opportunities, optimal royalty rate, optimize the brand relationship to best tell the brand story, focus investments, drive higher prices, leverage brand value to lower taxes, reduce turnover and quantify the damage. It is very intriguing when we look at the financial output of the brands, grouping the companies into two categories of highly and least engaged in brand engagement. The companies who were highly engaged grew on an average of 18% in revenues over the last 12 months, compared to the least engaged companies who on average saw a decline of 6% in revenue during the same period. The same holds true for two other financial metrics, gross margin and net profit. Interbrand was recently involved in brand valuation with respect to business and the approach used is as follows:Snapshots of couple of models or indexed used has by different organizations to measure brand engagement has given under the research design section. Consumer buying behavior has changed a tremendously over the last decade and below is the Worldwide Personal Luxury Goods Market Trend (this has been discussed in detail in the industry literature review at the end) to illustrate the fact:Third year in a row of double-digit growth for the personal luxury goods market: over the 200â‚ ¬B threshold! There are various challenges that brands face over the course of their engagement tactics. The brand’s core thought or value should be in sync with the target audience. If it’s not, then there is no engagement at an emotional level. For a consumer to be engaged with the brand, he has to continuously be bombarded with the brand’s advertising or communication through various mediums. This process is very costly to the organisation as it involves various media channels and every channel (print, digital, TV, etc) has its own rate structure. The competition in every industry has further caused problems for any brand to create its importance. The consumer mind space is cluttered with messages from different brands making it even more difficult for a particular brand to register itself. Even if a consumer gets engaged, there’s no specific tool to measure the impact of the engagement on the final sales/ profits of the brand. The huge costs therefore become difficult to justify. Competition is fierce in developed economies and consumers are bombarded with offers, many of which are very similar. In such a setting, differentiation is vital and academic research has revealed that brands can build sustainable competitive advantage by increasing customer loyalty and fostering personal recommendation. However, to achieve such a sustainable competitive advantage, brands need to go beyond their traditional focus on communication and advertising and become the key to integrated client experience management. In such a scenario, it becomes even more important to build a brand that is strong in its values. It involves designing campaigns to generate intention to purchase and top of the mind awareness, various metrics to measure the effectiveness of brand campaigns, retuning parameters, redesigning the campaign and measuring the metrics again till the time the campaign reaches its desired GRPs (gross rating points). A very interesting real life example of how a brand faces a situation when it’s present engagement measures don’t work and it has to continuously make new efforts to ensure engagement with consumers is illustrated in a research paper titled ‘Luxury Brand Exclusivity Strategies’ which can be visited through this link – URL: http://dx. oi. org/10. 5430/jbar. v1n1p106. It examines how luxury fashion brands renew themselves in order to balance the exclusivity that is associated with luxury goods and with profit maximization. Using consumers’ demand theory it is shown how luxury fashion brands go through different phases to renew the perce ption of exclusivity.

Descartes Dream Argument Essay

How do we know we are not dreaming some particular experience we are having, or we are not dreaming all our experience of this world? When we dream we imagine things happening often with the same sense of reality as we do when we are awake. In Descartes dream argument, he states there are no reliable signs distinguishing sleeping from waking. In his dream argument, he is not saying we are merely dreaming all of what we experience, nor, is he saying we can distinguish dreaming from being awake. I think his point is we cannot be for sure what we experience as being real in this world is actually real. When Descartes remembers occasions when he is dreaming, he falsely believes he is awake. Reflecting on this, Descartes thinks he cannot ever tell whether or not he is dreaming. How can he know he perceives his hands right now? Maybe, it is all just a dream. If it were just a dream everything would seem to be the same. In order to have knowledge the suggestion he is dreaming is false, he somehow has to have some knowledge of being awake. I believe his dream argument could be formed in this way: 1. When we are dreaming we are not in a good position to tell whether we are actually dreaming or awake. 2. Any experience you are having right now could also mean you are dreaming. In other words, you can’t possibly know you are dreaming even if it is a dream. 3a. For each of your experiences, you can’t tell whether your experience is a dream or not. (You can’t tell which of your dreams is a waking experience or a dreaming experience). 3b. For all you know, all of your experiences may be dreams. (You may be walking around in a dream, never having any walking experiences) Most philosophers think the dream argument supports both conclusions, but many philosophers also think this argument is strong enough to support 3a but not 3b. It is not really clear whether Descartes is arguing for the stronger claim or the weaker claim. It could be 3b, the weaker claim, is enough to support his purpose. Maybe he does not need a stronger claim to prove his theory. The last step in Descartes argument says if he cannot tell whether he is dreaming, then how can he trust any of his senses telling him about the environment? To know anything about the external world on the basis of his sensory experiences, it seems like Descartes would have to know those experiences are not all just a dream: To know anything about the external world on the basis or your sensory experiences, you have to know that you are not dreaming. I believe the things in my dreams must have been patterned after real things. So, even if I might be dreaming now, I know the world has colors, things that take up space, have shape, quantity, and a place in space and time. Now if you pull premises 1-4 together, we get the result of the conclusion: 5. Therefore, you can’t know anything about the external world based on your sensory experiences. In an interpretation of Descartes Dream Argument, premise 1 supports premise two and premise 3a and 3b support premise 4. So let us take a look at premise 2, 4, and the conclusion. This looks like the valid inference rule, such as modus ponens. P ? Q P__________ Therefore, Q However, that is not what is exactly happening in the dream argument. For premise 4 says to know you would have to know you are not dreaming. But premise 3 says you cannot know you are dreaming. In order for Modus Ponens argument to work, it would have to contain the premise: â€Å"I know I am dreaming. † Since Descartes cannot actually declare he is dreaming, it will not work. So there goes the premise of the argument. The most Descartes can say in his argument is â€Å"you can’t tell whether you experience is a dream,† premise two states â€Å"You can’t possibly know you are dreaming,† to premise 3, â€Å"you can’t tell if you are dreaming† to the conclusion, â€Å"You can’t know anything. † In order for Modus Ponens to work once again Descartes would have to know he was dreaming. As stated above he cannot state his position as if he is dreaming, so there goes the premises argument. So if this is not a valid argument, then perhaps there is a way to revise my interpretation on Descartes’ Dream argument so it turns out to be a valid rgument. Can we make the argument valid by changing premise 4? 2. Any experience you are having right now could also mean that you are dreaming. In other words, you can’t possibly know that you are dreaming even if it really is a dream. 4. I know that I am dreaming. Therefore, you can’t know anything about the external world based on your sensory experiences. This is now valid but is Descartes actually dreaming? Lets try switching around premises one. 1. If I cannot distinguish with certainty between sense perceptions and dreams, then I cannot believe anything based on images as true. . I cannot distinguish with certainty between sense perceptions and dreams. 3. Therefore, I cannot believe as true anything based on images. The argument is now valid again. But the question remains, whether the argument is sound and all the premises are true. A dream is a dream because its external conditions make it a dream and not because of a sense perception. If I am asleep and having an image of a body, than I am dreaming. If I am awake and having an image of a body, then I am not dreaming. Usually I am having a sense perception, but it could also be a hallucination. Dreaming is a certain kind of state. The only way to know you are not dreaming is to know you are not in a state of being asleep and having mental images, sounds, etc. No amount of images, sounds, can tell me I am in the state of being asleep and having images, sounds, etc. before my mind. If premise 2 is true, you can never be certain you are dreaming, as opposed to having sense perception. For instance, I can never step outside of myself to check what state I am in. It is indeed possible I could be dreaming. Descartes, however, has a very different kind of reply to the dream argument. He does not challenge premise 2 at all, instead he challenges premise one: If I cannot distinguish with certainty between sense perceptions and dreams, then I cannot believe as true anything based on images, etc. Descartes states in meditation one, â€Å"Nevertheless, it surely must be admitted that the things seen during slumber are, as it were, like plain images, which could only have been produced in the likeness of true things, and these general things —eyes, hands, head, and the whole body,–are not imaginary things, but are true and exist. This statement is actually very clear because the reply is the contents of dreams (Mt. Everest, other people, houses, etc) must come from reality. We get images through the world that we live in, so even if I am dreaming, I know there are mountains, people, and houses. They must exist in order to have dreams like the ones I have. If the world was different then I would have different kinds of dreams. † In Descartes final thoughts he admits it seems to be possible I am now dreaming even though no one could know anything about the world around us. I think Descartes point to be made throughout the dream argument is we are able we are not dreaming if we are to know an external world around us. If we are to know our external world around us, then we would have a better understanding of why we dream. It would also give us a better understand to distinguish from being awake to dreaming. It seems to me the point throughout his dream argument the point he is trying to make is we cannot be sure of what we experience as being real in the world is actually real. Descartes may have not made his point to be valid or true, but made us think outside the box, there are other possible choices to why we experience these thoughts when we dream.

The Effects Of Lumpectomy As A Breast Conserving Surgery

Lumpectomy. The lumpectomy is a breast-conserving surgery that removes only the tissue containing the cancer. Lumpectomies are more successful when tumor detection occurs in an earlier stage and smaller size. A patient may opt for a tissue biopsy and lumpectomy simultaneously however, research is dismal in the lifespan impact on this particular surgical approach. Radiation. Radiation therapy can be useful in all stages of breast cancer, however Stage I and II radiation therapy with lumpectomy is recommended. The ongoing research identifies without radiation treatment there is a relatively high chance of cancer recurrence up to 35%; with radiation as an adjuvant therapy the cancer risk decreases to 5-10% (MCGWC, 2007). Radiation treatment also accompanies a mastectomy if axillary lymph nodes test positive, a tumor is greater than five centimeters, or margin borders of the tumor are narrow between healthy cells and tumor cells (MCGWC, 2007). Systemic therapy. Both surgery and radiation therapy target tumor cells in a specific region. However, tumor cells can migrate and metastasize to other regions in the body through the lymph system. Adjuvant systemic therapy may be beneficial depending on staging, grade, tumor size, cell proliferation and oncogene activation. Oncogenes warrant further study as a treatment to alter genes that are unable to suppress cell proliferation; when damaged the proteins produced by the oncogenes can turn normal cells into cancer cells. The mostShow MoreRelatedBreast Cancer : Cancer And Cancer912 Words   |  4 Pagesan invasive breast cancer in their lifetime. In 2016, a projected 246,660 new cases of invasive breast cancer are estimated to be detected, along with an additional 61,000 new cases of non-invasive breast cancer. There are greater than 2.8 million women with a diagnosis of breast cancer in the United States, including women presently being treated and women who have completed treatment. 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