A Study Of Intactness Of Adoptive Families And Behavioral...

The Older Adopted Child: A Study of Intactness of Adoptive Families and Behavioral Problems of Older Children Sarah A. Kell University of California Riverside Abstract The older adopted child is a unique case of adoption where the child is of school age. The definition of what constitutes a case of older child adoption has changed numerous times over 20th century, but school age is currently the definition for an older child. This means children as early as five years old are considered difficult to place due to their age. Children who are considered a difficult placement are classified as special needs, even if they may or may not have any physical or mental disability. Other categories of special needs include transracial children and children who have a developmental disease. There has been an observation in recent studies that have shown the older a child is, the more likely they are to have behavior problems, as well as an increased chance of disruption in a family. The acceptability of older child adoption has only been recent, as older child adoption was rallied as acceptable by adoptive families. The claim that older children are adoptable is an extremely valid point, as in no way are these children different from any child who would be considered normal. This study shows how the mentality of an older child can effect an adoptive family, as well as how often disruptions occur and why they occur. The Older Adopted Child: A Study of Intactness of Adoptive

Philip K. Dick One of the More Prolific Science Fiction...

Philip K. Dick is one of the more prolific science fiction writers of the second half of the 20th century. His dark plots, themes, and characterizations differ greatly from those who preceded him. This has seemingly translated well onto the big screen, as at last count, nearly ten of his novels and short stories have been adapted into films. Several of these films have garnered critical acclaim for both their movie credentials and use of source material. Blade Runner, originally released in 1982 and based off a 1968 novel entitled Do Androids Dream of Electric Sheep? along with A Scanner Darkly, a 2006 film based off a book of the same name released in 1977, are two such examples. They provide an excellent base to compare the adaptations†¦show more content†¦Rather than rely heavily on action-oriented special effects, director Ridley Scott creates a futuristic environment that is at the same time both familiar and new to audiences. The sense of familiarity the viewer has wit h this future makes the modern advances in robotics and transportation introduced throughout the story more believable. In contrast, A Scanner Darkly is immediately noteworthy for its use of rotoscoping. The entire movie was first filmed as any normal movie would be. Afterwards, computer animators recreated the frames, using combinations of several techniques to create the appeal which director Richard Linklater envisioned. Though some would consider this a novelty, the rotoscoping helps recreate the distorted, dream-like sense of reality the characters in the film live in. Colors are flattened and perspective takes on a new feel, as the viewer sometimes feels detached from the environment, much like lead Bob Arctor feels on a daily basis while addicted to Substance D. Only time will tell if this technique still holds appeal after thirty years of like Blade Runner. As opposed to Blade Runner’s film noir style, A Scanner Darkly achieves its effect entirely post production. Both have a very strong impact and aid their respective storylines, so it is debatable as to which works better or has the more lasting appeal. What

Distraction Plate Fixation Post-Procedure free essay sample

Type III compression injuries o Require operative treatment if ? Intraarticular damage is significant ? Radial shortening is severe o Fixation with multiple Kirschner wires or plates is often necessary, and cancellous bone grafting is frequently required to fill impacted areas. Often a combination of open and closed techniques is necessary to satisfactorily treat type III fractures. Type IV avulsion fractures o Are usually associated with radiocarpal fracture-dislocations and are therefore unstable o Often the avulsed fracture fragments are so small that they can be repaired only with suture. o Secure reduction of the carpus to the distal radius can frequently be achieved only with Kirschner wires. Type V high-velocity fractures o Always unstable, frequently open, and difficult to treat o A combination of percutaneous pinning and external fixation is often necessary. Many of these fractures are so severely comminuted that open reduction is impossible. †¢ CONTRAINDICATIONS Severe medical comorbidities that prevent surgery EQUIPMENT †¢ †¢ †¢ Hand tray and hand table Small fragment and mini fragment set Technique-specific tray, as required ANATOMY †¢ The distal radius and ulna may be divided into three distinct columns. o The lateral and medial columns correspond to the scaphoid facet and lunate facets, respectively, of the distal radius. o The medial column is further divided into dorsomedial and volar medial parts. The ulnar column consists of the ulnar styloid and triangular fibrocartilage complex. ? ? Tears of the triangular fibrocartilage occur when the medial column of the distal radius, ulnar styloid, or both are intact. Distal radioulnar joint instability is associated with significant displacement of the ulnar styloid. TECHNIQUES †¢ †¢ †¢ Post-Procedure: Distraction Plate Fixation Post-Procedure: Volar Buttress Plate Fixation (Ellis) Post-Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff) Post-Procedure: Distraction Plate Fixation POST-PROCEDURE CARE †¢ †¢ †¢ †¢ †¢ Immediately begin finger and other joint upper extremity exercises. If a splint was applied, it should be removed at 3 weeks. Percutaneous Kirschner wires should be removed at 6 weeks. Activities of daily living are allowed, but lifting should be restricted to 5 lb. Once union is achieved, remove the distraction plate and begin range-of-motion exercises. COMPLICATIONS †¢ †¢ †¢ †¢ †¢ Median nerve injury Reflex sympathetic dystrophy Malunion, nonunion Tendon rupture Infection ANALYSIS OF RESULTS Studies have demonstrated a high percentage of good to excellent outcomes for distraction plate fixation. OUTCOMES AND EVIDENCE Ruch et al reported good to excellent outcomes in 90% of 22 patients using this technique. Procedure: Distraction Plate Fixation Post-Procedure: Volar Buttress Plate Fixation (Ellis) POST-PROCEDURE CARE †¢ Immobilize the wrist and forearm with a plaster sugar tong splint for 2 weeks. †¢ †¢ Next, use a removable ball-peen splint, permitting gentle active exercises two or three times a day for the next 2 weeks. All immobilization is removed at 4 weeks and progressive motion continued until union is solid. COMPLICATIONS †¢ †¢ †¢ †¢ †¢ Median nerve injury Reflex sympathetic dystrophy Malunion, nonunion Tendon rupture Infection ANALYSIS OF RESULTS The use of buttress plating for the treatment of distal radius fractures have proven to yield excellent results when surgical intervention occurs early and care is used to obtain anatomic reduction of the fracture. OUTCOMES AND EVIDENCE †¢ †¢ Smith et al: 100% union rate with 71% excellent, 18% good, and 11% fair results. Odumala et al: No difference in development of median nerve symptoms in patients treated with prophylactic carpal tunnel decompression compared with those without decompression. Procedure: Volar Buttress Plate Fixation (Ellis) Post-Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff) POST-PROCEDURE CARE †¢ †¢ †¢ †¢ Keep the extremity elevated at all times until postoperative swelling subsides. Beginning on the first postoperative day, remove the splint 2 to 3 times a day for rangeof- motion exercises. Allow clerical work at 2 weeks. Resistive loading is allowed when signs of radiographic union appear. COMPLICATIONS †¢ †¢ †¢ †¢ †¢ Median nerve injury Reflex sympathetic dystrophy Malunion, nonunion Tendon rupture Infection ANALYSIS OF RESULTS Studies have demonstrated a high percentage of good to excellent outcomes for the Medoff system. OUTCOMES AND EVIDENCE Medoff reported 20 good to excellent results in 21 patients with intraarticular comminuted distal radial fractures treated with the TriMed Wrist Fixation System (TriMed, Valencia, Calif. ). Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff) PRE-OPERATIVE AND POST OPERATIVE CARE Care of Pre-operative Patient Nursing Diagnosis Knowledge deficit R/T pre-op care. Expected Outcome Patient/parent will verbalize understanding of pre- post-op care. Nursing Intervention 1. Implement pre- post-op teaching program. 2. Document response. 1. Remove nail polish, make-up. 2. Bathe and shampoo the night before surgery. 3. Betadine scrub to surgical area. 4. Dress in hospital clothing after scrub. 1. NPO as ordered. 2. Sign at bedside; NPO sticker on patient. Potential aspiration R/T general No aspiration. anesthesia. 3. Re-emphasize importance of NPO to patient and parent; empty water pitcher and glass from bedside; check crib for bottles. 1. Explain procedures. 2. Provide time for patient/parent to ask questions, express fears or concerns. . Offer reassurance. Potential alteration of vital functions R/T surgery. Normal parameters for patients vital signs established. 1. Obtain baseline assessment of all systems N/V status within 8 hours pre-op. Potential infection R/T surgical procedure. Infection free post-op. Potential anxiety R/T surgery. Decreased anxiety. 2. Assess V. S. within 2 hours pre-op. Care of Post-operative Patient Nur sing Diagnosis Knowledge deficit R/T post-operative care. Expected Outcome Patient and family will verbalize and demonstrate understanding of postoperative care. Patient and family will cope effectively with surgical postoperative process. Nursing Intervention 1. Implement post-operative teaching program. 2. Document response. 1. Explain procedures. 2. Provide time for questions, expression of concerns and fears. 3. Offer reassurance. Potential anxiety R/T surgery, post-operative care. Potential respiratory Patient will not experience compromise R/T general respiratory compromise. anesthesia. 1. Assess breath sounds-HR/RR at least q shift. 2. Turn, cough and deep breathe q2 hrs. 3. Record vital signs. Patient will Alteration in comfort R/T verbalize/demonstrate relief surgery. rom pain. Potential neurovascular Patient will not experience compromise R/T surgical neurovascular compromise procedure. . 1. Assess for pain and medicate per protocol. 2. Reposition for comfort as ordered/prn. 1. Assess surgical site or affected extremity for color, capillary refill, sensation, temperature, pulses and active/passive ROM as ordered. 2. Document neurova scular status as ordered. 3. Report any neurovascular compromise to M. D. 4. Position extremity with elevation if ordered. 5. Apply ice or heat as ordered. Potential alteration in level of consciousness R/T anesthesia. Patient will exhibit appropriate LOC. 1. Assess LOC q shift. 1. Monitor I/O q hour with IV or foley. 2. Begin ice chips or clear liquids slowly as ordered. 3. Maintain IV fluids as ordered. 4. Call M. D. for catheter order if unable to void after surgery. 5. Assess GU status q shift. Potential alteration in bowel elimination R/T Patient will have BM by postanesthesia and postoperative day #4. operative immobilization Potential alteration in skin integrity R/T immobility. Patient will not experience skin breakdown. 1. Mobilize as ordered. 2. Administer laxative of choice or suppository for no BM after 3 days. . Assess GI status q shift. 1. Assess skin q shift. 2. Provide daily nursing care. Potential alteration in fluid balance R/T surgery. Patient will have adequate fluid intake and urine output. Medical Diagnoses: Impaired Physical Mobility, Acute pain, secondary to fractured left femur, ORIF surgery, Musculosketeal impairment Assessme Nursing Client Nursing *I Evaluation nt DX/Clin ical Goals/Desired Interventions/Actions/ Goals Interventio Problem Outcomes/Object Orders and Rationale ns ives Subjectiv Problem: Long Term: * Apply any ordered X Goal met. Continue e brace before Pt was intervention Impaired Pt will be able to mobilizing the client. able to s as listed. Pt Physical ambulate around ambulate Encourage screams Mobility the nurses’ Rationale: around pt to when station 2X by â€Å"Brace support and the continue the staff discharge. stablilize a body part, nurses’ use of attempts allowing increased station by braces and to move mobility. † (Ackley discharge. assistive the left Ladwig, 2008, p 552). Pt was devices lower able to after extremity *Increase complete discharge Pt demonstr ates difficulty with any movemen t of the left lower extremity . independence in ADLs Rationale: â€Å"Providing unnecessary assistance with transfers and activities may promote dependence and a loss of mobility. † (Ackley Ladwig, 2008, p 552). *Obtain any assistive devices needed for activity. Rationale: â€Å"Assistive devices can help increase mobility. † (Ackley Ladwig, 2008, p 552). R/T: Short Term: Obje ctive Pt states that his pain level is a 9 on a 10 point pain rating scale. is activity until he more than feels twice. Pt comfortable did not c/o. complain Encourage of any the pt to pain or continue his discomfort independen upon ce in ADLs ambulatio and c/o n. unnecessary assistance. Pt states â€Å"I feel like I’m finally getting back to my old self. † X Goal met. Pt able to fully complete passive range of motion exercises with assistance from the staff by the end of this shift. Pt did not complain of any pain associated with exercise session. Continue intervention s as listed. Continue to assess pain using the 10 point pain scale q4 hrs or PRN. Continue to provide pain control and treat as needed. *Assess the pt’s pain Acute Pt will perform by using the 10 point pain, passive range of pain rating scale q4 hrs secondary motion exercises or PRN. to by the end of this fractured shift. Rationale: left femur â€Å"Single- item ratings of Pt pain intensity are valid grimaces ORIF and reliable as during surgery measures of pain any kind intensity. of motion Anxiety or â€Å"The client’s report of movemen Musculosk pain is the single most t of his eteal reliable indicator of left lower impairmen pain. † extremity t (Ackley Ladwig, 2008, p. 604-605). AEB Pt’s ORIF *Before activity, treat Grimacing surgery pain. during movement Rationale: or activity â€Å"Pain limits mobility and is often Pt complaints about pain and discomfort Pt pain rating of 9 out of 10. Surgery that is 2 days postop exacerbated by movement. † (Ackley Ladwig, 2008, p 552).

Critical analysis of Fire Safety Legislation of Botswana

Question: Discuss about the Critical analysis of Fire Safety Legislation of Botswana. Answer: Fire outbreak is one of the potential risks that any organization may face anytime especially when there are no established measures of preventing or dealing with fire hazards. Various organizations have taken the initiative of equipping their organizations with fire fighting machines. Others have gone an extra mile and trained their employees about fire hazards, especially on how they should act when there is a fire emergency. All nations have fire safety regulations that provide guidance on fire prevention, evacuation, and fire fighting. The country of interest in this paper is Botswana which is my main place of work. Carrying out a critical analysis of the fire safety regulation in Botswana will aid in understanding its adequacy for life safety, and how this relates to the general property or asset protection, and reduction in business interruption. Botswana has a fire service team which comprises of fire brigades and is responsible for the control and prevention of fires in the country. This service forms parts of the Unified Local Government Service (ULDS). The Fire Service Act of 1996 is enforced by the local authorities. The service is headed by a director, a public offer whose duties include regulation and coordination of fire brigades in Botswana. The Fire Safety Legislation of Botswana is adequate in ensuring life safety. The fire service of Botswana has ensured that every council area has a fire brigade with the necessary equipment, and trained personnel to respond to fire outbreaks (Government of Botswana, 2005). Also, the fire service ensures that there is adequate provision of water supplies. Each council ensures that there is adequate water supply available for use when necessary. Various councils have entered into an agreement for water authorities under the recommendations of the Waterworks Act (The World Law Guide (WLG), 2016). This has enabled fire brigades in each council to have access to water when necessary. Under the provisions of the Waterworks Act, the fire brigade is required to replace the water of pay compensation for the water used thereof. Regarding the availability and response of fire fighting officers, Botswanas fire officers are always ready for duty always and may at any time respond to a duty call. Botswanas Statute Law, Volume 89, under fire prevention, requires every officer, at all times, to perform the duties allocated to him/her effectively and to fulfill the specific or general orders issued by the director of the fire brigade under which he/she operates. The duty of every fire officer is to act within all his power towards protecting persons, and property in case of fire outbreak. Most importantly, fire and police officers in Botswana may break into any business premise where fire has broken out for the purpose of extinguishing fire even without the consent of the occupier or the owner. This is to ensure the evacuation of the property and people in such premises. This is an indication of the responsiveness and alertness of the Botswana fire service according to the provisions of the Fire Safety Act of the country. Besides, the safety measures employed by fire brigades in Botswana ensure that fire outbreaks in any building are contained. Obeng (2001) asserts that any fire brigade officer, in regard to fire prevention, can obtain and assemble information concerning the quality of buildings and property in the area, the availability of water, means of accessing property and premises, and any other local situation. This is to provide advice concerning property and buildings for the aim of fire prevention, inspection and escape in case of fire purposes. Such data collection on buildings and property, as well as inspection is important for fire prevention and in the case of fire, successful and on time fire fighting to ensure the safety of persons and property. The Fire Safety Legislation of Botswana inspects buildings to ascertain their quality and equipment, the ventilation systems, and presence of fire extinguishing equipment. These are taken into account regarding the alleviation of fire outcome s. According to IAEA (2004), buildings are expected to have adequate access and escape routes for the field operators or fire fighters. Such routes should not have combustible materials. The legislation provides that the layout of premises should regard the prevention of the spread of fire, and smoke from neighboring fire cells to the access or escape routes. Also, ventilation systems should not compromise the availability of unnecessary safety systems. Such conditions on the nature of buildings are tackled in the fire risk analysis (Botswana Law Revision Commissioner, 2007). However, the Fire Safety Legislation of Botswana has not done enough towards the prevention and response to fire outbreak. Despite the fact that it has equipment for fire fighting and a ready trained response team, in several occasions, many businesses such as supermarkets lose their properties in fire outbreaks due to the delay of fire brigades. The legislation has failed to demand that all premises and organizations should train their employees on fire prevention and fighting. Only a few large organizations in Botswana have done so. In other workplaces, there are only one or two fire extinguishers, which are not enough to contain fire. The legislation should therefore ensure that all workplaces train their workers on fire prevention and fighting as a way of minimizing deaths and property loss in the event of fire. Also, most of the portable fire extinguishers in Botswana are not approved by the Botswana Bureau of Standards. This is according to a recent press release which advised fire service providers to ensure that their equipment are approved by the bureau by the 1st October 2016. The Fire Safety Legislation of Botswana, also known as the Fire Service Act has worked to ensure fire prevention through the provision of necessary equipment and have responsive and trained personnel to contain fire hazards. The fire service officials inspect the layout and quality of buildings to ascertain whether they have a safe escape and access routes in the event of fire. Also, fire brigades in each council area ensure that there is sufficient water supply and equipment for responding to fire outbreaks. This has minimized business interruptions due to power outbreaks, reduced the destruction of property, and loss of lives. Though the legislation has not demanded the training of workers on fire prevention in every organization, it is adequate in life safety and property protection. References Botswana. (2005). Statute Law, Volume 89. Government Printer Botswana Bureau of Standards (BOS). Press release; implementation of fire safety standards. Retrived from file:///C:/Users/Winnie/Downloads/Press%20Release%20-%20Implementation%20of%20Fire%20Safety%20Standards.pdf Botswana. Law Revision Commissioner. (2007). The laws of Botswana: LRO 1/2007 (up to and including Act 22 of 2006 and S.I. 96 of 2006). Republic of Botswana Fire Service Act. (1996). CHAPTER:40:04An Act to provide for the creation of a Fire Service for Botswana. Volume VII. Retrieved from https://www.elaws.gov.bw/desplaylrpage1.php?v=VIIvp=id=1246 Government of Botswana (GOB). (2005). Act 14; National Security Act. CHAPTER 23:01. Retrieved from https://www.vertic.org/media/National%20Legislation/Botswana/BW_National_Security_Act.pdf International Atomic Energy Agency (IAEA). (2004). protection against internal fires and explosions in the design of nuclear power plants. Safety standards series, No. NS-G-1.7. Retrieved from https://www-pub.iaea.org/MTCD/publications/PDF/Pub1186_web.pdf Obeng, K. E. (2001). Botswana:institutions of democracy and government of Botswana. Botswana: K.E. Obeng The World Law Guide (WLG). (2016). Legislation of Botswana. WEB. Retrieved from https://www.lexadin.nl/wlg/legis/nofr/oeur/lxwebot.htm