The morality of toture: Suspected Criminals And Terrorists

The morality of toture: Suspected Criminals And Terrorists The principle of torture has been brought back into the forefront of philosophical debate following the September 11th 2001 terrorist attacks in New York bringing about the War on Terror. So much so, that torture has been considered as a way of combating problems with suspected criminals and terrorists. The matter of torture has been the centre of legal discussion, often being juxtaposed against the human rights issue. Cases such as Abu Ghraib, the prison in Iraq and the detainees held at Guantà ¡namo Bay, have increased the publics awareness of issues surrounding torture, and have fuelled debates concerning the true liberalness of democratic countries; which countries like the US are supposed to encapsulate. What is more, should these democracies be condemning morally wrong topics like torture, or should their prime concern be the safety and security of its citizens? Furthermore, how can these two ideas be reconciled, and what implications will this have for the law? Why Is Torture Morally Wrong? It is fundamental to the understanding of this debate to recognise why torture is seen as inherently wrong with strong moral objections, and why it is regarded as a violation of rights. Only then, can we unravel its significance when posed with questions of terrorist threats and its repercussions on the legal system. If we are unable to dispel what it is about torture that we find morally inconceivable then it is hard to assess under what circumstances it can be practiced or even legitimised. Cesare Beccaria, wrote in his paper, Moral Protest, the impression made by pain may grow to such an extent that having filled the whole of the sensory field, it leaves the torture victim no freedom to do anything but choose the quickest route to relieving himself of the immediate pain. Thus, torture can be seen as posing two areas of concern, not only does it involve the application of extreme amounts of pain and suffering; it also infringes on a persons right to a fair trial. These both amount to why torture is morally wrong in its means of interrogating suspects. Within Western democracies, a key concept is the principle of human autonomy. Therefore, torture aims to completely disregard one of the essential foundations upon which democracy was built. It reduces a human to such a degree that they destroy all traces of individuality so that they are unable to make decisions. A tortured being is only capable of comprehending one thing; that being the urgency to be released from pain. It is this power that allows the torturer to gain the information or confession he wishes. In The moral wrongness of torture, Fatima Kola describes this state as an attempt to annihilate agency. Torture can annihilate agency because it seeks to lower the person to a standard in which they cannot make rational choices, being subject to physical or psychological torment. Hence, it is understandable why torture is considered morally wrong, and how anyone who accepts this as a means of interrogation must be able to justify the degradation of personal autonomy and human rights. We must also consider why it would be so morally repulsive to be tortured. Henry Shue believes that one of the main reasons for this is that it constitutes as an attack on the defenceless. This idea is furthered by Sussman who has a unique argument as to why torture is so repugnant. He states in, Whats Wrong with Torture? So construed, torture turns out to be not just an extreme form of cruelty, but the pre-eminent just an extreme form of cruelty, but the pre-eminent instance of a kind of forced self-betrayal. Thus torture is a distinctive kind of wrongness not often found in other acts. As what is embedded in the core of torture is the form of self-betrayal that it harbours. The victim if forced into a state of defencelessness and powerlessness. They are broken down until they lack all personal autonomy and rationality. Whats more, Sussmen believes that the victim is lowered to such a degree that their own body becomes their main attacker, leaving them to feel debased. Such a view t hen naturally finds the physical and emotional strains of torture as abhorrent, rendering it morally wrong in all circumstances. Alternative Arguments That Justify Torture Perhaps it is because society is no longer as shocked at images of torture that is has become more accepted within legal discussions. Exposure to scenes of pain and brutality in culture has allowed for people to be more open minded about the debate of torture. Yet, amongst this, two distinct arguments exist. There are those that believe torture can be morally justified where it prevents a greater devastation from occurring, that it is the lesser of two evils. Arguments from this standpoint are utilitarian, which allow the torturing of one life to save many innocent lives. The main focus for utilitarians is the end goal and the idea that torture can be justified according to the circumstances at the time. This is particularly important in terrorist cases, where utilitarians argue that a terrorist has lost his claim to a normal standard of human rights by endangering the lives of innocents, and therefore cannot expect to have the same amount of protection as an ordinary citizen. Henry Shue, gives a further explanation to justify acts of torture in that, since killing is worse than torture, killing is sometimes permitted, especially in war, we ought sometimes to permit torture. However this argument is flawed as there are other more important factors that need to be considered rather than just the degree of harm done. If we are to compare the acts of killing that take place in war to the torture of a suspected terrorist, then the most obvious difference is that in warfare, both parties have equal opportunities to kill or be killed. Whereas a terrorist or criminal who is being tortured is subject to the whim of the torturer. Thus, I do not believe this creates a valid argument to justify torture. On the other hand, there are those who believe torture should be absolutely prohibited, and that under no circumstance can it be morally justified. These arguments are based on a deontological view. Utilitarians claim this view is morally self-indulgent and sometimes it is acceptable to sacrifice your morality for the greater good. However, deontologists are criticised for their lack to reconcile with what is known as the ticking bomb scenario. One should consider the hypothetical example of where a man is aware of the location of a bomb that has been planted in a large shopping centre. He knows it will be detonated within the next few hours and the police have him detained. In this situation is it morally wrong to torture one person to find out the location of the bomb, in order to save the lives of many? In this most extreme situation, even the strictest deontologists cannot deny that torture may be justifiable to such a threat, despite it been inherently wrong. In this context the re are two conflicts at play. There is the moral consequence that exists in torturing someone; however this has to be balanced against the moral consequence of the death of many people, (it seems to be a simple matter of numbers.) Thus it is vital to consider this moral dilemma as a whole and as not individual parts. In this way, deontological morality is not completely lost by rendering utilitarian views as applicable. Moral deliberation can thus be settled by balancing the deontological objections of torture with the justification given by utilitarians, as Sussman argues, torture constitutes a moral wrong that requires more justification than killing. Thus, by focussing on the morality of the act, we are allowed to mediate between absolute prohibition and utilitarian ideas. However each circumstance gives rise to different issues on morality and torture, as not all situations will follow the ticking bomb scenario. At which point can you draw the line between appreciating the opposing demands and upholding moral integrity? As stated earlier, it is vital to look at the situation as a whole, made up of constituents, in order to weigh up where the morality lies. Only then is it possible to make credible conclusions and allow us to make a morally right decision. Implications For The Law For the law to include a provision for torture would be very brave, and require an act of moral courage. In Torture and Positive Law: Jurisprudence for The White House, Waldron argues that legalising torture will have negative ramifications on our legal system, leading to eventual malfunction. The basis of negating torture into law finds it origins in morality. The morally wrong nature of torture is reflected and reinforced by the law. The laws represent its regard for the superiority of human rights and its belief in personal autonomy. It embodies the concept that human life is sacred and must be shown respect. Therefore by including torture within the law it gives the impression that it is not disapproved in the same way and the moral integrity of the legal system becomes undermined. Promoting respect amongst your fellow citizens becomes a hypocritical concept, as torture is one of the worst offences against a person. This gives a tainted message to society as the law no longer pro hibits torture as a method of interrogation. Legalising torture will also have further international repercussions, especially for countries like the US and UK. These countries have a firm approach in not tolerating torture in other countries that do not give enough weight on the importance of human rights. By legitimising torture, these countries will be sending the wrong message to the rest of the world, implying that they encourage the State to use torture as a means to a way. R. Dworkin, in Laws Empire, believes that legalising torture could affect public morality. The law is a mechanism which guides citizens through their everyday lives, telling them the correct way to behave and what is acceptable conduct in society. In this way, prohibiting torture from the law mirrors the message of mutual respect and harmony that we wish to permeate through society. This could be compromised with the inclusion of torture within the legal system, lowering peoples standards of morality. The recognition of torture could have further affects on society through its interpretation; that people may find it suitable to be violent to those who they feel deserve it, thus generally increasing levels of crime. There is a risk that torture may not encompass a sense of inherent wrongness and taboo as it does now. As people become more open to its implications and practice, being confronted by its affects on a daily basis, so torture will become part of what is accepted. Therefore, the strength of the law will be severely undermined with the prohibition of torture no longer upheld to symbolise actions that can be regarded as morally wrong. As torture is claimed to be one of the most appalling acts that can be committed, its justification will lead to questions such as why other wrongs, which are considered as a lesser wrong than torture are not also legalised. Waldron concisely summarises this concept as the unravelling of the surrounding law. Sangeeta Mandhir, in Basing arguments for legalising torture on moral justifications, describes this as having a domino-type effect. In that once the prohibition of torture is challenged, it will be harder to justify why other acts such as battery, which is considered less offensive than torture, is not also made legal by law. Furthermore, if torture becomes legitimised, than the supposed guilt felt by the torturer is weakened. Since the act is no longer illegal it will justify his actions and so reduces the level of guilt, and in turn this is converse affects for what is seen as moral. If no guilt is felt then one cannot feel he has committed an immoral act. Indeed what makes torture worse for society is the justification in that it serves to benefit the community. This implies that society gives torture a mandate in which it can be implemented by allowing it into the legal system. As the torture is being carried out in the name of societys security and safety, citizens can be said to hold a shared responsibility for the shocking acts performed upon the victims of torture. Therefore, the State has multiple factors that are intrinsic when considering the legalising of torture. Consisting of not only of the end result, that being security for the nation; but also the upholding of liberal democratic values upon which society is based, so not to compromise principles such as liberty, integrity and human rights. Conclusion It is clear that for a debate on torture it is impossible not to consider morality, as the two concepts are inextricably linked. Torture, by definition in this essay is regarded as morally wrong and inherently abhorrent. Yet there seems to be circumstances for which people believe it could be the only course of action. Thus, if there are situations in which torture can be justified, should the State consider reversing the absolutist prohibition stance on torture within the legal system that exists today? In my opinion, the answer is no. Torture is fundamentally abusive to our morals and ethics. Its existence in society risks undermining the humanitarian principles that also exist. Despite the utilitarian views concerning the welfare of the greater good, what needs to be remembered is that the short term benefits for legalising torture for situations such as the ticking bomb scenario have to be measured against the long term consequences of legalising such a morally detested act, for its effects on society. I believe these two polar concepts can be reconciled through reasonable deontology. This approach allows for torture to occur in a situation that poses a serious threat to society, yet it does not justify the act and still remains firm on the view that torture should be legally prohibited in the law. As Jens David Ohlin in The Bounds of Necessity, believes, legalising torture opens a Pandoras Box of unsavoury consequences, especially for society. Society should not be allowed to excuse torture as a morally right way of interrogating criminals or suspected terrorists, for if this is allowed we stand to lose the fundamental principles that the law is supposed to uphold, thus changing the nature of societys moral commitments.

Stroke Care Management and Pressure Ulcer Assessment Tool

Student Number: 21127187 Module: Assessment and Therapeutic Care Management Module Code: AN 602 Assignment Title: A Case study: Stroke Care Management and Pressure Ulcer Assessment Tool Word Count: 3296 Date Submitted: 11th January, 2012 This academic work aims to present a clinical case study of a patient who is diagnosed of cerebrovascular accident (CVA), also called â€Å"stroke†, achieve a deeper understanding of debilitating post-stroke complications using an assessment guide and nursing interventions to the nursing diagnosis of impaired skin integrity.This essay aims to incorporate the utilisation of a pressure ulcer grading assessment tool to establish baseline assessment data and facilitate ongoing wound care management in relation to pressure ulcers (PrUs) as one of long term problems encountered in the care of a stroke patient. A holistic assessment of the patient will be required, identifying activities of daily living to enable the nurse to devise a plan involving the therapeutic team in line with identified nursing diagnoses.Due to limitation on word count, the essay will focus more on the present health status in relation to areas pertinent to PrUs management during the rehabilitation process. For the purpose of this academic work, the patient will be protected by the Nursing and Midwifery Council (NMC) Code of Conduct (2008) by use of a pseudonym, ‘Mr. X’. Mr. X, is an 87 year-old elderly obese patient, with long-term diagnosis of Hypertension (HPN) and Non-Insulin Dependent Diabetes Mellitus (DM), on maintenance medications, who was recently diagnosed of Cerebrovascular Accident (CVA).Mr. X was transferred to a nursing home after the acute hospitalisation for long-term care. Brunner (2008) defines CVA, Ischemic Stroke, or â€Å"Brain Attack† as sudden loss of neurologic functioning resulting from blood flow disruption in cerebral blood vessels. Stroke has two main types, Ischaemic and Hemmorhaegic: the former is caused by an infarct of blood clot in brain artery and accounts for 80 % of all stroke cases; while the latter is caused by bleeding into the brain tissues accounting to 20 % of stroke occurrences (Feigin et al, 2003).Stroke is the third leading cause of death and is a major cause of adult neurological disability which affects approximately 130,000 people a year in the UK (National Audit Office, 2005). Mr. X was diagnosed of having left middle cerebral artery (MCA) infarct 7 months ago resulting to neurological deficits on the contralateral side of the body. The extent of deficits following stroke depends upon the affected cerebral artery and subsequent areas of brain tissue compromised of blood supply by the damaged vessel (Porth, 2007). Upon assessment, Mr.X has right side hemiplegia, contralateral sensory impairment, dysphasia, bowel and bladder incontinence, and an existing Category I PrUs on both heels. The hemiplegia is explained by Brunner (2008) that because motor neurons decussat e, a disturbance of motor control on one side of the body may reflect damage to the motor neurons on the opposite side of the brain. Williams et al (2010) states that following a MCA infarct, there is alteration of the brain’s ability to process and interpret sensory data which results in Mr. X’s sensory impairment.Porth (2007) defines aphasia as a general term with varying degrees of inability to comprehend, integrate, and express language. Porth (2007) further states that a stroke on the MCA territory is the most common aphasia-producing stroke. It is then imperative to understand the pathology of affected areas of the brain to anticipate presence of motor, sensory, and speech deficits where the nurses and entire therapeutic team can intervene. For the purpose of data gathering and assessment, Gordon’s Functional Health Pattern (1987) is utilised as a framework of this essay.The model presents 11 functional health patterns categorized systematically for data c ollection and analysis, and is used as a guide in the development of a comprehensive nursing data base ( Gordon, 2000). The nurses can identify functional patterns as the clients’ strengths and dysfunctional patterns as the nursing diagnoses, which assist the nurse in developing the care plan (Gordon, 1994, 200). The assessment guide is particularly chosen because it gives the nurse a full opportunity to examine not only the physical aspect f human functioning but includes physiological and psychological disturbances experienced by the patient. Nursing diagnoses can then be derived from the wide-range of assessment data collected. The Gordon’s assessment tool is thereby used a framework for ensuring that all aspects of an individual’s patient’s life are considered. However, this essay will only focus on the following health patterns: Cognitive – Perceptual, Nutritional-Metabolic, Activity and Exercise where nursing problems were identified and ther eby require therapeutic care management.The Agency for Healthcare Policy and Research Guideline for Post-Stroke Rehabilitation (AHCPR, 2005) recommends that initial assessment of stroke patients should include a complete history and physical assessment with emphasis on medical co-morbidities, level of consciousness, skin assessment and risk of PrUs, mobility, and bowel and bladder function. Moreover, the following areas of assessment contribute to the development of PrUs: impaired sensory perception or cognition, decreased tissue perfusion, nutrition and hydration status, friction and shear forces, skin moisture, mobility, and continence status (Brunner, 2008; Porth 2007).The specific areas mentioned above will be of greater emphasis due to its contribution to PrU management in post-stroke Mr. X. Based upon history taking, Mr. X has been living with Hypertension (HPN) and DM for 12 years and has been insulin dependent for 5 months now after the occurrence of stroke. Past medical his tory must be taken into essential consideration especially in chronic conditions to ascertain levels of compliance to medical interventions, perception towards illness, and impact on patient’s lives (Crumbie, 2006).Establishment of rapport and consequently gaining trust from the patient thereby enables the nurse to create a good baseline history assessment and attain patient’s cooperation through the entire rehabilitation process. The nursing process first step is assessment which involves collecting data to help identify actual and potential health problems and patient needs. In order to develop appropriate nursing diagnoses, accurate assessments should be made to guarantee allocation of appropriate resources in the planning stage to achieve expected outcomes. Potter and Perry, 2008). It could be suggested that nurses in this stage of nursing process should employ opportunities for holistic assessments and use critical thinking in determining focus areas to be include d in the database. The cephalo-caudal principle of assessment is incorporated as a guide for presenting the health patterns, which sets the Cognitive – Perceptual pattern as the first to be approached highlighting assessments on cognition, perception, sensory, pain, and language.Williams et al (2010) states that post-stroke damage to the brain can result to cognitive and sensory impairment which often includes a decrease in thinking, effective decision-making, memory, and perception. Mr. X’s assessment of this health pattern reveals communication difficulty between patient and healthcare team. If communication problems arise, nurses conduct referrals to the Speech and Language Therapy (SLT) who diagnoses presence of aphasia. However, the type of aphasia has not been established yet since Mr.X has been reportedly uncooperative to therapies. It could be suggested however, that basing on research, the Frenchay Aphasia Screening test (Enderby et al, 1987) can be utilised b y the SLT to administer a quick language measure. Another recommendation is the participation of nurses in an interview (Inpatient Functional Communication Interview, McCooey et al, 2004) by the SLT to describe how Mr. X communicate at bedside to help the SLT diagnose communication problems, if any.The limitation on data gathering and assessment process can be compromised at this stage because of problems on communication between the nurse and the patient. It could be suggested that a referral to a speech pathologist can be made to evaluate the patient’s speech, language and ability to understand by testing verbal expression, writing ability, reading, and understanding of verbal expression (Barker, 2002). A nursing diagnosis identified is Impaired verbal communication related to effects of dysphasia.It may be suggested that nurses should provide patients with aphasia a constant way of communicating, through hand gesture, tone of voice, facial expressions and verify responses with family members when warranted ( Holland et al, 2003). It may also be necessary to talk slow, clear, in simple terms and render the patient ample time to understand the information given (Barker, 2002). Family members of aphasic stroke survivors may also experience difficulty in various roles of care giving since the patient cannot communicate effectively (Christensen and Anderson, 1989; Draper and Brocklehurst, 2007).Therefore, it is also necessary to include the family, caregivers, and the nurses at bedside during therapies to maximise nursing care (Intercollegiate Stroke Working Party, 2008). Mr. X’s perception of pain is assessed periodically at varying times of a day to ensure pain relief. Mr. X cannot verbalise pain, but most of the time shows facial grimaces while pointing to right shoulder and hand where pain are felt. Brunner (2008) says that as many as 70 % of stroke patients suffer severe shoulder pain that prevents patients to perform balance and perform self- care activities.Mr. X upon physical assessment has painful shoulder, swelling and stiffness on right hand, defined by Brunner (2008) as shoulder-hand syndrome which causes a frozen shoulder and subcutaneous tissue atrophy, and is always painful. However, according to Edwards & Charlton (2002), it cannot be a cause of pain if managed correctly with appropriate limb support. In this regard, pain assessments should always be subjective and be backed up with objective data gathered. Nursing diagnosis identified is Chronic pain related to immobility secondary to disease process (Heath, 2008).Mr. X has been prescribed with pain relief, Piroxicam gel onto pain areas three times a day and Tramadol tab daily. Piroxicam Gel is a non-steroidal anti-inflammatory drug that inhibits the enzyme prostaglandin thereby reducing pain and swelling whereas Tramadol is an Opiod analgesic (British National Formulary, 2010). Moreover, Mr. X has been receiving Amitryptiline HCl to help in the management of post-stroke pain but it causes cognitive problems and sedation (Brunner, 2008) thereby requiring safety nursing measures.However, non-pharmacological nursing interventions should be employed first hand before medical interventions. Brunner (2008) suggests elevation of the hand and arm to prevent edema. National stroke guidelines recommend any patient whose range of motion at a joint is reduced should undergo passive stretching of all affected joints on a daily basis, and furthermore, taught to carers (Carter & Edwards, 2002) provided that pain relief is achieved at all times.Referrals to physical therapy or occupational therapy are suggested to evaluate physical debilitations relating to functional mobility to promote pre-morbid independence and subsequently enhance quality of life (Barker, 2011). The second health pattern to be presented is Nutritional – Metabolic. Stroke can present a wide range of deficits which can affect ability to eat and predispose a post-stroke patien t from malnutrition (Williams et al. , 2010).It is supported by Shelton and Reding (2001) who integrates associated weakness and sensory loss on arm and face more than the leg in patients who has had occlusion of the MCA. Barker (2002) states that nearly one third of stroke survivors have dysphagia and chewing difficulties which prompts nurses strategies to liaise aspiration risk with SLT and nutritionist or dietitian. Special diet and caloric calculations may also be needed for Mr. X due to daily insulin management, not to mention daily blood glucose monitoring.Waterlow (1985) emphasizes that those with eating difficulties are likely to eat less, thereby slowly predisposing to poor nutritional intake, so efforts should be directed at creating good balanced diet, is well-presented, and if possible, assistive devices are provided such as adapted cutlery for ease in eating, plate guards, non-slip pads and beakers for drinking. Monitoring of nutritional deterioration of post stroke pat ients is essential during rehabilitation phase thereby giving attention to nutritional intake, weight, gastrointestinal function, and general health condition (NICE, 2005).Weekly weighing has been advocated and utilization of nutritional screening tools that are validated and reliable are recommended by NICE (2005). Review of systems provides skin assessment in nutritional metabolic health pattern which revealed presence of pressure ulcer on heels. The European Pressure Ulcer Advisory Panel (EPUAP) and National Pressure Ulcer Advisory Panel (NPUAP) (2009, p7) defines, ‘ A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence , as a result of pressure, or pressure in combination with shear’.Waterlow (1996) emphasizes that excessive weight increases pressure on a bony area thinly covered by tissue such as the sacrum, heels, and trochanters. Pressure ulcers (PrUs) on the heel is a very common site of PrUs, ranking second fro m the sacrum (Bennett & Lee,1985; Hunter et al, 1985; Wong & Stotts, 2003) and is often painful (Black, 2005). Krueger (2006) in her study, stated that 25% of heel PrUs are related to diabetic neuropathy and peripheral arterial occlusive disease.PrU classification systems describe how severe the tissue damage is through progressive numbers or categories (Dealey, 2009). Given that all professionals utilize same system, logic dictates that all PrUs will be objectively assessed, however, Ousey (2005) debates that many grading systems available are rather subjective in nature giving professionals varying assessment interpretations. Grading systems assists healthcare professionals identify the severity of PrUs and serve as a baseline for care plans. However, careful clinical judgement by the nurse s essential in ensuring that the classification systems are used only as a guide, professional skills in assessment are needed to ascertain objective assessment data. In conclusion, grading sys tems serve as valuable tools to determine pressure sore severity in clinical practice, audit, and research ( Beeckman, 2007). Moreover, consistency in the use of classification system will enable the professionals to define progress of healing, allow evaluation of goals of treatment, and revise plans as deemed necessary.Based on the European Pressure Ulcer Advisory Panel (EPUAP) and National Pressure Ulcer Advisory Panel (NPUAP) (2009) Pressure Ulcer Classification System, Mr. X has a Category I PrU and is defined as an area of intact skin with non-blanchable redness of a localized area, usually on a bony prominence, which may present as painful, warm, and edematous. The NPUAP and EPUAP classification system was designed to provide commonality in the definition and grading / categorization / staging of pressure ulcer, which is applicable in international settings.It has four categories, Category I to IV, each defining level of skin injury and adding physiologic descriptions, which i s recommended by NICE (2005). Terms such as unclassified or unstageable and deep tissue injury (DTI) which are classified as category IV is discussed separately in the new guideline (NPUAP and EPUAP, 2009). Ousley (2005) stated that Surrey system of classifying PrUs is the simplest tool available, presenting same four levels in plain terms, however, warns professionals of its relative subjectivity due to its simplicity.The EPUAP (2007) grading system is almost similar to NPUAP (2007), describing four grades, each is described in detail. However, according to a study done by Beeckman (2007), the EPUAP system of classification has a low inter-rater reliability because of complex details in the definition, leading to a low commonality of professionals identifying the categories of PrUs, jeopardising audit of prevalence rates and affectivity of wound management.The Torrance grading system involves five stages, each stage described simply and is easy to use, however it was not widely uti lised because of its number of categories (Ousey, 2005), which may impose confusion against four categories, rather than achieving consensus. Healey (1995) in her study, revealed that Surrey, Torrance, and Stirling systems do not have a high level of reliability. Similarly, the Stirling Pressure Sore Severity scale (SPSSS) tool is argued by Healey (1995) to have the lowest reliability rate because of its most complex subscales under each category.There are four stages starting from 0 where there is no evidence of pressure ulcer, then each category has subsections, describing the level of skin injury, wound bed, and presence of infection parameters (Ousley, 2005). However, Waterlow (1996) in her work on pressure sore prevention established the use of SPSSS as the standard classification system to be implemented because she argues that specialists and researchers need to define pressure ulcers in greater depth whereas the other systems’ relative simplicity is regarded as weakne ss in lieu of its use on clinical audit.In this regard, the NPUAP and EPUAP guideline is considered useful because it provides evidence-based assessment as it is proven to be an effective and reliable tool in every healthcare setting. This will enable the healthcare team to improve the care required for pressure ulcer due to a common baseline assessment of the ulcer, thereby requiring a specified care management depending on its stage. Nurses can then devise a care plan based on ulcer grading, identify appropriate treatment, allocate care resources, implement the plan, and do continual evaluation of the care plan with its goal directed at wound healing.However, to achieve this level of patient assessment and care, every nurse should possess the necessary knowledge and skills which can be achieved through continuing education and trainings in pressure risk assessment and PrUs management, an interdisciplinary collaboration ( NICE, 2005). Nursing diagnosis identified is Impaired skin i ntegrity related to immobility and decreased sensory perception secondary to disease process (Heath, 2009). Nursing management employed were repositioning Mr.X every 2 hours avoiding positioning on pressure area (EPUAP and NPUAP, 2009) and taking weight off the mattress by placing a pillow or a folded blanket under entire length of the leg and not under the Achilles tendon to protect the knee as well (Waterlow, 1996; NPUAP and EPUAP, 2009, Langermo et al, 2008). There are marketed devices for heel protection but needs constant care giver assessment since these devices are found to not keep the heels off the bed better than pillows do (Tymec et al, 1997).Relieving the pressure off the heels is often all that is needed to recover the tissues in category I Heel PrUs (Langemo et al, 2008) and if offloaded continuously hastens recovery time (Black, 2005). Periods of frustration and depression are sporadically experienced by 40 % of stroke patients throughout the recovery process or as a new phase in the trajectory of a chronic illness and is often underdiagnosed (Barker, 2002).Ideally, a psychiatrist or a clinical psychologist diagnoses depression, but according to Intercollegiate stroke Working Party (2008) a healthcare professional with mental health training can diagnose using a clinical interview. It can also be suggested to use brief screening tools to identify patients at risk of depression such as the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983) or the Geriatric Depression Scale GDS ( Yesavage et al, 1982) which are validated tools to assess mood in stroke populations (Williams et al, 2010). Amitryptiline HCl, a Tricyclic antidepressant (BNF, 2010) is prescribed for Mr.X, and is taken daily. Duncan (2005) sets the prevention of stroke recurrence as the highest priorities in stroke rehabilitation and is therefore the responsibility of the nurse to understand stroke risk factors and apply contemporary evidence based lifestyle changes after pr oper training (Lawrence et al, 2011). Barker (2002) reports that stroke survivors have 30% probability of recurring stroke within a year and 50% can suffer fatal strokes in 5 years. It could then be suggested that a Stroke Risk Screening Tool (Barker, 2002) be utilised to decrease risk of death and evaluate risk factors of Mr.X such as HPN which is managed at present with antihypertensives, DM managed with Insulin injections, Hypercholesterolemia managed with Antilipidemics, advancing age, obesity, and diet. Therefore, an important aspect of nursing care is health education whereby nurses promote lifestyle change and supportive behavioral approach towards long-term health modification. In conclusion, nurses’ role in the care of post-stroke patient is multi-faceted, one that requires interprofessional linkage and deep understanding of contemporary evidence based interventions to address issues.DH (2007) further suggests that post stroke patients and their carers should receive support from varying range of services made available locally. Most importantly, though nursing interventions are standardized as guidelines, it could be suggested that it may not be all applicable in every patient interaction and care should be individualized as needed (Landers & McCarthy, 2007). Therefore, it is of prime importance for nurses to understand that healthcare decisions are based from patient’s individual choices derived from rational decision-making and the objective and rofessional advice of every member of the therapeutic team. Reference List Agency for Health Care Policy and Research. (1992) Pressure ulcers in adults: prediction and prevention. 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The World s Leading Maker Of Hydration Solutions

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Stoichiometry Definition in Chemistry

Stoichiometry is one of the most important subjects in general chemistry. It is typically introduced after discussing parts of the atom and unit conversions. While its not difficult, many students get put off by the complicated-sounding word. For this reason, it may be introduced as Mass Relations. StoichiometryDefinition Stoichiometry is the study of the quantitative relationships or ratios between two or more substances undergoing a physical change or chemical change (chemical reaction). The word derives from the  Greek words:  stoicheion  (meaning element) and  metron  (meaning to measure). Most often, stoichiometry calculations deal with the mass or volumes of products and reactants. Pronunciation Pronounce stoichiometry as  stoy-kee-ah-met-tree or abbreviate it as stoyk. What Is Stoichiometry? Jeremias Benjaim Richter defined stoichiometry in 1792 as the science of measuring quantities or mass ratios of chemical elements. You might be given a chemical equation and the mass of one reactant or product and asked to determine the quantity of another reactant or product in the equation. Or, you might be given the quantities of reactants and products and asked to write the balanced equation that fits the math. Important Concepts in Stoichiometry You must master the following chemistry concepts to solve stoichiometry problems: Balancing equationsConverting between grams and molesCalculating molar massCalculating mole ratios Remember, stoichiometry is the study of mass relations. To master it, you need to be comfortable with unit conversions and balancing equations. From there, the focus is on mole relationships between reactants and products in a chemical reaction. Mass-Mass Stoichiometry Problem One of the most common types of chemistry problems youll use stoichiometry to solve is the mass-mass problem. Here are the steps to solve a mass-mass problem: Correctly identify the problem as a mass-mass problem. Usually youre given a chemical equation, like:A 2B → CMost often, the question is a word problem, such as:Assume 10.0 grams of A reacts completely with B. How many grams of C will be produced?Balance the chemical equation. Make certain you have the same number of each type of atom on both the reactants and products side of the arrow in the equation. In other words, apply the Law of Conservation of Mass.Convert any mass values in the problem into moles. Use the molar mass to do this.Use molar proportion to determine unknown quantities of moles. Do this by setting two molar ratios equal to each other, with the unknown as the only value to solve.Convert the mole value you just found into mass, using the molar mass of that substance. Excess Reactant, Limiting Reactant, and Theoretical Yield Because atoms, molecules, and ions react with each other according to molar ratios, youll also encounter stoichiometry problems that ask you to identify the limiting reactant or any reactant that is present in excess. Once you know how many moles of each reactant you have, you compare this ratio to the ratio required to complete the reaction. The limiting reactant would be used up before the other reactant, while the excess reactant would be the one leftover after the reaction proceeded. Since the limiting reactant defines exactly how much of each reactant actually participates in a reaction, stoichiometry is used to determine theoretical yield. This is how much product can be formed if the reaction uses all of the limiting reactant and proceeds to completion. The value is determined using the molar ratio between the amount of limiting reactant and product.