Expository writing essay topics
Personal Essay For College Application Samples
Wednesday, August 26, 2020
In Much Ado about Nothing, what is the relationship between female Essay
In Much Ado about Nothing, what is the connection between female force and language - Essay Example The scientist expresses that in the play ââ¬Å"Much Ado about Nothingâ⬠Shakespeare utilizes language to draw out the message gave to the crowd. Intensity of language is utilized in the satire. He utilizes charming, annihilates, and gives terrible notoriety then he reestablishes respect. Shakespeare additionally instructs of the public activity and structure. He advises us that there is a hole or strife among ladies and men. They don't coincide calmly by any stretch of the imagination. In the parody men treat ladies in an unexpected way. Ladies don't have a situation in the public eye. This is found in the part where a man like Don John who misdirects a sovereign so as to slander the respect of a lady. This demonstrates or shows the issues in the force status and structure of social concurrence. At the point when the relationship of Beatrice and Benedick is placed into thought in ââ¬Å"Much adoâ⬠one of the most essential subjects is around sexual orientation, jobs as ind icated by sex and the dissimilarities among ladies and men. It is mocking that a low positioning individual from the general public is the person who uncovered the negative behavior pattern of Don John and his coconspirators (Wick 4). Wear John is entirely unexpected from his individual Don Pedro and Claudio, who are exceptionally defensive male. At the point when they are presented to Leonato we can see the male pride of Conrad and Borachio. Shakespeare can bring to us the truth that those men of high status in the public eye, and loaded proudly are the ones who treat ladies. Through Shakespeare, it is seen that the vast majority who have terrible conduct stow away in obscurity imagining that what they do can never be found. They misuse others for the sake of making sure about their pride. Shakespeare shows the crowd to censure the language, job, and even the abuse of the Queenââ¬â¢s English. It is in this way leant that, the individuals who uncovered bogus observer purposefully to hurt others wind up being despondent, and wind up taking measure that are urgent so as to cover their exposed terrible conduct. This is an exercise that urges individuals to be ethically upstanding, and not utilize their forces to disparage others. Another instructing is of being a saint. Beatrice despite everything weds Claudio after improperly being blamed for cheating. In another manner this can be viewed as she didn't just do it however adore, yet to reestablish respect and devotion. This is considered as reestablishing her economic wellbeing. Economic wellbeing is likewise observed when Benedick needs to slaughter Claudio so as to wed Beatrice. He acknowledges the demand so as not to be viewed as a weakling. Ladies are depicted precisely in the play. There is the covering of generalizations of ladies in the play. All the characters that are female have characters that are broadly shifted. This assists with maintaining a strategic distance from the lady from being excessivel y amusing or disparaging. A scope of various connections are framed in the play. This is because of an assortment of social noticeable quality and characters. The base of this relationship is on genders that are extraordinary. This is male and female. There are likewise different fights like connections, struggle and double dealing. Ladies are believed to be available in every one of these topics. Numerous lines are deciphered in different manners that demonstrate significance to reflect what is truly occurring in the public arena. The female characters who are available in the play are Margaret, Hero, Ursula and Beatrice. Every one of them have characters that are unique. These characters contrast somehow. These characters that are female and they don't fit in the general public of Shakepeare.They are in this manner made to include funniness, difference or parody. One of them who doesn't fit and Shakespeare utilizes her to most extreme is Beatrice. In the primary scene of the play ,Beatrice is presented as a lady who is cunning and diverting. She is known to bet with words so as to demonstrate her point. She is known to be exceptionally factious
Saturday, August 22, 2020
Presumed Innocent
Amusement has consistently comprised of law related motion pictures. Lawful motion pictures are effective in light of open enthusiasm for various sorts of lawful cases and situations. A case of an effective lawful film is Presumed Innocent. The film Presumed Innocent was delivered in 1990. The famous actors Harrison Ford who plays Rusty Sabich, an investigator and right hand man of the head prosecutor Raymond Horgan. Rustyââ¬â¢s partner Carolyn Polhemus is discovered dead in her condo. She was supposed to be assaulted and killed. Raymond places Rusty accountable for her investigation.It is later uncovered that Rusty has a past illicit relationship with Carolyn Polhemus however made up with his better half. Polhemus dumped Rusty. During this season of the examination, Horgan is experiencing a political battle so as to keep his activity. Things being what they are, Horgan loses the political decision to Nico Della Guardia. Alongside Della Guardia comes his agent, Tommy Molto. Della Guardia and Molto arraign Rusty for Carolynââ¬â¢s murder as a result of his previous issue with her. Sandy Stern becomes Rustyââ¬â¢s barrier legal advisor in the homicide preliminary. The examination by the barrier group prompts that Rusty was encircled for Carolynââ¬â¢s murder.The individual of enthusiasm for the surrounding is Molto who needed Rustyââ¬â¢s work (Oââ¬â¢Cain). Della Guardia and Molto promptly assemble proof against Rusty. They discover a lager glass with Rustyââ¬â¢s fingerprints on it in Polhemusââ¬â¢ loft. This bit of proof causes a ton of contention all through the preliminary. It is uncovered that the brew glass is absent from the proof room. Corroded finds that Polhemus procured a pay off record (B document) from Horgan. There was a case including a man named Leon who paid $1,500 to get his case tossed out of court. Things being what they are, Polhemus was the person who set up the bribe.Rusty and Sternââ¬â¢s protection is that Della Guard ia and Molto set up Rusty as a major aspect of a concealment of a pay off case including Molto. Harsh never permits Rusty to affirm all through the preliminary since it may lead the jury to think he is blameworthy. The preliminary finishes with Judge Lyttle excusing the case in view of an absence of physical proof. Corroded isn't liable for the assault and murder of Polhemus. Toward the finish of the film, Rusty finds a mallet in the storm cellar with blood on it. His better half admits to executing Polhemus. The legitimate issues in Presumed Innocent incorporate clash of interests.Rusty faces an irreconcilable situation since he took part in an extramarital entanglements with Polhemus. They were once sweethearts and exceptionally cozy with one another. At that point he turns out to be a piece of the case that is examining her passing. It was emotional while viewing the preliminary realizing that Rusty and Polhemus had a mystery illicit relationship that lone Rusty and his significa nt other thought about. On the off chance that the updates on this issue was brought out away from any confining influence the preliminary probably won't have been excused so without any problem. In light of the closeness that Rusty and Polhemus shared at a certain point, there would be more doubt towards him being charged for the assault and death.When a respondent has this kind of relationship with a casualty generally there is all the more addressing of the ex-darling because of shared closeness and conceivable connection. Despite the fact that for reasons unknown, Rusty isn't blameworthy of her passing, it appears as though he avoided a few shots as the past issue was never considered. There could have been much more allegations if the undertaking was made open. Excusing the case on account of absence of physical proof is by all accounts exceptionally practical. It is reasonable that without physical evidence, Judge Lyttle can't make exact rulings.A part of the film that was ext remely amazing was fundamentally the most recent hour when the preliminary started. The preliminary felt intense and genuine. It was anything but difficult to follow the rounds of questioning and the legal advisors were carried on quite well. Another part of the film that was noteworthy was the flashbacks to Rusty and Polhemusââ¬â¢ relationship. It was extremely intriguing to perceive how their relationship was and how they acted before one another. At certain focuses I had enthusiastic associations with Polhemus and I really felt terrible about her death.She appeared to be a diligent employee and the manner in which she treated the little fellow affirming against his mom in the start of the film was contacting. She was by all accounts mindful and she needed what was best for the little fellow. Watching her interface with him was the first occasion when that I felt extremely upset for her horrendous demise. Another amazing part about the film is that there was consistent anticipa tion with respect to whether Rusty would be seen as blameworthy or not liable. The preliminary keeps you inquisitive and restless to discover the results.The connections between the entirety of the characters were likewise noteworthy particularly Polhemus, Judge Lyttle, and Leon. It was stunning to discover that Polhemus set up the pay off for Leon and that Judge who took the cash was really a similar Judge in Polhemusââ¬â¢ murder preliminary. The least amazing piece of the film was the way that it finished. It was cunning to end the film with Rustyââ¬â¢s spouse admitting to the homicide however actually, it appears that equity isn't served for Polhemus. Polhemusââ¬â¢ murder went down as an unsolved case yet now the watcher knows how it could be solved.It is justifiable that the film closes with a wind yet there is no equity for Polhemus. Rustyââ¬â¢s spouse gets the chance to be a liberated individual and bears no legitimate ramifications for killing Polhemus. His signif icant other would consistently pester Rusty about his continuous fixation on Polhemus despite the fact that she was dead. In spite of the fact that it is horrible to undermine an accomplice, it isn't worthy for Rustyââ¬â¢s spouse to execute Polhemus because of the undertaking. Any compassion that I had for Rustyââ¬â¢s spouse was excused toward the finish of the film. There are numerous positive and negative parts of the legitimate framework in this movie.An case of a positive viewpoint carried on by the lawful framework delineated in the film is Judge Lyttle excusing the case because of absence of clear proof. It is basic information that there should be clear data to make a judgment yet in the film, Judge Lyttle may have excused the case effectively because of different elements. He was affected by his investment in the missing B-document case. The B-document represented that he took kickbacks from Leon and he was most likely apprehensive that the B-record may turn up some pl ace. In the event that the record was to appear, his profession would be adversely affected particularly in light of the fact that he is a Judge.This model outlines the defilement that could exist in the lawful framework that nobody would get some answers concerning. It appears that Judge Lyttle utilized his forces to further his own potential benefit to shield himself from being gotten. Additionally, Stern and Horgan realized that Judge Lyttle was taking hush-money from Leon yet Horgan was the person who gave the Judge another opportunity. Normal individuals may never know about this sort of defilement that may happen in the legitimate framework. In the start of the film there is additionally political debasement inside the lawful system.Horgan places Rusty accountable for the Polhemus argument yet then betrays him. Horgan claims that Rusty demanded taking care of the case which causes it to appear as though Rusty may be concealing something. Watching law related motion pictures ca n show the open a great deal the lawful framework. Assumed Innocent delineates the debate of irreconcilable circumstance and a portion of the defilement that may happen inside an examination. Work Cited 1. O'Cain, Derek. ââ¬Å"Presumed Innocent (1990) â⬠Plot Summary. â⬠à The Internet Movie Database (IMDb). Web. 18 Feb. 2012. ;http://www. imdb. com/title/tt0100404/plotsummary;
Wednesday, August 12, 2020
Environmental Defense Funds Climate Corps 2014 COLUMBIA UNIVERSITY - SIPA Admissions Blog
Environmental Defense Funds Climate Corps 2014 COLUMBIA UNIVERSITY - SIPA Admissions Blog The Energy and Environment program is representing SIPA proudly in the Environmental Defense Funds Climate Corps 2014 with seven fellows! The selective summer fellows program places top graduate students from around the United States in leadership-focused companies here and abroad. The Climate Corps projects aim to reduce energy consumption, increase renewable energy production, and help forward-thinking companies prepare themselves for 21st-century business practices and advancement. Felise Man (EE 2015) will be working with CSX freight and rail company to increase energy efficiency practices throughout the company. Eric Schrago (EE 2015) will be working with Adidas to increase corporate and supply chain energy efficiencies. Rebecca Miaomiao Shao (EE 2015) will be working with Apples Global Energy Team and helping the company achieve its net zero energy consumption goal. Brandon Tarbert (EE 2015) will be working with Williams-Sonoma to develop and expand their renewable energy portfolio to reduce the carbon footprint associated with Williams-Sonomas energy consumption. Michael Didyk (EE/MBA 2015) will be with Caesars Entertainment, Sana Ouji (EE 2015) will be with Taylor Morrison, and Jan Schwarting (EE 2015) will be with Warburg Pincus. Environmental Defense Funds Climate Corps 2014 Post submitted by Brandon Tarbert, MPA 2015
Saturday, May 23, 2020
What Is Petroleum Jelly Chemical Composition
Question: What Is Petroleum Jelly? Petroleum jelly or petrolatum was discovered as a paraffin-like material coating oil rigs. Since then, it has been used in various ointments and as a lubricant. Here is a look at what petroleum jelly is and its chemical composition. Answer: Petroleum jelly is made by the waxy petroleum material that formed on oil rigs and distilling it. The lighter and thinner oil-based products make up petroleum jelly, also known as white petrolatum or simply as petrolatum. Robert Chesebrough is the chemist who devised and patented this process (U.S. Patent 127,568) in 1872. Basically, the crude material undergoes vacuum distillation. The still residue is then filtered through bone char to yield petroleum jelly. At room temperature, petroleum jelly is an odorless semi-solid which consists of a mixture of hydrocarbons. The primary hydrocarbon is 1,1,2-Trimethylbenzeindole (C15H15N), which has a CAS number 8009-03-8. Petroleum Jelly Uses Petroleum jelly is an ingredient in many cosmetics and lotions. Originally it was marketed as a burn ointment. While petroleum jelly does not cure burns or other wounds, it does seal a cleaned burn or injury off from contamination or further infection. Petroleum jelly also may be applied to dry or chapped skin to seal in moisture. A variation known as red veterinary petroleum confers some protection against UV (ultraviolet) exposure and has been used as a sunscreen. Safety Concerns While petroleum jelly is widely used, it often contains Mineral Oil Aromatic Hydrocarbons (MOHA) and polyaromatics, which may be carcinogenic. Sources Kircik, Leon H. (2013). Comparative study of the efficacy and tolerability of a unique topical scar product vs white petrolatum following shave biopsies. Journal of Drugs in Dermatology. 12(1), 86-90. doi: 10.1002/anie.201600521Warentest, Stiftung. Mineralà ¶le in Kosmetika - Kritische Stoffe in Cremes, Lippenpflegeprodukten und Vaseline - Stiftung Warentest. www.test.de.
Tuesday, May 12, 2020
The Success Of A Business Owner - 999 Words
Being an entrepreneur is about believing in something and standing for what you believe in. The reasons entrepreneurs start businesses is to be successful as well as to make money. No one ever starts a business with the intent to fail, however if a business does fail most entrepreneurs learn from their mistakes and try again. The mentality of successful business owner is an I will not lose attitude that motivates that person to not accept failure as an option. Having what it takes to survive and succeed is a core value of entrepreneurs, making it your civil duty to find solutions to problems people face on a daily basis. In my research I think the main objective of an entrepreneur, is to change the world in a way that will benefit everyone in one way or another. This is the entrepreneurs right and clear intention to make sure they are operating from a good intent and integrity. Entrepreneurs that have achieved a pinnacle of success often ask themselves, How can I help? or better yet you ask yourself, How can I serve?. These are the the main motivating factors an entrepreneur needs to create a plan of action. Any entrepreneur that is successful in business has an instinctive ability to see problems and needs that people have as an opportunity to apply their entrepreneurial capabilities to come up with solutions and satisfy a person s problems or needs. Another great example are social media entrepreneurs whoShow MoreRelatedThe Success And Success Of A Small Business Owner754 Words à |à 4 Pages This is a difficult feat many business owners find to be very difficult and challenging. The life of a small business owner is one filled with many challenges, both big and small. Many factors will determine the levels of confidence and success that a small business will experience. 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If a company doesnââ¬â¢t apply these techniques strongly to their business, they could end up with nothing very fast. Another idea is a deprecating rumor about a company that can lead to its downfall. A company is like building a house. If you donââ¬â¢t build the house on a solid foundation, then it will not last. Foundations Many variables go into building a solid business. When generating a new successful business, a business owner has to generate what his or her companyââ¬â¢s values and purpose willRead MoreMcdonald University School Of Hotel Administration1482 Words à |à 6 PagesOne of the biggest objectives for restaurant owners is proper planning and using a business plan to implement their companyââ¬â¢s goals, to raise their levels of success. Additionally, one needs to plan so that they can become experienced, be financially prepared, knowledgeable of their market and its customers, and pay close attention to customer quality. 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Just like any other organization Childrenââ¬â¢s Stop Resale Shop needs to have a vision, mission, and values in determining the strategic direction of the business. Developing the vision is important to know what direction the business is heading in. Laying out the guiding principles and values will assist in guiding the business in the correct directions. Childrenââ¬â¢s Stop Resale ShopRead MoreStakeholders Have A Huge Influence On Business1614 Words à |à 7 Pagesin the business; this could be an interest in the product or services, or the operations of the business. There are different types of stakeholders, this include the employees of the business, the customers, the suppliers, the owners, local people, the government and the trade unions. Stakeholders have a huge influence on business, they can change a lot of the operations if they are unhappy, and the business m ust make an attempt to fulfil their wishes to have an effective company. * Owners who are
Wednesday, May 6, 2020
One can learn a great deal about the Boreal Shield by taking a trip to Sudbury Free Essays
One One can learn a great deal about the Boreal Shield by taking a trip to Sudbury. It is a city in the Boreal Shield region where the lumber and mining industries dominate its economy. The paper and pulp mills and the Nickel mine are symbols of this great city. We will write a custom essay sample on One can learn a great deal about the Boreal Shield by taking a trip to Sudbury or any similar topic only for you Order Now Also, the re-greening program at Sudbury is a success, making the city unique in Canada. Sudbury continues to grow and strive from the benefits of the lumber and mining industries and the world-own re-greening program. Sudbury is famous for its mines that are filled with many types of ores. After the ores are mined, they become valuable minerals such as nickel and copper. It all started when Tom Flanagan, who is a blacksmith, discovered copper sulphide while constructing the Canadian Pacific Railway back in the 1883. (Noda) These copper sulphides were believed to have come from a meteorite that had crashed near Sudbury 1. 8 billion years ago. It also created a crater, which is now called the Sudbury basin. Today, two big companies, INCO and Falcon Bridge, are the most well known for mining the valuable minerals in Sudbury. INCO has been operating for twenty more years while Falcon Bridge has been around for less then twenty years. (Aelick) These mining companies provide jobs to Canadians living in the Boreal Shield. INCO employed nearly 20000 Canadian workers to dig and mine for the ores. Their jobs require them to go down to the open pits, which are approximately 1. 2 km long and 180 m deep. Each time they mine, they take out about 60 million tones of ore. Each ore mined only has 2. 5% of valuable minerals usable. Other minerals in the ore include 1. 2% of silver, 1. % of copper and 97. 5% of unusable waste. In average, mines can produce 462,000 kg of nickel and 116, 800 tonnes of copper per day. The mining industry is very important to the economy in Sudbury because nickel mined there are worth about 1. 5 billion dollars. That is also about 15% of the worldââ¬â¢s production of nickel. In Ontario, about 60% of copper is mainly found in Sudbury. Over the years of developing INCO, fewer employees work for the company. Since now, there are only 5000 employees left because technology and machines are built to mine for them. With better technology, the mining companies in Sudbury can be more productive and competitive in the global economy. (Aelick) It is reasonable to say that the forest industries survive well in the Boreal Shield because of the plentiful lumbers in the area. The trees near Sudbury are grown really slowly because of its low precipitation and long winters. The types of trees are mostly white spruce, balsam fir, black spruce, jack pine and tamarack. Lumber productions and Pulp and Paper industries use about 80% of the technique of clear cutting on the forest because it is a lot cheaper than selective cutting. Wallace) They are environment friendly because they replanted trees after cutting so new forests can grow. Another reason why the forest industries are doing so well is because they use efficient tools. Some machines they use to harvest wood are the feller buncher, skidder and de-limber. The feller buncher is used to grab and cut down trees. A skidder is a machine that pulls the wood out of the ground. A de-limber is another machine that snaps off the limbs of the trees. (DOMTAR) Paper and Pulp Mills is a company that uses chips of wood to create wood pulp. They use about 2000 tonnes of wood chips and cook it as it turns into pulp and paper. The wastes go into lagoons. They will drain it out to collect solids that are to be sold as fertilizers. (Ramsay) Today, approximately 95% of Canadaââ¬â¢s papers are made out of wood pulp. This pulp can create different sorts of papers such as newspapers, paper towel, magazine paper and cardboard, which may be sold to other parts of Canada. The success from the re-greening program in Sudbury is well known and complimented by many people. Many years ago, Mrs. Oââ¬â¢Learyââ¬â¢s cow accidentally kicked over a lamp, which caused a fire and destroyed most of Chicago. This affected Sudbury because of the sulphur dioxide blown from Chicago by the wind and it destroyed much of Sudburyââ¬â¢s vegetations. Vegetations have started to grow again. It has been hard to get rid the sulphur dioxide. Later in the 1969ââ¬â¢s super stacks were made to lift the poisonous gas to a height of 381 meters high. (Anonymous) As soon as the super stacks were created, the citizens want to re-green Sudbury. They started to plant thousands of trees but hardly any of them survived. They thought of new ways to plant and finally they experimented with limestone. It worked! As a result, they hired many students who were looking for part-time jobs. At one time, there were 200 students and 200 miners helping to re-green Sudbury. They would spend their summer pulling dead limbs, hauling countless bags of lime fertilizer and grass seed through Sudbury. Because of its success in re-greening, Sudbury won 4 national and international environmental improvement awards. One of them for highly respected commendation from the United Nations. (Globe and Mail) Along with the mining and forestry industries, the re-greening program in Sudbury allowed the city to be an important center for activities in the Boreal Shield. The mining and forestry created many jobs for Canadians and provide many products to the world. The re-greening program helped promote Sudbury and Canada to be environmental friendly places. All of this created a great place to live called Sudbury. How to cite One can learn a great deal about the Boreal Shield by taking a trip to Sudbury, Papers
Sunday, May 3, 2020
Current Surgical Treatment of Gallstones Free Samples to Students
Question: Discuss about the Current Surgical Treatment of Gallstones. Answer: Introduction: Effective clinical reasoning skills in nursing practice ensure positive patient outcomes. Conversely, poor clinical reasoning skills lead to patients deterioration (Salminen et al., 2014). The term clinical reasoning in nursing refers to the process of collecting cues, processing patient related information, understanding the health condition of the patient, planning and development of intervention, evaluation of outcome and reflecting on the outcomes and the process. The entire process is a not linear rather each step of the process is a cycle of linked and ongoing clinical encounters (Dalton et al., 2015). Levett Jone developed the clinical reasoning cycle and it is vital in nursing profession. The essay deals with the case study of 49-year-old man Mr. Kasim Al-Mutar who presents to the emergency department with cholecystitis. The essay presents the health assessment of the patient using the Levett Jones clinical reasoning framework. The clinical reasoning cycle is a dynamic Management process and consists of several stages. The first step of the framework is the consideration of the patients situation. In the given case study, Mr. Kasim Al-Mutar, a 49 year old man with cholecystitis is presented to the emergency department. He presents following two days of right upper quadrant abdominal pain, vomiting and fever. Cholecystitis is the condition associated with gallbladder inflammation. In this condition, the gallstones obstruct the cystic duct. It result in build up of bile in the gall bladder leading to inflammation. The most common sign of the acute cholecystitis is abdominal pain and tenderness in right upper quadrant or RUQ (Bosch et al., 2016). It is the typical compliant for his age and gender. According to Wichmann et al., (2010) the risk of cholecystitis increases with age. In Australia this is the common condition in 25-30% people aged 50 years and above. Acute cholecystitis is more common in men than wo men who get gallstones more often. Therefore, it is common for Mr. Kasim to experience these symptoms. However, further assessment is needed to determine the exact cause of the symptom and identify the presence of gallstones. The next step of the clinical reasoning cycle is collection of cues and information related to the clinical situation presented. For this purpose, it is important to review the handover information. Based on the clinical handover by previous nurse, the patient had heart rate of 126, blood pressure of 100/45 and temperature of 38.5 which indicates fever . The handover informs severe pain in right upper quadrant with last episode of vomiting 2 hours ago. Upon collecting more information on the patient from the previous nurse, it was found that the patient is pale with dry mucous membrane. The patient is thirsty and is requesting water to drink. Additional information gained from the previous reports includes shoulder tip pain. The patient reported a pain score of 7 on a scale of 10. Upon collecting information on patients family, it was found that the only member to support and care for Mr. Kasim is his 12-year-old daughter. The clinical handover does not provide information on presence of abdominal sounds which is the most common diagnostic test ordered to diagnose cholecystitis. The information does not indicate if the pain was initially colicky and if later has turned to be constant. There should have been more information on the level of bilirubin, alkaline phosphatase which, provide an evidence on the obstruction of bile duct. There is a need of complete blood count test for diagnosis and confirmation of a cute cholecystitis by identifying the markers of inflammation (Yabluchansky et al., 2016). The information collected from the handover needs to be processed to proceed with further health assessment of the patient. The processing of obtained clinical information is the next stage of clinical reasoning cycle. To start with the vital signs the heart rate of patient which is 126 beats per minute is indicative of tachycardia (Yabluchansky et al., 2016). His blood pressure of 100/45 indicates hypotension and fever is indicated by his temperature of 38.8C. Further, the patient has been vomiting 2 hours ago. According to Yabluchansky et al., (2016) the most common symptoms of acute cholecystitis include fever, vomitting, tachycardia, and abdominal pain. According to McPheeters and Karp, (2015) nausea and vomiting in this condition is associated with biliary colic which is the condition caused when bile duct is temporarily blocked by the gallstones. Therefore, these symptoms match in the case of the patient. The patients of acute cholecystitis report upper abdominal pain, which th en radiates to the right shoulder or scapula. Further, the pain frequently begins in the epigastric region and then localises in the RUQ (Bosch et al., 2016). A similar symptom has been absorbed in case of Mr. Kasim whose clinical history shows shoulder tip pain and severe RUQ pain. The pain score of 7 out of 10 indicates a dominant pain. It indicates severe pain that dominates the senses. This severe pain significantly interferes with sleep and limits the ability to perform the normal daily activities (Strong et al., 2014). Further, the pale skin of the patient indicates anaemia, and the patient is dehydrated as evident from the dry mucous membrane and patients willingness to drink water. It indicates the need of setting up intravenous fluid immediately (Jeong Jung, 2016). It is necessary to judge the present condition of the patient using critical thinking skills to identify the problems and issues. Based on the symptoms of the patient the most suspected diagnosis is acute cholecystitis considering the symptoms and literature (Le Finlayson, 2016). There is a need of focussed health assessment. The laboratory tests of amylase /lipase, liver function test, cardiac enzymes and b-HCG will better eliminate the irrelevant options from the differential diagnosis. Some of the symptoms are also common in case of common bile duct obstruction, and acalculous cholecystitis (Barie Eachempati, 2015).These diagnostic tests are essential because acute cholecystitis and common bile duct obstruction is confirmed with increased level of Alanine aminotransferase, aspartate aminotransferase, bilirubin and alakaline. In acute cholecystitis, amylase and lipase are mildly elevated. Therefore, these tests will rule out the possibilities of other problems such as appendiciti s (Victory et al., 2017). If the fever is due to infection it will be evident from the rise in WBC (positive blood cultures). The correct information of the diagnosis can be achieved from the acute abdominal series and ultrasound of the right upper quadrant. In case the acute abdominal series is negative then the information from the ultrasound test will be the last resort for correct diagnosis. It is because the right upper quadrant ultrasound informs about the presence of the gallstones, perichocholecystic fluid, thickening of the gall bladder wall thickening, sonographic Murphys sign and other abnormalities in pancreas, liver, kidney and other things such as air in the wall of the gallbaaldder. Further, secondary imaging tests such as computed tomography can help identify the extrabilary disorder (Adhikari et al., 2014). Most of the symptoms direct towards that of acute cholecystitis, which in most cases occur due to gallstones. However, in many patients having gallstones do not lead to these symptoms. Some patients may not have cholecystitis, however, may present with similar symptoms such as inflamed gallbladder (Yabluchansky et al., 2016). In cases other than acute cholecystitis such as catarrhal inflammation, patients have been found to be infected with pyogenic bacteria that lead to fever. It may result in inflammation and perforation of the mucous membrane. These conditions are different from the cholecystitis. In case of the patient Mr. Kasim, the possibility of Jaundice is not present. In most cases unless common bile duct obstruction, Jaundice is absent (Guo et al., 2014). Many people with typical gall bladder attack have similar symptoms but do not have severe pain similar to acute cholecystitis (Jeong Jung, 2014). The last step of the clinical reasoning cycle is the detailed health assessment of the patient. Prior to the assessment ad developing care plan there is a need of detailed assessment which include the following- Ultrasonography- it is the initial imaging test preferred for the patient of cholecystitis. It is followed by CT scan which is secondary imaging test to identify extra-biliary disorders. It also identifies acute complications of cholecystitis. Cholecystography as per Le and Finlayson, (2016) can reveal the stones in the biliary system. The nurse must assess the skin and mucous membrane followed by assessment of peripheral pulses and capillary refill. Followed this the nurse must assess for abdominal distension, and any reluctance to move. Nurse must report if there is any frequent belching and guarding in patient. Later the nurse must assess the pattern of the pain and any risk of malnutrition. Based on the assessment the major goals for the patient include relieving pain and promoting rest. The immediate attention to the patient include maintaing fluid and electrolyte balance and prevention of complications (Adhikari et al., 2014). In conclusion, the competent professional practice requires sophisticated thinking skills. Critical reasoning in nursing is vital as nurses are significant part of the judgements and the decision-making in heath care. Patients are sometimes presented with the complex symptoms which may overlap with other diseases. Ineffective judgment may lead to development of inappropriate interventions. Consequently, it may give rise to patients deterioration and mortality. Thus, clinical reasoning cycle is one of the most important learning approaches for preparedness of professional nurse practice. References Adhikari, S., Morrison, D., Lyon, M., Zeger, W., Krueger, A. (2014). Utility of point-of-care biliary ultrasound in the evaluation of emergency patients with isolated acute non-traumatic epigastric pain.Internal and emergency medicine,9(5), 583-587. Askew, J. (2005). A survey of the current surgical treatment of gallstones in Queensland.ANZ journal of surgery,75(12), 1086-1089. Barie, P. S., Eachempati, S. R. (2015). Acute acalculous cholecystitis. InAcute Cholecystitis(pp. 187-196). Springer International Publishing. Barie, P. S., Franck, P. (2015). History of Medical and Surgical Management of Acute Cholecystitis. InAcute Cholecystitis(pp. 1-16). Springer International Publishing. Bosch, D., Schmidt, J. N., Kendall, J. (2016). Acute Cholecystitis Detected by Serial Emergency Department Focused Right Upper Quadrant Ultrasound.Journal of Medical Ultrasound,24(2), 66-69. Dalton, L., Gee, T., Levett-Jones, T. (2015). Using clinical reasoning and simulation-based education to'flip'the Enrolled Nurse curriculum.Australian Journal of Advanced Nursing, The,33(2), 29. Guo, S., Lei, J., Zhai, Y., Chen, P., Zhang, H., Zhang, J., ... Guo, Y. (2014). Quantitative Analysis of Focal Liver Injury Using the Apparent Diffusion Coefficient in Patients with Biliary Obstruction from Common Bile Duct Stones: A Pilot Study.Current Molecular Imaging,3(3), 240-245. Jeong, C. Y., Jung, S. H. (2016). Acute Cholecystitis after Screening Colonoscopy.Korean Journal of Pancreas and Biliary Tract,21(4), 228-231. Le, S. T., Finlayson, E. (2016). Surgical vs Non-Surgical Management of Acute Cholecystitis in Nursing Home Patients.Journal of the American College of Surgeons,223(4), S118. McPheeters, R. A., Karp, J. (2015). ABDOMINAL PAIN, NAUSEA, AND VOMITING.Emergency Medicine Secrets. Salminen, H., Zary, N., Bjrklund, K., Toth-Pal, E., Leanderson, C. (2014). Virtual patients in primary care: developing a reusable model that fosters reflective practice and clinical reasoning.Journal of medical Internet research,16(1), e3. Strong, J., van Griensven, H., Vincenzino, B. (2014). Pain assessment and measurement. Victory, J., Meytes, V., Parizh, D., Ferzli, G., Nemr, R. (2017). Co-existent appendicitis and cholecystitis.Annals of Laparoscopic and Endoscopic Surgery,2(1). Wichmann, M. W., Lang, R., Beukes, E., Esufali, S. T., Jauch, K. W., Httl, T. K., Httl, T. P. (2010). Laparoscopic cholecystectomycomparison of early postoperative results in an Australian rural centre and a German university hospital.Langenbeck's archives of surgery,395(3), 255-260. Yabluchansky, M., Bogun, L., Martymianova, L., Bychkova, O., Lysenko, N., Makienko, N. (2016). Cholelithiasis, chronic cholecystitis and functional biliary disorders.
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