Locke vs Hobbes Essay Example for Free

Locke vs Hobbes Essay Locke believed that, â€Å"human behavior came from thought which was learned and subject to the influence of reason and observation.† Locke’s main ideas were positive to the human race. He also states that humans know right from wrong, and they are intelligent enough to solve the problems in front of them and realizing what is lawful and unlawful. Locke believed, â€Å"God created man and we were, in effect, God’s property.† John Locke believes that a government should be some form of a social contract, were the people who were being ruled, had some say in the laws. According to him, men are born with the three freedoms of life, liberty, and property. A government is there to protect those rights and improve the state of nature for each individual. An illegitimate government is one who fails to protect these rights, is ruled by a supreme ruler, and does not listen to what the people who are actually being governed have to say. To make a government equal and sufficient for the human race, ideas need to be taken from all kinds of people and applied to the rights each person enjoys every day. Locke believes that an absolute ruler can be over-thrown by the people if the choices they are making neglect the many things people enjoy. Many monarch powers were arising through Europe during this time period, and John Locke was creating the ideas and reasons to downplay the power of these rulers. On the other hand, Thomas Hobbes believed that humans were naturally evil. He thought the only way to control these naturally wicked people were to hold them under a strong government. Hobbes believed in Leviathans that are powerful sea monsters, which can equally resemble the amount of power a ruler, had during this time. Thomas Hobbes fully agreed with the idea of this ruler-centered government. By giving their rights to a supreme power, individuals were believed to gain law and order. This law and order will protect the individuals’ security and benefit their empire or region as a whole. The best government was one â€Å"which could impose order and demand obedience.† So in Thomas Hobbes view, to be a successful individual you need to hand your rights to that supreme ruler of your region and be granted with the simple laws which will govern you through your life.

Communicative Competence In Language Teaching

Communicative Competence In Language Teaching In this essay, I will first define what Communicative Competence is and what it includes. Secondly, making reference to the European Common Framework of Reference for Languages, I will synthesize why gaining Communicative Competence in a foreign language is so important and why it should be the main goal in an English Classroom. To finish with, I will summarize the best ways of teaching Communicative Competence. Task-based language teaching will be the model I will use as an example of how Communicative competence should be taught and the role instruction should pay in the Classroom. Communicative Competence refers to the ability of understanding, producing, and interpreting the different Communicative events taking into account not only their explicit sense (what it seems to be more immediate for us), but also its implications; that is to say, what the speaker wants to say, what the listener wants to understand, their relationship, the social context, etc. Therefore, Communicative Competence has to do with the social, cultural, and psychological rules that determine the use of a particular language in a particular situation. This term was introduced by Hymes in language teaching in 1972, to complete Chomskys Linguistic Competence term which couldnt explain all the factors which are important for a communicative purpose or in a communicative situation. According to him, Linguistic Competence only deals with the knowledge of language rules and forms, and Communicative Competence includes as well the knowledge that allows someone to communicate correctly and appropriately. Therefore, Communicative Competence is the only means we use to transform language into Communication instead of Linguistic Competence. According to the European Common Framework of Reference for Languages Communicative Competence is divided in: Linguistic Competence: it refers to the ability of producing utterances in an efficient way in all its grammatical levels. It is formed by these competences: lexical, grammatical, semantic, phonologic and orthographic competence. Sociolinguistic Competence: it is the ability of understanding and producing different utterances in different contexts of use where different factors play an important role, such as the relationship between participants, their situation, etc. Aspects to take into account here are social relationships markers, politeness norms, popular wisdom expressions, register differences, dialect and accent differences, etc. Pragmatic Competence: It makes reference to the ability of acting efficiently in a language taking into account grammatical forms and meaning to complete a text (spoken or written) in different communicative events. It includes students mastery of texts, discursive genres, and community speech interpretation. To master this, there are needed rhetorical, cohesive or cohesion devices for conversational organization. Strategic Competence: it has to do with the individuals effective use of language by means of his capacity for using verbal and non-verbal resources to fix errors that can be produced when communicating due to different events that may limit the communicative process. Communicative competence is the first of the eight basic competences that a learner has to have acquired by the end of ESO, but not only this, it is in the same way important to have acquired as well a B1 level of Communicative Competence in a Foreign Language to be admitted in University as the European Common Framework of Reference for Languages dictates. COMMUNICATIVE COMPTENCE IN TEACHING Teachers in ESO should develop in students communicative abilities and strategies in order to reach a B1 level in Communicative Competence by the end of this period, this competence should be acquired in all areas: speaking, reading, listening, and writing. Therefore, this has to be the main goal in the English Classroom. In order to analyze how Communicative Competence is implemented in school, Ive chosen the task-based method, which is a continuation of Communicative Language Teaching according to Rod Ellis. Task-based language teaching is a teaching method based on tasks whose main purpose is to make learners use the foreign language. Tasks are based on authentic events where authentic language is used: visiting a doctor, shopping, calling room service for food, etc. Assessment of errors is not considered as important as in other approaches because accuracy will be gained while practicing the L2 in an incidental way. Besides, Rod Ellis defends that what students really acquire is the implicit knowledge, and this is best facilitated looking at the language as a whole rather than breaking it into pieces in an attempt to teach item by item. Tasks differ from activities in that they focus on meaning rather than on form, in this sense, learners will be creating their own language instead of reproducing the language given to them. They also have an informational or reasoning gap which will make the conversation interesting and therefore it will make them eager to continue it even outside class. Learners also use their resources instead of reproducing the language given to them. The goal of tasks is not to make learners use a correct language, but to engage them in communication. WHAT ROLE PLAYS INSTRUCTION IN A TASK-BASED LEARNING CONTEXT? Instruction plays a different role in Task-Based Teaching: Instruction is seen in an interpretative rather than in a transmission perspective, so its main goal must be to facilitate students processes of learning, which in this case is the acquisition of implicit knowledge. The goal of language instruction is the development of implicit knowledge. If teachers make their students to focus mainly on language form they wont never be able to communicate effectively. The only place where learning occurs is inside learners minds, so teachers cannot just direct that learning. Therefore attention to form will be paid only when communicating, and not all the time, because excessive corrections may stop the conversations rhythm. That doesnt mean that Task-Based theorists dont care about grammar, they defend explicit teaching of rules as well, but only when necessary because the main goal is communication. Instruction has to focus on meaning rather than on form. Rod Ellis thinks that grammar is not needed for basic communication. Basic survival in language relies on vocabulary and formulaic sequences, not on grammar. Students will need grammar as they get involved in increasingly complex tasks, that is to say, the need to use a determinate grammatical form will be created in their minds as complexity increases in tasks. Instruction needs to be motivating, i.e. based on things that learners may find interesting, because its very important to call their attention in order to get them involved in the task. To conclude, I will sum up some characteristics a classroom should have to teach Communicative Competence: Inductive method. Preventing method rather than corrective. Teach sequences of language, not language in isolation. Teach through senses. Promote autonomy. Give your lesson an authentic and ludic character to make it interesting. Set learning goals taking into account the developmental cognitive level of the learner.

Public Health Policy in Australia

Public Health Policy in Australia Section 1 Healthy public policy is an denotative pertain for equity of health in all field of policy and for the benefit to impact in health. The importance of public health policy is to make a positive environment to enable people to lead healthy lives. Healthy public policy create a healthy choices possible for the citizens’ concerns. Public policy creates a physical and social environment of healthy lifestyle. As government sector pursuit of healthy public policy concerned with trade, education, agriculture, industry and communication require to take into account for the healthy consequences of their decisions in policy and these sectors should be answerable for the health consequences of their decisions in policy. The government should play an important role in healthy public policy for the economic consideration (1†¦.). According to the Catherine Althaus policies are theory about the world, some flourish while other shrivel up, the better designed the theory, the more tested its assumption’s, the greater the chance of success.(4..) The healthiness amends Quality of life, Productivity of workforce, Learning capacity, Strengthens of family and community. The government are responsible for making policy and allocate resources for the implemented policies, basically public policy can be defined as a system of law, course of action, regulatory measures and funding priorities regarding a given promulgated topic by a governmental representatives or entity.(3..) What is Health in All Policies (HiAP)? According to the definition of World Health Organization Health in All Policies (HiAp) is an approach path to public policies across sectors that consistently takes into account that the health decisions implications, synergies searches and destructive health impacts, avoidance in order to improve health and health equity of population. It also related to rights and obligations and improves accountability of impact in health policymakers at all levels of policymaking. The HiAP include a vehemence on the consequences of public policies on health systems, healthy wellbeing, and health determinants and contributes to sustainability of developments (2..). The HiAP approach are as follows; It ameliorates the public policy maker’s accountability for health impacts at all stages of policy making. It admits an emphasis on the effects of public policies on health systems, determinants of health and well-being. It contributes to sustainable development. Social determinants of health (SDH)is the core concept of HiAP in which health and wellbeing of the population is shaped. According to the definition of world health Organisation SDH is a conditions in which people are born, grow, work, live and age and theses circumstances are shaped by the distribution of money, power and resources at global, local and national levels(5†¦). For example transport, housing, education and the environment are some of the factors which affect health and wellbeing which lies outside of the main function of health systems and these are some of the broad changing areas in which most significant improvement in health and life expectancy over the 150 years and are not directly attributed to improvement in health care (6†¦). Health in all policy is a way of government working across to achieve better public policy results and simultaneously improve health of population and wellbeing consequences. A healthy population has positive impacts on economy, sustainability and productivity in which it benefit all sectors and society as a whole (6†¦.). How public policy are formed in Australia? In Australia the public policy is formulated not only by the influence of politicians but by contribution of many public servants and thousands of men and women who file the petition to parliament and ministers who join interest group, by media comment, union, corporation and community movements. The entire community is effected by public policy(4†¦.). The policy procedure are generally follow a logical system and that system seeks to structure the way problems are empathized and introduced, so that the decision makers can hear about the issues, understand options, learn of informed opinion, make choices, test their decision and evaluate their actions.(4..). Section 2 Issues are multi –sectorial and involve a range of interesting group Yes, according to the Food Security Policy it is clearly states about the multi sectorial issues which mostly affects Low income households such as sole parent, students English low proficiency peoples mainly newly migrants and refugees Aboriginal and Torres Strait Islander Northern suburbs householders People with mental illness or weak older adults who needed support for daily activities People with stress or who were homeless. HPP involves commerce, industry, voluntary, Organisation, community and government Yes, the Food Security Policy has been implemented with local government food security policy project which is funded by Victorian Department of Health. The main goal of this policy is to achieve to reduce the prevalence and impact of food insecurity. HPP involves the representation of: †¢ Northern Area Mental Health Service †¢ Neami Darebin †¢ Austin Health †¢ Northern Division of General Practice †¢ Spectrum Migrant Resource Centre †¢ Department of Health †¢ North East Primary Care Partnership †¢ Planning for a Healthier North †¢ Women’s Health in the North †¢ Mental Illness Fellowship of Victoria Darebin Community Health Darebin Council Community Health and Safety Officers **Table is created according to the information of â€Å"The Food Security Policy† data. Health risks are global and not confined to regional boundaries Yes, the Food security is a global issue which will affect the future food security due to the climate change and increasing the demand if food production resource were reduced worldwide. According to the 2014 repot around 805 million people that is one in nine of the world’s population were chronically undernourished. The vast majority of this issues in developing country. (7†¦)According to the city food security policy. Current global climate change will affect the global food insecurity and that will continue to grow the capacity to produce and distribute food undernourishment due to the changes in water scarcity, food producing land for production of bio fuels, degradation of lands and land lose due to urbanization due to these above factors will increase the demand for food as the grows of population. Simultaneously will impact the community and household level with increased food price, increased transportation price and utilities price as well. The above factors al so will influence the food that will be available with increased local product, more depends on seasonal products and low processed product such as meat, dairy and imported food items. Thus will mostly effect the average community household to manage due to its affordability and vulnerable to food insecurity(8†¦.). HPP aims should be educational and not persuasive This is a limited rational because the report only explains about the food security policy should focus to educate the following issues such as Daily intake of vegetable and fruit particularly for disadvantaged groups. Lack of knowledge and skills related to healthy cooking and eating habits. Lack of knowledge about the Australian food products and how to use and this effect mostly newly migrants who don’t speak English. Lack of motivation and cooking healthy meals on a daily basis. Action for HPP takes many forms lobby groups, local community action. Limited because according to the report the local government capacity is limited to address the determinants of food security which are complex and influenced by global environmental, economic and social factors that are related to skill and production of food. The state and federal leadership on this issue of food security has been minimal and slow issue. The local government are showing their leadership in the food security area slowly because of need in their local community. The HPP of the Food Security Policy has been designed to reflect areas of action where local government can play a role in addressing local food security issues through both broad systemic response and social welfare around local land use planning, environmental sustainability and transport. HPP is intrinsically a political activity. No, the HPP of City Food Security Policy is not a political activity. The policy of food security is formed due to the city council’s community planning, partnership and performance of department are carry importance for the co-ordination of Food Security Policy. The council are responsible for the implementation of particular aspects of the policy making. Policy Summery The main benefit of developing such food security policy is to recognize the local government limited capacity to explain the determinants of food security which are complex and determined by global environmental changes, social factors and economic that related to production and acquisition of food. The HPP of Darebin also admitted that local government carry an important role play for responding to undernourishment of food insecurity to their municipal setting and how they can improve by implementing such HPP in which HPP contributing for making local and regional food supplies for accessibility in the future. Section 3 Health is multiphase and no more defined in terms of disease and illness or according to the WHO definition of health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity†(†¦..), rather it is enlaced with social prevailing, economic, political and condition of environment where more food sustainability or access for land. According to Kaplan the major reason of disease and population suffering are rooted firmly in the social, behavioral and psychological world in which people grow, live and die are embedded in multiple factors of geographical, environmental, institutional and economic circumstances (9). The most responsibility for health inequities is due to the social determinates of health. When viewed through social health lens, the health inequities and public health opportunity which enables community health, planning and community priority circumstance is inconsistently used (10†¦). Health inequities is due to the social determinants of health within countries are influenced by political power, economically and socially unacceptable which is avoidable and unfair. The Health public policies made in all sectors can have profound effect on health of a population and health equity. The health of world is shaped by the demographic changes, climate change, globalization and urbanization. Some of the diseases disappear due to the living conditions improvement and in developing countries many poverty diseases is still present, this all factors will improve by implementing health public policy for the benefit of community and future development. In order to improve the population health and social determinants of health, Health in All policies is relevant method of public policy approach that accounts systematically into account, the decision implication in health and avoid harmful health impacts (11†¦). What are the major different between Health public policy and Health in All policy? Health public policy(HPP) Health in All Policy (HiAP) The redistribution of public policy income through : Pension provisions unemployment insurance child care (12†¦) giving opportunity to people to adopt healthy lifestyle; preventing people to adopt unhealthy lifestyle; and Creating healthy physical and social environments.(13..) The HiAP reflects the principles of legitimacy, accountability, Transparency (2..) Health implications of decisions, seeks synergies, Avoids harmful health impacts Improve population health and health equity. It access to information, participation, sustainability, and collaboration across sectors and levels of government (2..) *** Table is created according to the reference data given above. The benefit of Implication of Health policy is to plan, action and decision that are beneficial to achieve target society health care goals. Health policy outlines priorities and the expected roles of different groups and builds consensus and informs people (14..).For example the Food Security Policy distinguishes that local government is limited in its capacity to address all of the determinants of food security by implication of policy will improve the ongoing supply of nutritious and sustainable food available, and improving access to the available food supply, particularly for those who are most vulnerable to food insecurity (15..).The target group of this policy is Low income households ( sole person, sole parent and student ) English low proficiency people( new migrants and refugees ) Aboriginal and Torres Strait Islander Northern suburbs Households People with a mental illness or disability (15†¦) The new public health approach will brings changes in environment and preventive measures with appropriate therapeutic interventions, especially to old age community and disabled persons. However the new public health will recognizes the health lifestyle problems and Underlying health lifestyle problems are concrete issues of local and national public policy and require to address issues by variety of Health Public Policies and the policies in all sectors will support the Health promotion. (16..)

Side Effects, Directed by Steven Soderbergh Essay -- Movie Film Analys

The film, Side Effects, is quite twisted and unnerving as it begins with the impression of the female lead, Emily Taylor, walking through pools of blood and leaving her blood stained footprints on the wood floors. Later we learn this is the murder scene. The film flashed back 3 months time. Emily was visiting her husband, Martin, who was convicted of insider trading. He was finishing his 4-year sentence and was soon to be released. Emily and her mother-in-law arrived to bring Martin home. After his release, he explains to his wife a social worker stopped by to speak with him and had given him a pamphlet on reintegrating into the community. As Martin attempted to settle back into his normal life he learned his wife had her own struggles. Martin learned Emily was severely depressed with suicidal ideation. Emily was leaving for work one morning and was driving her vehicle through the parking structure of their apartment home. She drove her vehicle into a cement wall at high speeds. She was rushed to the emergency room where it was determined this was an intentional act. She was assigned a psychiatrist, Dr. Banks. Dr. Banks learned she had dealt with depression in the past and wrote her a prescription for an anti-depressant. She pled her case to not be admitted into the psych-ward, primarily because her husband was just released from prison and does not have employment. Dr. Banks accommodates her request after she promised to take the medication as prescribed and meet with him at his office for counseling. Martin saw the suffering Emily was experiencing and told her he had a friend he met â€Å"inside† who was very intelligent and wanted to start a business when he was released. He re-assured Emily h... ...search project with Ablixa. He however, fought back in a different way than that of Emily and Dr. Siebert. Although he had to do the harder right thing, he chose to remain a conformist and refused to attain his goals through illegitimate means. As in most movies there is a happy ending and in this case the conformist wins. In the real world however, the majority of society falls into conformity and very few move out of their subculture or move up in social class. Works Cited Cole, G., & Smith, C. (2011). Criminal Justice in America. Belmont, CA, United States of America: Wadsworth Cengage Learnig. Jezak, J. a. (n.d.). David Emile Durkheim Exploration of Durkheim's "Suicide" . Retrieved March 22, 2014, from http://edurkheim.tripod.com/id19.html Siegel, L. (2011). Criminology The Core. Belmont, CA, United States of America: Wadsowrth Cengage Learning.

Voice Recognition Software: Comparison and Recommendations :: essays research papers

Voice Recognition Software: Comparison and Recommendations Use of voice recognition software is under consideration by medical office administrators nationally. Administrators have long searched for alternatives to the expense, error rate, and record-completion delays associated with conventional transcription. It is no wonder that, with the recent advances in voice recognition software, medical transciptionists are looking at this emerging technology as a powerful way of accomplishing essential record-keeping tasks. This report investigates four of the leading voice recognition applications to determine whether this technology has become a practical option and to determine which application is the best choice. And so that this report and further study of the software can be better understood, an introduction to the subject of voice recognition software follows. Introduction to Voice Recognition Technology Several different voice recognition products currently exist in the marketplace, and viable choices are greater in number than they were only a few years ago. Rapid changes have been fueled by the ever-increasing power and plummeting prices of desktop systems. Though room for improvement still exists, accuracy has advanced tremendously in a stunningly short time. Brief history. The first software-only dictation product for PC's, Dragon Systems' DragonDictate for Windows 1.0, using discrete speech recognition technology, was released in 1994. Discrete speech is a slow, unnatural means of dictation, requiring a pause after each and every word [11]. Two years later, IBM introduced the first continuous speech recognition software, its MedSpeak/Radiology. These systems often had five-figure price tags and required very expensive PCs. Continuous speech technology allows its users to speak naturally and conversationally, relieving much of the tedium of discrete speech dictation [11]. Dragon Systems made an enormous stride in June, 1997, when it released NaturallySpeaking, the first general-purpose continuous speech software program. Much more affordable than earlier programs, it brought the realm of continuous speech recognition to a much wider range of users. Two months later, IBM released its competing continuous speech software, ViaVoice [10]. Stringent demands. Much is demanded of speech recognition programs. Accuracy is critical, and speed is essential to any effective program. Added to these challenges are the enormous variance that exists among individual human speech patterns, pitch, rate, and inflection. These variations are an extraordinary test of the flexibility of any program. Voice recognition follows these steps: Spoken words enter a microphone. Audio is processed by the computer's sound card. The software discriminates between lower-frequency vowels and higher-frequency consonants and compares the results with phonemes, the smallest building blocks of speech. The software then compares results to groups of phonemes, and then to actual words, determining the most likely match. Contextual information is simultaneously processed in order to more accurately predict words that are most likely to be used next, such as

A Look from “Dreams from my Father” by Barack Obama Essay

Barack Obama’s narration of mostly his father’s life story transcends many debatable topics such as racism and socioeconomic classifications. Topics such as those brought out literally as needed in his accurate and factual description of their lives but not to create any arguable pointers of discussions. Two scenes in the book that shaped this memoir as a whole and could be enough to make a thorough study on how Barack Obama Jr. seek his sense of belongingness and his finding a way to form an ambition being a public servant were: first, how his black father Barack Hussein Obama Sr. of Kenya and his white-coloured mother Ann Dunham of Kansas, USA met, fell in love, got married and divorced; and second, his absentee father’s thoughts and activities as told by his mother and grandparents. Having been recalling his parents blossoming relationship could manifest a picture of success as he recounted episodes where his father’s intellectual charisma and ambitious thoughts won his grandparents heart irregardless of colour and racial differences after opposing Barack Sr. and Ann’s love story. He pointed out that the only reason of his parent’s broke up was the lacking of money in which during that time, Barack Sr. couldn’t afford to take his wife and son back to Kenya. Thus, he went home alone to his motherland along with his ambition to complete a promise to serve Kenya and the continent of Africa, as it is the reason of his methodical studies in US, specifically in Harvard University. It was merely a patriotic deed and nationalism of Barack Sr. as he absolutely believed that Africa and Kenya need him and his service. It is also noted that Zeituni, Barack Sr. ’s sister, mentioned that his brother really has a heart that was too big. As for the comparison of these two episodes of Barack Obama Jr. ’s account, it suggests love and charity accomplished in two dissimilar forms. Barack Sr. ’s love with his wife Ann and their son broke the difficulty of racial discrimination in which Barack Jr. brought out in the world and raised freely despite of living in the land of white men. It is the same as what Barack Sr. s decision to leave his family in US. Barack Jr. made a justification out of his parent’s decision to be separated with each other that it was due only because of his father’s charitable instinct to serve and help Kenya because it is where his whole ancestors belong. Hence, who could say that neither of the two kinds of love is wrong? Colour difference has never been a problem on Barack Jr. ’s parents, and it is totally contradictory to the completion of the second story where the Kenyan roots of Barack Jr. ’s father has been an issue. Everyone could agree that loving both the nation and one’s own family at the same time doesn’t mean sacrificing one for the sake of the other. As an effect of demonstrating these two kinds of love, Barack Jr. ’s journey to look beyond his roots and himself being a black man in the land of the white race created a similar motive with his father’s to serve his own country, though on his end it is America, whether in sociocivic works or in a political slot. R E F E R E N C E Obama, Barack Jr. Dreams from my Father: A Story of Race and Inheritance. New York: Three Rivers Press, 1995.

Nursing Care of a Patient Diagnosed with Pneumonia Essay

Patient Description Patient is a Caucasian 83 year old female that came into the emergency department from Wynwood assisted living facility with an increase of fatigue, worsening confusion and a 1 day history of a fever. Patient weighs approximately 90 pounds upon admission with a height of 64 inches. Patient has known COPD and is a former heavy smoker that also has a history of pneumonia, hypertension, atrial fibrillation, and dementia. Upon presentation to the emergency department patient has had increased nasal drainage and cough. Patient came into the hospital about a year and a half ago with a diagnosis of right lower lobe pneumonia. Patient was arousable, alert and pleasant, but not a good historian and appears to be quite emaciated. Patient at first had a non productive cough and was put on anti-biotics and began to have a productive cough 2 days post admission. Patient had dyspnea, increase respiration rate, difficulty talking, coarse lungs, and had decreased SpO2 with activity. Patient lived in Wynwood assisted living facility where she lived almost independently. Patient was able to get around her apartment with a front wheel walker and provided her own care of activities of daily living. With this admission, hospital staff did not recommend patient going back to assisted living as she would not be able to take care of her self until her mobility is back to her normal limits and the dyspnea is decreased. Nursing Diagnosis Ineffective airway clearance r/t bronchospasm, excessive mucous production, tenacious secretions, fatigue AMB dyspnea, increase RR (28), difficulty talking, inability to raise secretions, ineffective cough, adventitious breath sounds. Goals A. Pt will demonstrate effective coughing and clear breath sounds by end of shift 5/15/10 (3 days) and until discharge. B. Pt will continue to have cyanotic free skin by end of shift on 5/14/10 (2 days) and until discharge. C. Pt will maintain a patent airway at all times by end of shift 5/15/10 (3 days) and until discharge. D. Pt will relate methods to enhance secretion removal (drinking warm fluids) by end of shift 5/15/10 (3 days) and until discharge. E. Pt will relate the significance of changes in sputum to include color, character, amount and odor by end of shift 5/15/10 (3 days) until discharge. Interventions| Rationale| 1. RN will auscultate breath sounds Q4 hrs and PRN until discharge. 2. RN and CNA will monitor respiratory patterns, including rate, depth, and effort Q4 hr and PRN until discharge. 3. RN will monitor blood gas values as available and pulse oxygen saturation levels Q8 hr and PRN until discharge. 4. RN and CNA will position the client to optimize respiration (HOB elevated 45 degrees and repositioned every 2 hrs) and PRN until discharge. 5. RN and CNA will help the pt deep breathe and perform controlled coughing Q2hrs until discharge. 6. RN will help the pt use the forced expiratory technique, the â€Å"huff cough†. The pt does a series of coughs while saying the word huff q4hr and PRN until discharge. 7. RN or CNA will assist with clearing secretions from pharynx by offering tissues and gentle suction of the oral pharynx if necessary Q4 hr and PRN until discharge. 8. RN will observe sputum, noting color, odor and volume PRN until discharge.9. RN and CNA will encourage activity and ambulation as tolerated TID and PRN until discharge. 10. RN and CNA will encourage fluid intake of up to 2500 mL/day within cardiac or renal reserve Q2 hrs and PRN until discharge. 11. RN will administer oxygen as ordered until discharge12. RN or RT will administer medications such as bronchodilators or inhaled steroids as ordered until discharged. 13. RN and CNA will monitor the patient’s behavior and mental status for the onset of restlessness, agitation, confusion and extreme lethargy twice a shift and PRN until discharge date. 14. RN and CNA will observe for cyanosis of the skin twice a shift and PRN until discharge. 15. RN or CNA will position patient over bedside table for acute dyspnea PRN until discharge. 16. RN & CNA will help pt eat frequent small meals and  use dietary supplements PRN until discharge. 17. RN will teach pt energy conservation techniques and the importance of alternating rest periods with activity by end of shift tomorrow and PRN until discharge.| 1. â€Å"The presence of coarse crackles during late inspiration indicates fluid in the airway; wheezing indicates a narrowed airway† (Simpson, 2006, p. 487).2. â€Å"A normal respiratory rate for an adult without dyspnea is 12-16. With secretions in the airway, the respiratory rate will increase† (Simpson, 2006, p. 486). 3. â€Å"An oxygen saturation of less than 90% or a partial pressure of oxygen of less than 80 indicates significant oxygenation problems† (Sanford & Jacobs, 2008, p. 125).4. â€Å"An upright position allows for maximal lung expansion; lying flat cause abdominal organs to shift toward the chest, which crowds the lungs and makes it more difficult to breathe† (Sanford & Jacobs, 2008, p. 125).5. â€Å"This technique can help increase sputum clearance and decrease cough spasms. Controlled coughing was the diaphragmatic muscles, making the cough more forceful and effective† (Sanford & Jacobs, 2008, p. 125).6. â€Å"This technique prevents the glottis from closing during the cough and is effective in clearing secretions in the central airways† (Sanford & Jacobs, 2008, p. 126).7. â€Å"In the debilitated client, gentle suctioning of the posterior pharynx may stimulate coughing and removing secretions† (Sanford & Jacobs, 2008, p. 126).8. â€Å"Normal sputu m is clear or gray and minimal; abnormal sputum is green, yellow, or bloody; malodorous; and often copious† (Sanford & Jacobs, 2008, p. 126). 9. â€Å"Body movements helps mobilize secretions and can be a powerful means to maintain lung health† (Sanford & Jacobs, 2008, p. 126).10. â€Å"Fluids help minimize mucosal drying and maximize ciliary action to move secretions. Some pts cannot tolerate increased fluids because of underlying disease† (Sanford & Jacobs, 2008, p. 126).11. â€Å"Oxygen has been shown to correct hypoxia, which can be caused by retained respiratory secretions† (Sanford & Jacobs, 2008, p. 126).12. â€Å"Bronchodilators decrease airway resistance secondary to broncho-constriction† (Sanford & Jacobs, 2008, p. 126).13. â€Å"Changes in behavior and mental status can be early signs of impaired gas exchange. In the late stages the patient becomes lethargic and somnolent† (Sanford & Jacobs, 2008, p. 388).14. â€Å"Central cyanosis of the tongue and oral mucosa is indicative of serious hypoxia and is a medical emergency. Peripheral cyanosis in the extremities may or may not be serious†Ã‚  (Sanford & Jacobs, 2008, p. 388). 15. â€Å"Leaning forward can help decrease dyspnea, possibly because gastric pressure allows better contraction of the diaphragm. This is called the tripod position and is used during times of distress† (Sanford & Jacobs, 2008, p. 388).16. â€Å"Improved nutrition can help increase muscle aerobic capacity and exercise tolerance. Nutritional problems in clients with COPD can be visual; early identification of clients at risk is essential to maintaining BMI† (Sanford & Jacobs, 2008, p. 389).17. â€Å"Fatigue is a common symptom of COPD and needs to be assessed and managed† (Sanford & Jacobs, 2008, p. 390).| Article Summary In the Article, â€Å"Respiratory Assessment,† by Heidi Simpson, intends for the audience to be nurses already working in the field. This article gives an order of a respiratory assessment that works for any nurse, whether they are a new graduating nurse or a nurse who has been working for years. This journal article gives all the required elements in order to do a full respiratory assessment which includes the â€Å"initial assessment, history taking, inspection, palpitation, percussion, auscultation, and further investigations† (Simpson, 2006, p. 484). This article is a general information article that focuses towards all and any patient population as all of our patients need to have a respiratory assessment done. This article gives a good breakdown of a respiratory assessment in which I currently use in practice. The article can be a good reminder of how an accurate respiratory assessment should be done and how to get good results in the technique a nurse may use. References Sanford, J.T. & Jacobs, M. (2008). Impaired gas exchange. In B.J. Ackley & G.B. Ladwig (Eds.) Nursing diagnosis handbook: An evidence-based guide to planning care (8th ed., pp. 388-390). St Louis, MO: Elsevier. Sanford, J.T. & Jacobs, M. (2008). Ineffective airway clearance. In B.J. Ackley & G.B. Ladwig (Eds.) Nursing diagnosis handbook: An evidence-based guide to planning care (8th ed., pp. 124-129). St Louis, MO: Elsevier. Simpson, H. (2006). Respiratory assessment. British Journal of Nursing (BJN), 15(9), 484-488. Retrieved from CINAHL with full text database.