The Stranger vs the Awakening Free Essays

In the novel The Stranger the primary character Numerals is a male not interested in the public eye and appears to think about literally nothing. In any event, when his mom bites the dust he is impassive about it, the main thing he can have any affections for whatsoever is the annoying warmth of the sun at the burial service. He even starts an undertaking with his special lady Marie the day after the burial service, unmistakably pondering sex, which is critical to him. We will compose a custom paper test on The Stranger versus the Awakening or on the other hand any comparable point just for you Request Now When Marie requests that Numerals wed her he says he could mind less in any case, which is an outright indication of indiscreet and deadpan contemplations. It isn't until Numerals is detained and condemned to death does he start to acknowledge the amount he enjoys his life. HE tells the peruser that he measures the sea and hungers for sex and cigarettes, which is the first occasion when he ever has a need or show of feeling towards anything. The Chaplin offers Numerals opportunity and life on the off chance that he will trust God, obviously Numerals won't surrender and conflict with his convictions. Not long before the machine of society cuts him from presence, Numerals chuckles in their face demonstrating quality and triumph. In The Awakening the principle character Is Edna who is disappointed with her marriage and parenthood. She ends up as an individual and follows up on her craving for sex and passionate association with her newly discovered love Robert. There Is a continuous separation among Edna and her significant other as the novel moves forward, yet Edna starts to gradually turn out to be progressively Independent and free willing simultaneously. Her wants and unmitigated disobedience to the principles of society overwhelmingly Isolates her, making her surrender end her life by self destruction. Taking into account that Campus Is a male expounding on a male character and Chopin Is a female expounding on a female character It Is a significant Interesting Idea to seek after this would influence the manner in which each character took care of misfortune. Campus’ character Numerals Is solid and Indifferent to society all through the novel and doesn't vive Into society. HIS absence of feeling likewise built up an Image of solidarity for the straightforward reality that nothing influenced him, and he was Indifferent to the entirety of society. This Is because of Campus experiencing childhood In a general public that powers guys to conceal their feelings to invigorate Off misguided feeling of and power. For the duration of Campus’ life he had never professed to be secured In marriage having various illicit relationships, having never really accepted confidence, just as living In separation before distributing the novel likewise influenced the manner in which the character picked his ways. Numerals is by all accounts a radical form of Campus myself, a model Is Merchants consistently aching want for sex and Campus various undertakings. This likewise discloses to the peruser Merchants quality and individual triumph through steadiness, which would just be given to a male character through the eyes AT a male pre-winter. Puzzle Deluge a Tamale composing tout a Tamale contracted probably has an immediate association with why Edna picked the choice she did toward the finish of the novel. In the timeframe Chopin grew up ladies were not taken a gander at as solid amazing figures that could deal with predicament. Chopin was composing this book after her husband’s passing in 1882, when he left her with $12,000 of obligations. She attempted to run their family manor and store yet she Just couldn't deal with it. Being raised with this idea and origination of ladies being frail just as her tough situations confronted while composing this novel is actually why she had Edna end it all toward the finish of the novel. For Edna there was no getting away from the issue, as there was no getting away from the issue of obligation for Chopin. She was either banished from society or stuck carrying on with an existence of misery; her answer was to escape by taking the path of least resistance and murdering herself. This activity plainly shows the author’s recognition that females are not substantial of suffering occasions of misfortune and difficulty since she herself needed to stop where it counts within. In the wake of perusing the two books is it simple to see which character is more grounded in their battle against society? Edna took the path of least resistance by getting away through self destruction, which is society over fueling her and basically winning the fight. Numerals then again was never crushed by society; regardless of what they tossed at him he held fast and kept his convictions. A definitive indication of his quality and triumph is the point at which he giggles even with society basically saying, â€Å"l won, I’m right, you can't and won't break me. † Step by step instructions to refer to The Stranger versus the Awakening, Papers

Samsung Analysis Essay Example

Samsung Analysis Essay Example Samsung Analysis Essay Samsung Analysis Essay 1/Identify the ressources and abilities of an association with which you are recognizable using Exhibits 1 and 2 ( WA ) . I chose to set about an investigation of the Samsung organization since I spend a full twelvemonth in South-Korea. from July 2011 until stupendous 2012. Henceforth. Samsung is an exceptionally of import pudding stone in this state. working there is for some considered as a  « dream-work  » and furthemore deliver each piece much as 20 % as the state whole fares. Samsung is acceptable known for their electronic product made by the electronic subordinates of the organization. Sansung Electronics. Their lead telephone. by and by being the Samsung Galaxy S3 sold more than 40 1000000s units. They produce Television. PC. Show. semiconducting materials. Cameras†¦ Be that as it may, if Samsung is predominantly known in the western states for the Samsung Electronics subordinates. it is conceivable in Korea to populate as long as you can remember with Samsung stocks. Without a doubt. among the subordinates. we can happen Samsung Life Insurance. Samsung Heavy Industries ( mostly a shipwright subsidiarie ) . Samsung C A ; T†¦ There is even some  « Samsung Cities  » . like the Suwon Samsung Digital City. It is nations where just the Samsung workers and their family units are permitted to procure in. Here. there is appartment. school. hospital. delight. furthermore, everything one’s need to end a real existence. then again, actually everyone around you is working for samsung. For sure. Samsung is realize forthing itself all the constituent the organization request. So there is enourmous creation requests. that lead to enourmous creation site. Huge numbers of the Samsung worker have so no other pick than populating nearby with their family. In the event that I am introducing this organization that way. it is so as to help us seeing probably the most significant in addition to of the organization. Samsung has prevailed upon the trust and the certainty 1000 of laborers who are eager to venture to every part of the abundance detail mi for the organization. Korea is praised to hold one of the longest work cut known to man. In fact. in a large portion of the organizations laborers must be eager to make numerous hours. Samsung has the impalpable advantage of an exceptionally adaptable work power. In any case, non only adaptable. this work power is other than exceptionally great taught. because of the Korean guidance framework. one of the hardest known to mankind. As we said before. working for Samsung is considered for some as a fantasy occupation. what's more, Samsung laborers are more willing than some other specialist to go to the overabundance detail mi. since they get a superior mediation than different laborers in comparable Korea organization as LG. and so on ( In term of pay. however, other than in term of protection. what's more, retirement program: we ought to non cover that Samsung is non just Samsung Electronics. be that as it may, other than Samsung Life Insurance. thus this organization can offer top of the line exchange to their laborers ) . There is other than an eminence for working at Samsung. Thusly. Samsung can simple enlist the first class of Korean understudy. of Korean research laborers. what's more, this so is an exceptionally of import competitory favorable position other the opposition. No organization in Korea has this fascination. what's more, outside Korea just Apple and Google may have the option to hold comparable favorable circumstances. Be that as it may, Apple and Google are western organizations. what's more, this imply non the entirety of their laborers consent to give their life to the organization. They are definitely non as much steadfast as Samsung specialist. since Samsung has become bit of Korea itself. a national pride. This permit Samsung to hold an extraordinary capablenesss for bearing large scale manufacturing of some random product at any clasp. Without the readiness of Samsung representatives. the organization would definitely non be these days overall figure one top marketing cell phone organization. nor have the option to deliver top notch stock and being perceived worldwide for their quality. 2/Undertake an examination of the vital capacity of an association with which you are natural so as to put which capablenesss. in the event that any satisfy the guidelines of ( a ) esteem. ( B ) rareness. ( degree Celsius ) solidness and ( incomparability ) .

Book review on Iacocca An Autobiography

Book survey on Iacocca An Autobiography The title of the book is Iacocca: An Autobiography is totally as per its substance in it, as the writer portrays as long as he can remember story without anyone else. Creator The writer of the book is Lee Iacocca who was the previous leader of Ford Motor Corporation and the previous administrator and CEO of Chrysler Corporation. His significant commitments in history of auto business is that of giving another life to chrysler by sparing it from close to chapter 11 and returning it on target of achievement. Beginning Pages The book likewise has Acknowledgments page, joined by Introduction to the soft cover Edition. At that point it is trailed by An Opening Word and before the creator begins his story there is Prologue. Uncommon Features This book explicitly doesn't have any uncommon highlights, however it does got pictures, and exaggerations in it. The entirety of the photos are clearly. Number of Pages The book has a sum of 300 and sixty five pages. This much measure of pages makes it a better than average, light weight helpful book and the peruser serenely can convey it without any problem. Number of Chapters This book has twenty eight long parts and one epilog in it. Size of Paragraphs About the size of passages is concerned, it has a blend of short just as long sections. Cost About the cost of this book, on the off chance that we rate it on global level or for perusers of United States it is $7.99 and for Canadians it is $ 10.99 which is a decent sticker price. On the other, in the event that one would see its cost for Pakistani perusers however it is Rs. 400 however to me it is still over the top expensive. Distributer This book is distributed by Bantam Books, a division of Random House, Inc. Its trademark, comprising of the words Bantam Books and the Portrayal of a chicken, is enlisted in US. Patent and Trademark office and in different nations. Marca Registrada. Peewee Books, New York, New York. ISBN The ISBN of this book is 0-553-25147-3. By utilizing this extremely number one can without much of a stretch get this book from anyplace in the globe. Kind of Book The class of this book is true to life and dependent on evident story of the authors life. Here, all the occasions and happenings were uncovered for what it's worth by a solitary individual. First Book or Second This Autobiography is journalists first book, which informs us concerning his spectacular vocation and life. His subsequent book is Where Have all the Leaders Gone. Thusly, till now the writer has written down an aggregate of two astonishing books. Target Audience This book is composed for individuals from varying backgrounds, from business understudies to business administrators. However, the book centers to vehicles, in light of the fact that the essayists calling and energy was automobile industry business. Yet at the same time as this book has no logical recipes, specialized works, and strategies, so one can without much of a stretch read it and appreciate what this book is about. Version This is the second version of this book Iacocca: A life account. It is known as the soft cover version and it was out in the market for perusers in July of 1986, where as, the first was known as the hardcover release and it came out for the perusers in November 1984. Reason for WRITING:- The writers reason behind composing this book isn't to get sovereignty cash from the distributers or to flaunt his accomplishments at Ford, how he had protected Chrysler from insolvency and run the issues effectively. Rather than this most importantly, Iacoccas reason to assist all the present and future business graduates in different sorts of issues and challenges they need to confront when they start their occupations. The essayist immovably accepts that when this book will help those youthful cerebrums in understanding their issues, at exactly that point it would fulfill my soul of accomplishing something positive, beneficial and worth to peruse. Creators STYLE:- The composing style of writer in this book is formal. In the event that one survey the nature of composing utilized here is of worth referencing. The speaker has flawlessly kept up the linkages of right from sentence to sentence and sections to passages and afterward parts at bigger level. The jargon of the book is effectively comprehendible and has utilized no languages in it. Most definitely, here too the author painstakingly uncovered everything in a bit by bit structure so the peruser while experiencing it can't be reduced. Particularly, in personal histories such things should be given a decent lot of significance. Where upon, the subtleties given in this book is totally a self-portrayal and doesn't contain any off base data which didn't occurred in journalists entire life. AT FORD:- Before moving towards the book survey it is imperative to review the synopsis and what occurred in the initial segment of this collection of memoirs, this covers the essayists life at Ford. So in the outline section one previously read that writer began his excursion of profession at Ford as a sales rep and went through a phase when he was an amateur and needed to gain proficiency with about his activity. He learned different sorts of selling strategies and rehearsed them. During this underlying range of his vocation he went over numerous great guides and Lee was affected by them a ton. Moving a head in his profession and turned into a specialist in deals field he chose to offer himself a reprieve and got married. At the point when the author was a piece of companys top administration and became General Manager of the Ford Division he was an alien to everyone. Now throughout everyday life, he wanted to accomplish something important; with this idea and aspiration Iacocca utilized his abilities, information and gave the world Mustang. This first gem to his name made Lee a known from the obscure. The storyteller, likewise gave two exceptionally fine vehicles to Ford speci fically as Fiesta and Mark III. Here at Ford when Lee was president and giving a yearly turnover of $ 2 Billion to the organization. On the other, such a benefit however was going to the association, and making Iacocca well known and boosting its picture among its rivals. In any case, this thing and notoriety of Lee made Henry Ford to think precisely the inverse. Henry accepting this as an immediate danger to his position of royalty since everyone looked at Iacocca as their genuine pioneer and began hating Lee. All disdain winds up in terminating Iacocca from president transport. Subsequently the tale of essayist at Ford keeps going right up 'til the present time. Presently we will be taking a gander at the second piece of the book, which recounts to us about the journalists story at Chrysler. AT CHRYSLER:- To uncover the Chrysler days it is smarter to proceed to investigate first what occasions occurred in quite a while life when he was in the end gotten by the Chrysler individuals. At the point when Lee left Ford, he found a new line of work in a distribution center, where he just remained for barely any hours. Indeed, these couple of hours constrained him not to surrender at any expense. Leave regardless of the negatives and got just the positives and push forward. The embarrassment of being at a normal office directly in the wake of filling in as a leader of an incredible organization for such a large number of years. There, he chose to retaliate with his life and that outcomes into coming to at the top in Chrysler Motor Corporation. Here I might want to cite Lees words for what it's worth from the book which goes as there are times in each one life when something productive is conceived out of misfortune. There are times when things appear to be terrible to the point that you must get your destiny by the shoulders and shake it. I am persuaded it was that morning at the distribution center that pushed me to assume the administration of Chrysler just couple of weeks after the fact. The author before getting supervisor of Chrysler was extended to numerous employment opportunities from different organizations however none of them was from the car business. These were right from worldwide paper, Lockheed, Charles Tandy and business college of NYU. (New York University). Yet, lee wasnt fulfilled upon these contributions, since vehicles were his solitary world, and he cannot consider joining to some other calling. He is of the view that all business abilities are not exchangeable at any level. The purpose for his this way of thinking should just seek after that line or calling in which he/she had and has a grip over it. Where one is a star and not someone who is distanced to the field and employment. That is the reason when he declined these non-automobiles industry employments a famous French vehicle creator Renault, offered Iacocca the post of their Global Head of Automotive Consultant. Where upon, Lee dismissed their offer, on the grounds that however the activit y was from a vehicle industry, yet it was not that one in which he got aptitude. He declined them exclusively of the way that in this specialist work he always be unable to put forth a strong effort. Iacocca later needed to shape a consortium of vehicle organizations which he named as Global Motors. His goal was to fabricate an astounding consortium, would be situated in Europe other in Japan and ultimately in the US. This was totally intended to break the imposing business model of GM, which they have kept up from quite a long while. However, this undertaking wont work on account of American Antitrust Laws. After that occasion, Lee discovered that in the circles of vehicle industry there may be a likelihood that Chrysler will get him for its significant post. What's more, they are needing somebody who can possibly lead and adapt to any sort of trouble. In this manner, after some time Lee was drawn closer by the load up individuals from Chrysler, who held couple of informal gatherings with him which wound up in extending to an employment opportunity at their organization. Iacocca in his heart concluded that this time he would just acknowledge the main man position in Chrysler. Al ong these lines, he educated the Chryslers top administration about his this arrangement where upon they revealed to Iacocca that his course of turning into the supervisor will be somewhat unique. From the start he was made the president and subsequently turned into the administrator CEO of Chrysler on January first 1980. Till now we have discovered that authors venture at Chrysler has recently begun. What is in store of him will be uncovered in the following heading. Start OF ANOTHER JOURNEY:- At the point when the creator authoritatively joined his office at Chrysler, that day his association announced its misfortunes of about $160 million. This was without a doubt an awful occurrence with a human and the organization itself. Along these lines, the start of narrat

Eval Evaluation Essay Topics For College

Eval Evaluation Essay Topics For CollegeThe best way to get good grades in college is to write good evaluation essays. With the help of these helpful tips, you can master the evaluation essay topic and achieve the highest grade possible in your college course.Focus on what you really like and how you feel about it. Find out what people might be saying about you and why, so that you can add the positive spin to what you have to say. Just about everything that happens to you is going to affect your performance.Sometimes the easiest way to improve your performance is to focus on the negative. These types of topics will make you feel better about yourself and they will give you an opportunity to write something positive about yourself. In many ways this might be more beneficial than writing a positive essay. Most high school students don't like themselves very much, which makes it hard to believe that they are more capable than some of their friends.Read through the reviews online, make notes on what you like and dislike about a particular product or service. Also, look for the type of people who wrote these reviews. You want to pick topics that you admire from them.Finding a topic that you like is actually an easy task. Just find something that you can write about that reflects well on you, and then incorporate all of the things that you learned about the topic into your evaluation essay.Writing an evaluation can be difficult at times. However, if you keep it simple and focus on your strengths, you should find that it becomes easier. No matter what subject you choose to write about, just make sure that you are not overpowering the other topics or aspects of the content.Keep in mind that the results of your writing will show up in the final grade. You want to write about topics which will help you with your grade.

Infant Toddler Observation - 1282 Words

Within this paper 6 scholarly research articles focusing on infant and/or toddler development will be discussed. These articles will cover physical, cognitive, and social or psychosocial development. A 30 minute observation of a 1month old (Willow) and a 13month old (Emmett) will be conversed, with particular focus on physical development including body shape and motor skills, cognitive development, and social development. The information obtained in the observations will be compared to the information obtained from the scholarly articles. The first article explains how music plays a big role in social, physical, thinking and language development. Music quite often provides opportunities to practice patterns, math concepts and thinking†¦show more content†¦A number of individuals feel they obligate a natural sense of child-rearing with â€Å"instinctive† impulses in reaction to child actions. Some feel they knowingly or automatically modified child-rearing styles and methods from their individual mothers and fathers or other caregivers Observation: Willow 4 weeks old Willow smiles a lot for a baby of 4 weeks. She lifts her head when lying on her tummy, reacts to sound and gazes at faces. While her vision is not so well she will track things temporarily with her eyes voices oohs and coos. Willow will suck her thumb and or fist, when removed she will whimper and fuss. She will cry to let her Mom know that she is hungry, wet, dirty or uncomfortable. Willow does not move much, mostly involuntary movement. She has not started to explore her surrounds at this point in her development. Willow is learning trust through her parent’s consistent and patient response to her cries. She is quietly alert. Willow can display distress and being content. Willow will respond to her mother’s voice. When her mother’s voice is heard she begins to move her eyes around and respond with little kicks and flailing of her tiny arms. Willow is becoming more sensitive to her surroundings. Her vision and hearing is improving she is noticing more of what s going on around her. Willows interaction with people, really has no effect on her. She can be passed from person to person with no change in temperament. Emmett is a very active 13Show MoreRelatedObservation: Infant and Toddler Development1568 Words   |  7 PagesObservation: Infant and Toddler Development There are various factors that play a role in a child’s development. Based on several articles I will be discussing the physical, cognitive, and social development of infants and toddlers. The level of exposure to these various factors will determine how successful they develop in years to come. All children develop at their own rate and no two children are the same. The development of the child is based solely on child’s caregiver to provide these essentialRead MoreUniversal Needs Of Infants And Toddlers1651 Words   |  7 Pages Three universal needs of infants and toddlers Infancy is an important stage of life. At this stage, babies and toddlers will have universal developments or needs which can connect physical, cognitive, language, social, emotional domain of development. I would like to discuss three universal needs, which are important for the infant / toddler learning and development foundations. There are exploring the world, learning from observation, Infancy is one of the periods which has most exploring spiritRead MoreUsing Video Based Techniques For Children Essay1198 Words   |  5 PagesINVESTIGATING THE â€Å"WHAT, HOWS AND WHYS† OF RELATIONAL PEDAGOGY WITH INFANTS AND TODDLERS Summary: According to the study, Researchers from TLRI and teachers came together to find solution to the key issue of understanding and articulating the â€Å"what, hows and whys† of infants and toddlers to support learning. Two hour video footage and learning stories compiled by teacher for three or four children per centre across five infants and toddler care centre from Auckland and Wellington were used as practiceRead MoreTransitioning For Children Transition Into Childcare Care1505 Words   |  7 Pages Transitioning to Strangeness Adults and infants/toddlers are very similar in the respect that we obtain great satisfaction and are tranquil to familiar people, places and environments, as we can slightly know what to expect. In terms of new situations, environments and people we become unsure, no sense of belonging maybe even anxious. In regards to children transition into childcare care, or from one room to another within the centre, there is always an element of unfamiliarity yet curiosity. ThisRead MoreHow Do Infants And Toddlers Develop Their Cognitive Abilities?1372 Words   |  6 PagesHow do infants and toddlers develop their cognitive abilities? Essentially, the formative years of research on the aspect of cognitive growth in infants made certain assumptions, for instance, an infant growth was significantly simplified. However, modern research indicates that there is a complex pattern of cognitive development in infants. To answer the question, it is imperative to start by understanding what the cognitive aspect of the development of infants is. Ideally, infants and toddlersRead MoreErikson s Stages Of Development And Child Directed Speech862 Words   |  4 Pagespsychologist and psychoanalyst, from birth to 1 year of age, children psychosocially go through the stage of Trust vs. Mistrust. At this stage infants either trust they will be taken care of in their basic needs such as physical contact, cleanliness, nourishment, and warmth or â€Å"develop mistrust about the care of others† (Berger, pg. 24, 2014). In observation one (infant), it was clear that the child trusted his parents, however, it was especially displa yed with his mother. The child’s biggest display ofRead Morecompetency statement 3780 Words   |  4 PagesPennsylvania Department of Education Bureau of Career Technical Education CDA-Ready Certificate Documentation Infant/Toddler (Developed from The Child Development Associate: Assessment System and Competency Standards Infant/Toddler Caregivers in Center-based Programs, Second Edition,  ©2006, www.cdacouncil.org ). Student Name: _______________________________________________________________ School: Instructor: ___________________________________________________________ Instructor ContactRead MoreMindful and Reflective Practice Essay1120 Words   |  5 Pageshelped me to learn ways to promote healthy development and well-being of all children and how to be an advocate for them. I believe this class enriched my knowledge about infant-toddler care and education to the point that I would most like to express to others its importance. One thing that I would like to share is that infant–toddler care and education is crucial for physical and cognitive development. The caregiver/parent interaction is necessary for the children to keep alive the desire for communicationRead MoreThe Effects Of Language On The Development Of A Child1261 Words   |  6 Pagesand/or guardians of infants and toddlers with Down’s syndrome believe that their child will one day be able to verbally communicate with them. They presume the possibility, but does research support their beliefs? For the purpose of this paper, the child from infancy through three-years o ld will be discussed in regards to the developmental domain that are affected by Down’s syndrome. The undeniable assumption is if an institution provides early intervention for an infant or toddler with Down’s syndromeRead MoreEssay On Childcare1323 Words   |  6 Pages(EHS-CC) partnership program located in the Vermillion area. A very recent program started on January 1, 2017 that runs all year round and serves infants and toddlers starting from just six weeks old to two years old. There is currently a waiting list for children to be enrolled in the program, but are currently servicing eight toddlers and six infants. The Vermillion EHS-CC is open four to five days a week from 9:00-3:30 each day. The program also provides wrap around childcare from 8:00-9:00 and

Renaissance The Last Supper - 1418 Words

Renaissance Art CP The Renaissance took place from the 14 century through the middle of the 17 century. It was a time of social rebirth in Italy and the mid west of the world. It reconstructed the political, social, and religious status of society in this area. It was a revival to follow the learning and values of Greece and Rome once again in a world ruled by political stability and the desire for development and prosperity. This was majorly reflected by the artists of this time presenting the mysteries and wonders of the natural world in their work. During this time there were multiple artists of professional status, whom we still remember today and honor for their expertise. These individuals were the forefront of the Renaissance and†¦show more content†¦Multiple years of restoration attempts finally resulted in a restoration of the painting, but there were very few original strokes left of the mastery behind Leonardo Da Vinci’s paintbrush. In relation to the story that the picture told, it was an interpretation of the supper which Jesus had before his hanging on the cross. The painting also represents the moment after Jesus reveals that one of His own disciples will betray Him, leading to His capture before crucifixion. It truly captures the distress amongst the disciples and the confusion, anxiety, and worry in their hearts. While in this moment of commotion, Jesus is found in the center of it all in a state of acceptance and found reaching for the bread and wine that He uses to show His love and sacrifice to the disciples. It is a painting that represents a turning point in the life of Jesus and these men. Within in the painting, is there a sign of Anger? Confusion? Peace? Debate? As the men turn to converse with each other, appearing to fall victim of doubt and questioning toward the leader whom they had been following for years now and given their whole life to, they were experiencing multiple emotions. They wondered why He told them that He was going to let one of them betray him as He could just snap his fingers and prevent any event of the sort from occurring. They were of the human mind and

Renal Failure free essay sample

The purpose of this paper is to utilize the importance of evidence based practice in the clinical setting by incorporating the validity in planning care for the patients whom endure renal disease. Evidenced based practice is such a crucial part in obtaining as much knowledge needed to prioritize and efficiently plan care. This is why it is important for nurses to individualize a patient’s care because nursing care is not universal for all. This paper will review a retired tobacco/dairy farmer. He is an obese, 76 year old white male who was admitted to the hospital with complications from renal failure. The kidneys play a vital role in the body by removing waste products and excess fluid in the body, which is performed through excretion of urine. This process is necessary to maintain a stable balance of chemicals in your body through excretion and re-absorption. The functions of the kidneys are to; balance the body’s fluids, remove drugs from the body, control the production of red blood cells, remove waste products from the body, and release hormones that regulate sodium and fluid in your body. We will write a custom essay sample on Renal Failure or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page If the kidneys are unable to filter the blood by failing to excrete excess wastes and fluids there may be a build up in your body causing other complications. The warning signs for kidney disease are; blood/protein in the urine, high blood pressure (HTN), generalized edema, frequent and/or painful urination, glomerular filtration rate (GFR) of less than 60, and a blood urea nitrogen (BUN) and creatinine test outside the normal range (Moustakas, Bennett, Nicholson, Tranter, 2012). Assessment Data On admittance to the hospital, Mr.  B was experiencing fatigue and excess weight gain of over 10 pounds in the last few weeks. Upon assessment at a measurement of 5 ft. 8 in. his weight was 219. 1 lbs. with a body mass index (BMI) of 33. 3. He complained of excess fluid accumulating in his upper and lower extremities. Mr. B had +1 pitting edema in his bilateral lower and upper extremities. During the last few weeks, Mr. B has said to be experiencing shortness of breath during exertion and often times at rest. He has had a decrease in urine output of less than 30 ml. an hour during his stay. His appetite has decreased during his hospital stay due to his increase fatigue and lethargy. He is on a renal/non-concentrated sweets diet and only eats approximately 10%-15% of his meals. His lung sounds were clear in the upper lobes with diminished sounds in the bases of his lungs. His respirations were 22, oxygen saturation (O2 Sat. ) 96% on 2 liters nasal cannula. His blood pressure was 108/43, with a heart rate of 78. Mr. B developed a hematoma on his right arm from a previous fistula that didn’t infuse correctly during his previous dialysis treatment. A central line was placed in his left chest during his stay due to the failed fistula. He developed a yeast infection in the left central line, which went septic and another central deep line was placed in his right IJ for future dialysis treatments. On admission Mr. B had an ECHO and an EKG done which displayed atrial fibrillation (AFIB) and an ejection fraction (EF) of 55%-65%. Mr. B has a history of atrial fibrillation and is currently on Coumadin therapy for thrombolytic prophylaxis. A chest X-ray was done that showed bilateral interstitial opacities and small pleural effusions. These findings on the chest X-ray are relevant to renal disease due to excess fluid accumulation within the pleural cavity, which may conclude the diminished lung sounds found during auscultation. A CT Scan of the chest displayed patchy consolidation throughout, which may also support the excess fluid accumulation that can occur during renal failure. Mr. B’s glomerular filtration rate (GFR) was 20 ml/min which is low due to his kidneys not being able to function properly at filtering the blood. Due to his GFR being low, his D-dimer was elevated at 1315 ng/ml. His blood urea nitrogen (BUN) was 70 mg/dL, and creatinine was 3. 22mg/dL which are both high levels as a result of his kidneys not being able to excrete excess nitrogen and urea, as well as creatinine from the blood. Mr. B’s urine chemistry indicated high protein levels in his urine (100-200) because of the inability of his kidneys to filter protein from the blood therefore excreting proteins as waste. As seen on Mr. B’s complete blood count (CBC), his red blood cells (RBC) are low at 3. 25, with a low hemoglobin (Hgb) at 9. 5 g/dL and his hematocrit (Hct) was also low at 30.2 %. These findings may play a role in why Mr. B could be lethargic and fatigued. Brain type natriuretic peptide (BNP) was elevated at 33,700. This is likely due to the lack of clearance of BNP from the body due to his renal failure. His BNP may also be elevated due to his congestive heart failure, due to the increase workload on the left ventricle. BNP released by the heart may indicate decreased cardiac output, which may indirectly relate to excess fluid volume within the vascular system. Mr. B’s calcium level was also low at 7. 8. This is likely due to his loss of appetite since most of the calcium we provide our body is through our diet. Due to his renal failure he is unable to absorb calcium as well, which also leads to low circulating calcium in the blood. Medications Mr. B is on Diflucan, this medication is an antifungal that is used to treat and prevent fungal infections in the body. Some common side effects associated with Diflucan are unusual weakness, fatigue, and loss of appetite. Mr. B experienced all of these symptoms during his stay which could have been a side effect of this medication. He was on this antifungal for treatment of his yeast infection that he contracted from complications of his central line. Mr. B is also taking hydralazine. Hydralazine is used by relaxing the blood vessels so that the blood can flow through the body more easily which helps lower blood pressure in the body. Mr. B has high blood pressure and is on this medication to help control it. Due to his renal failure, his blood pressure is increased due to the excess fluid volume in his body. Some common side effects that Mr. B experienced during his stay while on this medication were constipation and loss of appetite. He was prescribed Megace in the hospital to help stimulate his appetite as well as stool softeners to help with his constipation to make it easier for him to have a bowel movement. Mr. B was also given Drisdol during his stay. Drisdol is another name for Vitamin D, which is a fat-soluble vitamin that helps your body absorb phosphorus and calcium. This medication is used primarily to help promote bone density. When calcium levels are low in the body, the parathyroid glands produce increase amounts of the parathyroid hormone which causes the body to pull calcium from the bones to increase the amount of calcium in the blood. This can happen when the kidneys are not functioning properly. During normal kidney function, the body turns Vitamin D into an active hormone which increases calcium absorption in the intestines which helps increase the amount of calcium that is circulating in the blood. This is why people who have renal failure are at risk for osteoporosis, fractures and other bone disorders because they are lacking in Vitamin D. This is why Mr. B is prescribed Drisdol to help his body absorb calcium. Drisdol is better absorbed in the body when taken after a meal. However, it can be taken without food if necessary. Since Mr. B had a loss of appetite during his stay at the hospital, he was not getting the proper amounts of calcium in his diet. It is important for him to be on a medication that helps increase his calcium levels since calcium plays an important role in bone growth development. Calcium also plays a role in stabilizing blood pressure due to it being essential for muscular contraction for the heart to pump efficiently and is essential for blood clotting. Calcium works in the body with vitamin k to help the blood clot and without adequate levels of these nutrients, the body is at an increased risk of bleeding. If someone is on a blood thinner it is important to monitor them more closely for signs of bleeding because they already bleed more than someone who is not on a blood thinner. Since Mr. B has a history of high blood pressure and is on Coumadin for the treatment of chronic atrial fibrillation, he is at risk for bleeding by reducing clot formation so calcium levels are important to monitor as well as his blood panel (Potts, 2012). Presented with allergies such as; Cephalexin Monohydrate, Hydrochlorothiazide (HTCT), Lisinopril, Pseudoephedrine, Pseudoephedrine HCL, he should not experience any interactions with any of the medications he is taking. Once Mr. B’s renal system stabilizes and regains adequate function he will most likely be placed back on his Lasix which is a loop diuretic. Recent research has shown that loop diuretics are the hallmark pharmacological treatment for excess fluid volume. To help facilitate optimal fluid status the dose of the loop diuretic may be titrated intravenously to fit specific needs related to fluid excess (Albert, 2012). Health Maintenance and Past Medical History While in the hospital, Mr. B displayed good general hygiene, and is up to date with his influenza, pneumonia, and shingles vaccines. He has been tobacco free for 14 years and denies any use of alcohol. Prior to his health declining in the past few years, he enjoyed being outdoors and remained active by walking at least a mile a day. At home, his wife stated that Mr.B is pretty good at controlling his blood sugar on a daily basis by eating healthy, exercising, and taking his insulin as prescribed. Mr. B has a past medical history of; congestive heart failure (CHF), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), asthma, hypertension (HTN), anemia, diabetes mellitus, myocardial infarction (MI), hyperlipidemia, gastrointestinal reflux disease (GERD), benign prostatic hypertrophy (BPH), diverticulosis, vitamin D deficiency, skin cancer, renal disease, chronic back pain, right ankle fracture, cataracts, and depression. He has had a past surgical history of; an angioplasty/stent placement in 2012, and removal of his right cataract, a colostomy, and a colon resection with colostomy reversal. Attributable to the fact that his mother past away of a myocardial infarction at the age of 64, Mr. B is more susceptible to vascular problems himself. On admittance of renal failure to the hospital, Mr. B’s primary diagnosis was excess fluid volume related to his kidney’s insufficient ability to filter out excess fluid from the blood. His wife mentioned that he has gained about 10 pounds or more weight in fluid over the past few weeks. His chest x-ray showed bilateral interstitial opacities and pleural effusions, which means he has an accumulation of fluid in his interstitial space. He has had a productive cough with clear sputum and his lung sounds were clear in the bilateral upper lobes and then gradually diminished in the bilateral lower lobes. His diminished lung sounds may have been due to the pleural effusions found on the x-ray. His CT scan displayed patchy consolidation which also could support his excess fluid accumulation. As previously stated, Mr. B’s abnormal lab findings of; a low GFR, increase BUN and creatinine, proteinuria, increase BNP, decreased Hgb, Hct, and decreased RBC are all indicative of renal dysfunction. His intake of fluids for the shift was 425ml and his urine output for the same shift was only 225 ml. which shows he was retaining 200 ml of fluid. As a direct result of his excess fluid retention, Mr. B’s secondary diagnosis was imbalanced nutrition related to inadequate food intake. Inadequate food intake resulted in less than body requirements that his body needs to stay healthy. His kidneys inability to regulate excess fluid caused increased water retention in his extremities and throughout his body. He had +1 pitting edema in his lower and upper extremities. Excess fluid retention led to Mr. B being short of breath on exertion and fatigued. Being fatigued caused Mr. B to sleep large amounts during the day which caused him to not wake up much to eat his meals regularly resulting in a lack of nutrition. When Mr.B would wake up for meals he stated â€Å"this food isn’t like what she (his wife) fixes me. Expected Client Outcomes The first outcome Mr. B would like to achieve is a urine output of at least 30 ml per hour. Mr. B should also show a decrease in fluid volume retention as evidenced by a decrease in body weight. The second projected outcome is for Mr. B to have normal lung sounds that are clear throughout with no diminished sounds. This will be assessed and evaluated by auscultation of Mr. B’s lung sounds by discharge. The third important outcome for Mr.B to achieve upon discharge is decreased dyspnea, decrease edema in his lower and upper extremities, and improved activity level of at least walking short distances without getting short of breath. The fourth outcome we would like to see normal lab values pertaining to his kidney function and nutritional status before discharge. Mr. B is on 2 liters nasal cannula for comfort due to the shortness of breath he has been having. One of the outcomes we would like to achieve is to have Mr. B maintain oxygen saturation above 90% without use of oxygen before he leaves the hospital. Since Mr.B hasn’t been having much of an appetite another projected outcome is for him to eat at least 75% of his meals so that he can get adequate nutrition which will also help improve his strength. Nursing Interventions Due to Mr. B’s kidneys inability to filter out excess fluid from his blood he was placed on dialysis to help filter out the blood and reduce the fluid volume. A foley catheter was placed upon admission to help keep better track of his intake and output. Although, Mr. B’s blood pressure was substantially low at 108/43 on initial assessment, he does have a long history of hypertension. Evidence based researched presented by Lingerfelt Hodnicki (2012) displays HTN as the major risk factor in the occurrence and prevalence of chronic kidney disease. This is why it is crucial for Mr. B to not only know, but as well understand and perform how to monitor his BP. Utilizing automatic BP monitor devices are very helpful when monitoring BP at home. Evaluating Mr. B’s weight on a daily basis will help measure how much excess fluid he is retaining and it’s also important before and after dialysis treatments to make sure adequate fluid is being removed (Schick, 2012). Since Mr. B has had a decrease appetite since he has been in the hospital he was started on Megace, which is a medication that helps stimulate his appetite (Shumaker, 2009). Before discharge Mr. B may need to think more about gradually gaining stability while helping improve quality of life by an argument brought upon by Walsh Fahy (2011) which argues; that many health care providers overlook the significance in stressing a healthy diet, and as a result neglect the patient’s weight management. Ultimately, setting Mr. B up for complications far more substantial in the future. With being 5’8 in height and having a BMI at an elevated 33. 3 and weighing in at 219. 1 lbs. Mr. W. over displayed the qualifications needed for further education and reference to dietary. Since Mr. B has been complaining of shortness of breath at times, as previously stated he was started on oxygen to help him feel more comfortable and maintain adequate oxygen saturations above 90%. In addition to the oxygen, he was also given breathing treatments, which consisted of Albuterol-Ipratropium and Pulmicort. Resulting from Mr.B’s condition he is lethargic and fatigued, it is important that he is given proper rest from daily routines, healthcare workers and as well as visitors. Untreated fatigue may greatly impact quality of life, which may lead to depression, weakness, increased dependency and social withdrawal (O’Sullivan McCarthy, 2009). Due to the fact that Mr. B had an increase amount of swelling in his extremities, ace wraps were placed on his bilateral lower extremities to help increase venous return. While Mr. B is on hemodialysis and has a central line in place it is important to maintain a clean site. Using Chlorhexidine soap would help fight against infections by sterilizing the ports used during dialysis. Based on cost of supplies evidence based practice has shown that using the Chlorhexidine soap is the most cost-effective while fighting catheter related infections (Bakke, 2010). Evaluation During the clinical shift, Mr. B did not meet the projected outcome, while still edematous in his upper and lower extremities and his urine output is still less than 30 ml. an hour. Given time, the projected outcomes for Mr. B will be achieved by meeting previously mentioned criteria for the given interventions. Having an overall goal of decreased fluid volume excess with an increase in Mr. B’s quality of life, as evidence by; decrease in routine assessment of daily body weight, urine output of at least 30 ml. per hour, absent of diminished lung sounds, and maintains adequate oxygenation without episodes of shortness of breath. If the outcomes are not reached in the projected time, it is the nurse’s responsibility to suggest more drastic interventions to help reach the goals stated or develop a more realistic outcome to be reached for Mr. B.