Pelvic Inflammatory Disease Diagnosis And Management Nursing Essay

Pelvic Inflammatory Disease Diagnosis And Management Nursing Essay Pelvic inflammatory disease is an infection which causes wide variety of infection from upper to lower genital tract.(1) It ascends from cervix or vagina to peritoneal cavity include endometritis, salpingitis, parametritis, oophoritis, tuboovarian abscess and pelvic peritonitis. (2,3) PID is a major problem in public health consequences because it is related to fallopian tube inflammation which can lead to infertility as a final complication.(1) PID is polymicrobial disease, so some sexually transmitted microorganisms are associated with PID. These are Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoea, and bacterial vaginosis, predominantly anaerobes. (4, 7) PID can be prevent by regular screening for Chlamydia infection and appropriate treatment of it. (4) There is no single diagnosis or finding that can do specific diagnosis of PID. The diagnosis is based on the result of pelvic organ tenderness. Mild-to-moderate PID patients are treat as out patient which include tolerated antibiotic regimens against common microorganism in PID Clinically severe PID treatment done as hospitalization of the patient. (11) Sexually active women especially at the reproductive age and under the age of 25, are at the highest risk for acquiring this disease through sexually transmitted bacteria. The intrauterine devices (IUDs) are also increased risk in women who have this device in their uterus for contraception.(6) Pic: The female anatomy (6) Differential diagnosis: In case of PID the clinician should concern about differential diagnosis before confirm the diagnosis. The differential diagnosis PID of can be as follows (3): Ectopic pregnancy Endometritis Salpingitis(8) Cervicitis (8) Ovarian cyst torsion, rapture or malignancy UTI Appendicitis Clinical Diagnosis of PID: Clinical diagnosis of PID is based on the combination of patients clinical history, physical examination and some laboratory studies.(2,5) The following findings are important for diagnosis of PID: Physical or general finding: Low grade temperature, lower abdominal pain, abnormal intermenstrual bleeding or metrorrhagia, abnormal cervical discharge, postcoital pain and bleeding, urinary frequency, low back pain, nausea and vomiting.(5,8) Bimanual pelvic examination: Cervical and uterine motion tenderness or adnexal tenderness should present for confirming the diagnosis of PID.(10). Laboratory finding: Leucocytosis more than 10 x 109 WBC/L , elevated C-reactive protein, elevated ESR, Gram negative intracellular diplococcic on gram stain, and positive Chlamydia test.(5) Some definitive diagnosis: Endometrial biopsy for endometritis, transvaginal sonography or ultrasonography for pelvic or tubo-ovarian complex and the laparoscopic abnormalities associated with PID.(5) Management The PID management include short term and long term treatment. Short term treatment help to reduce or eliminate the sign symptom of patients. On the other hand long term treatment help to decrease the further complications. Outpatient therapy: As aforementioned that mild-to-moderate PID patients are given treatment as out patient therapy (5) Recommended Regimen: ceftriaxone 250 mg im as one dose + doxycycline 100 mg orally 12 hourly for 14 days or Azithromycin 500 mg orally followed by 250 mg orally daily for a total of 7 days + metronidazole 400 mg orally 12 hourly for 14 days Inpatient therapy: Clinically severe PID treatment done as hospitalization of the patient. (11) Recommended Regimen(5): Clindamycin 900 mg intravenously every 8 hours for 14 days PLUS Ceftriaxone 1g intravenously every 12 hours for 14 days Alternative Regimens(12) Cefoxitin 2 g intravenously every 6 hours for 14 days OR Cefotetan 2 g intravenously every 12 hours for 14 days PLUS Doxycycline 100 mg orally or intravenously every 12 for 14 days hours OR Ampicillin/sulbactam 3 g intravenously every 6 hours for 14 days PLUS Doxycycline 100 mg orally or intravenously every 12 hours for 14 days Indications for hospitalisation If the patients are required intravenous therapy for serious clinical condition, then patient should be hospitalised. The following patients should be hospitalised, clinically severe patients, pregnant woman with PID, surgical emergency such as appendicitis, ectopic pregnancy, failure of out patient therapy and immunodeficiency patient. (5) Removal of IUCD The intrauterine devices (IUDs) increased the risk of PID. So IUCD should remove if there is any clinical evidence of PID.(6) Complication of PID: Delay in diagnosis and treatment, or inadequate treatment increase the rate of complications.(13) The complications are (13): Chronic lower abdominal pain Ectopic pregnancy Increased risk of PID in future Tubo-ovarian abscess. Infertility The points should known to patients (5): It can be acquired other than sexually transmitted and the partners also should be tested and treated for sexually transmitted infections. The nature of infection and complication should be known to patients and they should know the importance of follow up. Contact tracing Contact tracing is finding and notifying the person with the infection so they can have counselling, testing and treatment and it is important for prevention the long term health problem.(9) Follow-up Close follow up is necessary for prevention of complications.(5) Prevention: Prevention of STD is necessary to prevent PID. So early detection of any lower genital infections is necessary to prevent PID. (14) Cervical Chlamydial infection identification and treating can make smaller the incidence number of PID. (4) Finally, sex partners of women with PID should be examined and treated for gonococcal and Chlamydial infection for prevention the spread of STDs in the community.(14)

Moral Matters in Hamlet :: essays research papers

Each book has its own fate, but there are a few works of art, that can compete in fame the most mysterious piece of art by Shakespeare –, the tragedy ‘,Hamlet’,. There is a bountiful amount of matters- moral, philosophical, and social ones, set in the plot of the book. The tragedy of the humanist and the fate of one honest person in the era of Renaissance, his tragic dilemma about his love and duty, about the crime, the punishment and the retribution, will never stop provoking the readers of ‘,Hamlet’,. What actually is situated in the core of Hamlet’,s tragedy?!? Is it just his confused mind because of his father’,s murder, or because he has not got enough strength to revenge for the terrible crime?!? The reasons for Hamlet’,s tragedy are more complicated and considerable than the disturbed mental balance and weakness, which turns out to be obvious. His rambling and suffering are deeply seated in a person, whose ideas of morality and humanity, good and evil are torn down suddenly and irrevocably. That is the tragedy of the humanist Hamlet, caused by the conflict between his ideals, regarding mankind and their wild passion for power and wealth at any price. Brought up with the spirit of humanism, Hamlet suffers a deep spiritual stress because he has to cope with evil in all of its dimensions for a short period: a murder, fratricide, adultery, incest, treachery and complicity of the crime. Shockingly for him, the people who have done the evil deeds are those who he loves- his uncle, his own mother, his love, some of his friends who he has known since his childhood. This confrontation with the evil that follows and attacks him takes the joy away from Hamlet and distorts his ideal of humanity. Hamlet seeks the relation between him and the common taint and violence which surround reality from the beginning itself. According to him the murder has been done because of these factors of disgust and hatered. His disappointment leads him to the insight that Denmark is a beautiful prison. Moreover, the tragedy of a humanist, forced to live in an inhumane society changes his idea of the world, which now different and in his view is a des ert garden, ruled by the weed that is among people.

The Fashion Channel †Case Study

The Fashion Channel – Case Study Exercise 1: What is expected outcome of each of the targeting scenarios? (complete both the Ad Revenue and Financial calculators to fully understand the financial impact of the scenarios) Exhibit 4: Ad Revenue Calculator TV HH Average Rating Average Viewers (thousands) Average CPM1 Average Revenue/Ad Minute2 Ad Minutes/Week Weeks/Year Ad Revenue/Year Incremental Programming Expense 1 Revenue/Thousand Viewer 2 Calculated by multiplying Average Viewers by Average CPM Current 2007 Base Scenario 1 110,000,000 110,000,000 110,000,000 1. % 1% 1. 2% 1,100 1,100 1,320 $2. 00 $1,80 $1,80 $2,200 $0 $0 2,016 2,016 2,016 52 52 52 $230,630,400 $0 $0 $0 $0 Scenario 2 110,000,000 0. 8% 880 $3,50 $0 2,016 52 $0 $15. 000. 000 Scenario 3 110,000,000 1. 2% 1,320 $2,50 $0 2,016 52 $0 $20. 000. 000 Exhibit 5: TFC Estimated Financials for 2006 and 2007 Revenue Ad Sales Affiliate Fees Total Revenue Expenses Cost of Operations Cost of Programming Ad Sales Commissions Marketing and Advertising SGA Total Expense Net Income Margin 2006 Actual 2007 Base Scenario 1 Scenario 2Scenario 3 Assumptions Insert scenario results from revenue calculator Grows 2% per year with population $230,630,400 $207,567,360 $249,080,832 $323,882,560 $345,945,600 $80,000,000 $310,630,400 $81,600,000 $81,600,000 $81,600,000 $81,600,000 $81,600,000 $81,600,000 $81,600,000 $81,600,000 $70. 000. 000 $72,100,000 $55. 000. 000 $55,000,000 $72,100,000 $55,000,000 $7,472,425 $60,000,000 $41,200,000 $72,100,000 $70,000,000 $9,686,477 $60,000,000 $41,200,000 $72,100,000 $75,000,000 $10,378,368 $60,000,000 $41,200,000Grows 3% per year with inflation Add incrementa l programming expense 3% of ad sales revenue Reflects increased spending of $15M Growing with inflation 3% Spradsheet calcuates automatically Spradsheet calcuates automatically Spradsheet calcuates automatically $6,918,912 $45,000,000 $40,000,000 $6,227,021 $60,000,000 $41,200,000 $216,918,912 $113,300,000 $113,300,000 $11 3,300,000 $113,300,000 $93,711,488 30% $54,640,339 19% $94,908,407 $151,496,083 $168,867,232 29% 37% 39% Exercise 2: Analyze the segmentation options and discuss pros and cons of each.Broad-Based Marketing Pros: When we compare the Net Income of the base 2007, the broad-based Marketing segment will deliver almost $40,000,000 more. Also by the investing in a major marketing and advertising campaign the Average Rating will increase from 1% to 1. 2%. Another advantage of this segment is that it does not need any additional costs of programming, like the other two segments. Cons: A disadvantage of this segment is that the competition would continue to penetrate the premium segments and further erode TFC? s pricing ability. In addition to that the average CPM will decrease $0,20 in comparison to the Current CPM.Fashionista Segmentation Pros: An advantage of this segment is that the Net Income in comparison to the Net Income of the Based 2007 will increase by almost $100,000,000. It is al so strong in highly valued 18-34 female demographics. Because of this the CPM will decrease to $3. 50 because of strengthen the value of the audience to the advertiser. It is also strong in highly valued 18-34 female demographics. Cons: To attract and retain the interest of this segment it is necessary to invest in new programming. This would mean they would have $15,000,000 more spending per year on programming.Another disadvantage it is smaller than the other two segments and represents only 15% of households, this can lead to a drop in the viewers of the other clusters. Another disadvantage is that the average Rating will decrease from 1. 0% to 0. 8%. Focus on the â€Å"Fashionistas† segment This segment was strong in the highly valued 18. 34 female demographic New programming are necessary to attract and retain the interest of this segment Spend 15$ million on programming Focus on â€Å"Fashionistas†, Planners and Shoppers and â€Å"Situationalists† Focus on Women aged between 18-24Fashionista plus Planners/Shoppers Segmentation Pros: An advantage of this segment is that the Net Income will increase more than $100,000,000 in comparison to the Net Income of the 2007 Base. Also the CPM will increase to $2,5 because of a dual targeting. In addition to this the average Rating will increase from 1% to 1. 2%. Cons: To ensure that there were selections aimed at both segments; Wheeler needs to spend $20,000,000 more on programming. Because of the determination only on this two segments it can be that the number of the loyal viewers of TCF will decrease.Exercise 3: If you were Dana Wheeler, what would you recommend and why? If I was Dana Wheeler I would recommend TCF that they should adopt Scenario 3. However, Scenario 3 has a few disadvantages. For example the possibility to lose some loyal viewers and furthermore TCF has to spend $20,000,000 more on programming which means investing a lot of money for them. But in my opinion, in Scenario 3, t he benefits exceed the disadvantages. On the one hand through this Scenario the Net Income will increase more than $100,000,000. In addition to that the CPM will increase to $2,5 and the verage Rating will increase from 1% to 1. 2%. On the other hand 50% of all US Television Households consist of Fashionistas and Planners/Shoppers. In these two markets the 18-34 year old female audience represents 50% and 25% of the cluster respectively. TCF should therefore increase the advertising revenue. The Scenario 3 is better than the Scenario 2 because Scenario 2 only focuses on the Fashionistas and doesn? t include Planners/Shoppers which are also important to consider. Target at â€Å"Fashionistas and the Shoppers/Planners Spend 20$ million on programming

Descriptive Speech On Disgrace - 1098 Words

How can anyone expect to learn unless they make mistakes? Receiving unnecessary comments from another pupil isn’t ever compelling. I can’t imagine anybody in this universe that prefers to be talked down by their peers; being told you’re incorrect is extremely humiliating. Mistakes are matters than can escalate out-of-proportion due to peers overwhelming you with anxiety; there’s nothing we can achieve to control this besides, development, cognitive therapy, or medication. Genuinely a majority of my mistakes occur in band class when playing the trombone. These mistakes range from cold lips, not focused (Off-Task), intonation, etc. Music is without a doubt entertaining to hear, but performing music does have its obstacles. Practicing has†¦show more content†¦My ears were racing with sound, from the woodwind instruments; they sounded absolutely exquisite from tone to articulation to even the trill. Before I could lay my hands on my warm lap, our teac her calls upon us to perform. Nervous wasn’t even the word you could describe. Anxiety was haunting my existence! I take in my air as if I were a vacuum that was sucking dirt out of a carpet. Still taking in the cold dark air, my heart started to sprint as the first note was projected. Surprisingly, no notes were cracked in this challenging spot; some of the notes are three ledger lines above the bass clef staff. My chops were warm and feet were ready for the next song â€Å"Can’t Hold Us†. In my previous year I performed Can’t Hold Us with no malfunction what so ever. Odd reasoning entered my mind and I imagined myself playing it poorly. I immediately overcame these terrible â€Å"mind games† and moved onto the optimistic point-of-view. I started to imagine myself playing the song with absolute precision. Picking up my horn felt, such as sticking my whole hand into a bucket of ice cubes. My trigger was as stiff as a board and my slide felt moving school glue. 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