Assessment of the child with complex needs Essay

Assessment of the child with complex needs - Essay Example Overall I feel that despite the set of abilities which the pupil demonstrates, she needs a holistic communication system that aims at making use of all the senses to support her communication, understanding and education. In addition to the diagnoses, reports dated 11.11.2010, 9.9.12.2010, 10.3.2011 by a multi-agency team based at Great Ormond Street Hospital for Children indicate that Pupil Z’s abnormalities in development impact on her motor development, and her visual and cognitive processing that support communication and learning. For example, the cerebral palsy affects her ability to control her body, head and eye movement, and this further impacts her learning and cognitive development. Due to the complexity of her needs she now attends a special school which caters for children with sensory impairments and learning difficulties. Aiming to determine the Pupil Z’s functional vision available for communication and education, led me to a review of literature and con cepts relating to assessment of learners who present significant difficulties for researchers. Addressing the issue of the heterogeneity of deaf-blind / multi-sensory impaired population was essential in selecting an assessment approach to assess functional vision for my pupil (Robson 1993 & 2002). ... There is literature relating directly to assessing vision for learners with multiply disabilities based on systematic investigation. However, I have chosen ‘Vision for Doing’ model designed by Stuart Aitken and Marianna Buultjens (1992) as this approach allows me to assess Pupil Z’s functional vision in the context of multiple disabilities. The strengths and limitations of this particular assessment model have been evaluated below. I observed Pupil Z over three weeks participating in group and one-to-one activities with different people. I noted time of the day; places (classroom, sensory room) and positioning (wheelchair, standing frame) to learn about how she uses her vision for learning. I felt that observations of Pupil Z during routine activities / tasks would be the most effective method of collecting data as it would give me first hand evidence of Pupil Z’s visual abilities. I also felt that well established routine activities will motivate her to us e her vision and try to communicate her responses more. SECTION 3 OBSERVING THE PUPIL Z Pupil Z likes / dislikes Activities: Likes / dislikes Number of observers: 1 Positioning: Pupil Z was observed in a quiet, distraction-free area as well as the busy classroom at a time of the day when she was alert and displaying neutral and communicative behaviors. She was positioned in her wheelchair / stander, 19.7 inch from the screen. Listening / watching to a story / song on the plasma screen: â€Å"We are going on a bear hunt† â€Å"Incy Wincy spider† Observations: During three weeks of observation of Pupil Z despite showing pockets of abilities, she was not consistent in her responses to these activates. We have observed mixed responses to both activities,

Pop-culture Essay Example | Topics and Well Written Essays - 1250 words

Pop-culture - Essay Example The print and the electronic media, entertainment tools like music and television, have done absolute justice to the job of brainwashing the impressionable minds of youth. Traditional culture and ideology have traditionally been the binding forces of the society, but in the contemporary age, spirit of the youth is being systematically destroyed by the onslaught of popular culture. The traditionalists and the modernists are permanently at war over approaches to social issues. While the modernists are positive that their endeavors are directed at development of a new society, the traditionalists lament about the steady demise of the indigenous values. A world of interconnectedness is slowly emerging and no one can precisely estimate how circumstances would shape up in the future. However, a strong view prevails that this interconnectedness is heading toward decay of moral and ethical values rather than leading to the path of cohesion and prosperity. In its attempt to pursue individual happiness, the younger generation has compromised societal values and become distracted and clueless. Ill effects of their activities mostly outweigh their honest dispositions and merits. An offshoot of the popular culture viz. the growth of Jazz provides an example. Jazz music arrived like an avalanche on the American media and became omnipresent in no time. Its growth was not contemplated, like the spread of greenery in the thick jungles of Amazon. The sapling of Jazz grew as it was watered with the agony of the black people. The roots of jazz can be traced back to the times of slavery when slave work songs were made as ‘call-and-response’ to narrate stories for pastime. These songs reflected the blacks’ internal rebellion against the sufferings and cruelties inflicted on them by the white race. Black people brought with them jazz to the big cities as they started to migrate to Chicago and New York with

Hank williams Sr Essay Example | Topics and Well Written Essays - 1250 words

Hank williams Sr - Essay Example He befriended music from the very start and the guitar given to him by his mother when he was eight years old, became his lifeline. Williams' childhood friend Rufus Payne (aka Tee Tot) taught him how to play the guitar and sing the blues. Hank Williams' home (now Hank Williams' Boyhood Home & Museum), surroundings and the initial hard family times influenced the style of his songs. Willing to take music as a career, Williams began performing around the Georgiana and Greenville areas of Alabama in his early teens. Forming a local band in Montgomery called the Drifting Cowboys, they became quite popular and the local radio station played their music regularly. Singing songs of the famous artists and his idol, Roy Acuff, the radio station dubbed him the Singing Kid. Lillie became the temporary manager for Williams and collected gate money, contracted and negotiated for gigs. Looking at the face of stardom, Williams contracted with alcoholism and turned intoxicated for his radio shows and eventually got fired due to his "habitual drunkenness". Audrey Mae Sheppard became Williams' manager and short time later in 1943, his wife. Although at the time Williams was a local hero, but he couldn't make it to big names yet. To get further in the limelight, the couple toured Nashville to meet with a songwriter/music publisher Fred Rose who was one of the heads of Acuff-Rose Publishing. Rose instantaneously liked Williams' songs and recorded two sessions for Sterling Records. This resulted in two singles, both hits. Seeing the success and potential in him, MGM Records signed a contract with him in early in 1947 and Rose became the Williams' manager and record producer. His first single with MGM, 'Move It On Over,' was instant hit and rose to the country Top Five charts. Songs released in 1948 like 'Honky Tonkin' and 'I'm a Long Gone Daddy' peaked in the charts too. Another huge success came in early in 1949 with 'Lovesick Blues,' which remained at number one for 16 weeks and crossing over into the pop Top 25. This song was performed at Grand Ole Opry and received a record six encores from the crowds. During this time, Williams and Audrey had their first child, Randall Hank in 1949. Soon afterwards, Williams gathered the guitarist Bob McNett, bassist Hillous Butrum, fiddler Jerry Rivers, and steel guitarist Don Helms to perform the most acclaimed versions of Drifting Cowboys. He and his band were earning handsomely and most of their shoes were sold out. In the early 1950s Williams made at least seven hits and most of them made it to the Top Five Charts. During these years, a different side of Hank Williams came to be known. He started to record some religious and spiritual records under the name of Luke the Drifter. The change of name was due to the fact that he thought that the dick jockeys and jukebox operators would not play his non-traditional songs and there spiritual songs would hurt his reputation as a country musician. Although the name was chosen to hide his identity, he couldn't cloak his voice. The next year Williams came back with more of the hits to please his fans. H e started taking parts in television shows and package tours to market him further. The music was going great with most songs of 1951 entering the top

Communication in Early Childhood Education Essay Example for Free

Communication in Early Childhood Education Essay Effective communication creates a learning environment where students can learn according to their individual needs in a safe and accommodating environment. Think about your early childhood education (or your child’s early education), was it flexible to suit individual learning experiences or were children required to conform to the teacher’s methods of teaching? If you answered the latter, do you think the former would improve the quality of education? Pedagogues’ in all divisions of education should possess proficiency in different levels of communication, whether  they are teaching primary or secondary students or university alumni, to be able to address a combination of the various age groups (colleagues, students, parents or superiors). Educators will face difficulties in providing a satisfactory level of education without the necessary skills to communicate effectively to these groups of people. Early childhood educators with effective communication skills demonstrate an ability to adapt their teaching methods to suit the needs of their young individual students, which benefits the progression in child development. The teacher’s positive mood determines the emotional climate of the classroom,  creating a healthy and safe learning environment for the children and allows teachers to communicate comfortably with children, parents and colleagues, therefore, resolving issues efficiently. Early childhood educators who communicate effectively with children and parents create a positive classroom atmosphere, where successful learning can take place. Teachers and parents must be able to communicate and cooperate to build a strong relationship for the best interests of the child. Do parents have an innate trust in teachers? (For them to leave their children in the teachers care, in some  cases, almost a stranger) Whether or not this is accurate, teachers must build on this trust to create a supportive parent-teacher relationship. Each situation is different and teachers should be aware of their body language, and use of language, so when speaking with parents their communication should be different when talking to parents than when they are chatting with friends. The first step is establishing a dialogue by approaching the parent first and making them feel welcome and relaxed, as parents may be resistant in making first contact, due to, a bad experience with teachers themselves, as children or bad experiences in other  schools with other teachers (Miller, 2003 Roffey, 2002 as cited by Porter, 2008). There are different strategies teachers can use to maintain effective communication with parents and build strong relationships once they have made communication. Keeping a parents trust is important in maintaining open lines of communication so they can discuss concerns relating to the child and solve issues promptly. Teachers can gain parents confidence by always respecting confidentiality and avoiding rumors. If a parent finds out that, their child’s teacher breached confidentiality or is  a known gossip, parents will find it difficult to confide in them with an issue regarding their child, particularly if it is of a personal nature. Parents are also more likely to approach their child’s teacher if they know they can discuss issues and reach a mutual agreement (Bender, 2005). Teacher-parent communication is all about showing trust and comfort with each other. Frequent communication between these two parties creates less tension, when an issue arises, allowing a constructive discussion to take place and reaching an agreement sooner without hostility. Teachers can increase parent participation in the child’s learning by updating  them in upcoming activities and events, so they can be included in their child’s education, stay informed in their child’s successes and concerns, participate in special events, and contribute to their child’s overall learning process. The activities and responsibilities of the school should not be limited to the school environment and cease once the child has reached home, therefore, teachers and parents should allow room for overlapping (Edwards, 2000). Keeping parents updated on their child’s school progress allows parents to provide the necessary support and encouragement at home, giving them a better understanding of their child’s development. At the same time, teachers should obtain information from parents regarding the child’s progress at home, so teachers can help children accordingly at school. This back and forth communication between parents and teachers will provide students with a supportive network that benefits everyone concerned (Ramirez, 2006). It is also the responsibility of teachers to advice parents when their child is involved in an accident. Teachers should always take detailed notes of incidents, remembering to keep confidentiality (between parents), if more than one student was involved (Koza, 2007).  If a parent became aware about an incident through their child, it may give the parent the impression that the teacher tried to conceal the incident. By keeping parents constantly informed, reinforces the parent-teacher relationship, giving parents’ confidence in the teacher’s ability to care for their child. Teachers need to be flexible in their teaching, to meet each individual’s needs. Teachers must demonstrate various teaching styles to accommodate how each individual â€Å"learnt-to-learn† (Edwards, 2009), by applying the learning methods children are familiar with enables them to accomplish more and feel comfortable in  their new learning environment. The way children learned to do tasks at home is crucial to their learning when they reach early childhood education, since each child learned to follow instructions and complete tasks differently, it would be insensitive to treat all children the same without taking into account their cultural differences and experience (Marotz, 2009). Educators teaching young children must consider the learning methods each individual is already accustomed to and design their teaching methods around the children’s experiences, and so, communication can be  used effectively by incorporating different teaching strategies such as speaking, writing and visual demonstrations. For example, a child who has learned to complete a task by reading instructions will perform more efficiently if they are able to read from the board or paper, instead of following verbal instructions from a teacher. Teachers should make the effort to understand each child’s previous learning experience and background, so they can identify the best teaching method required by each child. Teachers must adopt appropriate methods and language for teaching and should outline the schools (or teachers) code of conduct regarding  language, to parents, so they can enforce the same rules at home to avoid children bringing inappropriate language to school, causing disruptions in the learning of other children and disgruntling other parents. As teachers gain experience with children and parents of different cultures, religions and abilities, they develop their own communication skills so they can provide improved services to the children they teach in the future. A safe and positive classroom is an important environment for the learning and development of a child. As a classroom leader, the teacher must behave and  communicate in a manner that creates a positive emotional climate in the classroom; firstly, teachers must resolve or reduce stress caused by work and personal issues, doing so outside of the classroom, so they can concentrate on the needs of the children when they are in the classroom. Secondly, by displaying self-confidence, a strong sense of self-worth and control over their emotions creates a classroom atmosphere where children are happy, comfortable and safe, as a result, children respond more positively to their teachers and classmates (Marotz, 2009). Ebbeck Waniganayake (2003) stated that young children generally have a  sense of happiness and positiveness in them, but society depresses this and upsets the way children view the world and future, by creating fear in them (the media showing violence, bad behavior, and superficial concerns). However, teachers can empower children by showing them â€Å"how to take their place in society and create a better now and future† (Ebbeck Waniganayake, 2003) and give them a feeling of optimism in everything they try to accomplish. Teachers who build a trusting bond with their students are also better equipped, in understanding each individual, allowing children to open up and discuss personal problems with them. This enables  teachers to speak and listen to each individual easily and identify signs of possible abuse, bullying or other health and safety concerns. In conclusion, effective communication is essential to all learning environments and without it, teachers will struggle to teach and students will face learning difficulties, resulting in a decline in the quality of education. In early childhood education, it is up to the teachers to ensure that each child’s education environment is safe and comfortable for the child, by showing flexibility in teaching to meet individual requirements and showing care and understanding to assist children with concerns. A strong parent-teacher relationship creates a support network where information is exchanged and issues are solved, to allow the child to concentrate on his or her learning and development. Early childhood educators are there to guide and support children in all aspects of life. References Ebbeck, M. Waniganayake, M. (2003). Early childhood professionals: Leading today and tomorrow. East Gardens, Australia: Maclennan Petty Pty Ltd Edwards, MC (2000) Center for effective parenting is a collaborative project of: The Jones center for families, 3. Retrieved from http://www. parenting-ed. org/handout3/Parental Involvement/Communicating with. Teacher Handout. pdf Edwards, S. (2009). Early childhood education and care. Castle Hill, Australia: Pademelon Press Koza, W. (2007). Managing an effective early childhood classroom. Huntington Beach, USA: Shell Educational Publishing. Marotz, L. R. (2009). Health, safety, and nutrition for the young child (8th ed. ). Australia: Cengage Learning Porter, L. (2008). Teacher-parent collaboration: Early childhood to adolescence. Camberwell, Australia: ACER Press Ramirez, L (2006) Parent teacher The benefits of creating a supportive parent teacher relationship. Retrieved from http://www. parenting-child-development. com/parent-teacher. html.

The Growing Problem of Child Homelessness in America Essay -- Becoming

It is something that a lot of us are used to seeing on a regular basis standing at the end of an off ramp holding a sign say â€Å"homeless and hungry.† You will see them wondering the streets digging through trash in search for something to eat. We see them everywhere and our initial reaction when we see them is to ignore them and not look at them. You especially avoid making eye contact with them and automatically label them as someone who is too lazy to go get a job or is a drug or alcohol addict and that they would much rather live on the streets. Homelessness is a continuing growing problem, with more and more not just adults but children forced to live on the streets. Homeless people are humans just like us. Being homeless, you are faced with an everyday constant battle just to stay alive. With the government, creating laws that are against them along with being mistreated by society on a daily basis and with little or no support at all makes it very hard to want to survive. Homelessness affects everyone. No matter their race, age, ethnic background (Rosenheck, 2007). Stewart B. McKinney definition of a homeless person is described as someone who "lacks a fixed, regular, and adequate night-time residence; and has a primary night time residency that is: (A) a supervised publicly or privately operated shelter designed to provide temporary living accommodations (Homeless, 2009) (B) An institution that provides a temporary residence for individuals intended to be institutionalized (Homeless, 2009) or (C) a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human being" (Homeless, 2009). In 1987, the federal government decided to step in and passed the McKinney... ...ues are understood in terms of one’s society, culture, or even one’s own individual values (Mosser, 2010). Relativism, selfishness spread though our society like germs, To find a solution for homelessness and the cause and effects it has on a community as well as the person its self are complex. But no matter what skill, interest, age, or resource, there are always way to make a difference for some of the men, women, and children who are homeless (National Coalition for the Homeless, 2006). Works Cited Bonfantini, M. A., & Proni, G. (1988). To guess or not to guess? In U. Eco & T. A. Sebeok (Eds.), The sign of three: Dupin, Holmes, Pierce (pp. 112-119). Bloomington: Indiana University Press. An excellent essay on reasoning and the basis of guesswork. Wolf, E. (1990). Distinguished lecture: Facing power. American Anthropologist, 92, 586-596.

CT scan of abdomen and pelvis without contrast Essay

ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals, kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of the abdomen appeared unremarkable. No free air was seen. PELVIS: Good quality, non contrasted actual CT examination of the pelvis with coronal reconstructions. Prostate, seminal vesicles and urinary bladder appeared WNL. The bowels seen on the study appeared WNL, except for inflammatory changes of the appendix and seccum with acute appendicitis. Osseous structures of the pelvis appeared in tract with evidence of bilateral hip degenerative changes. IMPRESSION: 1. Findings consistent with acute appendicitis 2. Degenerative changes of the hips Paula Reddy NN:EF D: T: DISCHAGE SUMMARY Patient Name: Benjamin Engelhart Patient ID: 112592DOB: 10/05/Age: 46Sex: M Date of Admission: 11/14/2012 Date of Discharge: 11/17/2012 Admitting Physician: Benard Kester, MD General Surgery Procedures Performed: Laparoscopic appendectomy with placement of RLQ drain on 11/14/2012 Complications: None. Discharge Diagnosis: Acute subapperative appendectomy perforated. DIAGNOSTIC/IMAGING LABS: Lab results at the time of admission showed a WBC count of 13. CT scan done in the ED revealed an acute appendicitis with fleggon. HOSPITAL COURSE: The 46 years old Caucasian gentleman presented to the ED with a 3 day history of abdominal pain, however in the last 24 hours and it has________ migrated to the RLQ with anneorixia, guarding and elevated WBC of 13 and CT scan consistent with appendicitis. The patient was taken to the operating room where he underwent a laparoscopic appendectomy that revealed appendix perforation and phlegmon. The appendix was removed in toto with an intact stable line. A drain was placed in the RLQ due to the fleggmonous material. Patient did well over the successive 2-3 days postoperatively with resumption of an oral diet having past flatus with having bowel movement with minimal drain output. However his WBC lowered to 6. His drain has been left intact. Patient is being discharged on the post operative day 3 on a 1 week course of PO gentamicin. The drain left in place. The drain will be removed in my office on 11/24/2012 if the drain output is minimal. Patient is on a PO diet. He was given a script for both antibiotics and PO narcotics. (Continued) PLAN: Post operative visit in my office in 1 week for evaluation and possible removal of JP drain. No heavy lifting for 4 weeks following surgery. Patient is to complete his full course of post operative antibiotics. DISCHAGE SUMMARY Patient is to report to the ED or my office earlier if any redness or foul smelling drainage out of the wound sit. Any swelling, fever, pain or any other concerns. Patient and his wife verbalized the understanding of the agreement with the above plan. Bernard Kester CC: Max Hirsch, MD D:11/14/2012 T:11/14/2012 HISTORY AND PHYSICAL EXAMINATION Patient Name: Benjamin Engelhart Patient ID: 112592DOB: 10/05Age: 46 Date of Admission: 11/14/2012 Emergency Room Physician: Alex McClure, MD Admission Diagnosis: Acute Appendicitis HISTORY OF PRESENT ILLNESS: 46 year old gentlemen with past medical history significant only for degenerative disease with bilateral degenerative disease of the hips. Secondary to arthritis. Presents to the Emergency room after having had 3 days of abdomen pain. It usually started 3 days ago and was generalized vague abdomen complaint. Earlier this morning the pain localized and radiated to the RLQ. He had some nausea without amesis. He was able to tolerate PO earlier around 6am. but now denies having an appetite. Patient had very small bowel movement earlier this morning that was not normal for him. He has not passes has the morning. ‘he is voiding well. Denies fevers, chills or night sweats. The pain is localized to the RLQ without radiation at this point. He has never had a colonoscopy. PAST MEDICAL HISTORY: Significant for arthritis of bilateral hips seen by Dr. Hersch. PAST SURGICAL HISTORY: Negative MEDICATIONS: Piroxicam for degenerative joint disease of bilateral hips ALLERGIES: No known drug allergies SOCIAL HISTORY: Patient admits alcohol ingestion nightly and on weekends. Denies tobacco use and illicit drug us. He is married. FAMILY HISTORY: No history of cancer or inflammatory bowel disease in his family. REVIEW OF SYSTEMS;;12 point ROS was preformed and is negative except noted in above HIP, PMH and PSH. Careful attention was paid to endocrine, integumentary, pulmonary, renal and neurological exam PHYSICAL EXAMINATION: Vital Signs. TEMPERATURE: 101.0, Blood Pressure- 127/179, Heart Rate-129, Respirations- 185, Weight-215. Situations 96% on room air. Pain Scale- 8/10. HEENT-Normal cephalic, atrumatic pupils equally round and reactive to light. Extra ocular motions intact. ORAL: Shows oral pharynx clear but slightly dry mucosal membranes. TMS: Clear. NECK: Supple, No thrangegally or JVD. No cervical,  subclavicular, axilarry or lingual lymphinalpathy. HEART: Regular rate and rhythm. No thrills or murmur heard. LUNGS: Clear to aspiration bilateral. ABDOMEN: Obese with minimal bowel sounds, slightly distended there is RLQ tenderness with guarding and pinpoint rebound. Positive _____. Actuator signs with negative psoas side. RECTAL: No evidence of blood or masses. PROSTATE: WNL. EXTREMITIES: No clubbing, cyanosis, clots or edmea. 1+ pedal pulses bilaterally. NUERO: Cranial nerves 2-12 grossly intact. DIAGNOSTIC DATA: WBC was 13.4, Hemoglobin and hematocrit 15.4 and 45.8, platelets 206 with 89% shift. Sodium 133, Potassium 3.7,Chorlide 99, Bicarbonate 24, BUM and Creatine 18 and 1.1, Lukeuos 146, adermin 4.3, total bulliru,1.7, remainder of the LFTs is WNL. Urinary analysis reveals trace keytones with 100 mg per decimeter with small amount of blood. CT scan was preformed revealing evidence of acute appendicitis with parasitical inflammation as well as facilitation of appendix inflammation and haziness in aperparacifiacal dilation. There is evidence of degenerative joint disease in bilateral hips on the cat scan as well. ASSESTMENT PLAN: This 46 year old Caucasian gentleman has signs and symptoms and radiographical findings consistent with acute appendicitis without evidence of abscesses. The plan is to take him to the operating room for laproscopic possible open appendectomy and possible large bowel dissection should the case resisitated. Plan was discussed with patient with his wife. Risk, benefits and alternatives were discussed. There was no barriers to communication and all questions were answered appropatily The patient understands the plan and desires to proceed . (Continued) The plan was discussed with Dr. Keslerof general surgery who agrees and will take patient to operating room . Alex McClure, MD D:11/14/2012 T:11/14/2012 PATHOLOGY REPORT Patient Name: Benjamin Engelhart Patient ID: 112592 DOB: 10/05/Age: 46Sex: M Pathology Report No: 10-S-9044 Date of Surgery: 11/14/2012 Attending Physician: Bernard Kester, MD general surgery Preoperative Diagnosis: Acute appendicitis Postoperative Diagnosis: Necrotizing acute appendicitis Specimen Received: Appendix other than incidental Date specimen received: 11/14/2012 Date reported: 11/16/2012 CLINICAL HISTORY: Acute appendicitis. GROSS DESCRIPTION: The specimen was received in formily? With patient name, ID and appendix. It consist of a appendix measuring 6 x1.5Ãâ€"1.5 cm there periepdesial fat attached to it measuring 6Ãâ€"4 by1 cm. The cirrosal surface is hemmoraggric. Upon opening the appendix there is percudent exudates material. The wall thickness measures 0.3cm. Representive sections are present is 1 cassettes. MICROSCOPIC DESCRIPTION: Performed MICROSCOPIC DIAGNOSIS: Appendix appendectomy, Necrotizing acute appendicitis. ICD Diagnosis Code: 540.9 (Continued) CPT Code: 8-88304 Georgia Tamato,MD ALW: D:11/14/2012 T:11/14/2012 OPERTIVE REPORT Patient Name: Benjamin Engelhart Patient ID: 112592DOB: 10/05Age: 46Sex: M Date of Admission: 11/14/2012 Date of Procedure: 11/14/2012 Admitting Physician: Bernard Kester, MD General Surgery Surgeon: Bernard Kester, Assistant: Jason Wangner, PAC Circulating nurse: Jimmy Dale Jet, RN Preoperative diagnosis: Acute appendicitis. Post operative diagnosis: Perforated appendicitis. Operative Procedure: 1: Laparoscopic Appendectomy. 2: Placement of RLQ drain. Anesthesia: General endotracheal. Specimen Removed: 1 Necrotic appendix. IV Fluids: 1700 crystalloid. Estimated Blood Loss: 10mL. Urine Output: 300mL. Complications: None. INDICATIONS: This gentleman is a 46 year old Caucasian male that came in with a 3 day history of abdominal pain, however the pain worsened after 24 hours to the RLQ and caused a significant amount of anorixia. He presented to the ER department. CT scan to abdominals and pelvis showed acute appendicitis. Labs showed WBC at 13. Laparoscopic appendectomy procedure was explained along with the risk, benefits and possible complications. Patient voiced his desire to proceed. Patient was started on preoperative gentamicin. DESCRIPTION OF PROCEDURE: Patient was ID’d times 2 in the pre op holding area. A final timeout was held in the nursing area, anesthesia and surgical service during in which the patient ID was confirmed and the surgical site was initialed. He was given preoperative antibiotics. He was taken back to the OR and placed in the supine position. General endotracheal anesthesia was induced. SEDs were placed on his lower extremities. His Left arm was tucked to the side. Foley Catheter was placed. His abdomen was shaved and prepped with betadine solution, and draped in the usual standard fashion. A small semicircular umbilical incision was made to the subcutaneous tissue down to the fascia. And was gasped at either side and was incised. Kelly clamped was easily inserted. Stay sutures made a _____on either side the Hasson trocar was placed and pneumoperitoneum was easily  achieved. 10 mL port was placed in Left abdomen and a 5 mL was placed in the LLQ. Inspection of RLQ showed a significant amount of adhesions and the small bowel trying to wall off perforated appendix. Milky purulent exudates was noted in surrounding area. The small bowel was carefully peeled off the RLQ side wall. Fibrous exudate the vermiform appendix was identified. It was neurotic perforated in appearance The cecum was mobilized by taking down the lateral attachments laterally. The adhesions of the terminal illium through the pelvis were significant, attempts at this time were not made to free them. There was no evidence of obstruction. The base of the appendix was Identified and dissected and lifted free. Stapler loaded with___ was used to transect the base______however again inflammation extended to the level of the cecum. Though the cecum itself was also inflamed. The remainder of the mesoappendix was divided with a Endo GIA loaded with a _____. Appendix was placed into a endo catch bag was brought out through the umbilical cord site and sent to pathology for routine processing. Inspection of the RLQ and the area was irrigated coupsuley, there was no further evidence of purulent exudate. The appendicualr stump remained and doesn’t appear to be inflamed. However____wasn’t bl eeding. There was some fibrous exudate in the area. Consequently I felt like we had 2 options, we either perform a right epicolodectomy, given the intent of the adhesions in the pelvis would likely require a laparotomy or place a drain with antibiotics possibly controlling the fistula until the inflammation resolves. But hopefully it will heal on its own spontatensouly. Consequently we placed a19 French round Blake drain in the RLQ and brought it out through the LLQ in the 5mm port site. It was secured to the skin using a micro suture. Nuenopartiumeum was then desufflated the fascia of the umbilical port site was closed using a 2,o vicro that had been previously placed. All wounds were enthsitized using 1/2% marking solution and was coupsley irrigated. Skin edges approximated using 4 or monocro. The wounds were dressed with beatdine spray and steri strips. Drain sponge was placed around the drain, Foley catheter was removed. The patient was awakened, exubated then taken to recovery PAR in stable condition. Having tolerated the procedu re well. No complications were observed. DISPOSISTION: 1: The patient will be transferred to the floor. 2: He will be kept at least overnight. 3: He will be taught drain care. 4: He will go home with the drain on place. 5: He may require a fistulagram in the future. Benard Kester, MD D:11/14/2012 T:11/14/2012

Democracy as a Form of Government

In today’s time, the call for freedom and democracy echoes all around the world. Democracy simply means freedom for the people staying in a country. A democratic government simply is a government â€Å"of the people, by the people and for the people. † A government which is elected by the citizens of the country, which is been elected of the people and elected for the betterment of the citizens residing in the country, is a democratic government. Democracy is a very popular type of a government that features free elections, periodically. Democracy is a form of government in which the government is elected completely by the people under a free electoral system. In today’s world, democracy is the best form as a government. Democracy simply means freedom; in a democratic government a citizen has freedom to elect a representative (vote), freedom of speech, freedom of rights, and many more. In a democratic government all the citizens have equal access to power. Democracy is also called â€Å"the last form of government. There are two types of democracy; direct democracy and representative democracy. Direct democracy is a pure democracy. Direct democracy is where there is direct participation of the people. Everyone would gather in town meetings and vote on issues concerning the town. Representative democracy, as the name states, is a system in which the people select others to act in their places. For national purposes, America has two representatives from each state. Liberal democracy exists in the United States of America and also in most parts of the world. The term â€Å"liberal† in â€Å"liberal democracy† does not imply that the government of such a democracy must follow the ideology of liberalism. It is merely a reference to the fact that liberal democracies feature constitutional protections of individual rights from the government. The best and the latest example of an evidence of democracy in America is the election of the new president Mr. Barrack Obama. History has been created as for the first time a non-white president has been elected. This is the biggest and the best example of democracy in the United States of America.