Impact of Terrorism and Violence on Global Tourism

Introduction According to World Travel and touring carry Council 1997, touristry Industry is the worlds prominent industries contributing $3. 6 trillion to the global gross domesticated product (GDP) and employing 255 million populate. (Apostolopoulos, Sonmez &Tarlow 1999). It is withal considered one of the most exciting and progressive industries which has a puffy impact on all other industries. Although tourerry industriousness has sh stimulate dreadful growth in recent years providing incredible experiences to its consumers yet it body highly prone to natural (e. g.Tsunami, Hurri rottere & volcanic eruptions) and human caused calamities (e. g. war, crime & act of act of act of terrorism). This turn out on that pointfore discusses or so terrorism in relation to touristry. It focalizationes on the impacts of terrorism on global touristry and provides an understanding of the relationship among policy- fashioning instability, terrorism and tourism. Tourism, Pol itical Instability and Violence Definition of terrorism ?The US Department of severalize defines terrorism as . . . premeditated, policy-makingly motivated strength perpetrated against civilians and unarmed military personnel by sub national groups sually think to influence an audience? (Sihmez 1998) Definition of governmental instability ?Political instability describes the condition of a country where a government activity has been topp guide, or is controlled by f exploits by-line a coup, or where basic functional pre-requisites for social-order control and alimentation atomic human body 18 unstable and periodically disrupted? (Cook 1990, cited in Sihmez 1998). The study of DAmore & Anuza 1986 states that, Closer scrutiny of terrorism- for the purpose of understanding some of its underlying currents-begs a look at world conditions.As a new millenary is active to begin, nations wrestle with hunger, disease, and numerous other socioeconomic and environmental problems, wh ich are throw out exacerbated by the alarming growth in the worlds population rate, the combination of which may nurture terrorism. It is suggested that terrorist organizations can easily set up members by offering crack conditions to throng living in undesirable circumstances in undeveloped nations. thitherfore, in a situation where terrorism is on rise, safety and stability are the two factors that cannot be ignore while undertaking go a delegacy to other countries.Over the years, tourism industriousness has undergone tremendous changes wherein crime and violence wealthy person increased to a commodious extent. Such exertions suck up had a big impact on tourists mend their travel. Political instability can be categorised into various forms such as international war, riots, social unrest, civil war, terrorism etc. closely of the evidence on tourist motivations points to fear and insecurity as a major barrier to travel and thus a limitation on the growth of the industry .In addition to the openly stated fear there is practically an expression of lack of interest in travel, which can cover an underlying fear. In these circumstances, the possibility of terrorism, how incessantly remote, will have an doing on the tourism demand of a large number of strength tourists. (eds Mansfeld & Pizam1996) Political instability and tourism can be best explained with an baby-siting of crackdown by Chinese government on students who protested in Beijings Tiananmen SquareIn a volume edited by Mansfeld & Pizam (1996), The smokestack of tanks rolling into the Square the violent battles between students and troops the steadfastly relentless attitude of Chinese authorities it was all watched by the world on prime-time television. And most people living in free societies felt repugnance and anger those planning holidays to China cancelled, while those with a vague legal opinion of visit the country correct it on hold for the distant future- if ever General imp acts of terrorism and political disturbances upon the tourism industry Even its exhibit economic success does not shield international tourism from the morose power of terrorism (Sonmez, Sevil F. , 1998). No country is safe from the threat of terrorism and look has shown that no part of the world has been spared by it. The fear of a totally unexpected terrorist attack grips the pass of todays tourist, disregarding of region he is travelling to. terrorist act started to take its toll on tourism from mid 80s, when international tourism was at its jacket (Sonmez, Sevil F. 1998), and it became a major concern for m any countries. Its impacts vary from direct to corroboratory and individual to global. Usually, subsequentlywards a terrorist attack or violence erupted referable to political clashes, a goal recovers back to its normal inflow of tourists in about a seat, but some major incidents can in like manner extend to tourist visitation for a longer period of time, the indicate being over popularity by the media (Sihmez, 1998).For example, India was overexposed in the media after(prenominal) the Mumbai attacks in November 2008 which has had a interdict effect on inbound tourism to India during the showtime quarter of 2009 (Tourism prognosticate Committee, 2008). Political disturbance, on the other hand, has long-term and deeper personal effects on a destination as it threatens the economy, the law and the society as a whole, thus jeopardizing the potential of a country as a tourism destination (Sihmez 1998). Economic impacts Terrorism and political turmoil mainly affect the economy of a country or a region.Worst flush are the countries, which are majorly dependent on the tourism industry. A dear example can be given from 1986, when 54% of Americans who planned to go to Europe, cancelled their bookings because of the risks implied by the rise of terrorist activities during that period (DAmore and Anuza 1986, cited in Sihmez 1998). Furthermore , countries fit(p) nigh a politically agitated country may suffer from a perceived lack of safety by tourists who associate the neighbouring countries referable to geographical proximity, although travelling in the former may be without any risk.Countries often have to bear the costs of terrorism, in terms of investments in security, terrorism risk insurance premium, airport screening opportunity costs and consumer offbeat losses to escort safety and security for their people (Keefer P. , 2008). Psychological impacts meets of terrorism on tourist behaviour and decision-making process (Sihmez, 1998 pg. 13) however, depend on the fictitious character of tourists slewiness travellers and leisure travellers will not react the same mode in regards to risk, as they do not have the same motivations and postulate for travel.Image deterioration / Negative films native all the samets such as floods, tsunami or earthquakes do not have the same impact on a countrys cast as a terr orist attack has. Natural calamities may draw sympathy, and may affect inflow of tourists for a piddling period, but people know that natural disasters are undeflectable, so the image they form of a destination is different. Fall in tourist arrivals in these destinations may recover earlier because these destinations are not perceived as unsafe, as in case of a destination, where terrorist activity is prominent.politically unstable environment of a destination usually has a negative and a much stronger impact on peoples mind over a longer period of time because human action is deliberate and physical injury is most of the time the aim of these actions. Examples and focus on a particular region or destination There are a haulage of tourist destinations which suffer from terrorist attacks. Egypt which had almost 4 billion dollars in tourist pass on in 1999 depended a lot on the tourism revenue. However, the revenue from this sector of economy decreased due to the terrorist attacks by al-Gamaa al-Islamiya.The first attack occurred on October 1, 1992. One British tourist was killed and two others were wounded. During the five year period about speed of light tourists were killed in the attacks including the tourists from Germany, Greece, Switzerland, Japan and Great Britain. One year after the first attack tourism revenue in Egypt felt by 11 percent. However, it increased by four percent in 1994 and by 34 percent in 1995. Moreover, net increase in tourist receipts between 1993 and 1997 was 93 percent (Essner, 2003). The Egyptian government managed to pay back its tourism sector and contribute to the GSP by 5% (Weaver).The factors of this success are the extensive historic and cultural heritage of Egypt that keeps drawing international visitors, but in any case incentive measures taken by the industry in order to sustain inbound tourism. For instance, the national airline, EgyptAir, cut its airfares by 50% after the 1997 Luxor put to death of 58 tourists (W eaver). Event in New York City and Washington D. C. on September 11, 2001 was one of the most significant terrorism attacks which occurred recently. This event influenced the economies of states which depended on the tourism industry a lot.Furthermore, the whole economy of the USA was dismantled which led to the global economic slump (Pizam, 2002). Certain sectors of the tourism industry suffered from the terrorist attack. Hotel occupancy rank decreased dramatically. It plummeted to 41. 8 percent the week following the attacks, a 52-percent decrease from the same period in 2000 (Stafford et al, 2002). In total, 3016 people died including passengers and crew on the planes, people within or beneath the agree Towers and on the ground at the Pentagon. This attack has certain impacts on travel and tourism industry in the USA. security measures measures at the places where large number of people including tourists are likely to gather were reconsidered. The number of US field guards i n the airports increased and other security measures in the airports such as better screening and checking of passengers and baggage technologies were introduced. Security measures were improved in seaports, bus stations and train station as salubrious. It included increasing of the oversight cameras and checkpoints. The number of security guards in these places grew up as well.Moreover, the Federal melodic line giving medication set up the program of increasing the number of bomb-sniffing dogs. The FAA proficient 175 dogs for 39 airports (Goodrich, 2002). Many other countries which have high rates in tourism receipts also suffered from the terrorist attacks. Establishing of an Islamic Palestinian State in place of Israel resulted in the attacks initiated by both Israelis and Palestinians. This disturbance led to dramatic drop in 1996 in the number of tourists which grew steadily between 1970 and 1994 (Sihmez Sevil F. 1998). Another example of suffering from terrorism attack is Peru.Attacks by the Sendero Luminoso (Shining Path), a Maoist terrorist group caused the decrease in number of tourists from 350,000 in 1989 to 33,000 in 1991 (Sihmez Sevil F. 1998). Word of mouth and previous experience Media Reporting & Image making Intergovernmental relationsGovernment policies and interests Figure 1 Political instability, violence and the imaging process dorm room &OSullivan study (cited in Mansfeld & Pizam 1996) The above figure is a model of various factors that lead to image creation of the political stability of the destination region.Three factors word of mouth, media and the government lead to the images creation of destination, in the tourist generating regions. Domestic tourism is equally affected by the occurrence of any kind of violence or terrorist activity. Many factors such as promotion, tourist attractions, development, new routes, travel prices contribute in to reasonable changes in domestic as well as international tourism. As per the study of B ar-on (cited in Mansfeld and Pizam 1996), act of violence can affect tourism in following ways Tourists may fear being killed or injured. Security checks, peculiarly at airports, may take a long time and even be unpleasant for some tourists. Tour operators, travel agents and airlines may not want to risk organizing trips to specific regions. Travel insurance of tourists and airlines may be difficult, limited or expensive. Friends or relatives at the destination may advice against the proposed trip. This is also supported by Hall and O Sullivan study (cited in Mansfeld & Pizam 1996) which states that, . . . tourism may decline precipitously when political conditions appear unsettled. Tourists simply prefer alternative destinations.Unfortunately, many national leaders and planners either do not understand or will not accept the fact that political serenity, not scenic or cultural attractions, constitute the first and key requirement of tourism. Although, political violence ma y not last for a longer period yet it has the tendency to leave a formidable impact on the tourism industry for many years which further can affect the confidence of the tourists and also the investors in tourism industry. Crisis care and recovery methods employed by the tourism industry Tourism has been a way for under-developed and developing countries to get more revenue.Therefore tourists are a potential target for terrorist groups looking to destabilise and undermine these countries by gaucherie the revenue they get from tourism activities. Recent events such as 9/11, the southwestwardeast Asian tsunami and the Bali bombings have had devastating consequences upon the tourism industry and have shown crisis management and recovery measures have become unfavourable in managing a destination (Robson 2008). According to Santana (cited in Weber 1998), crisis management comprehends five step signal detection, preparation/ retainion, containment/damage limitation, recovery and le arning.Planning and training before, during and after the crisis have also been highlighted (Santana, cited in Weber 1998). On the one hand, research has shown the tourism industry was able to fully recover from terrorist assaults in a period of six to twelve months, at the condition these events were not iterate in the future (Pizam and Fleischer, cited in Arana 2008). However, appropriate management methods must be employed and applied by destination managers in order to ensure image destination rehabilitation.To this end, the management and coordination of human and financial resources as well as public relations through the media for example are critical when it comes to managing terrorist events at a destination (Stafford et al 2002). For instance, a set of recommendations accumulate crisis management, preventive management and recovery methods through marketing could be useable for the tourism industry to restore a destinations image (Sonmez 1998) and prevent any negative p ublicity from spreading (Stafford et al 2002).Furthermore, coaction between tourism industry actors and government organisations can often be preventive and mitigate the impacts of the crisis (Stafford et al. 2002). In terms of preventive and recovery methods, tourism destinations should conjure up the use of information for locals and visitors (Weber 1998) in order to ensure their own safety, for example by signalling any suspicious piece of luggage in a public space through the use of official signs stick on in public areas such as airports, railway stations and stadiums.The office staff of advertising and education as recovery methods is also of importance. For example, the Vigipirate Plan was put in place by the French government in 1991 after several terrorist attacks took place in Europe in the nineties. It is made up of 4 levels of emergency (yellow, orange, red and purple) and has been greatly promoted in France at the local administration levels as well as to the gener al public, especially after massive terrorist attacks such as the March 2004 Madrid attacks and the July 2005 London bombings.Furthermore, government initiatives such as the Australian travel advisory (smartraveller. gov. au) which issues travel recommendations to destinations presenting a certain degree of risk is a preventive way to avoid any accidental or dangerous event. For example, the Australian Government gives tips about Cyprus in terms of safety and security in both the bawd and Turkish part of the island, as well as details about local laws, entry and exit requirements and health issues (Department of Foreign Affairs and heap 2009).On the other hand, tourism may be a way to enhance peace, mitigate tensions between countries and recover from any negative effects of terrorism. An example of this is given by the situation between North and South Korea (Kim 2007). Research was conducted in order to evaluate the reactions of South Koreans after visiting a natural site, Mt Gu mgang, an emerging tourist destination located in North Korea. The findings suggested that South Korean visitors to North Korea had a better image of the country and the people after their tourist trip, although both countries have technically been at war for decades (Kim 2007).To conclude, tourist destinations have the possibility to prevent terrorism actions from happening or mitigate their effects through combine policies of crisis management involving different participants such as governments and private/public tourism bodies. Nevertheless, although tourism is often a victim of terrorism and political disturbances, it can also be used as a tool to promote and enhance peace between countries affected by political tensions. References Adams, S. 2004, wholly the Troubles Terrorism, War and the World after 9/11, Simon Adams, Australia Arana J. , 2008, The impact of terrorism on tourism demand,Annals of Tourism Research, Vol. 35, No. 2, pp. 299315. Apostolopolous Y. , Sonmez S. & Tarlow P. 1999, Tourism In Crisis Managing the cause of Tourism, Journal of Travel Research, Vol. 38, No. 1, viewed 17 May, http//jtr. sagepub. com. ezproxy. lib. uts. edu. au/cgi/content/ regard/38/1/13 Bar-On R. , Measuring the effects on tourism of violence and of promotion following violent acts, in Mansfeld Y. & Pizam A (eds), Tourism, iniquity and International Security necks, legerdemain Wiley & Sons Ltd. , pp. 159-160 Department of Foreign Affairs and workmanship 2009, last viewed May 17th 2009, http//www. smartraveller. gov. au/Essner J. 2003, Terrorisms Impact on Tourism What the Industry May Learn from Egypts press with al-Gamaa al-Islamiya, viewed on May 15,2009, http//sand. miis. edu/research/student_research/Essner_Tourist%20Terrorism. pdf Hall C. & O Sullivan V. , Tourism, political instability and violence, in Mansfeld Y. & Pizam A (eds), Tourism, Crime and International Security Issues, John Wiley & Sons Ltd. , pp. 105-114 Kim S. , 2007, Using tourism to promo te peace on the Korean peninsula, Annals of Tourism Research, Vol. 34, No. 2, pp. 291309. Mansfeld Y. & Pizam A. , Conclusions and Recommendations, Tourism, Crime andInternational Security Issues, John Wiley & Sons Ltd. , pp. 311-312 Mueller J. 2007, Reacting to Terrorism Probabilities, Consequences and the persistence of Fear, Ohio State University, viewed 17 May, http//scholar. google. com. ezproxy. lib. uts. edu. au/scholar? hl=en&lr=&q=REACTING+TO+TERRORISM%3A+PROBABILITIES%2C+CONSEQUENCES%2C+AND+THE+PERSISTENCE+OF+FEAR&btnG=Search Pizam A. 2002, Tourism and Terrorism, cordial reception Management, Vol. 21, No 13 Robson, L. , 2008, Crisis Management in Tourism, Annals of Tourism Research, Vol. 35, No. 2, pp. 600601. Sihmez Sevil F. 1998, Tourism, Terrorism and PoliticalInstability, Annals of Tourism Research, Vol. 25, No. 2. Sonmez, S. F. 1998, Tourism, Terrorism and Political Instability, Annals of Tourism Research, Vol. 25, No. 2. Stafford, G. Et al, 2002, Crisis Management a nd Recovery, Cornell Hotel and Restaurant Administration Quarterly 27, Cornell University Tourism Forecasting Committee, 2008, Forecast 2008, Issue 2, Tourism Forecasting Committee, Canberra, pp 91-92 Weaver D. , Tourism Management, 2000 Weber, S. 1998, War, Terrorism and Tourism, Annals of Tourism Research, Volume 25, Issue 3, Pages 760-763 Tourists Destination Region Generating Region Media Government

Defining Abnormality †Towards a definition Essay

The statistical approach is based on the appraisal that certain deportments ar statistically r ar in the population. If you measure some(prenominal) type of human behaviour you should find that citizenry with varying degrees of the behaviour are normally distributed around the flirt with. For practice there are a lot of people who are of average height but a a couple of(prenominal)(prenominal) people who are very small. If we plot a graph of for sheath IQ scores, It is bell shaped. The majority of individuals are clustered around the mean (the curves highest maneuver).The further you go away from the mean, the fewer people there are. Problems Desirability-some statistically infrequent behaviours, e.g. being a genius are desirable. Cut-off point-who decides at what point you are to be considered abnormal? Statistical Definitions-The Same standards or norms are not relevant to all social groups/ ages/cultures for example in basis of anxiety.Children have more irrational fea rs than adults. Deviation from social norms Social norms are behaviours that are desirable for both the individual and society as a whole. Deviance from social norms is both undesirable and abnormal. Most mentally unfortunate people do behave in a socially aberrant way but this doesnt mean that you can base clinical abnormality on this theory alone.Moral standards-social norms falsify over sentence and basing mental illness on deviation from social norms is dangerous. Context-for example, wearing few items of clothing on the beach is acceptable, on the high street it is not. triggerman Cultures-for example in the Mormon religion it is acceptable to have several(prenominal) wives. In England that is a crime called bigamy Good/Bad-in some certain caboodle being socially deviant is a good thing for example in Nazi Germany people who were opposed to Nazism were socially deviant. socialistic cultures-cultures which emphasise the greater good of the community rather than focusing on individual achievement would not find the first three characteristics relevant. Difficult-most people would have difficulty fitting all these criteria at most quantify in their lives. Cultural relativism A limitation to all ways of specify abnormality is that no definition is relevant to all cultures. Also cultures definitions change over time. For example Homosexuality was considered to be a mental ailment till the 80s.

Poetry comparison essay- ‘Poem’ and ‘Sonnet 19’ Essay

For my appointment I am going to comp ar two sonnets, written in early-mid 1590 and the second in 1990s, by popular poets William Shakespeare and Simon Armit mount up. I forget be musical composition astir(predicate) their content, meaning, construction, style, rhyme pattern, somebodya, imagery, language and the tone set in each piece of writing and comparing how each characteristic is mistakable and different.In the early-mid 1590s, William Shakespeare wrote a sonnet, in his own style Shakespearean in the traditional context love. It was vaguely called Sonnet 19, which suggests he is displaying that by chance he was not completely connected, emotionally, with the sonnet. However, this incident could be contradicted in the mood that all his sonnets were simply identified with a number, this kick downstairsicular one not being different.The sonnet itself is written as a reference it is meant to be perceived as coming from a character, possibly from one of his plays? It i s ab egress the love one of the fiber, aging with time, and the narrator pleading to devouring epoch (time, in this case, being classed as a noun) that He shouldnt age his loved one. In this spirit, it is a traditional sonnet it is about love.Consisting of fourteen lines, and a structure of an octane, followed by a quatrane and then a pair it is a typical Shakespearean sonnet.This poem has a rhyme outline of ABAB, CDCD, EFEF for the scratch line dozen lines of it, however for the final couple a naive GG is employ instead. This rhyme scheme gives a rhythm to the sonnet, and creates a little drastic and eerie atmosphere when cultivation because the rhythm is more unrecorded that that of a poem without the use of direct, full rhyme.Also, the iambic pentameter present in the sonnet gives out a more flowing beat when practice the poem. It likewise makes the sonnet seem a little little sliminess and tense, as it releases ease for the readers. The ten syllables on each lin e are important to the poem, to increase flow and to possibly give the audience a little humor whether or not this was purposeful we dont know. notwithstanding we do know Shakespeare mean to include ten syllables in each and every line of Sonnet 19.The first octane introducing the paradox the persona is faced with in this case the fear that the one he loves will be negatively affected by time. This tells the reader what the person the poem is directed from, is possibly quite shallow- due to the fact he pleads with Devouring Time not to carve with thy hours his loves bonny brow. This means that he doesnt want time to withdraw an effect on his loved ones appearance, which brings out a hint of arrogance from the writer.However, this point can be treat by the time the reader gets to the couplet at the conclusion of the text. The persona comes to the compromise that, even if time does eat away at his loved one, the beauty and youth will exist forever in his writing his love shall i n his verse ever live young.Referring second to the first eight lines of the sonnet, lots of imagery is apply in the introduction. At first, the imagery creates middling more stubborn and fierce images as if the persona is ordering Time to not touch his loved one. However, on the 9th line, O carve not with thy hours my loves fair brow gives the reader the impression that the persona is suddenly changing his attitude, and possibly realising the harder sense that was presumptuousness murder in the first octane. It paints an image of him almost begging, given the O put as the opening to the line softens his tone sufficiently to create an imagery that puts the persona in a much slight dominant place.Imagery in the first octane includes more angry classs, as he is almost demanding an answer for Times cruelty to the Earth, and to muckle and animals. This is shown through lines such(prenominal) as, Time plucks the keen teeth from the tigers jaws. This is utter that Time makes a t iger age, and therefore be drawn to less youthful features loss of teeth, sufficiently less strength etc. But instead of saying this, a harsh image of somebody ferociously pulling the set of a tigers teeth out is created to add the effect of anger which has overcome the persona.The text itself is about love- on with the majority of other traditional sonnets. However, the poem is believed to be addressed to a man, however this doesnt forecast a homosexual relationship amid the persona and the subject. It is believed that Shakespeare may have been gay, but it will never be known for veritable and this is entirely one interpretation of his writing.The second sonnet I am going to compare is one of which by Simon Armitage and is called, still again- vaguely, Poem. Already, a similarity is appearing between the two sonnets with just the name and the appearance of a poor connection between the poet and the true(a) piece of writing. The sonnet was written in the 1990s and so will be much newer than that of Shakespeares, but there are in fact many similarities between the two, despite the time difference.Once again, the comparable structure has been used first an octane, then a quatrane and a couplet to check with. The eight lines and the last two serve the same purpose as the Sonnet 19 does to introduce, and the couplet to conclude. However, the quatrane between the two simply continues the first octane in more detail- introducing the situation.Within this structure, yet another pattern was used speaking in three lines about a positive part of the situation then including one negative fact, before returning to a lighter tone for three more lines.Also, the iambic pentameter is as well as used in this sonnet- and was likely to be purposeful to lighten the mood slightly, maybe to enhance the slight use of humour in some part of the poem.However, the rhyme scheme ABAB CCCC DDDD and EE, also makes the text more rhythmic and upbeat. Although, because the rhymes are mainly just half-rhymes (not full ones) we cant be sure that the rhyme scheme was purposeful, and if they were, whether they were purposefully just half.Half rhymes generally, if used in thrifty format, dampen any humour included in a piece. This is because rhymes usually make it easier to read and more happy, or upbeat, but when reading Poem, you get a sense that a deliberate meritlessen to the mood was put into the text.The actual poem itself is not about love, contrasted Sonnet 19 and many other traditional poems it is thought to be an obituary. It speaks about somebodys life, and also as if this person has passed away, or been removed from society. This also adds to the eerie feel, yet speaks of his life with a slightly humorous side.The imagery created in the positive lines of the poem develops a happier phase in this persons life in each stanza. Phrases such as, he praised his wife for every meal she made give off an impression he was a very kind man, and that he was a lso family-orientated. It tells us he was appreciative of others- showing a kinder, softer side to him.However, the fourth part line of each phase cuts out the happier tone and surprises the reader with the fact that he one punched his wife in the face for laughing. This immediately develops a cold image of this man and the reader recognises that he had a dark side as well as a good one. It also makes him out to be a violent and possibly incontrollable man.The use of take in is present in this poem, joined by many other of Armitages pieces, in the way he uses the word slippered when describing the way he punished his daughter for lying. This is not proper English and perhaps was deliberate to create a picture of this man being very common, crude and possibly just your everyday person.This constantly switching of imagery soon develops a balanced view in the readers sound judgement that perhaps this man represents any normal person- for having some(prenominal) good and harmful inside us is in everybodys mannerisms.In the final couplet of this sonnet- which also includes a half-rhyme, instead of full- Armitage concludes the poem, saying the man the first twelve lines painted of was considered to be normal, and when people looked back at his time, their thoughts were sometimes he did this, sometimes he did that. This tells us that his moods changed, along with his attitude and that he did both good and bad in his time.The way the final couplet concludes is the same as Shakespeares finale and they both end the poem in a generally lighter tone.I believe that the two sonnets compared in my coursework are very similar, despite the change in times. Poetry intelligibly will not differ over time, and the similarities between the two indicate that sonnets- if kept traditional- will always be very similar.

Irish and Mexican Culture and Customs Essay

If we start to analyse how irish spate greet to another(prenominal) person and how Mexicans we can capture a big difference because as we know mexican plenty al elans solelyege hi with a kiss in the buttock and is a normal way to greet even although they dont know separately other. Irish people with only ordinate hi is a find to greet another one, for them is sincerely rear to establish a kiss in the cheek. For mexicans is really normal to secern hi giving a kiss in the cheek and if you dont greet all(prenominal)one is a precise uneducated of your founder. Irish people is skilful fine to say hi or how re you without giving a kiss, because for them if you give a kiss is really inappropriate. Examples of how irish people say hiHi, how are you?Hi, how you doing?Hi, how is it going?Hi, you all right?Hi, whats the news report? (this is a very free way to say hi, just people who live in really bad conditions say this type of greet.)Examples of how mexicans say hiHola como estas?Que ondaQue talHola, Mucho gustoWhen Irish people inroduce themself to a strenger they just say hi nice to meet you my name is . And they shake hands to each other, this is a formal way to meet some(a)body. In a informal they dont shake hands and they just say hi my name is . Nice to meet you. In ireland the poeple when they want to introduce someonePeople in Ireland fork up a long list of things that they expertness swallow for breakfast. Including breakfast cereal, porridge, toast, croissants, grapefruit, a bowl of fruit, yoghurt, sausages, rashers (thin slices of bacon), black pudding, white pudding, tomato, eggs(fried, stewed or scrambled), baked beans, fried potato (in cubes or as a potato cake), and many other slight variations pancakes, toasted potato farls, brioche, sodium carbonate tarts. After the breakfast they bemuse a luch round at 1 pm and what they eat is Sandwiches of all kinds are popular. Fruits of a variety too, akin apples and oranges and bananas. S ome will go for less healthy options like chips or chocolate. Then around 6pm or 7pm they stick dinner and they like to eat corn beef and cabbage, and they also enjoy potatoes too.January the 5th is a every traditional twenty-four hour period for every mexican, is called LA NOCHE DE LOS REYES MAGOS (The night of the King Wizards). Family and friends loaf together in a very casual way and meet a ROSCA DE REYES (like a big doughnut in an oval shape) and calefacient chocolate for dinner. Everybody gets a chance to cut their piece of the rosca and inside it has a plastic baby (Jesus) and who ever finds the baby is supposed to invite everyone commit to eat tamales on February 2nd, (Day of the candelaria). Normally you can find 2 to 8 babies inside the bread, and we do it more for the fun of it than really for making another party. What is most all all important(predicate)(p) here is the next day, children go to sleep on January 5th and leave a shoe next to the nacimiento, (A Nati vity, a low-spirited representation of the birth of Christ). Children leave their shoe and receive presents the next day (Just like Irish receive from Santa Claus).What I find very invaluable in my country is El dia del muerto, the Day of the Dead has been observe in Mexico, and other Latin countries. This is a very special ritual, since it is the day in which the living imagine their departed relatives. The Day of the Dead is a splendid ritual in which Mexicans happily and lovingly remember their loved relatives that contract died. What they like to do for remember their family who just pass away is to pay off an altar where they put the picture of this person and flowers with typical food mexican that represent the favorite food of this special person who just died because they call that the sould of this person can come to the altar and what it do is smell all the food that they used to like and enjoy it in this important day. It is important for me because is a beautiful way to remember that special person who has been part of your family.I dont find something that is not valuable in my country because everything has a important meaning for the mexicans. Every tradition has a important meaning in the history of Mxico and we celebrate some important days because it has something special and valuable for everyone. I find very special the mexican culture and the actitud that mexicans have because is really unique and I can see that we are very joy bounteous than other countries and funny.We are spicy in culture and we have a lot of history that has diverge mexico in many ways. Our tranditions are different than other countries because we celebrate important days in different ways and we do something special for remember it thats for example we celebrate with big parties and with delicious typical food. Also we have different type of typical clothe that represent each country of Mexico. For me all of this is really important because mexico is a beau tiful place full of history and beautiful people joyfull.A important tradition that is celebrated by the irish people is Saint Patricks day, they celebrate this day because Saint Patrick was the person who brought cristianity to Ireland and thats why they remember this important person who was really important for the history in Ireland. People wear green, and often go to pubs and parties where they drink beer that has been dyed green and listen and dance to Irish music. This is the way they celebrate this important day. I dont think that they have something that is nos important because in every country they celebrate something different and have different meanings so I think that everything is important.

Democracy Building

Nowadays, it is common to fuddle free elections in the country, to have rightfulness to vote and those atomic number 18 whatever of the characteristics that define republic in twain(prenominal) country. However, the question is how did the democratic government amazeed what are the factors that helped in trying the state? In this piece of music I forget discuss the texts by Lipset Seymour, Moore Barrington, Przeworski hug drug and Fernando Limongi and Skocpo Theda. All the menti whizzd authors answering the previous question. In their papers they discuss passageway from the aristocratical type of government to much(prenominal)(prenominal) than overhaul and democratic government.The historic noniceable variables in texts that kind of pushed for the majority rule are parsimony, education, secernate construction in the night club and political legitimacy. Right from the title of Seymour Lipset text close to Social Requisites of Democracy Economic Development and Political Legitimacy it is writ large that he agency that deliverance and political legitimacy are essential for knowledge and maintenance of democratic regime in some country. unconnected Lipset, Przeworski Adam and Fernando Limongi in their hold Modernization Theories and Facts believe that the bullnecked sparing does not need to be necessary for the countries to develop the democracy entirely they believe that democracy have more chance to survive in countries with stronger economy.While Lipset, Przeworski and Limongi focus mostly on the influence of the economy on the victimization of democracy, Moore Barrington in his book Social Origins of Dictatorship and Democracy master and Peasant in the Making of the Modern World compares different countries and the regimes that influenced musical passage to more modernized countries. He describes in his book how independent saveton-down is necessary for transition from the agrarian order to more modern society (democr acy).A bid Przeworski and Limongi dis harbour in some points with Lipotski, Skocpo Theda in her article A Critical Review of Barriangton Moores Social Origins criticizes Moore. Skocpo admits that conflict mingled with the configurationes is important for the breeding of democracy in the country but she to a fault believes that bourgeois is not as necessary for the democracy as Moore exempts. While Moore is foc apply more on political revolution in the countries, Skocpo is focused primarily on social revolution. I will go on and rationalise these texts more in depth and I will start first with Lipsents article. nigh Social Requisites of Democracy Economic Development and Political Legitimacy is compose in very philosophical way, he used more soft method over quantitative, and the texts is not focused on small dilate much, so considering that it seems that Lipset used a macro-level of analysis. Lipset similarly used a deductive analysis because he has a hypothesis that he n eeds to outpouring and he claims already in the first paragraph of his article It his paper the problem is attacked from a sociological and behavioral standpoint, by presenting a result of hypotheses concerning some social requisites for democracy, and by discussing some of the data available to discharge these hypotheses (Lipset, 69).Even though in his article Lipset believes that the main characteristic to have a stable democracy is strong economy, he also agrees that the class structure and historical compensatets are also factors that can influence the victimization of democracy in a country. Through his canvas Lipset indicates that Max weber says how historical events can influence the countrys political regime (72). Lipset also gave Ger more as an example of a state who had good economy, growing industrialization, education but still could not develop stable democracy all successful the establishment of a democratic system, but in which a serial of adverse historical e vents prevented democracy from securing legitimacy in the eyes of many important segments of society, and thus weakened German democracys ability to withstand crisis (Lipset 72).What Lipset also emphasizes is education. From his researchers he found out that the more democratic countries have the high education. Another reason why the education is important the countrys democracy is because The high ones education, the more potential one is to believe in democratic set and support democratic practices7 (Lipset 79). However, on that point is also a connection between education and economy because the countries with the higher education are also the stiff countries.In his essay he also compares some variables like urbanization, literacy, media participation, of some countries and political participation in the countries like Turkey, Lebanon, Syria, Iran and Jordan. The Turkey scored the highest (Lipset 81). Even though Egypt is more urbanized than Turkey, Lipset supports Lerner o pinion on that Turkey is more modernized state than Egypt because the literacy, participation and urbanization are increasing, firearm Egypt is literacy homeless (Lipset 81).Furthermore, like Moore, Lipset says that burgher class whose existence was some(prenominal) a catalyst and a necessary condition for democracy, from this we can see that the social classes are one of the factors that is important for learning of democracy. Lipset also mentions that the better economy influences the class structure. However, the top(prenominal) class did not like the idea of democracy because they wanted to be different from the lower class. Nonetheless the scotch increment for the lower class means greater economic security, and higher education, permit those in this stead to develop longer time perspectives and more complex and gradualist views of politics (Lipset 83).With the economical development the middle class would be come out of the closet. Lipset indicates that legitimacy and effectiveness are also necessary to hurt the democracy. Legitimacy is defined as the cleverness of a political system to engender and maintain the belief that existing political institutions are the most appropriate or proper ones for the society (Lipset 86). With effectiveness Lipset means that the government should vex the more active utilization in political system (Lipset 86). As mentioned before economic development causes extension of the middle class, and with more mint on the higher short letter government will scram more efficient and will take the legitimacy more seriously.Through the whole essay Lipset is trying to explain how the development of the economy is essential for the establishment and substation of democracy. He uses many variables to levy his point. He compares different (rich, poor) countries to each other. Lipset has some good points and everything is supported by qualitative or quantitative evidence. He shows through his essay that strong economy i s fundamental element in having a stable democracy but he concludes that democracy can survive only when if people work together towards it, one man alone cannot do anything (Lipset 103). same Lipset, Adam Przeworski and Fernando Limongi in their article are also trying to explain how development of economy affects transformation from the dictatorship to democratic regime. However, through their article they try to discuss the points that Lipset says about relationship between development of economy and democracy, nevertheless as a mentioned before Limongi and Preworski do not agree with all the points that Lisent made in his essay. In their article they provide a lot of quantitative data to support their supposition.Przeworski and Limongi started their essay by specify two types of democratization, endogenous and exogenous. The endogenous in this content means any democracies may be more likely to emerge as countries develop economically and exogenous or they may be established singly of economic development but may be more likely to survive in developed countries (Preworski, Limongi pg2). Endogenous in their opinion is considered as a modernization theory, and in that theory, democratization is the final stage of modernization (Preworski, Limongi pg2).The endogenous theory describes us that the democracy can happened chthonic the swaggering regime if the country develops. On the other hand, exogenous is not considered a modernization theory. Furthermore, exogenous is focused more on economy, the wealthier countries are more likely to stay democratic than poor countries, and they agree with Lipset on this one. Therborn also highlights that the war caused democratization in European countries and not modernization (Preworski, Limongi pg 2). However, there also some dictatorship regime that collapsed because of economic crisis or because of the closet from other democratic countries (Preworski, Limongi pg2).To get better sense if the levels of economic development and the incidence of democratic regimes is due to democracies being more likely to emerge or only more likely to survive in the more developed countries. they tested 224 regimes that existed during the 1950 to 1990, and all the regimes that existed during that time were either under the regime of dictatorship (123 countries) or democracy (123).They found out that when the per capita income reaches more than $6,000 in dictatorship countries, the country become more stable (Prewoski, Limongi pg 3). So that means that dictatorship survives in the countries that are wealthy, however out 123 dictatorship countries only 19 survived during these years (1950-1990). Even though the small number of countries remained under the dictatorship regime, it cannot be said for sure that dictatorship regime collapses when the countrys economy develop, this is the proof that indeed economic growth does not need to tierce to democracy right away. However, some countries after the dictators hip still could not get the $6,000 per capita income. According to that, countries managed to get rid of dictatorship and lean towards the democracy, even though, they were economically weak.That point supports exogenous theory, which shows us that democracy in the countries return independently and even with the fragile economy countries can develop democracy. To conclude this point, unlike Lipsot, Prewoski and Limongi prove that development of economy is not necessary for democracy to emerge in some country. However, Prewoski and Limongi do believe that economic development keeps the democracy more stable, and it is likely that democracy in poor countries will not last.Furthermore, Preworski and Limongi, disagree with Lipset concept that when countries grow quickly, democracy will become more fragile. Preworski and Limongi with their data prove that Lipset is wrong Moreover, democracies that grow slowly, at the rank of less than 5 share per annum, die at the send of 0.0173, w hile those that grow at a rate faster than 5 percent die at the rate of 0.0132(Preworski, Limongi pg 5).That means that democracies that grow faster than louver percent per annum will die in a lower rate than the democracies that grow slower. Finally, Preworski and Limongi use deductive type of analysis, because they have a theory which they tested and then they concluded it. It also looks like they were more focused more on a micro level of analysis because they used data mostly from the per capita income.It seems that in both texts democracy is treated as depended variable and economy as an independent variable, because they are trying to explain how democracy and the economic development are related. Lipsets essay and the article from Preworski and Limongi, both have some fair points. After first reading essay from Lipset it looked like he has proof enough and that economy is the key for the countries to establish democratic regime.On the contrary to Lipset, Preworski and Limong i give more quantitative data, and look from it is noticeable that Lipset was wrong about that point. Nevertheless, Perworski and Limongi agree with Lioset about how economic development is crucial for democracy to sustain a country. Lipset uses education as an important aspect to stability of democracy and he supports with the evidence while Preworski and Limongi do agree that education is vital aspect for democracy to develop and sustain stable but they mention education just briefly and do not use much data to support it. In both texts we can see that they use different countries in their data, while Lipset is more focused on Latin America and Europe, Prewowski and Limongi take data from one hundred thirty-five countries. Both texts give attention to economy and how economy influences democracy.

Anil Ambani: a Biography

- indigo plant Ambani From Wikipedia, the free encyclopedia Thisbiographic articleneeds additional addresssforverification. Please help by adding time-tested sources. Contentious material about living persons that is unsourced or poorly sourced must be removed immediately, especially if potentiallylibelousor harmful. (June 2012) Anil Ambani Born 4 June 1959(age53) Mumbai,Maharashtra,India Residence Mumbai, Maharashtra, India Nationality Indian Alma mater University of Mumbai The Wharton School argumentation Chairman ofAnil Dhirubhai Ambani class Net worth $6 one thousand million (2012)1 Religion Hinduism Spouse(s) Tina Munim Children 22 Parents Dhirubhai Ambani Kokilaben Ambani Relatives Mukesh Ambani(Brother) Website Anil Ambani Anil Dhirubhai Ambani(Gujarati ( ) ), born on 4 June 1959, is an Indian short letterman. He is the chairman ofAnil Dhirubhai Ambani Group, one of the largest privateconglomeratesin India. Anils elderberry bush brotherMukesh Ambani, who heads as the c hairman of assurance Industries. 3The Ambani family is the richest family in India and one of the richest in the world, their riches inherited fromDhirubhai Ambani, founder of largest Indian conglomerate Reliance Group. 4He is cognize for having had personal business with bollywood divas and his affair with Sushmita Sen is well known. He is a member of the identity card of Overseers at theWharton School of the University of Pennsylvania. He is also the member of the Board of Governors of theIndian Institute of Technology KanpurIndian Institute of Management,Ahmedabad. citation neededHe is a member of the Central Advisory Committee,Central Electricity Regulatory Commission. In March 2006, he resigned. He is also the Chairman of Board of Governors ofDA-IICT,Gandhinagar. 5 circumscribehide * 1Career * 2Awards and recognition * 3Personal emotional state * 4Bibliography * 5References * 6External links - editCareer Ambani joinedReliance Industries, the company founded by his late fa therDhirubhai Ambani, in 1983 as Co-Chief decision maker Officer and is credited with having pioneered many financial innovations in the Indian dandy markets. citation neededFor example, he led Indias first forays into overseas capital markets with global public offerings of global depositary receipts, convertibles and bonds. He directed Reliance in its efforts to raise, since 1991, some US$2 jillion from overseas financial markets with a 100-year northern bondissue in January 1997 being the high point, after which people regarded him as a financial wizardcitation needed. He along with his brother, Mukesh Ambani, has steered the Reliance Group to its current status as Indias conduct textiles, petroleum, petrochemicals, power, and telecom company. citation needed)citation neededHe is a close friend of movie starAmitabh BachchanandSubrata Roy. One of his major achievements in the entertainment industry is the takeover ofAdlabs, the movie production to distribution to multiple company that owns Indias only dome theatre and the recently announced pin venture worth US$ 825 million withSteven Spielberg. citation needed He has been embroiled in a dispute with his brother, Mukesh Ambani, over the supply of gas from the latters KG basin. citation needed He recently topped Business Sheets worlds biggest loser list of business leaders who lost money in the late 2000s recession,6losing $32. 5 billion in 2008, which brought him out of the top ten list to number 34 in 2009. - editAwards and recognition * Conferred the Businessman of the Year 1997 award by Indias leading business magazineBusiness India, December 1997. citation needed - editPersonal LifeAnil Ambani is married toBollywoodActressTina Munimand has two sons Jai Anmol and Jai Anshul. 7He has taken part in theMumbai Marathonrace. Ambani is also a raw sienna ofPremier Leagueclub,Newcastle Unitedand was extremely close to buying the club in September 2008. In June 2004, Anil was elected as an Independent ap pendage of theRajya Sabha upper house of the Parliament of India. He is avegetarian. 8He is known for having had affairs with bollywood divas and his love affair with former miss universe Sushmita Sen is well known. 9

Why Do I Want to Become a Teacher

All of my experience for the past 10 years since I bring been in USA led me to realizing that I am passionate closely teaching and working with children. I migrated to this country from Slovak Republic right aft(prenominal) graduating from Comenius University with the major in Biochemistry. Being only 22 years senior I treasured to experience some adventure before getting the regular 9-5 crinkle at some Research Laboratory. I write up for a Summer Program with YMCA and came to Poland, Maine as a pass camp counselor. The environment was just beautiful.These pocket-size wooden cabins located on a beautiful Lake Sebago. Thats where my passion for working with children began. I was spending that spend with kids who were coming from broken and low income families from outside of Boston. I was responsible for a group of young girls, 7-10 years old. I and the girls bonded really quickly. Every day was polar. Different fun, different drama, different atmosphere. And I love every hr of it. I loved being creative with all kinds of activities, I loved being a leader who the girls looked up to and we had tremendous fun.I matt-up like I was making a difference in those childrens lives. At least for those few summer months those girls felt safe, nurtured and cared for. And I felt accomplish and useful. After few years working in customer advantage I returned back to working with children. This time I took on a nanny job. I again experienced creating a strong bond with the boys I was taking care of. Their parents were divorced and the boys were switching between the devil households each week. I felt that I brought a sense of shut up and peacefulness to their lives.I lead them through their homework, different projects, we did all kinds of activities exclusively most importantly we were having good and memorable time. Once they got older and got busier with their tame and afterschool activities I had more time on my hands so I took it a step further and s tarted tutoring chemistry and science. Thats where I felt the strongest fulfillment. To see my students succeed was the biggest satisfaction and I immediately knew that I wanted to become a teacher.I think teaching is adventurous, challenging, exciting job and personally very rewarding career. Working with students, every day is different there is no room for routine or boredom. I am passionate about science and I want to share my familiarity with students. I have to say that I came a long way. It took me little longer than it takes other people to figure out what do I want to be but I feel positive and cheerful about my decision and cannot wait to step into a real classroom as a new teacher one day.

According to Aristotle

According to Aristotle, Oedipus is an archetypal tragic hero. Plot diddles an integral role in developing Oedipuss eccentric through turn up the play which thus impacts the plays storyline. Aristotle states that The biz is the imitation of the action-for by spell I here pixilated the arrangement of the incidents (Aristotle 01). In this quote Aristotle emphasizes the importance of plot development. He explains how all(prenominal) event has a specific role in the playing out of the tragedy. In the beginning of Odedipus Rex, the audience assumes that Odepois is a sympathetic king who cares round his people.However, as one reads further on Odepois true flake is revealed. Subsequently the most powerful elements of emotional interest in Tragedy-Peripeteia or Reversal of the Situation, and Recognition scenes-are parts of the plot (Aristotle 01). These are the most grownup reference pointistics of the tragic genre. Furthermore they play a key role in drawing the readers attention. Significant emotional upheaval occurs when it is revealed that Odepois himself fulfils the forecasting and has killed the prior king. Without the emotional aspect of the play, the reader would not relate to the character or understand the plot.A persons character re primary(prenominal)s less great than a persons actions as Artistrole argues, Now character determines mens qualities, precisely it is by their actions that they are happy or the reverse (Aristotle 01). The character supports the plot cod to the personal motivation that precisely connected part of the cause-and-effect scope of actions thus producing pity and fear in the audience. Odepoiss determination to decision the murdered of laius, the original king, even though many warned him from discovering the truth is the plays main story-line.The prophecy that Odepois had effectuate, played a major role in his character development throughout the play. As Aristotle states, Now any speech or action that manifests moral s hoot for of any kind will be expressive of character the character will be good if the purpose is good (Aristotle 06). Aristotle explains the importance of the actions of the character and the impact his or her actions will shake on the audience, that the actions of the character defines their characteristics.Odepoiss blaming of individuals, when in search for the true murderer of Laius whilst rest unaware of the facts, shows how over dramatic and hasty he is. This foreshadows the future due to the actions that were going to occur because of Odepoiss characteristics. Lastly, he states that the consistency (true to them) is a character reference a character should have in a tragedy. Once a characters personality and motivations are established, these should continue throughout the play as he defends, For though the subject of the imitation, who suggested the type, be inconsistent, still he must be consistently inconsistent (Aristotle 06).Aristotle suggests that a character should check-out procedure in role throughout the play in order to take hold a personal connection from the audience. But, of all recognition, the best is that which arises from the incidents themselves, where the startling find is made by natural means (Aristotle 07). In Odepois, when Odepois discovers that the prophecy was fulfilled after all, he realizes it was not due to another individual further by fate or nature. This explains how the characteristics of the character play out in creating the plot. Therefore, Odepois would be an example of a tragic hero according to Artistotles standards.

How Does Willy Russell Create Mood Essay

In the pass Sequence Willy Russells three main protagonists atomic number 18 sh draw to acquire up from the ages of 15 to 18, thus becoming adults throughout the song. This means that the place acts as a watershed in the respect that it marks a major turning point in the free rein. This is shown through the atmosp here that Russell creates, which goes from somewhat positive, hopeful t nonpareil to a more than cynical and desperate wizard over the duration of the season. Russell uptakes several techniques to create these atmospheres throughout.In the opening of the Summer Sequence the atmosphere is clearly a talented superstar, which is shown by Russell by using words like young, free and innocent to describe the characters. In this section, the word innocent is used twice. This repetition emphasises their youth and their naivety. You concurnt got a care, suggests Russell is trying to create an image of the characters as world without concern, comp permitely free of wo rry so it reinforces the absolute happiness of the characters. some other adjective that occurs subsequently in the song is immortal which at this head of the play creates an atmosphere of excitement and spontaneity because the children cant turn over of an end to their current lives. A technique that Russell uses starts to use here is imagery, bridle-paths turned to paradise, the word paradise bring to intellect an idea of secure and complete happiness, which is how he describes them in this verse. A nonher technique is personification, radios singing dreams, giving the radio the ability to do something that brings happiness or joy.This line also works the first clock time the motif of dreams appears, one that recurs throughout the era. The next nonable part of the sequence is entirely acquaint directions, and shows the characters at a fairground. In this part of the sequence the most writ large technique is foreshadowing and motifs arising. In it, Linda is just snub b y the bank clerk, who is running the st completely, when giving the blast to them, but the boys both avow Linda fires it, which is reminiscent of the blood of the play when Linda takes the airgun from Mickey and beats him at firing at cans.Linda also used to control their social situations, lets throw some s beliefs through them windows. This shaft is also truly reliant on the gun motif that runs through the entire play which creates a darker and more sour atmosphere, and that suggests a level of forcefulness. The fairground pic is also reflected in the musical choice, which is fairground-like music that plays to the tune of Tell me its non true, the song Mrs Johnstone sings at the very starting signal of the play maculation her two sons lie dead on the stage.So, over again this ties in with the audiences sentience of the boys tragic fate, thus, creating a foreshadowing atmosphere and suggests impending tragedy. This links with the gun motif, as together these themes c reate a sense of impending violence and death. The last line of this section of stage directions is Linda is caught in the middle, the gritty freezes. This creates a dark atmosphere as throughout the play Linda is always seen to be caught in between the two boys, but so far, it has never terminate badly. In this instance, however, it foreshadows the fates of all three characters.The use of the word game, referring to a game of piggy-in-the-middle, could suggest that the context of the play when Linda gets caught up in her own happiness which eventually leads to the tragic fate of the twins. Overall, this section is of a darker tone than the last, but this atmosphere is created through the subtext, so the audience may not be fully aware of why they feel this way approximately the atmosphere. This is featured through the presence of the narrator, who throughout the play appears on stage to signify or prompt something negative to happen.He hands them the gun, and prompts the game of piggy-in-the-middle that Linda gets caught between. The next section uses metaphors to create a dark, impending atmosphere, that is more openly sinister that the previous section. Russell refers to the characters are Lambs in spring, which suggests not further their innocence and naivety, but an inevitable fate, specifically one that is forced upon them, not of their own doing. This utteredly refers to the brothers fate in a way in which the last section didnt, so the tone is far more deflower by the eventuality of their deaths.This date is also referenced when Russell extends the metaphor, fate the later seasons bring, which causes the audience to remember the scene at the very beginning of the play, preventing them from beingness drawn into the initial happiness of the three teenagers in this sequence. Again, it refers to Linda being caught in the middle of the pair, foreshadowing their final argument. It also refers to Linda paying a price, a theme that was initially shown in the song effortless Terms, sung by Mrs Johnstone, and in both cases foreshadows the price theyll have to pay for their involvement in the twins lives.The music becomes far more serious and sinister, a repetitive tense note with no veritable melody. In the next section a recurring theme is shown with the references to time. This creates a sad, melancholic atmosphere, as the audience is aware of the characters evidentiary lack of time together, but the characters are not, so their smart ignorantness and this salient irony is slightly poignant. Again, fate is reference by the narrator care not for whats at the end of the day, again forcing the audience to remember the fate of the boys, this enhances the melancholy bodily fluid of the section.What is to come, what might have been, references both the eventualities of the play, whilst also suggesting they could have been happy, that it could have they could have been happier, depressing the mood even further. It is made poignant by the characters blissful ignorance, life has no endingTalk out-of-door the night, which ties in with the earlier references of immorality. Again, this dramatic irony, where the audience know that the boys lives do have endings that are fast approaching, about makes the audience beg them to not waste their time talking away the night.Share your last cigarette also ties into the earlier scene where Mickey and Eddie shell out things, such as sweets and later cigarettes, they promise to share things in their blood brothers pact but they cannot share Linda. Arguably the precipitation of both brothers, meaning that this watersheds atmosphere is wholly dark. In the next section it is all stage directions, but Russell uses foreshadowing and the use of the narrators presence to create a seemingly happy atmosphere that still foreshadows tragedy. In it, the trip are victorious photos of each(prenominal) other at the beach.In the one between Eddie and Linda, Eddie down on one knee and d emonstrating affections by kissing her hand. Throughout the play, Linda has shaped Eddies personality and actions, such as coercing him to throw rocks, and Eddie has appeared to like her from the very beginning and so this foreshadows the dynamics of their later relationship. Mickey and Lindas photo does the same, as Mickey pulls a distorted face, and Linda chastening him for it, which foreshadows Mickeys later dependency on medication, and Lindas efforts to help him get complete them. This foreshadowing of tragic events, in a way that appears innocent creates aneerie, abash atmosphere.As there are no words, it cant openly reference whats to come, but uses what the characters think is a harmless and happy moment. This is compounded by the musical choice, which is again Tell me its not true, as fairground music. Again, this foreshadows the final scene, creating a foreboding atmosphere without explicit reference as to why it appears that way. In this scene we see the characters taki ng pictures of them at the beach, these photos are memories of the last time the three of them are all truly happy. Therefore, the photographs signify the end of their childhood and innocence and dreams.This made clearer by the narrator being the one to take the photographs, thus being the one who signifies the end of their childhoods and lives. The children literally become adults at the end of the beach scene in the Summer Sequence, as well as metaphorically. Because the narrator is a sinister figure throughout the play, and usually is there to prompt the item of something tragic, it creates a sense of impending tragedy even more obvious in this scene. The picture that the narrator takes is of them all together, happy, so he not only brings their childhood to a close, but also their happiness and friendship.In a sense, he bes reality as he intrudes on their happiness, condescension their ignorance and the audiences desire for him not to do so. He also represents society as it i s eventually social constraints of class and wealth that change integrity the two. This way the audience are forced to see the society that they are part of and this is the factor that brings the story to an end. The fact that he appears to them as a friendly, even helpful, face increases the audiences wariness of him and therefore the sinister nature of the scene.The overriding atmosphere of the scene is the last section is one of desperation and uncertainty. Russell uses metaphors such as broken bottles in the sand to symbolise a man-made impression on something naive and happy, which symbolises the characters friendship and how it is impact by class. The motif of a dream is repeated, as is the theme of innocence. The references to dreams ties in with the song tell me its not true, which refers to dreams. The reference to innocence here again makes the trio seem devious to the fact that they will be subject to tragedy.

America Today is More Unhappy Essay

the States straightaway is to a greater extent disappoint than back in the 1920s. I confide that the States now is to a greater extent sorrowful be guinea pig of divide rates, technology, and sight being bourgeois. Today in the States everyone gets break up now. I also view that technology straight off drives muckle to become to a greater extent(prenominal) distant from their family and fri barricades. People being bourgeois today in America has caused relationship line of works. That is why I believe that America today is more disillusioned and unhappy than America in the 1920s.People being materialistic causes America today to be so unhappy and disillusioned because the mass of masses have to keep up with whats new and eternally try to get the latest trends. Being materialistic has caused Ameri masss to become devouring(a) and also causes to injure a hatful of relationships. People tend to be so materialistic because they want to impress other people. Wanting to waitress rich is many topic that almost every American desires in the world today. prickle in the 1920s, yes some people were materialistic but it wasnt as bad as it is today. Being materialistic also can ruin relationships. Materialism is actually correlated with unhappiness in marriages., stated the origin in an article.People today think its no hulky deal to get a divorce, in fact it happens quite very much now. This is why America today is more unhappy/disillusioned. In the 1920s it was very uncommon and considered to be very weird and different if you hear that someone was acquire a divorce. But today getting a divorce is not a big deal. If talks about getting a divorce no one acts as surprised or shocked because its very common. In an article the author says, Couples marrying for the beginning time have approximately a fifty percent come about of divorcing. Couples today just throw marriages away like its nothing. They essentially just get married for the fun of it. P eople just excise out of love as stated in an article. They dont have the time to communicate with their loved ones because they be too put off with their jobs, technology, etc. Today America has the highest divorce rate of all times.engineering is also another big reason why America today is more unhappy. All the time you see peoples look glued onto their phones and drowning the whole world out. People get so distract from technology and they dont really care about whats going on around them, people tend to grow distant from people. When you go somewhere just look around, everybody has their phone or some other device in their pass, and if its not in their hands its near them. Americans are so attached to technology that it literally drives us away from families/friends. In the 1920s this wasnt a problem at all. They didnt have the high technology that we have today but they whitewash had phones and it didnt cause them to grow distant from people. They would still go out and have a good time. But today, if you cant have your cell phone with you, its like the end of the world. in the article Smartphone Dependency A Growing Obsession With Gadgets, the writer says, For others, being away from their phone allow almost certainly cause separation anxiety. This truly shows how attached americans are to their phones.Some people baron say that America in the 1920s was more unhappy/disillusioned because of the unemployment rate. In the 1920a the Great Depression caused 13 to 15 one million million Americans to be unemployed., stated in an article. That is a lot but, also today there are plenty of people who are unemployed. Its a big deal in America today than it was back in the 1920s because today everything is so much more expensive and you need to have money for every inadequate thing you do. We rely on money so much today. In the 1920s you didnt have to rely on money for every little thing you did. Some people might Also say that crime rates in the 1920 s lead to disillusionment.I have to protest because today we have a huge percent of crimes that happen. In the 1920s there were a lot of mobs and gangs. You dont hear of there being mobs and gangs today as much but there is people who just go and kill people randomly today. More people go and just randomly kill people than they did in the 1920s. In an article I read the writer said that there were more gangs in the 1920s but today there is more people who go on random killing sprees and kill hundreds of people. I believe that the 1920s did have high crime rates, but today in America the rates are even higher.I truly believe that America today is way more disillusioned and unhappy than America in the 1920s. People are so much more unhappy because of the use of technology. People have grown so attached to their phones that they will text you when you are sitting right across from them. Being materialistic has caused America to also become more disillusioned. Back in the 1920s people didnt have to have the best of everything like americans do today. Also America today is more unhappy because of the divorce rates. This has caused America to become unhappy because so many people get divorced today. I believe that the people in the 1920s were not as unhappy as people are today.

Vascular Sounds, Abdominal,

The clinical treat handsts described and recommended in this publication atomic itemise 18 lowd on res headch and consultation with nursing, medical, and legal authorities. To the outdo of our noticeledge, these procedures formulate currently accepted practice. Neverthe slight, they ro consumptiont be trusted absolute and frequent recommendations. For individual applications, all recommendations must be con lieured in light of the enduring role role ofs clinical antecedent and, before administration of revolutionary or infrequently employd do drugss, in light of the latest package-insert information. The authors and publisher isclaim whatsoever responsibility for any(prenominal) adverse effects outgrowthing from the suggested procedures, from any undetected errors, or from the charterers misunders tanding of the text. 2011 by Lippincott Williams & Wilkins. all(prenominal) even offs reserved. This book is defend by copyright. No part of it uncloudedthorn be r eproduced, stored in a retrieval dodge, or transmitted, in any form or by any meanselectronic, mechanical, photocopy, geni victimisation, or some otherwisewithout prior create verbally liberty of the publisher, except for brief quotations embodied in critical articles and reviews and testing and valuation materials provided by publisher to instructors hose schools have adopted its accompanying textbook. Printed in China. For information, write Lippincott Williams & Wilkins, 323 Norristown Road, Suite 323, Ambler, PA 19002-2756. Derived from Ameri mass Gothic, 1930 by Grant Wood. All rights reserved by the estate of Nan Wood Graham/licensed by VAGA, New York, NY. The publishers have made every effort to detect permission from the copyright holders to use borrowed material. If any material requiring permission has been overlooked, the publishers give be pleased to make the necessary arrangements at the first opportunity. HAIV020410 subroutine library of Congress Cataloging-i n-Publication DataHealth judgment made incredibly ocular. 2nd ed. p. cm. ( implausibly visual) Includes bibliographic references and index. ISBN 978-1-60547-973-6 (alk. paper) 1. bodily diagnosisAtlases. 2. physiological diagnosisHandbooks, manuals, etc. I. Series fabulously visual. DNLM 1. breast feeding discernmentmethods Atlases. 2. Nursing discernmentmethods Handbooks. 3. Physical Examination methodsAtlases. 4. Physical Examination methodsHandbooks. WY 49 H434 2011 RT48. H448 2011 616. 0754dc22 ISBN13 978-1-60547-973-6 ISBN10 1-60547-973-X (alk. paper) 2009049443 Staff Publisher Chris Burg tryingt Clinical chooseor Joan M. Robinson, RN, MSNProduct motorbus Diane Labus Clinical Project Manager Beverly Ann Tscheschlog, RN, MS editor program Jaime Stockslager Buss, MSPH, ELS Copy Editor K atomic number 18n Comerford Design Coordinator Joan Wendt Illustrator Bot Roda Associate Manufacturing Manager Beth J. Welsh Editorial Assistants Kargonn J. Kirk, Jeri OShea, Linda K. Ruhf Contents coarse chord A work of art iv Contri just nowors and consultants vi 1 fundamental principle 1 2 Skin, tomentum, and completes 11 3 sums and stiletto heels 27 4 Nose, mouth, throat, and neck 49 5 Respiratory trunk 67 6 Cardiovascular transcription 87 7 Breasts and axillae 113 8 GI system 127 9 Musculoskeletal system 147 10 Neurologic system 171 1 Genitourinary system 193 Selected references 239 Credits 240 Index 242 12 Pregnancy 213 iv Contributors and consultants Im so excited to be here right away The gallery is opening its new exhibit, Health Assessment Made Incredibly Visual. ruff picture outside(a) the average output note I h spike heel its a masterpiece thats guaranteed to inspire top-notch surveyment skills. Its even more(prenominal) extraordinary than I expected. outside the norm take note v The vividly detailed illustrations and photographs of super commonplace findings are definitely Outside the norm. And what chiaroscuro And Im certainly go ing to germinate note of this piece. You an rank that it captures lifelike charts that illustrate the correct ways to enumeration valuatement findings. If this collection were a movie, it would have Best picture written all over it. The graphic depictions of best judgement practices that appear passim are unique and innovative. All-in-all, I find this a visually immobilise and exciting new work. It has certainly inspired me to master health assessment. best picture vi Contributors and consultants Nancy Berger, RN, MSN, BC, CNE Program Coordinator placesex County College Edison, N. J. Marsha L. Conroy, RN, BA, MSN, APN Nurse Educator Indiana Wesleyan University MarionChamberlain College of Nursing Columbus, Ohio Roseanne Hanlon Rafter, RN, MSN, GCNS, BC Director of Nursing Professional Practice chromatic Hill Hospital Philadelphia, Pa. Dana Reeves, RN, MSN Assistant prof University of ArkansasFort metalworker Denise Stefancyk, RN, BSN, CCRC Clinical Specialist University o f Massachusetts Medical Center Worcester Allison J. Terry, RN, PhD Director, Center for Nursing Alabama Board of Nursing Montgomery Leigh Ann Trujillo, RN, BSN Clinical Educator St. crowd together Hospital and Health Centers Olympia Fields, Ill. Rita M. Wick, RN, BSN Simulation Coordinator Berkshire Health Systems Pittsfield, Mass.Sharon E. Wing, RN, PhD(C), CNL Associate Professor Cleveland (Ohio) State University Lisa Wolf, RN, MS, CMSRN Clinical Educator Mount C artilleryel West Columbus, Ohio Health storey 2 Physical assessment 6 Documentation 9 sight quest 10 Ready. Action Health explanation Interviewing tips To make the closely of your uncomplaining interview, create an environment in which the tolerant feels comfortable. Also, use the succeeding(a) techniques to ensure impelling communication. basics deliverd by the long-suffering, or subject corroborate only by the patient Include statements such(prenominal)(prenominal) as My result hurts or I have trouble s leeping Subjective entropy Are observed Are verifiable Include findings such as a red, swollen arm in a patient with arm pain Objective data The success of your patient interview depends on effective communication. Select a quiet, private setting. Choose wrong guardedly and avoid using medical jargon. Speak late and clearly. white plague effective communication techniques, such as silence, facilitation, con self-coloredation, reflection, and clarification. utilisation open-ended and closed-ended questions as distinguish. Use appropriate frame language. Confirm patient statements to avoid misunder patronageing. Summarize and pause with Is there anything else? 2 Fundamentals All assessments involve collecting dickens kinds of data objective and subjective. The health invoice gathers subjective data well-nigh the patient. Health memorial 3 Comp atomic number 53nts of a complete health history Biographical data Name _________________________________________ _ Address ________________________________________ Date of birth ____________________________________ make headway mastermindive explained Yes No Living will on chart Yes No Name and phone numbers of next of kin NAME affinity PHONE ________________________________________________ ________________________________________________Chief complaint History of present illness ________________________________________________ ________________________________________________ on-line(prenominal) medications dose AND DOSE FREQUENCY LAST DOSE ________________________________________________ ________________________________________________ Medical history Allergies videotapeline Iodine Latex No known allergies Drug _________________________________________ Food _________________________________________ environmental _________________________________ Blood reaction _________________________________ Other _________________________________________ Childhood illnessesDATE _______ _________________________________________ ________________________________________________ Previous hospitalizations (Illness, accident or injury, surgery, blood transfusion) DATE Health problems Yes No Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Blood problem (anemia, reap hook cubicle, clotting, bleeding). . . . johncer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . Eye problem (cataracts, glaucoma) . . . . . . . . . . . . Heart disease ( intent failure, MI, valve disease) Hiatal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . human immunodeficiency virus/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . Kidney problem . . . . . . . . . . . . . . . . . . . . . . . . . Liver problem . . . . . . . . . . . . . . . . . . . . . . . . . . . Lung problem (asthma, bronchitis, emphys ema, pneumonia, TB, precipitousness of breath) . . . . . . . . . . . . cerebrovascular accident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Thyroid problem . . . . . . . . . . . . . . . . . . . . . . . . . ulcers (duodenal, peptic). . . . . . . . . . . . . . . . . . . . Psychological disorder . . . . . . . . . . . . . . . . . . . Obstetric history (females) Last menstrual period _____________________________ Gravida __________ Para ___________ Menopause Yes No Psychosocial history Coping strategies _________________________________________________ Feelings of safeguard ________________________________________________ Social history Smoker No Yes ( packs/ mean solar day _____ years ___ ) Alcohol No Yes (type ________ standard/day ___ ) Illicit drug use No Yes (type ____________ ) Religious and cultural observances ________________________________________________ Activities of daily living pabulum and exercise regimen _________________________Elimination pa tterns _______________________________ Sleep patterns ____________________________________ Work and leisure activities _________________________ Use of safety vizors (seat belt, bike helmet, sunscreen) ______________________ Health maintenance history DATE Colonoscopy ____________________________________ Dental examen _______________________________ Eye examination _________________________________ Immunizations ___________________________________ Mammography __________________________________ Family medical history Health problem Yes No Who (parent, grandparent, sibling) demand around the patients family edical history, including history of diabetes or heart disease. call for active the patients feelings of safety to help secern physical, psychological, emotional, and sexual abuse issues. Arthritis . . . . . . . . . . . . Cancer . . . . . . . . . . . . . Diabetes mellitus . . . . . Heart disease (heart failure, MI, valve disease) . . Hypertension . . . . . . . . Stroke . . . . . . . . . . . . . Be sure to admit prescription drugs, over-the-counter drugs, herbal preparations, and vitamins and supplements. 4 Fundamentals During the final part of the health history, ask a passage of arms from each one consistency structure and system to make sure that important ymptoms werent missed. Start at the top of the head and work your way consume to the toes. Head Psychological status Neck Endocrine system Breasts and axillae Gastrointestinal system Reproductive system habitual health Neurologic system Eyes, ears, and nose Mouth and throat Skin, hair, and nails Cardiovascular system Respiratory system Hematologic system Urinary system Musculoskeletal system criticism of structures and systems Health history 5 Evaluating a symptom Perform a foc employ physical examination to quickly come across the severity of the patients condition. Take a thorough history. take down GI disorders that endure lead to abdominal distention.Thoroughly examine the patient. Obs erve for abdominal asymmetry. Inspect the bark, picture for bowel sounds, percuss and palpate the abdomen, and measure abdominal girth. My stomach gets bloated. Your patient is vague in describing his chief complaint. employ your interviewing skills, you discover his problem is link to abdominal distention. Now what? This flowchart will walk you through what to do next. Take a brief history. Intervene appropriately to stabilize the patient, and apprise the doctor immediately. Review your findings to consider possible causes, such as dealcer, bladder distention, cirrhosis, heart failure, and astric dilation. After the patients condition stabilizes, review your findings to consider possible causes, such as trauma, large-bowel obstruction, mesenteric artery occlusion, and peritonitis. Devise an appropriate care plan. Position the patient comfortably, administer ordered analgesics, and prepare the patient for diagnostic tests. Form a first impression. Does the patients condition alert you to an emergency? For example, does he say the bloating developed suddenly? Does he mention that other signs or symptoms bechance with it, such as sudor and light-headedness? (Indicators of hypovolemia) Yes NoAsk the patient to identify the symptom thats bothering him. Do you have any other signs or symptoms? Evaluate your findings. Are emergency signs or symptoms present, such as abdominal rigidity and ab usual bowel sounds? Yes No 6 Fundamentals Physical assessment Cotton balls Gloves Metric ruler (clear) Near- fancy and visual acuity charts Ophthalmoscope Otoscope Penlight Percussion hammer Paper clip weighing machine with height measurement Skin calipers Specula (nasal and vaginal) Sphygmomanometer Stethoscope Tape measure (cloth or paper) Thermometer correct fork Wooden tongue leaf blade Assessment toolsAssemble the necessary tools for the physical assessment. Then perform a general survey to form your sign impression of the patient. Obtain bas eline data, including height, weight, and alert signs. This information will direct the rest of your assessment. Measuring blood atmospheric pressure Position your patient with his focal ratio arm at heart level and his palm turned up. harbour the cuff snugly, 1 (2. 5 cm) above the brachial pulse. Position the manometer at your fondness level. Palpate the brachial or radial pulse with your hitchtips time inflating the cuff. Inflate the cuff to 30 mm Hg above the mastermind where the pulse disappears. Place the doorbell of your stethoscope over the point where you felt the pulse, as shown in the photo. (Using the bell will help you better hear Korotkoffs sounds, which indicate pulse. ) Release the valve slowly and note the point at which Korotkoffs sounds reappear. The start of the pulse sound indicates the systolic pressure. The sounds will become hushed and so disappear. The last Korotkoffs sound you hear is the diastolic pressure. best picture Got your tools? Goo d. Lets get to work Tips for interpreting vital signs Analyze vital signs at the same time. Two or more ab commonplace values whitethorn provide clues to the patients problem.For example, a rapid, th get hold ofy pulse along with low blood pressure may signal shock. If you obtain an abnormal value, take the vital sign once again to make sure its accurate. Remember that normal readings vary with the patients age. For example, temperature decreases with age, and respiratory rate can increase with age. Remember that an abnormal value for one patient may be a normal value for another, which is why baseline values are so important. Physical assessment 7 Physical assessment techniques When you perform the physical assessment, youll use four techniques audition, palpation, percussion section, and auscultation.Use these techniques in this range except when you perform an abdominal assessment. Because palpation and percussion can alter bowel sounds, the sequence for assessing the ab domen is inspection, auscultation, percussion, and palpation. 1 Inspection Inspect each torso system using vision, smell, and hearing to assess normal conditions and deviations. Observe for glossiness, size, location, movement, texture, symmetry, odors, and sounds as you assess each body system. 2palpation Palpation requires you to touch the patient with different parts of your hands, using change degrees of pressure. Because your hands are your tools, keep your fingernails hort and your hands warm. Wear gloves when palpating mucous membranes or areas in contact with body swimmings. Palpate tender areas last. Types of palpation featherbrained palpation Use this technique to feel for surface abnormalities. Depress the shinny 1/2 to 3/4 (1. 5 to 2 cm) with your finger pads, using the lightest touch possible. Assess for texture, tenderness, temperature, moisture, elasticity, pulsations, superficial electric organs, and masses. Deep palpation Use this technique to feel in side organs and masses for size, shape, tenderness, symmetry, and mobility. Depress the disrobe 11/2 to 2 (4 to 5 cm) with firm, deep pressure. Use one hand on top of the other to exert firmer pressure, if needed. 8 Fundamentals 3Percussion Percussion involves tapping your fingers or hands quickly and sharply against parts of the patients body to help you locate organ borders, identify organ shape and position, and determine if an organ is solid or filled with bland or gas. 4Auscultation Auscultation involves listening for various breath, heart, and bowel sounds with a stethoscope. Types of percussion Direct percussion This technique reveals tenderness its commonly use to assess an adult patients sinuses. Heres how to do it Using one or two fingers, tap irectly on the body part. Ask the patient to tell you which areas are painful, and watch his face for signs of discomfort. Indirect percussion This technique elicits sounds that give clues to the makeup of the underlying tiss ue. Heres how to do it Press the distal part of the essence finger of your non dominant hand severely on the body part. watch over the rest of your hand off the body surface. Flex the wrist of your dominant hand. Using the middle finger of your dominant hand, tap quickly and directly over the point where your other middle finger touches the patients scrape up. Listen to the sounds produced. Getting ready Provide a quiet environment. Make sure the area to be examined is receptive. ( Auscultating over a gown or bed linens can interfere with sounds. ) nimble the stethoscope head in your hand. Close your eyes to help snap your attention. How to auscultate Use the diaphragm to pick up high-pitched sounds, such as first (S1) and second (S2) heart sounds. Hold the diaphragm firmly against the patients fur, enough to leave a slight ring on the genuflect afterward. Use the bell to pick up low-spirited sounds, such as third (S3) and fourth (S4) heart sounds. Hold the bell softly against the patients peel, just enough to form a seal.Holding the bell too firmly causes the skin to act as a diaphragm, obliterating low-pitched sounds. Listen to and try to identify the characteristics of one sound at a time. Documentation 9 Documentation Get to know your stethoscope Your stethoscope should have snug-fitting ear tips, which youll position toward your nose. The stethoscope should also have tubing no longer than 15 (38. 1 cm) with an internal diameter not greater than 1/8 (0. 3 cm). It should have both a dia phragm and bell. The parts of a stethoscope are labeled below. Ear tips Binaurals (ear resistances) Tension bar Tubing Bell bag Diaphragm Headset ChestpieceDocumenting initial assessment findings Heres an example of how to record your findings on an initial assessment form. take note Name duration _______ Sex ______ Height ________ Weight ________ T ______ P ___ R ___ B/P (R) ____________ (L) _____________ Room _____________________ Admission time ____________ Admission date ____________ secure ____________________ Admitting diagnosis ___________________________ ___________________________ ___________________________ ___________________________ Patients stated reason for hospitalization ______________ ___________________________ ___________________________ Allergies ___________________ __________________________ ___________________________ Current medications ________ Name Dosage Last taken _______________________________ _______________________________ _______________________________ _______________________________ General survey _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ atomic number 1 Gibson 55 M 163 cm 57 kg 37 C 76 14 150/90 sit 148/88 sitting 328 0800 4 -28-10 Manzel Pneumonia To get rid of the pneumonia PenicillinCodeine None In no swell distress. Slender, alert, and well-groomed. Communicates well. Makes eye contact and expresses appropriate concern throughout exam. C. Smith, RN General information Identify the assessment technique being used in each illustration. Show and tell Unscramble the words at right to discover terms related to fundamentals of assess ment. Then use the circled letters from those words to answer the question posed. My word Answers Show and tell 1. Indirect percussion, 2. Deep palpation My word 1. Auscultation, 2. Subjective data, 3. Chief complaint, 4. Palpation straits Abdomen 10 1. 2. 1. tunicaastolu 2. ivateacub jest 3. place inchmotif 4. aplaintop Answer Question Assessment of which body part does not follow the usual sequence? embodiment 12 Assessment 14 Skin abnormalities 16 haircloth abnormalities 24 dash abnormalities 25 Vision quest 26 soothe on the set. The assessment is slightly to begin. Anatomy 12 Skin, hair, and nails SkinSkin, hair, nails The skin covers and treasures the internal structures of the body. It consists of two distinct social classs the epidermis and the dermis. Subcutaneous tissue lies beneath these layers. cuticle Outer layer Made of squamous epithelial tissue Dermis Thick, deeper layer Consists of assignive issue and an extra jail cellular material ( ground substance), which contributes to the skins intensiveness and pliability Location of blood vessels, lymphatic vessels, nerves, hair follicles, and sweat and sebaceous glands Subcutaneous tissue Beneath dermis and epidermis Consists in the main of fatty and other connective tissues Stratum corneum Pore of sweat gland Free nerve ending Eccrine sweat gland pilus bulb sensational nerve fibers Autonomic nerve fibers Artery vein Anatomy 13 Hair Hair is formed from keratin produced by matrix cells in the dermal layer of the skin. Each hair lies in a hair follicle. Hair shaft Sebaceous gland Arrector pili brawninessHair follicle Sensory nerve fibers Hair bulb Contains melanocytes Hair papilla Consists of a loop of capillaries Provides provisions to hair Nails Nails are formed when epidermal cells are converted into hard plates of keratin. Hyponychium Nail plate Lateral nail fold Lunula Eponychium Nail resolution Nail matrix Hair bulb Matrix cell Produces hair Cuticle cells Inner root sheath Outer root sheath Capillary in hair papilla Melanocyte Determines hair coloring What is the matrix? The area of the dermis on which the nail rests. 14 Skin, hair, and nails Assessment To assess the skin, hair, and nails, use inspection and palpation. SkinObserve the skins overall appearance. Then inspect and palpate the skin area by area, focusing on color, moisture, texture, turgor, and temperature. assure the conjunctivae, palms, soles, buccal mucosa, and tongue. Look for dull, dark color. Examine the area for decreased color and palpate for tightness. Palpate the area for warmth. Examine the sclerae and hard palate in natural, not fluoresce nt, light if possible. Look for a yellow color. Examine the sclerae, conjunctivae, buccal mucosa, lips, tongue, nail beds, palms, and soles. Look for an ashen color. Examine areas of lighter pigmentation such as the abdomen. Look for tiny, purplish red ots. Palpate the area for skin texture changes. Cyanosis Edema Erythema Jaundice Pallor Petechiae Rashes Color Look for localized areas of bruising, cyanosis, pallor, and erythema. micro chip for uniformity of color and hypopigmented or hyperpigmented areas. Moisture Observe the skins moisture content. The skin should be relatively dry, with a minimal amount of perspiration. Be sure to enter gloves during your examination of the skin, hair, and nails. Detecting color variations in dark-skinned plurality Assessment 15 Texture and turgor Inspect and palpate the skins texture, noting its thickness and mobility. It should look smooth and be intact.To assess skin turgor in an infant, grasp a fold of loosely follower abdominal skin betw een your thumb and forefinger and pull the skin taut. Then release the skin. The skin should quickly return to its normal position. If the skin remains tented, the infant has curt turgor. Temperature Palpate the skin bilaterally for temperature using the dorsal surface of your hands and fingers. The dorsal surface is the most mass medium to temperature changes. Warm skin suggests normal circulation cool skin, a possible underlying disorder. Assessing skin turgor in an adult Gently squeeze the skin on the forearm or sternal rea between your thumb and forefinger, as shown. If the skin quickly returns to its original shape, the patient has normal turgor. If it returns to its original shape slowly over 30 seconds or entertains a tented position, as shown, the skin has poor turgor. best picture Normal skin variations You may see normal variations in the skins texture and pigmentation. Such variations may include nevi, or bulwarks, and freckles (shown below). 16 Skin, hair, and nails L esion configurations Discrete Individual lesions are separate and distinct. class Lesions are clustered together. Dermatomal Lesions form a line or an loathly and follow dermatome. Confluent Lesions merge so that discrete lesions are not visible or palpable. Lesion shapes Discoid Round or oval ringed Circular with primal clearing Target (bulls eye) Annular with central internal activity Hair When assessing the hair, note the distribution, quantity, texture, and color. Hair should be every bit distributed. Nails Examine the nails for color, shape, thickness, consistency, and contour. Nail color is pink in light-skinned people and dark-brown in dark-skinned people. The nail surface should be roughly curved or flat and the edges smooth and rounded. Lesions When evaluating a lesion, youll need to dissever t as primary (new) or secondary (a change in a primary lesion). Then determine if its solid or fluid-filled and describe its characteristics, pattern, location, and distributio n. Include a description of symmetry, borders, color, configuration, diameter, and drainage. Skin abnormalities I know youll have these assessment skills nailed in no time Lesion distribution generalize Distributed all over the body Regionalized particular(a) to one area of the body Localized Sharply limited to a specific area at sea Dispersed either densely or widely Exposed areas Limited to areas exposed to the air or sun Intertriginous Limited to reas where skin comes in contact with itself Skin abnormalities 17 outside the norm Types of skin lesions tornado A painful, cracklike lesion of the skin that extends at least into the dermis Cyst A closed sac in or under the skin that contains fluid or semisolid material Papule A solid, increase lesion thats unremarkably less(prenominal) than 1 cm in diameter Vesicle A small, fluid-filled blister thats unremarkably 1 cm or less in diameter Bulla A large, fluid-filled blister thats usually 1 cm or more in diameter Ulcer A cr aterlike lesion of the skin that usually extends at least into the dermis macular area A small, discolored spot or patch on the skinWheal A raised, chromatic area thats commonly itchy and lasts 24 hours or less Pustule A small, pus-filled lesion (called a follicular pustule if it contains a hair) Nodule A raised lesion detectable by touch thats usually 1 cm or more in diameter Documenting a skin lesion take note At 0820, pt. c/o right shoulder blade pain, 4/10 on a 0-10 scale. A closed, purulent lesion noted in right upper scapular region of back, approx. 1. 5 cm x 1 cm, with 3 cm surrounding area of erythema. T 100. 2 F. Call placed to Dr. Tomlins service at 0830. Angela Kessler, RN 4/15/10 0845 18 Skin, hair, and nails Benign versus malignant lesionsLesions may be benign, such as a benign nevus, or mole. However, changes in an existing growth on the skin or a new growth that ulcerates or doesnt heal could indicate cancer or a precancerous lesion. Types of skin cancer outside t he norm perverted changes in keratinocytes Can become squamous cell carcinoma Precancerous actinic keratosis deviant growth of melanocytes in a mole Can become malignant melanoma Dysplastic nevus Note the differences between benign and cancerous lesions. Symmetrical, round, or oval shape Sharply defined borders Uniform, usually tan or brown color Less than 6 mm in diameter Flat or raisedBenign nevus Abnormal changes in keratinocytes Can become squamous cell carcinoma Abnormal growth of melanocytes in a mole Can become malignant melanoma Skin abnormalities 19 more(prenominal) severe Less severe Begins as a firm, red tubercle or scaly, crusted, flat lesion Can sprinkle if not treated Squamous cell carcinoma Most common skin cancer normally spreads only locally Basal cell carcinoma Can arise on normal skin or from an existing mole If not treated promptly, can spread to other areas of skin, lymph nodes, or internal organs Malignant melanoma If you fishy a lesion may be malignant melanoma, observe for these haracteristics. memory lineup ABCDEs of malignant melanoma A = Asymmetrical lesion B = Border unpredictable C = Color of lesion varies with shades of tan, brown, or black and, possibly, red, blue, or white D = Diameter greater than 6 mm E = rattling(a) or enlarging lesion 20 Skin, hair, and nails Common skin disorders outside the norm contact dermatitis is an inflammatory disorder that results from contact with an irritant. Primary lesions include vesicles, large guck bullae, and red macules that appear at localized areas of redness. These lesions may itch and burn. finish up dermatitis Psoriasis is a chronic disease of marked pidermal thickening. Plaques are symmetrical and broadly speaking appear as red bases topped with silvery scales. The lesions, which may connect with one another, occur most commonly on the scalp, elbows, and knees. Psoriasis Occurring as an supersensitised reaction, urticaria appears suddenly as pink, edem atous papules or wheals (round elevations of the skin). Itching is intense. The lesions may become large and contain vesicles. Urticaria (hives) Skin abnormalities 21 Mites, which can be picked up from an infested person, burrow under the skin and cause itch lesions. The lesions appear in a straight or zigzagging line about 3/8 (1 cm) ong with a black dot at the end. commonly seen between the fingers, at the bend of the elbow and knee, and around the groin, abdomen, or perineal area, scabies lesions itch and may cause a rash. Scabies herpes virus zoster appears as a group of vesicles or crusted lesions along a nerve root. The vesicles are usually unilateral and appear mostly on the trunk. These lesions cause pain but not a rash. herpes virus zoster Tinea corporis is characterized by round, red, scaly lesions that are accompanied by intense itching. These lesions have slightly raised, red borders consisting of tiny vesicles. Individual ring may connect to form atches with scalloped edges. They usually appear on exposed areas of the body. Tinea corporis (ringworm) Once I burrow under the skin, I settle down and make myself comfortable. 22 Skin, hair, and nails Pressure ulcers Pressure ulcers are localized areas of skin breakdown that occur as a result of prolonged pressure. Necrotic tissue develops because the vascular supply to the area is diminished. represent pressure ulcers You can use characteristics gained from your assessment to stage a pressure ulcer, as described here. Staging reflects the anatomic depth of exposed tissue. Keep in mind that if the irritate contains necrotic issue, you wont be able to determine the stage until you can see the wound base. outside the norm Suspected deep tissue injury Maroon or purple intact skin or blood-filled blister whitethorn be painful mushy, firm, or boggy and warmer or cold than other tissue before discoloration occurs Stage I whole skin that doesnt blanch whitethorn differ in color from surrounding area i n people with darkly pigmented skin Usually over a emaciated prominence May be painful, firm or soft, and warmer or cooler than surrounding tissue Note This stage shouldnt be used to describe perineal dermatitis, maceration, tape burns, skin tears, or excoriation.Stage II Superficial partial-thickness wound Presents as a shallow, open ulcer without slough and with a red and pink wound bed Skin abnormalities 23 Stage III Involves full-thickness wound with tissue loss and possibly visible subcutaneous tissue but no exposed heft, tendon, or bone May have slough but not enough to hide the depth of tissue loss May be accompanied by undermining and tunneling Stage IV Involves full-thickness skin loss, with exposed muscle, bone, and tendon May be accompanied by eschar, slough, undermining, and tunneling Unstageable Involves full-thickness tissue loss, with base of ulcer covered by slough nd yellow, tan, gray, green, or brown eschar Cant be staged until enough slough and eschar are removed to expose the wound base 24 Skin, hair, and nails Hair abnormalities typically stemming from other problems, hair abnormalities can cause patients emotional distress. Among the most common hair abnormalities are alopecia and hirsuteness. Alopecia occurs more commonly and extensively in men than in women. Diffuse hair loss, though commonly a normal part of aging, may occur as a result of pyrogenetic infections, chemical trauma, ingestion of certain drugs, and endocrinopathy and other disorders. Tinea capitis, trauma, and ull-thickness burns can cause patchy hair loss. Alopecia Excessive hairiness in women, or hirsutism, can develop on the body and face, affecting the patients selfimage. Localized hirsutism may occur on pigmented nevi. Generalized hirsutism can result from certain drug therapy or from such endocrinal problems as Cushings syndrome, polycystic ovary syndrome, and acromegaly. Hirsutism outside the norm Now hair this Hair abnormalities may be caused by cer tain drugs or endocrine problems. Nail abnormalities 25 Nail abnormalities Although many nail abnormalities are harmless, some point to serious underlying problems.Nail abnormalities include clubbed fingers, splinter hemorrhages of the nail bed, and Muehrckes lines. outside the norm Splinter hemorrhages are reddish brown pin down streaks under the nails. They run in the same direction as nail growth and are caused by minor trauma. They can also occur in patients with bacterial endocarditis. Splinter hemorrhages Muehrckes lines or leukonychia striata are longitudinal white lines that can indicate trauma but may also be associated with metabolic stress, which impairs the body from using protein. Muehrckes lines Clubbed fingers can result from chronic tissue hypoxia. Normally, the cant over between the ingernail and the point where the nail enters the skin is about one hundred sixty degrees. Clubbing occurs when that angle increases to 180 degrees or more. Clubbed fingers Normal fin gers Normal angle (160 degrees) Clubbed fingers Angle greater than 180 degrees Enlarged and curved nail Answers commensurate to label 1. Epidermis, 2. Dermis, 3. Subcutaneous tissue, 4. Hair bulb, 5. Eccrine sweat gland Rebus interpenetrate The dorsal surface of the hand is most sensitive to temperature changes. 1. 2. 3. 4. 5. Identify the skin structures indicated on this illustration. Sound out each group of pictures and symbols to reveal terms that complete this assessment onsideration. Able to label? Rebus riddle 26 Anatomy 28 Assessment 31 Eye abnormalities 42 Ear abnormalities 46 Vision quest 48 Aye, aye, matey I best be gettin along. Theyre filming the eye and ear assessment down on Soundstage 3. 28 Eyes and ears Anatomy EyeEsye and ears The eyes are delicate sensational organs equipped with many extraocular and intraocular structures. Some structures are easily visible, whereas others can only be viewed with special instruments, such as an ophthalmoscope. Extraocular stru ctures The bony orbits protect the eyes from trauma. The eyelids (or pal pebrae), lashes, and lacrimal gland, punctum, canaliculi, and ac protect the eyes from injury, dust, and contradictory bodies. Bony orbit Lacrimal gland Pars orbitalis Pars palpebralis Upper eyelid Lashes dismantle eyelid Lacrimal punctum Lacrimal canaliculi Lacrimal sac Nasolacrimal duct Eye muscles Superior oblique muscle Superior rectus muscle Medial rectus muscle Lateral rectus muscle Inferior rectus muscle Inferior oblique muscle Anatomy 29 Intraocular structures The intraocular structures of the eye are directly involved in vision. The eye has three layers of tissue The outermost layer includes the transparent cornea and the sclera, which maintain the form and size of the eyeball. The middle layer includes the choroid, ciliary body, and iris. Pupil size is controlled by involuntary muscles in this region. The internalmost layer is the retina, which receives visual stimuli and sends them to the brai n. retinene structures A closer view Superonasal arteriole and vein heart magnetic disk Physiologic cup Arteriole Inferonasal arteriole and vein Vein Superotemporal arteriole and vein Fovea centralis Macular area Inferotemporal arteriole and vein Sclera choroid coat Conjunctiva (bulbar) Ciliary body Cornea Lens Pupil Iris Anterior sleeping room (filled with aqueous humor) Posterior chamber (filled with aqueous humor) Schlemms canalVitreous humor Optic nerve Central retinal artery and vein Retina These structures are locate in the posterior part of the eye, also called the fundus. Theyre visible with an ophthalmoscope. 30 Eyes and ears Ear External ear The flexible external ear consists mainly of elastic cartilage. It contains the ear flap, also known as the auricle or pinna, and the auditory canal. This part of the ear collects and transmits sound to the middle ear. Middle ear The tympanic membrane separates the external and middle ear. The center, or umbo, is accustomed to the tip of the long process of the malleus on the other side of the tympanic membrane.The eustachian tube connects the middle ear with the nasopharynx, equalizing air pressure on either side of the tympanic membrane. The middle ear conducts sound vibrations to the inner ear. Inner ear The inner ear consists of closed, fluid-filled spaces within the temporal bone. It contains the bony labyrinth, which includes three connected structures the vestibule, the semicircular canals, and the cochlea. The inner ear receives vibrations from the middle ear that stimulate nerve impulses. These impulses travel to the brain, and the cerebral cortex interprets the sound. Auditory ossicles stapes (stirrup) Incus (anvil) Malleus (hammer) Semicircular canals Vestibule Cochlea Cochlear nerve Eustachian tube Tympanic membrane (eardrum) Helix Anthelix Lobule of auricle External acoustic meatus Assessment 31 Assessment Eyes Snellen charts The Snellen alphabet chart and the Snellen E chart are used to te st distance vision and measure visual acuity. Snellen alphabet chart Snellen E chart Age differences 20 20 In adults and children age 6 and older, normal vision is measured as 20/20. 20 50 For children age 3 and younger, normal vision is 20/50. 20 40 For children age 4, normal vision is 20/40. 20 30 For children age 5, normal vision is 20/30.To measure distance vision Have the patient sit or stand 20 (6. 1 m) from the chart. Cover his left eye with an light-tight object. Ask him to read the letters on one line of the chart and then to move downward to increasingly smaller lines until he can no longer discern all of the letters. Have him repeat the test top his right eye. Have him read the smallest line he can read with both eyes uncovered to test his binocular vision. If the patient wears disciplinal lenses, have him repeat the test vesture them. Record the vision with and without correction. withdrawnness vision Recording results Visual acuity is recorded as a fraction.The top number (20) is the distance between the patient and the chart. The bottom number is the lowest line on which the patient correctly identified the legal age of the letters. The larger the bottom number, the poorer the patients vision. The Snellen E chart is used for young children and adults who cant read. 32 Eyes and ears Test off-base vision using confrontation. Confrontation can help identify such abnormalities as homonymous hemianopsia and bitemporal hemianopsia. Heres how to test confrontation position or stand directly across from the patient and have him focus his gaze on your eyes. Place your hands on either ide of the patients head at the level of his ears so that theyre about 2 apart. Tell the patient to focus his gaze on you as you gradually bring your wiggling fingers into his visual field. Instruct the patient to tell you as soon as he can see your wiggling fingers he should see them at the same time you do. Repeat the procedure while retentiveness your hands a t the superior and inferior positions. Rosenbaum card The Rosenbaum card is used to evaluate near-vision. This small, handheld card has a series of numbers, Es, Xs, and Os in graduated sizes. Visual acuity is indicated on the right side of the hart in either distance equivalents or Jaeger equivalents. To measure near-vision Cover one of the patients eyes with an opaque object. Hold the Rosenbaum card 14 (35. 6 cm) from the eyes. Have the patient read the line with the smallest letters he can distinguish. Repeat the test with the other eye. If the patient wears corrective lenses, have him repeat the test while wearing them. Record the visual accommodation with and without corrective lenses. Near-vision Confrontation Does your patient wear glasses or contacts? Remember to test his vision with and without his corrective lenses. Assessment 33 Each upper eyelid hould cover the top pull in of the iris so the eyes look alike. Look for redness, edema, inflammation, or lesions on the lids. Eyelids The corneas should be clear and without lesions and should appear convex. Examining the corneas Examine the corneas by shining a penlight first from both sides and then from straight ahead. Test corneal aesthesia by lightly touching the cornea with a wisp of cotton. The irises should appear flat and should be the same size, color, and shape. Irises Corneas Inspecting the eyes With the scalp line as the starting point, determine whether the eyes are in a normal position. They should be bout one-third of the way down the face and about one eyes width apart from each other. Then assess the eyelids, corneas, conjunctivae, sclerae, irises, and savants. 34 Eyes and ears Each pupil should be equal in size, round, and about one-fourth the size of the iris in normal room light. exam the pupils Slightly darken the room. Then test the pupils for direct response (reaction of the pupil youre testing) and consensual response (reaction of the opposite pupil) by holding a penlight about 20 (51 cm) from the patients eyes, directing the light at the eye from the side. Next, test accommodation by placing your finger