Sunday, January 26, 2020

Assessment Of Mrs Baker Nursing Essay

Assessment Of Mrs Baker Nursing Essay Upon admitting Mrs. Baker to the ER assist her into a gown. While assisting into the gown notice any skin issues, such as injury from the fall, or irritation from possible prior falls or injuries. Elderly people often have issues such as dehydration, of which the signs may be skin tenting, poor turgor, and red areas from pressure, ask about fluid intake and record capillary refill. Mrs. Baker, as a known diabetic, could have unhealed sores or ulcerations and signs of neuropathy, ask about any numbness or tingling. Assisting the patient into a gown may also determine if there are bladder and bowel continence issues. While assisting to gown use the opportunity to question the patient about what, in her opinion, happened. While asking about the incident, ask if there have been periods of light headedness or dizziness, apply a cardiac monitor and pulse oximeter, for observation. Ask the patient if there are any areas that hurt, or if there is any pain even unassociated with the fall. Whi le questioning the patient about what happened and the patients theory of why, evaluate speech pattern and level of orientation, the patients awareness of time and cognitive ability may be assessed at this time. Determine if the patient can provide an accurate account of the fall and what preceded the fall. While assessing the patient, it is essential to look at each system and watch for nonverbal signs of pain. Observe the patient, for signs of confusion and check for pupil response to light. Auscultating lung sounds, listen for adventitious sounds such as rhonchi, rales, or wheezes. Listen to determine if lung sounds are present in all lung fields. Auscultate heart sounds, listen for irregularities, is there a murmur noted. Evaluate cardiac monitor for arrhythmias. Question the patient about any chest pain, tightness, or heaviness. Palpate peripheral pulses, note if they are equal, note the quality if they are thread /bounding, and are pulses even on each side. Obtain vital signs such as blood pressure, orthostatic if possible as this is common with HCTZ and Lisinopril; maintain a 30 minute check on blood pressure readings, note rate and quality of respiratory effort along with oxygen readings. Ask again if the patient has any pain as pain may increase readings in blood pressure, respiratory rate, and pulse. The elderly are sometimes reluctant to report pain, thinking it is all part of the aging process and accepts it as a part of life. Many may not report physical discomfort due to the fear that they may lose independence or the risk of being viewed as a burden. Anxiety may also raise vital sign readings; attempt to explain all procedures to the patient. This not only contributes to trust from the patient, but also reduces some of the fear from the unknown. Listen to bowel sounds, indicate the presence of or lack of in all quadrants. Ask the patient about bowel pattern if possible when the last bowel movement was, palpate for any sign of tenderness or guard ing. Examine the face, hands, and feet for edema. While checking the lower extremities for edema, indicate the quality of pulses in the legs. Pay attention to color and texture of the skin in the legs and feet, note any sores or red areas, note capillary refill. Pay attention to the temperature of the legs as lower extremities blood clots is common. Again, it is necessary to explain the examination to the patient in order to reduce anxiety and to reassure the patient. If the patient is able, ask about medications and when was the last time they were taken. Ask about the time the last meal was eaten. Once the initial assessment is completed, explain to the patient that there will be some tests to assist in determining the medical problems at present. It is advisable to ask if the patient has questions for the nurse; this may aid in preventing any misunderstandings. Technological tools, uses, and benefits Some of the tools frequently used in the assessment, of any patient, start with auscultation and palpation. Listening to the patients verbal response is an advantage to the assessment; however, listening to the heart, lungs, and abdomen is required. To begin, start an IV site and obtain the needed blood for testing, this may prevent a delay in treatment. Be aware of the length of time the tourniquet is applied to the patient, quality of the lab draw is also a factor in the values obtained. After obtaining the blood work, begin a physical assessment. Listening to heart sounds may provide information about various cardiac problems such as a heart murmur; deviation in heart sounds may indicate a cardiac condition. Lung sounds may determine if there are pulmonary issues such as bronchitis, pneumonia, or pulmonary edema. Listening and palpation of the abdomen may indicate irregularities in the gut, such as an obstruction or potential aneurysm. Asking about pain or tightness in the chest m ay also indicate a possible cardiac condition. Ask about any history of chest pain or tightness. Noting the rate and respiratory effort, along with a continuous pulse oximeter, assist in determining pulmonary problems. Ask if there have been any problems with shortness of breath. Blood pressure readings, especially orthostatic in a falls patient may lead to indications leading to the fall. Along with the possible reason for the fall, this may also assist in the determination of medication misuse. The elderly may sometimes forget they have taken their medication and repeat the dosage. Obtaining a blood glucose level may also determine if the fall is related to hypoglycemia. Knowing or having an idea of when the last meal was eaten, and when the medications were taken, also assist in determining possible reasons for the fall. Having knowledge of the estimated fluid intake may also be useful as a tool in the analysis of causative agents. Dehydration in the elderly can cause confusion a nd light headedness. The continuous cardiac, oxygen, and blood pressure readings are necessary to watch for sudden changes that may occur. Cardiac monitors assist in determining if there are irregularities in the electrical conduction, in the heart, early detection and treatment may prevent further complications. Oxygen readings assist in determining the amount of capillary oxygen and profusion difficulty; this may indicate the need for supplemental oxygen before further decompensation. Frequent checks in blood pressure may be the first sign of sepsis in an elderly person. Other testing and tools used is a chest X-ray, viewing a chest X-ray aids in determining pulmonary issues not noted during the physical examine treatment for pulmonary issues can quickly be obtained. A CT scan of the brain, without contrast, may be used to rule out a brain bleed. A CT scan of the lungs, without contrast, will assess for possible pulmonary embolus. To use contrast, the results of the renal function are needed. Blood testing is critical in determining the bodily functions. Obtaining a complete blood count tells the general hydration, amount of volume and signs of infection with an elevated white blood count, hypervolemia can be promptly corrected; low red blood count indicates the lack of oxygen carrying capacity and may require a transfusion. A complete metabolic profile lends details of renal and hepatic function, as well as levels for key electrolytes such as potassium, sodium, magnesium, and glucose, this also aids in monitoring for metabolic acidosis or alkalosis. With lisinopril, it is common to see an elevation in bun, creatinine, and lowering of glucose levels. HCTZ is known for lowering the potassium, sodium, and magnesium levels. The combination of HCTZ and lisinopril are known to cause dizziness, and palpations and should be monitored closely especially in people with renal impairment and /or of advanced age. Cardiac enzymes are drawn to evaluate the cardiac muscle, to determine if there are cardiac issues. Arterial blood gases assist in determining the pulmonary system function, this also aids in determining respiratory acidosis or alkalosis. Another lab test highly beneficial is a urinalysis with culture and sensitivity. When there is a urinary infection in an elderly person, it may cause dizziness and confusion. The culture helps to determine the proper medication for the organism responsible for the infection. The urine tests also indicate if there are ketones or proteins being spilled in the urine; this is a frequent problem in diabetic patients. Obtaining a twelve lead EKG aids in determining any irregularities in the cardiac conduction, such as heart blocks and ventricular ectopy that are often seen as a result of low potassium. Blood cultures may also be required to determine if there is an infection. Frequently an opportunistic infection may lead to sepsis, and the elderly often do not present that ill until the infection is severe. T he elderly may not always present with an elevated temperature; this cannot be the only sign of illness. All the testing and the physical analysis will help to determine potential health issues, but the best source of information is to monitor the patient. Being aware of changes in the patient status and comfort level is required. Continuous visual monitoring may assist in treating sudden changes in the patient. Frequent questions pertaining to the comfort level are required in the elderly as they may be reluctant to admit pain. Explain that pain, of any level, can be addressed, and that comfort may assist in the treatment. Data collection prioritization It is essential to prioritize the data collection and report findings to the physician. The application of monitoring devices, such as a cardiac monitor, blood pressure machines, and pulse oximeter, may be done as the patient is being gowned. Visual inspection of the skin may also be done at this time. While gowning the patient, asking about medications and history may also be accomplished. Starting the IV site and obtaining blood work will get information to the physician quickly and should be done as soon as possible. Collect a finger stick for blood glucose, as this may determine if the patient is hypoglycemic. The EKG and ABGs are also critical information needed as soon as possible. A chest X-ray may be done next, along with a CT scan of the brain and lungs, without contrast. Collection of the urine for testing can be collected after the other departments have finished what needs to be done. As the patient is on a continuous monitor for cardiac, respiratory, and blood pressure i t is easy to monitor for changes. It is now appropriate to complete the physical assessment of the patient. This saves time while awaiting the results from lab, x-ray, and cardiopulmonary departments. Report any irregularity in the assessment to the doctor as soon as possible. While obtaining information from the patient, it is necessary to ask about pain and monitor for nonverbal cues during the assessment. Morphine, low dose (0.05mg/kg IV) for pain may be appropriate at this time as it decreases the oxygen demand from the heart and may reduce anxiety. Tylenol may not be the medication of choice until liver function is established. Advise the physician that the patient has been taking HCTZ, Lisinopril, and metformin. The combination of HCTZ and Lisinopril may cause dizziness and dehydration. Lisinopril also aids in lowering blood glucose levels, and should be monitored closely especially in people with renal impairment and/or of advanced age. This combination may also cause palpati ons and dizziness. HCTZ can cause electrolyte imbalances leading to alkalosis. The patient may also be experiencing a drug hypersensitivity to the lisinopril. Signs would include dyspnea, chest tightness, and arterial acidosis, requiring intubation (Hydrochlorothiazide and Lisinopril side effects, Drugs.com). If the patient was medicated for pain, check for relief of symptoms. Verbal affirmation should be listed on a scale of 1-10 according to the flacc scale. If the patient has pain relief, note this with the physician. Monitor for lab results and report any findings outside the normal range, the same with EKG, ABGs, x-ray, and CT scan. Monitor the patient for changes in mentation, and visible signs of changes. The elderly may have sudden changes; it is advisable to monitor closely. With continuous monitoring, and noting the change in status of Mrs. Baker, there would be more aggressive measures taken. A rapid response from respiratory therapy would be needed, and a request for the attending physician, for the mental status and respiratory changes and the possible need for increased measures such as intubation. A repeat of ABGs would be needed; STAT results are indicated. Radiology should be available for potential tube placement. All team members should be alerted for the possibility of a code blue alert. The staff needs to be monitoring the cardiac status at all times. With respiratory arrest, cardiac is soon to follow. Rapid response to changes in respiratory status can prevent further complications. Constant monitoring of the flacc scale may assist in monitoring the patients comfort level. A patient may show signs of discomfort by moaning, thrashing about, or facial grimace. Being aware of this may aid in the quality of patient care. The patient may not be a ble to tell that they hurt, but body language speaks volumes. If the patient is indicating that they are in pain, morphine at a low dose may be used (0.05mg /kg IV). Considering the slower metabolism of the elderly, it is necessary to medicate accordingly. This not only aids in pain relief, but also lowers the oxygen demand by the heart. Close observation of the patient is mandatory. If the medication is effective the signs observed will diminish and the patient will appear more relaxed, with little or no signs of pain (possible lower BP and heart rate, no facial grimace, more relaxed, less restlessness). The alert patient can verbalize the effectiveness of pain medications, with an unresponsive person we must rely on physical cues that are presented. Again, it is important to report pain relief to the physician and continue to watch for changes in the patient. Rapid evaluation and assessment, accurate data, and concise information are imperative to patient care. When assessing the elderly it is necessary to remember that due to the aging process, metabolism of medications may be slowed. With advanced age, there is also a reduction in renal and hepatic filtering. The elderly may also be reluctant to report pain. When caring for the elderly, it is necessary to keep their viewpoint in mind, and to explain procedures prior to the procedure. A reduction in anxiety may assist in a trusting relationship and aid in lowering blood pressure and heart rate. It is also helpful to remember that changes can occur rapidly with the elderly and that they may not always present as with a younger person. Keep an open mind and alert at all times.

Friday, January 17, 2020

The Accidental Tourist Essay

Life just is. You have to flow with it. Give yourself to the moment. Let it happen. † -Jerry Brown If an individual allows changes to occur in one’s life, then love can be the wonderful result of that acceptance. The theme of reasons why we love and how we love different people is demonstrated throughout the book The Accidental Tourist, written by Anne Tyler. There are two main characters that undergo and accept the changes in their lives, and one character that stays static throughout the book, helping one of the characters to change.Macon Leary is first grounded by loneliness and comfort, then slowly opens himself up to what appears to be a whole new world for him. Then, there is Sarah Leary, who controls some of the changes in her life, and tries to make the best of the rest of them. The character that remains the same throughout the book is Muriel Pritchett—a dog-trainer who takes an interest in Macon and helps him to accept the changes in his life. Above all, the universal theme of this book is love—a surprising new journey for all the characters.In the beginning of the book, it is explained how Macon and Sarah Leary’s son is murdered and how their marriage suffers because of this. Sarah leaves Macon, which is the beginning stage of Macon’s renovated life, but one that does not start off happily: â€Å"He didn’t eat real meals anymore†¦His hair, which Sarah used to cut for him, jutted over his forehead like a shelf. Ande something had caused his lower lids to droop. He used to have narrow gray slits of eyes; now they were wide and startled†¦Ã¢â‚¬  (14). Macon is not at all used to living alone.He wants to control everything and likes nothing to be left to chance—Sarah’s departure is not something he can control and he does not deal with it well. Macon begins to think that he cannot live without his wife, but soon realizes a few things that really make him think about the marriage: Hi s brain buzzed with little worries†¦The worries changed, grew deeper, he wondered what had gone wrong with his marriage. Sarah had been his first and only girlfriend; now he thought he should have practiced on someone else beforehand.During the twenty years of their marriage there’s been moments—there’s been months—when he didn’t feel they had really formed a unit the way couples were supposed to. No, the stayed two distinct people, and now always even friends. Sometimes they’d seemed more like rivals, elbowing each other, competing over who was the better style of person†¦ (15-16) Macon realizes that he and Sarah never actually became one person; they had always stayed as two separate people living in a stale, routine marriage. Finally, Macon comes to terms with the fact that Sarah is not coming home to him: â€Å"Well, of course she wasn’t there.He knew it the instant he stepped inside that house, when he smelled that sta le hot air and heard the muffled denseness of a place with every window shut. Really he’d known it all along. He’d been fooling himself. He’d been making up fairy tales† (41). Macon knew that when he got home from his business trip that Sarah would not be there waiting for him like she used to. Although he did not ask for this change in his life, and after living alone for a while, moves back with his sister and brothers—a comfortable change for him.This all begins to change when Macon meets an unusual woman working at the animal hospital where he takes his dog and becomes acquaintances with her. Muriel allows Macon to open up to her, and Macon shows his willingness to do so: ‘I lost my son,’ Macon said. ‘He was just†¦he went to a hamburger joint and then†¦someone came, a holdup man, and shot him. I can’t go to dinner with people! I can’t talk to their little boys! You have to stop asking me. I don’t mean to hurt your feelings but I’m just not up to this, do you hear? She took one of his wrists very gently and she drew him into the house, still not fully opening the door, so that he had a sense of slipping through something, of narrowly evading something. She closed the door behind him. She put her arms around him and hugged him. (189-190) At first, Macon does not give Muriel Pritchett a second thought, but before he knows it, he is dating her and soon living with Muriel and her young son. This shows a tremendous change for Macon, and a step forward in his life. Muriel helps Macon to see the world in a different way.She is the character that seems to know exactly what she is after in life, and therefore does not change during the course of this book. On the other hand, all Macon does throughout the book is change his life in extreme ways. Macon learns how to love and trust Muriel in a way that he never has with anyone. In an addition to Macon’s changing life, ther e is his wife, Sarah, who makes the decision to leave Macon a year after the death of their son. Sarah feels that Macon does not express his emotions as she would like him to, and that he does not provide her with the comfort she needs and has needed in the past.This frustrates Sarah greatly and she does not feel as if she can continue in the marriage: I said to you the other day, I said, ‘Macon, now that Ethan’s dead I sometimes wonder if there’s any point to life. ’ Do you remember what you answered? †¦ ’You said, ‘Honey, to tell the truth, it never seemed to me there was all that much point to begin with. ’ Those were your exact words†¦ ’You just go on your same old way like before. Your little routines and rituals, depressing habits, day after day. No comfort at all. ’†¦ ‘I just can’t live with you anymore,’ Sarah said. 3-4) Sarah is heart-broken with this decision, as is Macon, but s he is just not happy with her marriage. During Macon and Sarah’s separation, Sarah starts to move on and begins dating a man. Though she has an apartment of her own, which is what she wanted, Sarah realizes how much she truly loves and misses Macon, and makes a slight and almost unnoticeable attempt to get back together with him much later in the book during a conversation between her and Macon: ‘It [the rain] looks like strips that just fade away about halfway down from the sky. ’ ‘I wish I were there to watch it with you,’ Sarah said†¦ ‘Macon?Do you†¦What’s her name? The person you live with? ’ ‘Muriel,’ he said. Which he knew before she asked, he suspected. ‘Do you plan on staying with Muriel forever? ’ ‘I really couldn’t say,’ he said. (289-290) Sarah is now the one longing for Macon. Macon thinks that the only thing to do is go back to Sarah, since, after all, he had bee n longing to get her back for some time. Macon returns to his house with Sarah, leaving Muriel: â€Å"He rode on through the city, up Charles Street, into his old neighborhood. He parked and cut the engine and sat looking at the house.The downstairs windows were dark. The upstairs windows were softly glowing. Evidently, he had come home† (291). Macon is reluctant about coming home to Sarah, but in the back of his mind he still feels like he needs her because they shared so much of their lives together. Soon after, while Macon is on another business trip to Paris, his back goes out and Sarah flies in to take care of him. Things seem to be going well, but then Sarah sees Macon packing his things a few days later, which provides yet another change for Sarah, as well as Macon: Sarah said, ‘Macon? †¦ ‘What are you doing? ’ ‘I’m packing to leave. ’ ‘But what about your back? ’ she asked. ‘And I’ve got all those a ppointments! And we were going to take a second honeymoon! ’ ‘Sweetheart,’ he said. He lowered himself cautiously till he was sitting on the bed. He picked up her hand. It stayed lifeless while she watched his face. ‘You’re going back to that woman,’ she said. ‘Yes, I am,’ he said. ‘Why, Macon? ’ ‘I just decided, Sarah. I thought about it most of last night. It wasn’t easy. It’s not the easy way out, believe me. †¦ he saw now how such couples evolved. They were not, as he’d always supposed, the result of some ludicrous lack of perception, but had come together for reasons that the rest of the world would never guess. (339-340) Macon realizes that he is happier with Muriel, and although he does not want to cause Sarah pain, this time, it is Macon that is making a change that Sarah cannot help—instead of the other way around. Therefore, Sarah must accept these changes in her life, along with all the ups and downs.Finally, Muriel Pritchett is shown to be the one character that does not go through changes in the duration of the book, already having experienced major alterations in her earlier life. Muriel assures Macon of himself and makes Macon feel needed for the first time in a long time: â€Å"Macon presented himself in front of her, holding out the pizza. ‘Ta-da! ’ he whispered. She looked up at him and gave that perky smile of hers—an ornate, Victorian V. ‘Ma,’ she said, ‘I’m going now! Macon’s here! ’ It had been a long time since anyone made such an event of his arrival† (196).Macon shows that he is beginning to allow himself to care for Muriel, and to be happy with her and this change in his life—being needed. Later on, when Macon is at his sister’s house, he begins to actually miss Muriel: Macon laid the photos aside without looking at the rest of them. He knelt to pat Ed ward†¦Macon suddenly wished he were at Muriel’s. He wrapped his arms around Edward and imagined he smelled her sharp perfume deep in Edward's fur†¦ above all else he was an orderly man†¦ There was no room in his life for anyone as unpredictable as Muriel. Or as extreme.Or as†¦well, unlikable, sometimes†¦ Then he knew what mattered was the pattern of her life; that although he did not love her he loved the surprise of her, and also the surprise of himself when he was with her. (201) As much as Macon never thought he could care for Muriel, he finds himself almost loving her, and loving himself more whenever he is with her. He begins to enjoy his time with Muriel, and now moves with the flow of life, instead of life passing him by while he is still standing still. After Macon leaves Muriel to get back with Sarah, he finds that Muriel will not give up on him.She follows him to his business trip to Paris: â€Å"‘†¦why Muriel? Why are you doing this? ’ ‘Because I felt like it,’ she said. ‘You felt like spending five days alone in a Paris hotel? That’s what is will be, Muriel. ’ ‘You need to have me around,’ she said. ‘Need you! ’ ‘You were falling to pieces before you had me† (318). Muriel is very persistent—just like when she had been pursuing Macon; she refuses to give him up. In the end, Macon cannot refuse Muriel, and leaves Paris without Sarah. This shows Muriel to be a stagnant character in this book—with her unwillingness to give up and her belief in the goodness of people.In conclusion, Macon and Sarah prove to be the characters that undergo the most rapid changes, and Muriel remains static. Above all, Macon’s desire to control his own life in such a regimented way as packing for trips with a great notion of order is probably due to the fact that he does not trust other people. He feels that he cannot rely on others a nd instead can only trust himself. However, this all changes with the help of Muriel, who proves to be one of the most beneficial people to come into Macon’s life.Sarah learns the hard way that you cannot always go back to people and places in your life and try and fix things that are not worth fixing, or not capable of being salvaged. In this case, it was she and Macon’s marriage. Sometimes it is better to let go of the past and move on to the future. The main theme of this book is love, and it is substantiated by Macon’s capability to lose sight of his fear and love someone completely different from himself and all that he has known. All of this happened because of one individual’s acceptance of change and the flow of life. The Accidental Tourist Essay Life just is. You have to flow with it. Give yourself to the moment. Let it happen. † -Jerry Brown If an individual allows changes to occur in one’s life, then love can be the wonderful result of that acceptance. The theme of reasons why we love and how we love different people is demonstrated throughout the book The Accidental Tourist, written by Anne Tyler. There are two main characters that undergo and accept the changes in their lives, and one character that stays static throughout the book, helping one of the characters to change.Macon Leary is first grounded by loneliness and comfort, then slowly opens himself up to what appears to be a whole new world for him. Then, there is Sarah Leary, who controls some of the changes in her life, and tries to make the best of the rest of them. The character that remains the same throughout the book is Muriel Pritchett—a dog-trainer who takes an interest in Macon and helps him to accept the changes in his life. Above all, the universal theme of this book is love—a surprising new journey for all the characters.In the beginning of the book, it is explained how Macon and Sarah Leary’s son is murdered and how their marriage suffers because of this. Sarah leaves Macon, which is the beginning stage of Macon’s renovated life, but one that does not start off happily: â€Å"He didn’t eat real meals anymore†¦His hair, which Sarah used to cut for him, jutted over his forehead like a shelf. Ande something had caused his lower lids to droop. He used to have narrow gray slits of eyes; now they were wide and startled†¦Ã¢â‚¬  (14). Macon is not at all used to living alone.He wants to control everything and likes nothing to be left to chance—Sarah’s departure is not something he can control and he does not deal with it well. Macon begins to think that he cannot live without his wife, but soon realizes a few things that really make him think about the marriage: Hi s brain buzzed with little worries†¦The worries changed, grew deeper, he wondered what had gone wrong with his marriage. Sarah had been his first and only girlfriend; now he thought he should have practiced on someone else beforehand.During the twenty years of their marriage there’s been moments—there’s been months—when he didn’t feel they had really formed a unit the way couples were supposed to. No, the stayed two distinct people, and now always even friends. Sometimes they’d seemed more like rivals, elbowing each other, competing over who was the better style of person†¦ (15-16) Macon realizes that he and Sarah never actually became one person; they had always stayed as two separate people living in a stale, routine marriage. Finally, Macon comes to terms with the fact that Sarah is not coming home to him: â€Å"Well, of course she wasn’t there.He knew it the instant he stepped inside that house, when he smelled that sta le hot air and heard the muffled denseness of a place with every window shut. Really he’d known it all along. He’d been fooling himself. He’d been making up fairy tales† (41). Macon knew that when he got home from his business trip that Sarah would not be there waiting for him like she used to. Although he did not ask for this change in his life, and after living alone for a while, moves back with his sister and brothers—a comfortable change for him.This all begins to change when Macon meets an unusual woman working at the animal hospital where he takes his dog and becomes acquaintances with her. Muriel allows Macon to open up to her, and Macon shows his willingness to do so: ‘I lost my son,’ Macon said. ‘He was just†¦he went to a hamburger joint and then†¦someone came, a holdup man, and shot him. I can’t go to dinner with people! I can’t talk to their little boys! You have to stop asking me. I don’t mean to hurt your feelings but I’m just not up to this, do you hear? She took one of his wrists very gently and she drew him into the house, still not fully opening the door, so that he had a sense of slipping through something, of narrowly evading something. She closed the door behind him. She put her arms around him and hugged him. (189-190) At first, Macon does not give Muriel Pritchett a second thought, but before he knows it, he is dating her and soon living with Muriel and her young son. This shows a tremendous change for Macon, and a step forward in his life. Muriel helps Macon to see the world in a different way.She is the character that seems to know exactly what she is after in life, and therefore does not change during the course of this book. On the other hand, all Macon does throughout the book is change his life in extreme ways. Macon learns how to love and trust Muriel in a way that he never has with anyone. In an addition to Macon’s changing life, ther e is his wife, Sarah, who makes the decision to leave Macon a year after the death of their son. Sarah feels that Macon does not express his emotions as she would like him to, and that he does not provide her with the comfort she needs and has needed in the past.This frustrates Sarah greatly and she does not feel as if she can continue in the marriage: I said to you the other day, I said, ‘Macon, now that Ethan’s dead I sometimes wonder if there’s any point to life. ’ Do you remember what you answered? †¦ ’You said, ‘Honey, to tell the truth, it never seemed to me there was all that much point to begin with. ’ Those were your exact words†¦ ’You just go on your same old way like before. Your little routines and rituals, depressing habits, day after day. No comfort at all. ’†¦ ‘I just can’t live with you anymore,’ Sarah said. 3-4) Sarah is heart-broken with this decision, as is Macon, but s he is just not happy with her marriage. During Macon and Sarah’s separation, Sarah starts to move on and begins dating a man. Though she has an apartment of her own, which is what she wanted, Sarah realizes how much she truly loves and misses Macon, and makes a slight and almost unnoticeable attempt to get back together with him much later in the book during a conversation between her and Macon: ‘It [the rain] looks like strips that just fade away about halfway down from the sky. ’ ‘I wish I were there to watch it with you,’ Sarah said†¦ ‘Macon?Do you†¦What’s her name? The person you live with? ’ ‘Muriel,’ he said. Which he knew before she asked, he suspected. ‘Do you plan on staying with Muriel forever? ’ ‘I really couldn’t say,’ he said. (289-290) Sarah is now the one longing for Macon. Macon thinks that the only thing to do is go back to Sarah, since, after all, he had bee n longing to get her back for some time. Macon returns to his house with Sarah, leaving Muriel: â€Å"He rode on through the city, up Charles Street, into his old neighborhood. He parked and cut the engine and sat looking at the house.The downstairs windows were dark. The upstairs windows were softly glowing. Evidently, he had come home† (291). Macon is reluctant about coming home to Sarah, but in the back of his mind he still feels like he needs her because they shared so much of their lives together. Soon after, while Macon is on another business trip to Paris, his back goes out and Sarah flies in to take care of him. Things seem to be going well, but then Sarah sees Macon packing his things a few days later, which provides yet another change for Sarah, as well as Macon: Sarah said, ‘Macon? †¦ ‘What are you doing? ’ ‘I’m packing to leave. ’ ‘But what about your back? ’ she asked. ‘And I’ve got all those a ppointments! And we were going to take a second honeymoon! ’ ‘Sweetheart,’ he said. He lowered himself cautiously till he was sitting on the bed. He picked up her hand. It stayed lifeless while she watched his face. ‘You’re going back to that woman,’ she said. ‘Yes, I am,’ he said. ‘Why, Macon? ’ ‘I just decided, Sarah. I thought about it most of last night. It wasn’t easy. It’s not the easy way out, believe me. †¦ he saw now how such couples evolved. They were not, as he’d always supposed, the result of some ludicrous lack of perception, but had come together for reasons that the rest of the world would never guess. (339-340) Macon realizes that he is happier with Muriel, and although he does not want to cause Sarah pain, this time, it is Macon that is making a change that Sarah cannot help—instead of the other way around. Therefore, Sarah must accept these changes in her life, along with all the ups and downs.Finally, Muriel Pritchett is shown to be the one character that does not go through changes in the duration of the book, already having experienced major alterations in her earlier life. Muriel assures Macon of himself and makes Macon feel needed for the first time in a long time: â€Å"Macon presented himself in front of her, holding out the pizza. ‘Ta-da! ’ he whispered. She looked up at him and gave that perky smile of hers—an ornate, Victorian V. ‘Ma,’ she said, ‘I’m going now! Macon’s here! ’ It had been a long time since anyone made such an event of his arrival† (196).Macon shows that he is beginning to allow himself to care for Muriel, and to be happy with her and this change in his life—being needed. Later on, when Macon is at his sister’s house, he begins to actually miss Muriel: Macon laid the photos aside without looking at the rest of them. He knelt to pat Ed ward†¦Macon suddenly wished he were at Muriel’s. He wrapped his arms around Edward and imagined he smelled her sharp perfume deep in Edward's fur†¦ above all else he was an orderly man†¦ There was no room in his life for anyone as unpredictable as Muriel. Or as extreme.Or as†¦well, unlikable, sometimes†¦ Then he knew what mattered was the pattern of her life; that although he did not love her he loved the surprise of her, and also the surprise of himself when he was with her. (201) As much as Macon never thought he could care for Muriel, he finds himself almost loving her, and loving himself more whenever he is with her. He begins to enjoy his time with Muriel, and now moves with the flow of life, instead of life passing him by while he is still standing still. After Macon leaves Muriel to get back with Sarah, he finds that Muriel will not give up on him.She follows him to his business trip to Paris: â€Å"‘†¦why Muriel? Why are you doing this? ’ ‘Because I felt like it,’ she said. ‘You felt like spending five days alone in a Paris hotel? That’s what is will be, Muriel. ’ ‘You need to have me around,’ she said. ‘Need you! ’ ‘You were falling to pieces before you had me† (318). Muriel is very persistent—just like when she had been pursuing Macon; she refuses to give him up. In the end, Macon cannot refuse Muriel, and leaves Paris without Sarah. This shows Muriel to be a stagnant character in this book—with her unwillingness to give up and her belief in the goodness of people.In conclusion, Macon and Sarah prove to be the characters that undergo the most rapid changes, and Muriel remains static. Above all, Macon’s desire to control his own life in such a regimented way as packing for trips with a great notion of order is probably due to the fact that he does not trust other people. He feels that he cannot rely on others a nd instead can only trust himself. However, this all changes with the help of Muriel, who proves to be one of the most beneficial people to come into Macon’s life.Sarah learns the hard way that you cannot always go back to people and places in your life and try and fix things that are not worth fixing, or not capable of being salvaged. In this case, it was she and Macon’s marriage. Sometimes it is better to let go of the past and move on to the future. The main theme of this book is love, and it is substantiated by Macon’s capability to lose sight of his fear and love someone completely different from himself and all that he has known. All of this happened because of one individual’s acceptance of change and the flow of life.

Thursday, January 9, 2020

characteristic of management - 1092 Words

Assignment 1 With the progress of history, the definition, content, method and characteristic of management is in constant development. The history of management theory and idea is evolving. Between the twentieth century and twenty first century, the environment of management has been changed from stable and predictable to unending changeable. According to Kiechel’s (2012) theory, with the definite law, principle and regulation, management belong to a real science system. In this essay, two topics will be discussed. The first one is management theories and ideas have changed over time with two factors which are the transformation of labor were treated from machine to human and the connection between organization and external†¦show more content†¦Abrahamson (1966) suggested that, change is a global effect; the customer is more sensitive on the quality of the product or service. Managers should seek a new technology to help them handle new conditions which is the performance gap cau sed by environmental changes. Finally, with the widely used of the development of science and technology and information technology, lots of things could be done which may not be done easily. So the traditional management mode faces the enormous challenge. Moreover, by Rodrigues(2001)’ theory, the development of effective management skills to deal with specific problems and challenges of each organization in the global competitive environment is to make a frame work. The urgent need of many enterprises and organizations are rapid changes in technology and the environment. Today, the new trend of training and development organizations around the world are dealt within their own organization. In order to achieve networked, flat, flexible, effective development skills, specific challenges different new organizations of their mission and objectives of the organizations all over the word. Effective management skills help people and organizations to improve its effectiveness and efficiency. The rapid development of globalization and technology shows that we are in fierce competition. Proper management is crucial to the complex environment. The quality manager andShow MoreRelatedCharacteristics of Scientific Management1674 Words   |à ‚  7 PagesIntroduction Scientific management can be defined from a broad sense as the endeavors made in order to come up with suitable systems in the sector of industrial production and organization. In a narrower sense, it refers to the specific principles that were championed by Fredrick Taylor who was an engineer before the First World War. Taylor focused on ways of increasing productivity and reducing waste that resulted from management controlling the labor process. It is important to realize maximumRead MoreThe Characteristics And Actions Of Management Essay866 Words   |  4 Pagesorganization, I am very observant of the characteristics and actions of management. I watch management to see how they tick. I am curious to how management functions, what roles they play, and what skills they possess. In my last job, I witnessed a manager that struggled to do the basic management functions, no designated managerial role, and ineffective managerial skills. Basically, I learned that my previous manager how not to operate in management. Management Functions Robbins Judge (2012) saysRead MoreWhat Is Management? Explain Characteristics of Management?828 Words   |  4 PagesWhat is Management? Explain characteristics of Management? Management in all business and organizational activities is the act of coordinating the efforts of people to accomplish desired goals and objectives using available resources efficiently and effectively. Management comprises planning, organizing, staffing, leading or directing, and controlling an organization (a group of one or more people or entities) or effort for the purpose of accomplishing a goal. Resourcing encompasses the deploymentRead MoreDisaster, Characteristics And Management Stages Essay1317 Words   |  6 PagesDisaster Characteristics and Management Stages The purpose of this paper is to examine a recent natural disaster. The number of natural disasters has risen dramatically in the past two decades. Natural disasters are increasing exponentially and creating expanding amounts of destruction each year. A recent natural disaster to examine is the flooding in Louisiana August 2016. This paper will discuss the type of disaster, characteristics of the disaster, and the application of disaster management stagesRead MoreDisaster Characteristics And Management Stages Essay1198 Words   |  5 PagesDisaster Characteristics and Management Stages A disaster is defined as a natural or man-made incident in which the degree of destruction, death or injury overwhelms the community, exhausts the available resources and decreases the community’s ability to respond (Nies McEwen, 2015). The frequency of natural disasters in on the rise. Studies show that since the 1970’s, floods, storms, droughts and heatwaves have increased five-fold (Unesco, 2011). Many experts point to climate change as the causeRead MoreDefinition And Characteristics Of Service Management1195 Words   |  5 PagesINTRODUCTION TO SERVICE MANAGEMENT Customer’s quality perception is effectively influenced from outside the hotel by the marketing communication in place. In general, hotels will use brochures, advertisements and social media to promote their venue. Customer’s recommendation through word of mouth is still largely expected to contribute to promote a specific product or service provided by the hotel (Glynn Mangold W., 1999). 1.1 Definition and characteristics of service management According to AlbrechtRead MoreThe Characteristics Of Master Data Management1450 Words   |  6 PagesBackground After discussing with Professor Bechor, my research problem is now better defined and aligned to move forward. My focus will be on mapping cyber repositories and creating metadata from these repositories such that the characteristics of master data management (MDM) can be leveraged to collect, aggregate, match, consolidate, and validate the diversified quantity of cyber sources. Currently, there doesn’t seem to be a good method for collecting, maintaining, and correlating cyber vulnerabilitiesRead MoreCharacteristics of a Successful Entrepreneurial Management Team1290 Words   |  6 Pagesdiversity of culture, talent and opportunity. These three areas of characteristics provide broad insights into the mindset of the entrepreneur; perhaps the genetic makeup of the entrepreneur†. So, what are the personal characteristics required to be a successful entrepreneur? Dingee, Haslett, and Smollen (1997) found that to answer this question, there has to be some personal introspection. â€Å"Begin by studying the following characteristics that successful entrepreneurs, venture capitalists and behavioralRead MoreStatement Of Characteristics In Business Management832 Words   |  4 Pagesgathering, analysis, and management are directly responsible for 70-80% of project failures. Realizing the importance of business analytics in work, I wish to acquire th e advanced business knowledge with analytical skills to make insightful business decisions, and become a successful business leader in future. Majoring in International Economics and Trade at University of International Relations, I have significantly enhanced my business and mathematical skills, improved my management understanding andRead MoreCharacteristic of Effective Supply Chain Management3155 Words   |  13 PagesTITLE: CHARACTERISTICS OF EFFECTIVE SUPPLY CHAIN MANAGEMENT Table of Content Executive Summary 1 Introduction 2 Effective Distribution Networks 4 Effective Network Design 5 Effective Global Supply Chain Networks 5 Planned Demand and Supply 7 Managed Uncertainty (Safety Inventories) 7 Optimal Product Availability 7 Designed and Planned Transportation

Wednesday, January 1, 2020

Essay on Franz Kafkas Use of Humor - 1619 Words

Franz Kafkas Use of Humor Franz Kafka, born on July 3, 1883 in Bohemia, in the city of Prague, has been recognized as one of the greatest writers of the twentieth century. His works have been called cloudy, mysterious, inexplicable (Oates ix). Most people hear the term Kafkan or Kafkaesque and think of dark, fantastic tales with almost no basis in our known reality. But what of Kafkas sense of humor? I personally laughed out loud several times while reading Kafkas Amerika. Were these snippets of humor part of Kafkas plan or mere accidents? According to Roy Pascal, author of Kafkas Narrators: A Study of His Stories and Sketches, There is a good deal of humour in these early stories, as in the novels and later stories, but†¦show more content†¦Georgs father goes on to kick and yell at Georg extensively. Through this entire barrage and beating from his father the only thought that pops into Georgs head is he has pockets even in his shirt (Kafka 86) referring to his fathers nightshirt. This left turn from the heat of the moment is quirky enough to give the reader pause and wonder what is going on. Such was Kafkas intent. Another good example is in the novel Amerika. Here, protagonist Karl Rossman comes to at 3:00 am after a serious fight with two men, Robinson and Delamarche, whom he met shortly after his arrival to the United States from Germany. He wanders out onto the balcony of the apartment he is trapped in and makes the acquaintance of a student studying on the balcony next door. Karl discovers the student works at Montlys department store all day and then studies and goes to school all night. When asked when he sleeps Karl hears, Oh sleep! said the student. Ill get some sleep when Im finished with my studies. I keep myself going on black coffee. A fine thing black coffee. I dont like black coffee, said Karl. I dont either, said the student laughing. But what could I do without it? If it werent for black coffee Montly wouldnt keep me for a minute. I simply dont know how I would get on in the shop if I didnt have a big bottle like this under the counter, for Ive never dared to risk stopping the coffee-drinking... (Kafka 267). WhyShow MoreRelatedEssay on Franz Kafkas The Trial1514 Words   |  7 PagesFranz Kafka’s famously translated novel The Trial was thought by many to be strongly influenced by his strong background and affiliations with theater and literature. Within the novel, Kafka refers to various types of the art form including, physical art, performing arts and acting, and the art of how a person moves and/or interacts with others. Critics have argued that Kafka’s background was the influence to the novel, while others strongly disagree. Was Kafka’s references to the performing artsRead MoreEssay on Kafka and his Portrayal of Characters2820 Words   |  12 Pages Kafka’s Portrayal of Characters Franz Kafka, born on July 3, 1883 in Bohemia, in the city of Prague, has been recognized as one of the greatest writers of the twentieth century. Virtually unknown during his lifetime, the works of Kafka have since been recognized as symbolizing modern mans distress and distorted alienation in an unintelligible, hostile, or indifferent world. None of Kafka’s novels were printed during his lifetime, and it was only with reluctance that he published a fraction of hisRead MoreIs The Metamorposis : Drhosis Magical Realism?1009 Words   |  5 PagesMetamorphosis is or is not Magical Realism. However, The Metamorphosis, by Franz Kafka, can be classified as magical realism when compared to â€Å"The Handsomest Drowned Man in the World,† by Gabriel Garcà ­a Mà ¡rquez, and â€Å"What is Magical Realism, Really?† by Bruce Holland Rogers, using aspects of magical realism including realistic elements, magical elements, dark humor, and distortion of time. One aspect of Magical Realism Franz Kafka uses is realistic elements. The start of Gregor’s morning is similar to aRead MoreComedy and Tragedy in Kafkas The Metamorphosis2608 Words   |  11 Pagesc The subtle yet powerful combination of comedy and tragedy in Franz Kafka’s The Metamorphosis was not an accident. Kafka combined these genres in order to convey the mixture of emotions that accurately mirrors the cruelty of life. The main character, Gregor Samsa, is used to illustrate the betrayal that can exist in a family unit as well as a place of employment. Together, Kafka is making a strong commentary on life in order to express his own feelings of desolation and cynicism regarding societyRead MoreRole of Humour in Franz Kafka ´s The Metamorphosis, The Trail, and Ameria2643 Words   |  11 PagesRole of Humour in Franz Kafka’s ‘The Metamorphosis’, ‘ The Trial’ and ‘Amerika’ â€Å"Humour is the tendency of particular cognitive experiences to provoke laughter and provide amusement.† The term Humour has been derived from the Greek language, which teaches that humour is the balance of fluids in the human body. Humour is savoured by different taste-buds like: Anecdotal, Blue, Dark/Gallows/Morbid, Epigrammatic, Hyperbolic, Ironic, Satirical, Satirical, Situational and Slapstick. Franz Kafka, the authorRead MoreAbsurdity Between Kafka and Camus4307 Words   |  18 PagesThis paper seeks to compare and contrast the philosophical views of two great philosophers, namely Albert Camus and Franz Kafka. The works involved in this argument are Kafkas The Metamorphosis and Camus The Outsider. The chief concern of both writers is to find a kind of solution to the predicament of modern man and his conflict with machines and scientific theories. Death, freedom, truth and identity are themes to be studies here in the sense of absurdity.    Kafka was born in Prague in 1883.Read MoreANALIZ TEXT INTERPRETATION AND ANALYSIS28843 Words   |  116 Pagesfor they introduce us to information that would otherwise be unavailable and thus increase our knowledge and understanding of present events. Evaluating Plot Having studied a given story or novel, to see how the author has arranged and made us use the elements of plot, we should be ready to evaluate his or her success. The customary test of a plot’s effectiveness is its unity: the degree to which each episode and the place it occupies in the narrative structure of the work bear in some necessary