Case Study Treating An Ischemic Brain Attack Nursing Essay

Case Study Treating An Ischemic Brain Attack Nursing Essay J Sparrow, a 70-year-old patient, presents to the emergency department 4 hours after experiencing an ischemic brain attack confirmed on the CT of the head without contrast. The patient is a candidate for intra-arterial thrombolytic therapy to dissolve the blood clot causing the significant stroke symptoms. The patient is scheduled for the emergent cerebral angiogram with possible intra-arterial thrombolytic therapy. The nurse provided patient and family education and received the informed written consent from the patient’s spouse. The patient has intravenous normal saline at 100 mL/hr infusing into the right forearm with an 18-gauge angiocath, which is patent. Interpretations and findings done by the group: Most books have cited the importance of the â€Å"3-hour window† for administration of thrombolytic therapies. This is to adhere to the fact that irreversible brain injuries usually take place after 3 hours from the onset of stroke, and any intervention to reverse t he condition would be deemed useless. But recent studies show that the 3 hour window was extended to 4.5 hours, and was proven to still be therapeutic if the drug was administered up to this time. In the patient’s case, even if it was 4 hours after the onset of stroke, he was still allowed to undergo possible Intra-arterial Thrombolytic therapy following a cerebral angiography since this was indicated for stroke patients with onset of symptoms for more than 3 hours. CT scan of the head without contrast was done as a differential diagnosis as to what type of stroke patient JS had experienced. This was an important test to determine further interventions needed, and to reduce risks for any complications if the client’s stroke was classified as hemorrhagic. Cerebral angiography was ordered to identify the exact area of occlusion, so that immediate administration of the thrombolytic drug can be done. Before patient JS became a candidate for thrombolytic therapy, several cr iteria for eligibility were assessed since not all stroke patients can have this kind of therapy. What labs should the nurse assess before the procedure and why? Patient JS is about to undergo cerebral angiography, wherein a contrast dye is to be injected to view the area of occlusion. Before the procedure, certain laboratory tests need to be assessed and reassessed as a standard protocol, and for further procedures which requires it. The cerebral angiography test is done to locate the area of occlusion or infarction to determine the area of administration of Thrombolytics. Since the client is about to undergo EMERGENT cerebral angiography, only the most significant laboratory tests are to be assessed. Blood tests Complete blood count with Platelet Count Hemoglobin count is important to determine the amount of oxygen in the blood. Low oxygen in blood aggravates the condition of the patient (in which a part of the brain is deprived already of oxygen), by depriving other parts of the brain or body of proper oxygen. Hematocrit can also determine if the client experiences alterations in fluid volume, especially within the blood vessels. Assessing these values can determine further interventions needed to be done before the procedure, such as administration of oxygen and increasing the rate of administration of fluids.

Burden and Standard of Proof Case Study Example | Topics and Well Written Essays - 2500 words

Burden and Standard of Proof - Case Study Example Accordingly, the claimant usually bears the legal burden (and by necessity an evidential burden) of proving all the elements of his claim. Similarly, the defendant bears the legal (and evidential) burden of proving any defence and/or counter claim against the claimant. The burden of proof in criminal cases: The basic rule was laid down by Viscount Sankey LC in Woolmington v DPP3, 'Throughout the web of the English criminal law one golden thread is always to be seen, that it is the duty of the prosecution to prove the prisoners guilt4'. It would be possible to justify the rule as part of a policy to avoid embarrassing criticisms of the administration of justice by minimising wrongful convictions. These are more likely to be avoided if the burden is fixed in this way then if an accused person has to prove his innocence. It is also possible to justify the rule by appeal to principle. For example, it would be a necessary feature of the law if it were accepted that, in Dworkin's words, people have a profound right not to be convicted of crimes of which they are innocent. Viscount Sankey said that the rule was subject to exceptions in the case of the defence of insanity and subject also to any statutory exception. But there have been Challenges to the idea that it is ever just to place a legal burden of proof on defendants. Standard of Proof of civil and criminal cases: In criminal cases the standard of proof to which the prosecution must prove its case has been variously described as 'beyond reasonable doubt' (Woolmington v DPP5). In Miller v Minister of pensions6, Denning J described the standard of proof in civil cases as follows: If the evidence is such that the tribunal can say; 'we think it more probable than not,' the burden is discharged, but, if the probabilities are equal, it is not. There are, however, some exceptional cases where the criminal standard of proof is required: (a) Contempt of court (Re Bramble vale Ltd7; Dean v Dean8) (b) Where a person's livelihood is a stake (R v Milk Marketing Board, ex p Austin the Times, 21 March 1987). (c) Allegations of misconduct amounting to a criminal offence in disciplinary hearings (Re A Solicitor9, R (on the application of s) v Governing Body of YP School10). (d) Where statute requires the criminal standard of proof (Judd v Ministers of Pensions and National Insurance11). Presumption of innocence: Legal burdens on defendants may have to be considered in the light of the European Convention on Human Rights, which is now incorporated into English law Under the Human Rights Act 199812. The ECHR, Article 6(2) provides that every one with a criminal offence shall be presumed innocent until provided guilty according to law. The leading authority is Attorney-General's Reference (No 4 of 2002)13, from which the following principle may be distilled. a) The Defendant has a right to a fair trial, b) The Presumption of innocence is an important but not an absolute right and so derogations from the principle are permitted. c) The ECHR require a balance to be struck between the rights of the individual and wider interests

Critical review of Antonio Damasio's theory of core consciousness Essay

Critical review of Antonio Damasio's theory of core consciousness - Essay Example Each convergence zone handles a category of objects (faces, animals, trees, etc): a convergence zone does not store permanent memories of words and concepts but helps reconstructing them. Once the image has been identified, an acoustical pattern corresponding to the image is constructed by another area of the brain. Finally an articulatory pattern is constructed so that the word that the image represents can be spoken. There are about twenty known categories that the brain uses to organize knowledge: fruits/vegetables, plants, animals, body parts, colours, numbers, letters, nouns, verbs, proper names, faces, facial expressions, emotions, sounds." (Damasio, 1999). Damasio is the firm believer of the theory that the reasoning area of the brain and the area of the brain responsible for generating emotions virtually overlap each other. As a result and thus he derives the hypothesis that emotion and reason cooperate. He believes that this is the neural, or better to state physical evidence in favour of his theory. Damasio also implies that this is the proof of the brain-body communication that is so much essential for the survival of a species. In his current neurobiological work 'The Feeling of What Happens: Body, Emotion and the Making of Consciousness' Damasio states that evolution developed two different levels of consciousness. One is 'core consciousnesses and the other 'extended consciences'. "Core consciousness is what we share with some nonhuman animals - a simple biological phenomenon, the scope of which is the Here and Now. This basic, integrated representation of one moment and one place is independent of language, reasoning and memory" (Metzinger, 1999). Damasio states this as a organism builds up its memory of its biography, or in other words, a flow chart of its core self each part of this memory bank induces and enhances the core consciousness by becoming a portal of each function submitted in the autobiography of its mind. This core consciousness also enables this organism to draw reference and induce conclusion from this autobiographical memory bank. In accordance to the ability of the organism the autobio graphical memory bank stores data for an extended period of time for usage in times of need. The need can be the ability to define itself processing the collective data available or to interact with outsiders in favourable and inauspicious circumstances. The autobiographical memory bank creates a mental map where the self image of that organism is stored. But the perimeter of this core consciousness ends here. After that the domain of extended consciousness begins. Thus it is obvious to state that "active scratchpad" of mental life (Baars, 1988) is absent in this regard. It could be termed that the domain of core consciousness is specified on the usage where there is nothing called tomorrow. Core consciousness only deals with the immediate present and 'now'. It has no functionality in the hyperspace of time. It should be noted that core consciousness does not overlap the idea of space either. In other words core consciousness is not worried about what happens outside the perimeter o f its own existence it is only aware of the area where it is present physically. For core consciousness, everything is 'here' as in the context of time- 'now'. Damasio states that at this point