The Carolina Wilderness Outfitters Is A Retailer For...

Background The Carolina Wilderness Outfitters is a retailer for outdoor enthusiasts. The company was started in the 1930’s and grew to have a following of consumers from its North Carolina residents within fifty years of growth. The head of internal auditing Sue Ramos initiated an investigation after receiving a Tel Tel report. The call that was noticed was from an ex-employee from the company alleging that there was wrongful termination that had taken place. Ms. Ramos had assumed that the investigation would be completed and she would be able to move on to more pressing matters until new evidence was presented last week showing issues with the accounting for the company. Ms. Ramos did not feel that the allegation made by the caller†¦show more content†¦The details referred to other departments and shed light on more than just age being the reason why Ms. Koster was terminated from the company. Scope The purpose of this investigation is to determine whether or not there is was a financial statement issue within the accounting department of Carolina Wilderness Outfitters. Though the initial investigation is based on another issue regarding the accounting department, there may be more to incident that is an underlying issue. This investigation is predicated by a phone call made to the ethics hotline by Betty Koster alleging that she was wrongfully terminated due to her age and claims discrimination. Approach The Investigation Team Members †¢ Sue Ramos, Head of Internal Auditing †¢ Anthony Payne, Investigator Procedures The investigation team took the following actions during the investigation: †¢ Conducted phone interviews with Betty Koster, Simon Peel, and Mark Tomkin. †¢ Obtained and reviewed notes of phone calls with Betty Koster. †¢ Obtained and reviewed performance evaluations of Betty Koster during her eight-year tenure with the company. †¢ Obtained and reviewed possible journal entries about volume rebates made from within the Accounting Department. Individuals That Were Interviewed: the members of the

The World There Are Many Cultures, And Religions - 1231 Words

In the world there are many cultures, and religions. One of the oldest cultures, and religion is that of Jewish people. Not being jewish makes you see Jewish people in a different light. Sometimes that light is often very different that what reality is. By going through the life of a typical Jewish person for a week you will be able to see just how they live and what types of things differ and are similar. And what you will find is that most often times the differences are fewer than the similarities. Days go by very normally for jewish people most of the time. Most of time they go about their day very similarly to everyone else. Depending on the type of person they could go about their day differently. there are only some jewish people that still live very traditionally like they use to in the old days. If you go through a typical day of a jewish person this is what you would find out. 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Foot Infection for Body Temperature Regulation- myassignmenthelp

Question: Discuss about theFoot Infection for Body Temperature Regulation. Answer: Introduction The biggest part of the heath profession in health care setting is nurse. They utilise judgements and reasoning for taking decisions in terms of patients care. On the broader scale nursing profession understands intuitive reasoning as the experts hint. Thompson et al., 2010 approximated that nurses that is employed in health centres shall take a mean of single results per 10 min. In patients safety agenda decision making plays a very crucial role (Yang, 2009). This report illustrates clinical reasoning cycle to give a clinical decision regarding diabetic foots infection. This may occur due to acute or chronic skins compromise, outer neuropathy, arterial insufficiency or the mixture of all these. Around 20% of diabetic patients with ulcer in foot may have inadequate peripheral atrial supply, approximately half of them have peripheral neuropathy and about 30% will showcase all. The writer chooses this issue in the present clinical practicum because there are large numbers of clients having foot infection in the heal care settings especially diabetic patients having this problem. Adding to this, patients are exposed to danger situation. The major objective of this paper is to develop a clinical decision utilising the clinical reason cycle. It also illustrates about the essentiality and the appropriate stages to take proper decisions. It will also be supporting the condition which is faced by HAAD after which certain recommendations shall be provided. Diabetic Foot infection Clinical reasoning is said to be as the reasoning that is utilised by the nurses and other staffs to gather cues, information processing, reach to a conclusion of the situation or issue, implement, plan, analyse results, learn and reflect prom the process. During the process it connected the way of thinking in respect to care of patients, ability to think critically and with experience and practice clinical reasoning changes to natural skill. Adding to this, clinical reasoning is a crucial skill since it provides positive results for the clients; empower efficient management in complex situations and bifurcates among things that need instant attention and what not. Writer utilises process of clinical reasoning that is described as dynamic process which moves in clockwise direction begins at 12:00. It is crucial and advantageous cycle in decision making since the nurses can go forward and back before taking action or reaching decision or evaluating the results. It is also essential si nce it contains 8 steps that assist in understanding and work through every step instead of making approximations regarding problems of patients and starting intervention. It also gives a framework for the nurses intervention with sufficient consideration and planning (Levett-Jones et al.2010,p.516:Hoffman 2007). Scene Mr M has an age of 55 years. In his left ankle she was diagnosed with foot infection. In his interrogation with doctor she said that she was knows about the infection. She understood it as a simple wound that will be healed by time. That is why she ignored it for about a week. After few days she noticed that wound got larger, it did not healed and there was severe pain which impaired his movement. Underlining that she is diabetic from past 15 year and having family history of diabetic mellitus. She also had cholesterol. Her doctor suggested her 4 antibiotics and 4 analgesic and swelled left leg at the time of getting admitted. Their plan was to do inspection, swab wound care, dressing and mobilisation. Etiology and Epidemiology of diabetes foot ulcer Diabetes is accumulation of metabolic disease categorised by hyperglycemic outcomes from lack of insulin secretion, action or both. Blurred vision, weight loss, polydipsia and polyuria are the symptoms of Hyperglycemia. Problem of diabetic foot has an influence of the patients lifes quality which may result in depression and decreases movement. It also has financial angle with it (American Diabetes Association, 2014a). Moreover, diabetic foot ulcer is caused by peripheral neuropathy, outer arterial disease that lead to gangrene and necrosis, infection and osteomyelitis (NICE, 2011). Patients Condition Good morning, my name is Noor, I am RN from ED. Today Mr. M was diagnosed with the wound infection at the age of 55. The infection is mild and is present in the left ankle. She visited ER at 23:00 pm. Her condition is that she was hit by the thrown rock at the floor which she hit by mistake. His ankle got ruptured from where continuously blood was coming out for half an hour. He just wrapped it up for the week with a towel without cleaning it up. The wound become painful and the situation got worst as she exclaims it to be the worst pain of his life. She arrived at ER in lot of pain and the legs were swelled. She receives an antibiotic levofloxacin 500 mg and IV and acetaminophen 1000mg IV. Wound got dressed with silver cell and gelonet it was wet, swelled and 1 inches in breadth, 3 inches in length and fresh blood cells release at the time of dressing. Vitals of his like blood pressure was 130/81, temperature 36.1C, oxygen saturation was 99% , his pain score was 5 and she was depressed with his respiratory rate of 20/min. Her blood sugar was 270mg/dl, 4th hurly blood checking was done. Mr. M is in sliding scale utilising insulin aspart 2 unit fixed dose and 2-10 unit unfixed. Her attributes are 71 kg in weight, 163 cm in height and having BMI of 26.72. Mr M labs outcome was ordinary except HDL low 33 mg/dl and LDL high 189 mg/dl. She is under atorvastatin 40 mg and asked for repeating of her lipid profile. She does not have allergy from medicine or food. After receiving the patients hand over from ED nurse, me and my preceptor introduce ourselves to Mr. M and we started the assessment. Formal admission process to the ward was done by us that involved risk assessment, physical assessment and history taking. Information/Cues Review present data Second step of clinical reasoning cycle is to begin reviewing and thinking regarding condition of Mr M. Her temperature is low 36.1 C, pain scale the score is 5 and respiratory rate scores 20/min. Expression on the face of Mr. M suggested that he was depressed. 262 mg/dl was his blood sugar level. She also had the cholesterol medical history. His LDL and HDL was not ovious. New Information Beginning with the assessment , me and my preceptor returned to the patients room to access her. We took her vital sign where his temperature was still low i.e. 36.2C, pain is measured through wong baker it scores 5. Legs elevation was not present and the patients position was bad. For wound culture we do swab. Mr M said I not ok in depression, we looked his blood sugar it is high 277 mg/dl. As she says her highest blood sugar she reached is only 221mg/dl. We understood from the subjective data obtained from him that patient has a very less knowledge regarding his health condition. Recall knowledge In diabetic patients foot is infection is very serious and common issue. Existence of infection understood as occurrence of 2 or more inflammations characteristics. For suggesting that infection, positive swab is enough. Since most of the diabetic foot infection is caused by polymicrobial infection with aerobic Gram-positive cocci and staphylococci. Starting therapy related to antibiotic has to emphasize on these bacteria so that therapy must be narrowed to a particular area. For mild to moderate infection, the effective treatment is usually of 1-2 weeks. Information processing Interpret Analysing the Mr Ms data, the writer collects and accumulates it with careful analysing and application of the knowledge associated with diabetic foot infection. By comparing abnormal with normal helps in understanding the sign and symptoms of Mr M. Beginning with the vital his temperature was normal i.e. 36.2C. The hypothermia range is between 36.5C to 37C. As per Hall JE (2015) hypothermia happens when temperature is from 35C and less. In the Pain score she scores 5 out of 10 in which suggest that she is under moderate pain. Respiratory rate was 22 which was high since normal patient is between 16-20 and hence she was having tachypnea. Blood sugar was still on the upper side i.e. 262. As per Joslin Diabetes Center 2016 the before meal blood sugar for diabetic individuals was 70-130. After meal 180 and at bedtime it was between 90-150. However her HDL was low i.e. 3mg/dl the normal between 40-59mg/dl. Risk of heart diseases is higher in this condition. The LDL high is 189 mg/dl. 10 0-129 mg/dl is between 100-129 mg/dl (Hall JE., 2015). There was still swelling. Discriminate Here writer will narrow down information and flinging which requires excessive attention. Beginning with the temperature it was on the lower side, but my worrying was not about it since it was under normal low. With rest patients depression will decrease and so will the respiratory rate. The pain will come down with medication and the results of the lab will be repeated. My worry was regarding his higher blood sugar level and the wound was still fresh as his legs was still swelled. Taking evidence from the raising sugar level the infection may not reduce and the wound may take longer time to get healed. However the rising amount of glucose level in the blood may result in rigidity and stiffness of the cell walls. Weakening blood circulation of the smaller vessels presents in the injured regions surface and may delay the wound recovery (Jana Nemcova Edita Hinkova., 2013). Relate, and (d) Infer In this part I will make collection and link the cues to collect. To find the linkage among the important complain and concern to make interference on these relationship. Mr Ms swelled leg with pain might be an enhancement of his infection on the effected region. Mr M blood sugar is still on the higher side due to the fact that she did not have meal on time, she had infection as well as she was depressed. Mr M was feeling cool may be the sign of depression. This is due to the fact she has limited amount of knowledge regarding his condition which can be seen that she had little knowledge regarding the wound (Diabetic UK., 2012a). Predict Here the writer requires critical thinking to think regarding Mr M results. If author does not think about the condition then patient condition may not improve. It is predicted that Mr M may develop more infection and can lead to his cognitive impaired eyes due to high sugar levels. Adding to this if his blood sugar level may not increase then it may cause hypoglycemic coma (American Diabetes Association, 2014a). Match Here the author shall discuss regarding one patient who having almost same condition in the previous clinical rotation. There was another diabetic patient Mr X having type 2. She was 65 year old with the assumption of right leg having infection and has reached the whole leg. This patient again developed toe infection and at this time patient was highly careful regarding the infection due to his bad experience regarding the infection. They treated the toe, leg was elevated and the client was taking food at regular time in an appropriate manner. Due to one week of antibiotic course the wound got healed since infection was gone. This also becomes possible due to the fact that she was highly co-operative and hence his course completed in one week. She was obeying all the instructions that were given to him. Doctors were surprised comparing the results of the two cases. For better health and quality of life the first and foremost priority that the patients co-ordinates while treatment is going on (Levett-Jones et al.2010,p.516: Hoffman., 2007). Identify the problem As per the process of nursing defining the issue comes when the assessment is already done. It is also termed as nursing diagnosis. The condition of Mr M starting from first diagnosis to the latest is illustrated. First is that the pain associated with the right legs infection as manifested by high sugar levels in blood, swelling in legs, pain score was 5 and the client said I am not ok. Second is that she had hyperglycemia associated with excessive intake of carbohydrate as said by patient himself that I like pasta and breads, enhanced blood sugar and the wound. Third was the activity associated with effected limbs as said by Mr M that I am very weak how I will do my activity and how will work. Adding to this she was also deficient of knowledge. Establish Goals Moving towards the third step in the process of nursing is planning to have long and short term goals. Before making any action nurses must provide goals to have appropriate plan for care. The short term goal for the patient is to bring the blood sugar level is under 240 in the next 24 hours. Client will be pain free in the next 12 hours. For the long term goals patients will be pain free in the next day until discharge, patients will control his diet after education, patient will have healed wound with no infection and client will be satisfied before getting discharged. Patients will perform daily activity by himself. Take Action The forth step to this is nursing intervention is to achieve the objectives. The intervention must be related with the best care plan. Offered timely opiate pain medication as prescribed and the assessment are done in every 30 minutes. It will let us know that if the dosage is enough to manage the pain. Then teach about non-pharmacological techniques like listening to music, yoga or peaceful environment which will assist patient to be relaxed and he remains in comfort. After that reduce or remove factors which will bring or rise experience of pain (e.g. monotony, fear, fatigue and knowledge lack since these factors will influence his tolerance of pain). Mr M must be educated to ask for pain medication before the pain becomes worst. This shall be done before the pain becomes difficult to manage and handle (Chris Pasero and Margo McCaffery., 2016). Evaluation Last step of this process is to evaluate the whole thing that you did to see if it is fruitful and check whether the entire plan is effective or not. Vitals of Mr M becomes normal, the lipid profile HDL and LDL is within the appropriate range 122mg/dl and HDL 51mg/dl with assistance of proper intake of atorvastatin. Sugar in the blood was 200 mg/dl with proper diet and timely insulin. Patient verbalize" I am comfortable I cannot imagine that pain went"," thank god I can go to work know", "I will do the advice that given to me to avoid such complication. She is now stable the goals is achieved with the co-operation of Mr M. Reflect In this part reflection regarding client condition will be discussed and explained. This condition happened due to my clinical rotation for Advanced Clinical Decision making in nursing in ALMAFRAQ in the surgical ward 2A. With the use of Gibbs cycle of reflection that contain 6 stages that are describing the situation, your feels, analysing, evaluating, concluding and your action plan for reflection about the incidents (Chang Daly, 2012). For a start, I was in 2A ward doing day duty with my preceptor. She assigned with five patients two of them immobile and two contacts. The fifth one is with foot infection that is Mr M who is 55 years old. My preceptor was highly busy on that day since doing documenting, going to OT and collecting blood. Moreover she neglected Mr M but the time she reached her, he was in the very difficult condition. The room was singing IV machine ringing due to the medication finish, she is trying to get out of the bed with effected leg. Mr M was asking and screaming for help. As per my feeling I was surprised having no reaction on my face by looking Mr M not been able to move. I was thinking about the things that happened and put him in terrible condition. I thought that if the preceptor continues to ignore the condition of him then it can be dangerous for him. I evaluated the condition in both good and bad way. Good in the sense that condition of Mr M made me good reactor and made me watchful. Bad part of it was that doctor takes longer time answering to their needs. Patients safety is in danger when one nurse is assigned more than 5-6 patients. Seeing such situation I ran to find the aid in such situation and hence forming a team leader without the help of my preceptor. Units manager called my preceptor for three minutes meeting so as to relax and say her that not to be afraid of while handling the report. Next day units manager thanked the preceptor and gave her two days off. This situation came to an abrupt ending for which me and my preceptor were not ready. We were also worrying about the response we will receive from others. At last everyone was cheerful. This was done by the units manager to let other understand that they must not get afraid of any situation. Same way f thee nurses takes their personal decision rather than asking for help they may save many lives. If in future such incidents arise I will do the same thing where I could use my experience and critical thinking to save patients from any further harm rather than waiting for help. While working in various units I can gain this experience. Clinical errors occur since the nurse neglects the patients. Applying HAAD standers are required for all the RNs in Abu Dhabi to give excellent care to patients. Such competencies are for ensuring safety and security of both RNs and clients. Nurses responsibilities are categorised into 3 categories. First is the class where nurses decide how RN must behave, act or perform. They needed to put appropriate and safety care of each patient. Second one is ethical practice professionalism which describes about understanding of RNs about their job and the code that keeps them independent. Third is the creation of the professionalism that makes RNs to sustain their individual life learning essential for jobs. Gathering the first to the second they will emphasize on behaviour professionalism when the nurse in the last situation fails to safeguard Mr M from harm. The nurses were unable to do their task by applying organised technique (Health Authority of Abu Dhabi., 2009). Recommendation All the patients of diabetes requires a inspection on daily basis if she is in the risk of infection and ulcer. Multidisciplinary expert agrees that it is a foot care pathway for individuals with DM. Referrals at rapid speed is required for managing patients with infection (Diabetes UK., 2012a). A special health card is provided to patients with DM in UAE where they can visit specialist doctors in the imperial college London diabetic centre. More study is needed to make sure that implication of nurses delivering diabetic foot care program in treatment of diabetic foot infections where the hospital lacks trained podiatrist (van Battum P et al., 2011). Conclusion In the concluding remark it can be said that foot infection in diabetic patients is a complicated issue. Such incidents are rising and are costly to the people with DM. Educating people can be an efficient tool which can contribute to changing of behaviour of patient. The selected topic may aid the writer to learn about such situations and practice to enhance critical thinking. Adding to this writer utilised Gibbs cycle to reflect upon Mr M situation that experiences foot infection. At the end the author provides recommendations for future so as to reduce ulceration for patients of diabetes. References American Diabetes Assosition (2014a) Dignosis and classification of diabetes mellitus. Diabetws Care 37 (suppl 1): S81-S90. Doi: 10.2337/diacare.27.2007.S5 Chris Pasero and Margo McCaffery. (2016).Nursing Diagnosis Acute Pain - Nanda NIC NOC.Available: https://nursing-diagnosis-intervention.blogspot.ae/2012/07/nursing-diagnosis-acute-pain-nanda- nic.html. Last accessed 15th March 2016. Chang, E. Daly, J. (2012). Transitions in Nursing: Preparing for Professional Practice. 3rd Edition. Elsevier. Australia. Diabetic UK (2012a) Putting Feet First: Transforming Foot Care Service in diabetes http//bit.ly/ZdhpbO (accessed 15 February 2016). Hall JE. Body Temperature Regulation and Fever.Guyton and Hall Textbook of Medical Physiology. 13th ed. Saunders; 2015 Jun 03. Chapter 74, 911-922. Health Authority of Abu Dhabi. (2009). Health Authority - Abu Dhabi Monitor RNS competences domains. Retrieved 21 Feb 2016. Jana Nemcova Edita Hinkova. (2013). The efficacy of diabetic foot care education.Journal of Clinical nursing. 23 (1), p877-881. Doi: 10.1111/jocn.12290 Joslin Diabetes Center. (2016).Goals for Blood Glucose Control.Available: https://www.joslin.org/info/Goals-for-Blood-Glucose-Control.html. Last accessed 15th March 2016. Levett-Jones, T., Hoffman, K. Dempsey, Y. Jeong, S., Noble, D., Norton, C., Roche, J., Hickey, N. (2010). The five rights of clinical reasoning: an educational model to enhance nursing student ability to identify and manage clinically at risk patients. Nurse Education Today. Lipsky BA, Berendt AR, Cornia PB et al (2012) 2012 Infection Disease Society of American clinical practice guideline for the diagnosis and treatment of diabetic foot infection. Clinical Infection Disease 54(12): 132-73. National Institution of Health Care Excellence (2011) Inpatient management od diabetic foot problem. NICE Clinical guideline 119. https://bit/1C2HB7Z(accessed 29 Feb 2016) Thompson, C., N. Cullum, D. McCaughan, T. Sheldon and P. Raynor. 2010. "Nurses, Information Use, and Clinical Decision Making- The Real World Potential for Evidence-Based Decision in Nursing." Evidence Based Nursing 7(3): 68- 72 Van Battum P, Schaper N, Prompers L, et al. Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation. Diabet Med 2011; 28:199205. Yang, H. 2009. The Effects of improving Representatives Design on Nurse Risks Assessment: A Comparison of Written Case Simulations and Physicals Simulations'. PhD Thesis, University of York, York, UK.