Distress Simulations

Distress Simulations
The purpose of this study was to determine differences in levels of distress (as measured by self
report pain scores, physiological measurements, and behavioral distress) experienced by children
during venipuncture when assigned to one of four treatment groups – (Group A) positioned supine
and receiving a distraction intervention during the procedure, (Group B) – positioned supine and not
receiving a distraction intervention during the procedure, (Group C) positioned on the parent's lap
and receiving a distraction intervention during the procedure, (Group D) – positioned on the parent's
lap and not receiving a distraction intervention during the procedure. The impact of gender, age, and
temperament on pain response were also addressed. Subject demographics will be presented as well
as significant findings related to the research questions. . Forty four preschool and school age
children admitted to the pediatric unit of a large urban medical center and meeting study criteria
(appendix ) were enrolled in the study (Table ). Children admitted as outpatients for sedation during
radiological procedures comprised the majority of the sample (40/44). The remaining 4 subjects
were admitted for dehydration and lab testing. The type of ... Show more content on Helpwriting.net
...
The remaining three were inserted between 3 and 5pm. Thirty five of the 44 venous cannulations
(79.5%) were performed by the same RN.. The mean duration of insertion overall was 248.98
seconds, for preschoolers – 243.54 seconds and for school age children 255.50. The mean difficulty
of insertion score (appendix ) completed by the IV nurse was 1.25 overall, for preschoolers – 1.08,
and for school age children 1.45. Thirty five of the 44 catheters were inserted in the left hand and 9
in the right hand. An attempt was made when possible to always insert the cannula in the
nondominant hand to allow optimal
... Get more on HelpWriting.net ...

Acute Respiratory Distress Syndrome and Primary Care...
1. A physician is called to the intensive care unit to provide care for a patient who received second–
and third–degree burns over 50 percent of his body due to a chemical fire. The patient is in
respiratory distress and is suffering from severe dehydration. The physician provides support for two
hours. Later that day the physician returns and provides an additional hour of critical care support to
the patient.
2. A 23–month–old infant with a heart condition presented to the ED. The physician examined the
infant and , after reviewing the patient's history of a heart condition, ordered a transport to a
specialty cardiac hospital. This specialty hospital is 150 miles away from the current hospital. The
physician accompanies the patient in ... Show more content on Helpwriting.net ...
The patient complained of right lower quadrant pain and of feeling faint. Dr. O'Donnel documented
a chief complaint, a brief history of present illness, and a systemic review of the gastrointestinal
system and respiratory system. Dr. O'Donnel also documented a complete examination of all body
systems, which included all required elements. Medical decision making was of moderate
complexity. 7. A full–term baby girl was born at a local community hospital on 07/08, at which time
the infant's APGAR scores were 9 and 10 and the normal infant was examined prior to her
admission to the nursery. On the second day of admission (07/09), the normal newborn was
discharged home with her mother. Code the discharge.
8. Dr. Williams treated a 9–month–old new female patient in the office for diaper rash. An expanded
problem focused history and exam were performed, and MDM was straightforward. 9. A 72–year–
old patient with a history of breast cancer has a suspicious mass in her uterus. A biopsy was done.
The determination was that the patient had a carcinoma in situ of the uterus. The physician who
conducted the surgery called a face–to–face meeting with his fellow surgeons, the patient and the
patient's family and discussed the case and the patient's outcome for 30 minutes.
10. Dr. Martin provided 1 hour and 20 minutes of critical care services to Jack Smithton, age 64,
who is in the Intensive Care Unit with acute respiratory distress syndrome

Distress Thermometer
Distress is an unpleasant emotional experience of a psychological, social and/or spiritual nature that
might interfere with the ability to cope effectively with cancer, its physical symptoms and the
treatment that occurs, before, during and/or after the diagnosis (NCCN, 2003). In the Psychosocial
aspect of cancer patients and their diagnosis, the distress thermometer is a tool that can help both the
patients and staff in beginning a conversation with each other about difficulty going on before or
after a cancer diagnosis. People who are at a higher risk of heightened distress, are people with
subordinate cancer diagnosis, in reoccurring cancer patients, in younger patients, and in married
people.
There are many potential consequences that can occur when patients are not screened for distress.
Consequences are and not limited to poorer faithfulness to management advices, worse satisfaction
with care and worse quality of life (Jacobsen & lee, 2007). However, the benefits of using a distress
thermometer with cancer patients is that psychosocial technicians can see the amount ... Show more
content on Helpwriting.net ...
If a patient scores 5–7 the score indicates that the patient is experiencing some sort of distress that
might be affecting the quality of life and needs to use the additional resources to assist them and if a
patient scores 8–10 the score indicates that the patient is suffering from high levels of distress and it
can become difficult for the person to make decisions and should be referred to rigorous treatment
immediately to heighten the quality of life. In my opinion, the cutoff score for distress should stay
the same for now until because psychosocial resources are so limited that it should only be presented
to people who are really in need for the help. The cutoff score should also stay the same until there
is a certain way to limit the number of false positives that

Separation Distress And Traumatic Distress
on these facts, I intend to have Gary do two different empty chair exercises by placing both Chris
and himself in the chair at different points during his therapy. As important as it is for Gary to
experience and work through the emotions associated with Chris's death, I do not believe that this
alone will be enough to help him work through his grief. Matthews and Marwit (2004) suggest that
complicated grief is a pattern of non–normative behavior triggered by the loss of a loved one. The
authors argue that complicated grief may resemble depression while often also including symptoms
relating to separation distress and traumatic distress, illustrated by Gary's feelings of loneliness and
rumination over his relationship with Chris in addition to his anger, guilt, and social isolation. This
article describes how, traditionally, it was thought that a bereaved person needed to go through
"grief work" by confronting and processing emotions associated with the loss of a loved one.
However, this confrontation of emotion may not be enough and recovery may also require
addressing the cognitions of the bereaved person. In addition, the authors of this study suggest a
dual–process model in which the bereaved person oscillates between confronting various types of
stressors, then taking a break from those stressors. By utilizing EFT, Gary will essentially be doing
grief work by experiencing the emotions associated with loss. Experiencing his feeling of guilt may
trigger cognitions such

Respiratory Distress Syndrome Case Study
Introduction:
Respiratory distress syndrome (RDS) which is presented by higher respiratory rate than normal
range for age and other clinical symptoms and signs including grunting, nasal flaring, retraction and
cyanosis [5] have a variety of causes in newborn infants and other pediatrics. The main causes of
RDS in newborns including lack of pulmonary surfactant in preterm neonates, transient tachypnea
of newborns, Meconium aspiration syndrome, infections, pneumothorax due to artificial ventilation
and congenital heart disease [5]. Moreover, RDS due to Alveolar surfactant deficiency in preterm
neonates considered as the most important cause of death between this group age during first 28
days of life, and it is the main responsible ... Show more content on Helpwriting.net ...
Since last three decades, surfactant administration for immaturity–related respiratory distress
syndrome considered as a main therapy for preterm neonates [3][6]. Different researches and studies
have been conducted about the efficiency of applying exogenous surfactant on reducing the
morbidity and mortality rate and improving the survival rate in early preterm neonates (28–34
gestational weeks), late preterm neonates (34–37 gestational weeks) and other infants and pediatrics.
Theme 1: Surfactant therapy in early preterm neonates (28–34 gestational weeks)
A: Effectiveness of ST in early preterm neonates
Point #1: Increasing the gestational has a positive influence on alveolar pneumocystis maturation
which are responsible for producing Alveolar surfactant [4].
Point #2: Surfactant therapy significantly reduce mortality rate in early preterm neonates [3][5].
Point #3: Surfactant therapy in early preterm neonates declines not only mortality rate but also the
rate of morbidity and subsequent lung complications in early preterm neonates [1][3][5].
B: Comparison between early and late treatment of respiratory distress syndrome by exogenous
surfactant
Point #1: Early treatment is performed during first 2 hours of

Observational Distress
The purpose of this study was to compare music with standard care to manage pain and distress in a
Pediatric Emergency Department. The study found evidence that children who listen to music had a
drastically decreased in pain and fear during medical procedures than those that did not listen to
music.
On the primary outcome patient distress was measured using the Observational Scale of Behavioral
Distress. There was a decrease in distress for the music group than the non music group. Children
identified as ethnic minority had less increase in distress. Researchers believed the reason for a
decrease anxiety in ethnic minority may be due to cultural differences in experience, perceptions, or
expectations.
On the secondary outcome measuring, children's

The Negative Effects Of Stress
Stress, what is it, how it Affects you and How to Deal With it
Riley C. Keim
Culver–Stockton College
Stress, what is it, how it Affects you and How to Deal With it
Stress can have both positive and negative effects on your body. Stress is what gives a person that
last burst of energy in a competition. Stress is what keeps people up at night, what makes them stray
from their normal diet and it can even go as far as making someone physically ill.
What is stress? Stress is one's body's natural response to threats and pressure. Athletes feel stress
during any game or race, students feel stress before a big test or exam. Workers feel stress when they
are assigned to a big project or up for a promotion. Stress causes feelings of nervousness, low
energy, and even tenses us up and makes us feel on–edge and easily irritable. When a person is
stressed out their adrenal gland kicks into overdrive causing high levels of adrenaline in the brain.
Distress is negative stress in a person's life. Examples of distress may include,
The death of a family member
The death of a lifelong friend
Separation from your spouse
The end of a long relationship Having money issues
If distress is not handled correctly it can lead to the feelings of hopelessness, irritability, and even
getting physically ill.
Eustress is the good stress in a person's life. Eustress can be caused by events such as
Entering into big tournaments
Being up for a promotion at work
The holiday seasons
Going on

Case Study of an Eighteen Month Old Toddler In Respiratory...
As a respiratory therapist at a local hospital, I was called to the Emergency Department to await the
arrival by ambulance of a 32 lb. (14.54 kg.), eighteen–month old male toddler with a history of
coughing, congestion, fever, and runny nose for the previous five days. He is currently taking
prescribed medication, by his pediatrician, consisting of acetaminophen to control fever as well as
cough syrup to lessen his cough, congestion and runny nose. He has been on this medication for the
past two days but suddenly, within the past hour, has developed an audible wheeze and cyanosis
around his lips. This change in condition alarmed his mother and she called 911 to have an
ambulance come to her home. While in route to the hospital, the EMS ... Show more content on
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I would choose pressure controlled – continuous mandatory ventilation (PC–CMV) for this patient. I
would set up the ventilator with the following settings: initial PIP of 20 cm H2O and once patient is
attached, I would adjust the PIP to 10 cm H2O above the determined plateau pressure, tidal volume
at 90 ml (patient's IBW is 14.5 kg and the recommended VT is 5 – 8 ml/kg), frequency at 30
(recommended is 20 – 35 for a toddler), FiO2 at 100%, PEEP at the recommended pressure of +5
cm H2O, and inspiratory time of 0.6 seconds (recommended is 0.6 – 0.7) (Walsh 335). I would also
add heated humidity to the circuit via a heated pass–over humidifier set at 37 degrees Celsius. The
alarm settings would be the following: humidifier high temperature alarm at 38 degrees C. and low
temperature alarm at 30 degrees C., high pressure alarm set to 10 cm H2O above PIP and low
pressure alarm set to 5 – 10 cm H2O below PIP, low exhaled tidal volume alarm set to 80 ml (10 –
15% below set tidal volume), high PEEP set to 7 cm H20 and low PEEP alarm set to 3 cm H2O (2 –
3 cm H2O above and below set PEEP), high respiratory rate alarm set to 42 and low respiratory rate
set to 18 (40% above and below the set rate) (Cairo 106–109). To assess the appropriateness of the
ventilator settings, I would first assess the patient by listening to breath sounds, monitoring heart
rate, respiratory

The, And Caregiver Moral Distress
Whose decision is it anyway? Patient 'autonomy' and caregiver moral distress
Dana Bergman
250 348 937
Western University
9 October, 2014
The value placed on the autonomy, well–being, and social justice for all participants in health care
interventions is biased towards the patient and family, sometimes to the detriment of health care
providers who are obliged by professional ethical commitments to continue to provide care. The
principles guiding ethical healthcare practices were birthed from a genuine need to protect people
against harmful medical interventions and experimentation (the Belmont Report, 1978). The
autonomy and authority of the patient or her substitute decision maker (SDM) is currently valued
above other guiding principles central to nursing and biomedical ethics, namely beneficence, non–
maleficence, and justice (Beauchamps & Childress, 2013; Canadian Nurses' Association, 2008). The
primacy of autonomy and patient or SDM choice is also reflected in recent legal precedents in
Ontario (Cooper, Chidwick, & Sibbald, 2011). Whether such decisions are in fact an exercise in
autonomy is debatable. The end result is an imbalanced provision of care, and subsequent moral
distress for health care providers. Nurses are particularly vulnerable to the ill effects of participating
in care they see as unethical for a number of reasons, including perceived futility of outcome,
prolonged patient suffering, or the untoward results of decisions made based on unsound or

Respiratory Distress Syndrome Analysis
Respiratory distress syndrome (RDS), "is a developmental deficiency in surfactant synthesis
accompanied by lung immaturity and hypoperfusion" (Blackburn, 2013, p. 342). Based on the above
scenario, there are so many factors that could lead to surfactant deficiency and I would like to
discuss on three factors like preterm birth, poorly controlled diabetes, and cesarean section as the
reasons for RDS. First factor that places this infant at risk for RDS is being a preterm infant.
Normally the lungs mature at about 35 to 36 weeks (Blackburn, 2013, p. 318). Here the newborn is
born at 34 weeks gestation, and the lungs are not mature enough to function effectively, thus being
one of the reasons to develop RDS. Pulmonary surfactant is a lipoprotein ... Show more content on
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Choline and cortisol incorporation into the PC is decreased in case of hyperglycemia and
hyperinsulinemia. Lamellar bodies of the type II pneumocytes cell produce PC (Blackburn, 2013, p.
312) and this production is delayed when hyperinsulinemia is present (Blackburn, 2013, p. 318).
High Insulin level delays the morphological lung maturation and inhibits the gene transcription of
surfactant proteins (SPs) (Blackburn, 2013, p. 318) namely SP–A, SP–B, SP–C, and SP–D
(Blackburn, 2013, p.314). Surfactant synthesis gets mature, when the glycogen is depleted from the
lung and liver. High Insulin level may inhibit the breakdown of glycogen and decrease the substrate
needed for the synthesis of PC. Glucocorticoid plays an important role in the synthesis of surfactant,
by increasing the depletion of glycogen and increasing the synthesis of phospholipids . When
glycogen is depleted, the walls of alveoli get thinner and increase in size. In diabetic mothers,
Insulin prevents the breakdown of glycogen, thereby decreasing the substance needed for the
production of phospholipid and inhibits the synthesis of surfactant production (Blackburn, 2013, p.

Exposure To Prenatal Distress
It has been said that exposure to prenatal maternal stress can have lifelong consequences resulting in
problems with child cognitive development and motor skills as young as the age of 16 months. The
researchers that conducted this study hypothesized that the severity of objective hardship and
subjective stress reactions would predict different aspects of child development.
U70100955 S17
They anticipated that relationships with child development would be moderated by timing and sex.
And lastly, they hypothesized that a cascade of maternal stress reactions would link flood exposure
with child development, with higher flood exposure related to worse development. In order to be
eligible for this study, participants were part of the QF2011 already; ... Show more content on
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The participants were tested and asked questions on their reactions to the flooding using a five–point
scale ranging from 0 (not at all true) to 4 (extremely true). Parenting stress was also measured 16
months after the child was born using the Parenting Stress Index which is a 36–item questionnaire
that measures stress within the parent– child system and three subscales. The Parental Distress
subscale measures perceived competence, conflict, social support and role stress. The Parent–Child
Dysfunctional Interaction subscale (PSIDI) measures the extent to which the child meets the parent's
expectations, and the level of reward associated with interactions. The Difficult Child subscale
measures the parent's perception of the child's temperament, compliance and demands. The last
measure tested was child development. The Cognitive and Motor scales of the Bayley Scales of
Infant Development were administered to children at 16 months of age by researchers who were
unaware to the mother's stress

Definition And Definition Of Counselling
Definition of Counselling British Association for Counselling & Psychotherapy (BACP), an
international counselling body, defined Counselling as:
1. A contractual arrangement when a counsellor meets a client in privacy and confidence to explore
a difficulty, distress they may be experiencing, perhaps their dissatisfaction with life or loss of a
sense of direction or purpose; and
2. An umbrella that cover a broad range of taking therapies, delivered by trained practitioners who
work with people over a short or long term to help them bring about effective change or enhance
their wellbeing. (as quote by Sarah Bolitho, 2013)
In layman's term, we can say that counselling is giving advices to resolve a problem.
There is a formal way of counselling which referred to as therapy or psychotherapy. According to
Christine Wells Dip.Hum. N.D., counselling is "talking confidentially to a trained professional about
your difficulties, past or present, in a safe, non–judgmental, private and supportive environment." To
be able to offer this service, the person must fulfil academic requirements. People with serious
emotional conflicts which sometimes resulted in health issues are those usually consume the service.
The person who receives counselling is called a client or a patient. ... Show more content on
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Approaches of Counselling According to Sanders 1997, the following are some of the approaches of
counselling:
Counselling skills may be used by (1) a helping service professional like qualified counsellor,
psychotherapist or psychiatrist, (2) a voluntary counsellor who has been trained to use counselling
skills, (3) a person who use counselling skills as part of their work like a teacher or doctor, and (4)
an Informal counsellors such as friends and family
A helping relationship
A repertoire of interventions, determined by the specific orientation and approach of the

Respiratory Distress Syndrome Essay
Respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD), is a disease
that predominantly affects premature neonates. It is due to a deficiency in surfactant which is vital in
increasing lung compliance, preventing atelectasis at the end of expiration, and promoting the
recruitment of collapsed alveoli by reducing surface tension. Its other name, HMD, is derived from
the characteristic histological findings in early post mortems of premature babies, hyaline
membranes were observed, which did not occur in stillborns (Halliday, 2008). RDS is the most
common cause of respiratory distress in the neonate. Over 90% of RDS is seen with preterm births.
The incidence is much higher in males, at approximately 66%. It is ... Show more content on
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Although mice studies have demonstrated morbidities in SP–A and SP–D deficiency, no cases have
been reported in humans (Serrano et al., 2006). With insufficient surfactant, the lungs have an
increased critical pressure, causing atelectasis. Increased pressure and oxygen toxicity results in
damage to the endothelial and epithelial cells within the alveoli. This results in an exudate that forms
a fibrous hyaline matrix. SP–B deficiency (SFTPB gene) has been identified in full term infants who
demonstrate hyaline membrane–like disease on x–ray. It is usually fatal. Thirty–four mutations have
been described in this deficiency, with over two–thirds having the c.397delCinsGAA mutation
(121ins2) in exon 4. The result of this mutation causes a frameshift, leading to a premature
termination signal which ultimately leaves the individual completely SP–B deficient. SP–B
deficiency further causes a lack of lamellar bodies (Figure 3) in alveolar type II pneumocytes which
are responsible for the storage of surfactant proteins, thus reducing the amount of SP–C. SP–C
mutations have also been identified (SFTPC gene) in the cause of interstitial lung disease and
emphysema in the older patient (Kurath–Koller, 2015). Another genetic mutation identified is the
ABCA3 mutation. It has been demonstrated that this mutation is more common than SP–B
deficiency (Somaschini et al., 2007) This gene encodes the ATP–binding cassette protein A3. The
protein is highly

Acute Respiratory Distress Syndrome Analysis
Acute respiratory distress syndrome is a disease process that requires specific, intensive care to
increase the odds of patient survival. Due to the rapid and significant decline in a patient's ability to
maintain their respiratory status, ventilation techniques in treating acute respiratory distress
syndrome are specific and unique. Multiple techniques have been studied extensively and a few
stand above the rest in changing the mortality rate. High frequency percussive ventilation and high
frequency oscillatory ventilation may be good options for ventilating some of the most critical
patients.
Understanding acute respiratory distress syndrome (ARDS) is a critical aspect of managing a
patients ventilatory needs. The definition of ARDS is "the ... Show more content on Helpwriting.net
...
The oscillate trial reported a 35% conventional ventilation mortality rate compared to 41.1%
mortality rate in the Oscar trial. Both trials demonstrated that mortality rates in utilizing HFOV is
higher, 47% in the Oscillate trial and 44.1% in the Oscar trial. The Oscar trial patients who were
randomized to the HFOV had a closer margin of mortality to the conventional group with only a
difference of 2% favoring conventional ventilation, compared to the Oscillate trial which concluded
with a difference of 12% also favoring the conventional ventilation

The Ventilation Strategies For Acute Respiratory Distress...
The purpose of this assessment is to critique a related pair of published papers surrounding the
ventilation strategies for Acute Respiratory Distress Syndrome (ARDS) within the Intensive Care
Unit (ICU).
My role as an Advanced Critical Care Practitioner (ACCP) involves me working with patients with
multi–organ failure and more often respiratory failure following prolonged periods of ventilation
and lung insult. ARDS has been studied in a variety of settings since it was first introduced by Dr
Ashbaugh (Ashbaugh et al, 1967), at which time mortality was between 60% and 70%, however, the
most effective way to ventilate patients with ARDS is still being researched. Despite this ongoing
research into the management of ARDS, mortality remains at 35–40%. It is thought this is linked to
lack of knowledge and evidence regarding the pathological process of ARDS.
ARDS can be defined as an acute decrease in the ratio of arterial oxygen partial pressure to
fractional inspired oxygen (P/F) 30% surface area burns or any other condition which had a >50%
6–month mortality. Although there are significant differences in each of these papers exclusion
criteria they are clearly identified, which is good practice and not always done (Van Spall et al,
2007). However, these extensive exclusion criteria can impair generalisability of the trial results in
the ICU.
Sample sizes required to show
Critique the sample sizes – look at sample size representivity.
INTERVENTIONS – drafted and critique

Symptoms Of Acute Respiratory Distress Syndrome
There are many diseases all around the world that affect our loved ones. One in particular that is
common among many hospitals is Acute Respiratory Distress Syndrome, also known as ARDS.
Originally it was called Adult Respiratory Distress Syndrome but realized that was not accurate
because it not only affects adults but children also. ARDS is defined as "the acute onset of
respiratory failure, bilateral infiltrates on chest radiograph, hypoxemia as defined by a PaO2/FiO2
ratio ≤200 mmHg, and no evidence of left atrial hypertension or a pulmonary capillary pressure
(Fanelli et al., 2013) It can also include cyanosis, tachypnea, dyspnea, reduced respiratory
compliance and an arterial blood gas showing respiratory alkalosis with evidence of hypoxemia. Out
of the many pulmonary disorders out there, ARDS is one of the most difficult diseases to manage
and has a high mortality rate that comes with it. For this condition to occur, many things have to
take place in the body. First the pulmonary capillaries and alveoli epithelial tissues become
inflamed. This results in absorbency of these layers of tissues which then leads to plasma, which is
abundant in protein, to escape out of the capillaries and into the alveolar space. After the trauma to
the alveolar lining occurs, this allows fluid into the alveoli, which then results in pulmonary edema.
During this whole process damage to two different types of cells is being done. Type I and II of the
alveolar epithelial cells. Type II

No Apparent Distress Summary
Pearson's storytelling method in No Apparent Distress is very effective in describing a complex
system and problem that causes heated discussion. After an anecdote about injustices towards people
due to race or class, the author supports any claim she makes with facts. She would then end the
story with a firm, solemn sentence that made you think about the system as a whole. Throughout the
book, Pearson made the connection between class, race and medical care very clear.
For example, when Jimmy has to die because he can't afford the treatment, the author struggles with
how to deal with his wife, Vanessa. The author feels terrible and outraged about what Vanessa has to
go through. She calls Vanessa to Saint Vincent's to help Vanessa fill out all of the paperwork.
Despite the complicated paperwork, Vanessa knows what she needs from experience. As she helps
Vanessa fill out the paperwork, Pearson rejects the idea that she is acting as a doctor by helping her
fill out paperwork instead of helping her grieve. Pearson also highlights the unjust system from how
the caregivers treat patients. Jimmy's only hope for treatment was that he is a "RANDO, or 'resident
ain't never done one'" patient. If he had insurance, or a better healthcare system, he may have
survived or received more ... Show more content on Helpwriting.net ...
She highlights her errors, and the errors of her peers, to show that the system takes advantage of
people. The author tells a story of how she messed up helping a delivery with Dr. Leuke. However,
the important part of the story is that the mother didn't have a say as to what happened to her during
her treatment because "she had no way to refuse." Her delivery was also "old–school" which is
usually more uncomfortable for the mother, but more convenient for the doctor. This shows how
while making mistakes is a part of the learning process, the way the system allows these mistakes to
happen is clearly

Distress Across Cultures
Distress Across Cultures
The article "Expression and Communication of Distress Across Cultures" by Lena Andary et al.
talks about the Western assumptions about the expression of distress, how people from different
cultures can experience and express distress differently, and how this can influence on the medical
treatment they receive. Language is a very element of a culture, which can affect the communication
among individuals who come from two or more different cultures.
Clients of non–English speaker background may have difficulties on receiving the medical treatment
that they should due to Western medical assumptions about distress. This could cause the doctor to
misunderstand the client's medical problem, which can result on the incorrect ... Show more content
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We could not assume that emotion concepts are universal. It is well known that many idioms may or
may not translate from one language to another because of the culture's vocabulary. This is the same
for emotion concepts. A word in English like "sad" or "happy" can have a slightly different meaning
in another language. According to Andary et al., "This has direct implications for psychiatric
assessment, during which the process of reaching a diagnosis depends partly on eliciting
individualistically oriented self–statements" (56). Language barriers can definitely interfere with the
adequacy of the information that the clinician is trying to gather in order to help the patient. In the
Western culture, feeling hopeless can be one of symptoms of a depressive person, and sometimes the
feelings of a suicidal person, but in other cultures it has a different meaning and value. According to
Andary et al. in the Iran culture "... a sad person with a tragic life is regarded as being someone with
a depth of inner self; while a happy person may be regarded as being shallow and socially
incompetent" (58). The way that the Iran culture sees sadness and happiness is very different from
how the Western culture sees

Damsel In Distress Archetypes
Marisa Knorr
English 802
Brad Windhauser
February 12, 2015
"The Damsel in Distress" An archetype is defined as typical character or action that represents a
universal pattern in human nature. When used throughout films they help to portray a message and
represent a stereotypical characteristic that is familiar to everyone and is repeated in multiple
movies. The "damsel in distress" is a common archetype that has been seen in many movies
throughout history. When someone thinks of the character playing the damsel in distress they think
about the female that is always in trouble because of the male hero and in the end needs "saving".
This is exactly what happens to Belle in Beauty and the Beast, but is not necessarily the case for ...
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This particular movie of the trilogy was released late in 2014. Katniss Everdeen, the main female
character, wakes up in District 13 after making it through her second Hunger Games. She was
retrieved along with several other competitors of the games when the 75th Hunger Games had
finished. Katniss and the other competitors were taken to District 13, which was previously
destroyed and was rebuilt underground in hopes of striking a rebellion. Katniss is then asked to
become the symbol of this mass rebellion and is known as "The Mockingjay." She is now known as
the face of the rebellion against the Capital, the head power over all 13 districts. Her true goal and
only condition of becoming the Mockingjay is that no matter what they save her partner and
portrayed lover, Peeta Mellark, and other remaining tributes, who after the most recent Hunger
Games had been taken captive by the Capitol. Peeta becomes the Capital's ransom, in hopes to
prevent the rebellion and destroy District 13. They do this because they know Katniss will do
whatever possible to save Peeta. After a series of events, Peeta is retrieved from the Capitol. But
little do the people of District 13 know that Peeta has been "hijacked" by the Capital, which means
in his mind he needs to kill Katniss. The only way to keep him from doing this and returning to
normal is by keeping him in isolation, away from Katniss and the other people of District

A Life Of Distress And Terror
A life of distress and terror lead the largest ethnic group in Ethiopia to start a protest movement for
their rights and faced critical challenges within it. The ethiopian government needs to end cracking
down Oromo protest with violence and mistreating the ethnic group simply because they are
different. The Ethiopian government has a blueprint to expand the lands in the capital, sounds like a
great idea for the counties eco and a profitable goal but that plan comes to contact with the Oromos
treasured land and coastline. News and protest broke out, placing the Oromos in a position of scares
from the government but also help them put their position spread in Ethiopia and America. Ethiopia
is the birthplace of the oldest human "lucy" and also the place I was born. I came to the U.S at age
four and have family and friends from all corners of Ethiopia so I am in a position to defend all
including the Oromos and anyone who comes to conflict with this issue. The Ethiopian government
is using savagery action and targeting Oromos for their better good which is leading the Oromos to
lose their rights as citizens of the country. Thus making it wrongful and injustice for the people of
Oromo and the government needs to stop the trouble it 's causing. The Oromos and Amharas have
experienced hatred and discrimination when they were colonized in the 1900's and violence grew
towards them because they are so large in population, have a far and different language and creed
then the rest

Symptoms And Symptoms Of Neonatal Respiratory Distress...
Outline
I. Introduction
II. Continuous Positive Airway Pressure (CPAP)
a. History
b. Physiological Effects
c. Types of CPAP Delivery Devices
i. Nasal Masks ii. Nasal Prongs iii. Nasopharyngeal Prongs
III. Bubble CPAP System
a. Understanding How it Works
i. System Setup ii. Nebulization of Drugs iii. Cost iv. Difficulty of Use
IV. Indications for Bubble CPAP in Neonatal Patient
a. Neonatal Respiratory Distress Syndrome (RDS)
i. Definition of Neonatal RDS ii. Characteristics of RDS in Different Gestational Ages
1. Diagnosis
2. Causes
3. Risks
4. Clinical Management
5. Morbidity
b. Idiopathic Respiratory Distress Syndrome (IRDS)
i. Definition
1. Diagnosis
2. Causes
3. Risks
5. Morbidity
c. Meconium Aspiration
i. Definition
1. Diagnosis
2. Causes
3. Risks

5. Morbidity
d. Pulmonary Hypertension of the Newborn
i. Definition
1. Diagnosis
2. Causes
3. Risks
5. Morbidity
V. Complications
a. Failure of NCPAP
b. Pneumothorax
c. Nasal Trauma
d. Agitation
VI. Treatment with Bubble CPAP
a. NCPAP level
b. Monitoring
i. Cardiorespiratory Monitor ii. Pulse Oximetry iii. Blood Gas Analysis
c. Effect of Body Position
d. Length of Therapy
VII. Weaning from NCPAP
a. Titration of NCPAP Level
b. Monitoring
i. Cardiorespiratory Monitor ii. Pulse Oximetry iii. Blood Gas Analysis
VIII. Treatment followed by NCPAP
a. Oxygen via Low Flow Nasal Cannula
IX. Summary
Abstract
Continuous positive airway pressure (CPAP) is

Acute Respiratory Distress Syndrome ( Ards )
According to the American Lung Association, "Acute respiratory distress syndrome (ARDS) is a
rapidly progressive disease occurring in critically ill patients." ARDS is an extreme manifestation of
a lung injury that can be associated with an acute medical problem. This occurs as a result of direct
or indirect trauma to the lungs. With nearly 200,000 cases in the United States each year, ARDS is
not extremely common ("Acute Respiratory Distress Syndrome"). Most people who acquire this
disease are critically ill patients within the hospital. The most common predisposing medical
problems of ARDS consist of: shock, trauma, pulmonary infections, sepsis, aspiration, and
cardiopulmonary bypass (Ignatavicious, 2013). ARDS is a severe syndrome and even with prompt
and aggressive medical treatment, almost fifty percent of those diagnosed do not survive. Those who
survive have a longer hospital stay along with recurring hospital admissions throughout their
lifetime ("Acute Respiratory Distress Syndrome"). Acute respiratory distress syndrome is a rapidly
progressive disease which requires thorough assessment, rapid diagnosis, and emergency treatment
measures in order to successfully respond to the disease process.
ARDS is acute respiratory failure with persistent hypoxemia, decreased pulmonary compliance,
dyspnea, noncardiac–associated pulmonary edema, and dense pulmonary infiltrates on the chest x–
ray. The main site of injury within the lung is the alveolar–capillary membrane

Acute Respiratory Distress Syndrome (ARDS)
Acute respiratory distress syndrome (ARDS) is a life–threatening lung condition that prevents
enough oxygen from getting to the lungs and into the bloodstream. According to Kacmarek, Stoller
and Heuer, " it has been proposed that ARDS can develop via different mechanisms and the risk
factors for ARDS should be categorized either by direct injury to the alveolar space or indirect
injury initiated by systemic disease (2014, p. 601)". Common direct injuries to the lungs can include
pneumonia, lung transplant, trauma, septic shock and aspiration among others. Without enough
oxygen, an individual's brain and other organs can be severely damaged. The brain is what controls
the rate and depth of respiration. ARDS can lead to a buildup of fluid ... Show more content on
Helpwriting.net ...
The individual may experience an absence in breathing, also known as apnea. Rapid labored
breathing or hyperventilation, a decrease in blood pressure, and unusual movements such as chest
retractions while breathing may also be present. Mennella and Schub state in a recent work, that
signs and symptoms of ARDS include hyperventilation, agitation, cough, joint stiffness, lethargy
followed by obtundation (i.e., diminished sense of awareness), pain, and apnea (2014, p. 2). A
thorough exam of the lungs may reveal brief, popping or bubbling like lungs sounds known as
coarse crackles. A lack of communication from an adult patient may also be present, depending how
much pain or discomfort they are experiencing. Physical signs from the patient may also include
nasal flaring, moist and cyanotic skin, and extreme

Financial Distress : A Company
Financial distress can have many different meaning, however in a corporate world it refers to a
circumstance where a company struggles to pay off financial obligations to the creditors. In order
for a company to become distressed that means their fixed cost are extensive and all their assets are
liquid. This happens when the cash flows could not fulfill and meet its obligations financially. The
results of being in financial distress means an increase in non–invigorated workers, economic cost
and exclusive financing. They would have to borrow additional capital in order to make ends meet,
which makes it harder for them to pay off. To ensure short term obligation the company might
decide to go with opportunity's that will benefit them in the future. The employees are also affected
by financial distress as a result, they might have lower self–esteem and a higher stress load. The
employees who work for a company that is in financial distress know that the company can go
bankrupt at any time. Meaning they would be out of work, with such worries on their mind
constantly the workers might not be as productive. As long as a company takes the right precautions
while in financial distress it will not go bankrupt and end up liquidating everything. This situation
may arise because of the economy which is having an unfavorable effect on the company. Reducing
or removing the risk of financial failure, which come from many things and leave firms in a hard
spot, is an important

The Damsel In Distress Trope
In the mini–series of three twenty–three to twenty–six minute episodes, Anita Sarkeesian explains in
full, attentive detailing, the tropes embedded in video games since the very beginning of the Video
Game era. The mini–series uses a systemic, big picture outlook to ultimately examine the plots and
designs in video games to explain why women have always been objectified in video games. The
most well–known way the female character is objectified is through a video game is by placing her
in a Damsel in Distress position, woman in the refrigerator position, or any other position that
creates a trope. In the mini–series description, Sarkeesian also states that even though critical
analysis of the video games will be done, it is certainly probable ... Show more content on
Helpwriting.net ...
Because the female is normally involuntarily taken due to her inability to do anything but just be
there in the game, waiting rescue while in the view of the male, he is even more compelled to save
her (incentive/motivating force). In other games, the male protagonist is sometimes restrained, but
unlike the Damsel, he can free himself for the sake of his heroic Sarkeesian believes this is a
problem because a female in that situation is not able to do the same for irrational reasons.
Sarkeesian claims this works because the disempowerment of the female is traded to empower the

Respiratory Distress Syndrome Essay
Respiratory distress syndrome (RDS) is a breathing disorder that affects newborns. RDS rarely
occurs in full–term infants. The disorder is more common in premature infants born about 6 weeks
or more before their due dates. It usually develops in the first 24 hours after birth. RDS is more
common in premature infants because their lungs aren't able to make enough surfactant. Surfactant
is a liquid that is produced from the alveolar type two cells and coat the inside of the lungs. It breaks
up the surface tension found within in the alveoli. Without enough surfactant, the alveoli will stick
together and the lungs will collapse, which means the infant has to work much harder to be able to
breathe. He or she might not be able to breathe in enough oxygen to support the body's organs. The
lack of oxygen can damage the baby's brain and other organs if proper treatment isn't given.
According to an article titled "What is the Respiratory Distress Syndrome" by the National Heart,
Lung, and Blood Institution, states that "In fact, nearly all infants born before 28 weeks of
pregnancy develop RDS (2012, p. 1)." This paper will discuss the pathophysiologic problems, ...
In adults, there are ventilation strategies such as the pressure control ventilation (PCV) and airway
pressure release ventilation (APVR) that are commonly used. The PCV is designed to prevent
ventilator–associated lung injuries. Kacmarek et al. mention that "although there is not enough data
showing that this machine improves the outcomes in ARDS, they have been successful in improving
patient comfort (2014, p.615)". Breathing support or oxygen therapies are all designed to help
increase the oxygen flow throughout the body. These machines and types of therapy are needed
since the cardio–respiratory system is failing to achieve its primary function, which is to deliver
oxygen to the lungs and in turn the rest of the

Intentional Infliction of Emotional Distress
MEMORANDUM
RE: Intentional Infliction of emotional distress Relevant Facts
George worked for the Charlotte Bobcats based in Charlotte, NC. George has a contract that
guarantees his employment with the Bobcats for a period of 5 years. Jerry, who is George's boss,
wants to get rid of him NOW. Jerry resolves to using tactics to make conditions with the Bobcats
uncomfortable for George to entice him to quit. George eventually quits after Jerry turned off his air
conditioner in mid–July and convinced others to not speak to George. Jerry also tapped George's
phone and played his personal conversations over the loud speaker. George sues Jerry for Intentional
infliction of emotional distress.
Issue Presented
Under North ... Show more content on Helpwriting.net ...
In our case, the plaintiff wouldn't be granted compensation for the intentional infliction of emotional
distress because he didn't prove that the behavior of the defendant caused him severe emotional
distress.
Conclusion
In conclusion, under NC law, George is not entitled to compensation for intentional infliction of
emotional

Acute Respiratory Distress Syndrome
Introduction
Acute respiratory distress syndrome, also known as ARDS, is the abrupt collapse of the respiratory
system. It can advance in anyone 1 year and older who is critically ill. An individual with ARDS has
accelerated breathing, difficulty getting adequate air into the lungs and decreased blood oxygen
levels. ARDS normally develops in people who have major injuries or already ill with another
disease. ARDS is usually a hospital acquired disease. ARDS is normally grouped with an almost
indistinguishable condition called acute lung injury, but people with ARDS have much decreased
oxygen in their blood, the condition is more dangerous. ALI can progress into ARDS if the oxygen
levels continue to decrease.
What causes ARDS?
No one is certain about exactly what triggers ARDS, but it normally happens when you are
previously ill or severely injured. Examples of conditions that may cause ARDS include: drug
overdose, bacterial infection in the blood (sepsis), pneumonia, aspiration, near drowning, breathing
in poison, multiple blood transfusion and severe injury. ARDS usually develops very rapidly,
normally within 12 to 48 hours after the circumstance that caused it (Mancini, 2013).
Signs and Symptoms of ARDS
Initial symptoms of ARDS may include: low blood pressure, confusion, loss of consciousness,
fatigue or extreme tiredness, anxiety or a feeling of impending doom, fever caused by infection,
faster breathing, severe respiratory distress, agitation and rapid heart rate. ARDS

Quantitative Review : Moral Distress Experienced By Nurses
Quantitative Review: Moral Distress Experienced by Nurses
Data Sources:
A literature review was performed using the following databases: MEDLINE, Embase, CINAHL,
PsychInfo, Web of Science and Cochrane Library for articles published between January 1984 and
December 2011 on nurses' moral distress. This review was inclusive of studies that featured:
empirical research with a quantitative study design, addressed moral distress experienced by nurses,
based on a conceptual framework of moral distress as defined by Jameton, Wilkinson, or Corely, and
published in English (Oh and Gatsmans, 17). This was the criterion required to screen the studies for
inclusion in the review.
Procedure:
The sampling procedure was performed through 3 phases. In Phase 1, researchers carried out the
search to find all relevant articles (979 articles). All articles were then screened by title. All that
were found to be irrelevant were then excluded from the study. Remaining articles (543 articles)
were sent on to Phase 2. During phase 2, the remaining articles were had their abstracts evaluated
for relevance. 465 articles were excluded, which passed 78 onto Phase 3. During phase 3, the
remaining 78 articles were read for inclusion criteria. Irrelevant texts (47 articles) were excluded
along with qualitative studies (13 articles). A final total of 19 article were included in the study.
Results
The review included 19 different articles. Studies were conducted in 7 different countries, which

Neonatal Respiratory distress syndrome reflective practice...
This assignment describes my own reflective experience while caring for a sick neonate with
Respiratory Distress Syndrome (RDS) in the neonatal unit. This has enabled me to explore the
meaning and significance of my clinical practice and to recognise the complexities within it. The
experience raises a number of issues frequently encountered in daily nursing practice. Within this
assignment, I will be discussing a particular pre term baby with RDS and critically analyse the use
of nasal continuous positive airways pressure (NCPAP) and surfactant therapy and possible effects
on baby's outcome. Pseudonyms will be used to maintain patient confidentiality in order to keep in
with the nursing and midwifery council code of conduct. (NMC 2004)The ... Show more content on
Helpwriting.net ...
To understand whether the actions carried out was rational or whether it did more harm or good, it is
necessary to review the development of RDS in a preterm baby. Neonatal RDS is a condition of
increasing respiratory distress commencing at or shortly after birth (BAPM–2006). It's the single
most important cause of morbidity and mortality in preterm infants (Greenough, et al 2004).
Typically RDS affects preterm infants with the incidence being inversely proportional to the
gestational age (Stewart 2005) Approximately 60% of those born before 28 weeks gestation are
affected (Fraser, et al 2004) Incidence also increases in infants of diabetic mothers those born via
elective caesarean section (Fraser, et al 2004) and perinatal asphyxia (Rodriguez, 2003). RDS is
characterised by tachypnoea, nasal flaring, intercostal and sub costal in drawing with sternal
retraction and a predominantly a diaphragmatic breathing pattern and a characteristic expiratory
grunt or moan and cyanosis without oxygen, all persisting within 4–6 hours of delivery. Diagnosis
can be confirmed by history, blood gases showing impaired respiratory function and an X–ray film
showing ground glass appearance and air bronchograms (Fraser, et al 2004) RDS is caused by a
defective or delayed production of surfactant in structurally immature lungs. Surfactant is a complex
mixture of phospholipids and proteins secreted by the type

An Intentional Infliction Of Emotional Distress
Question Presented Does Samuel Taylor, the former member of the Local 718 Teamsters Union,
have a cause of action against Ronald Murray, Local 718 business representative, who repeatedly
harassed Taylor for about four months and intentionally inflicted emotional distress which resulted
in Taylor's loss of twenty pounds, extreme nervousness, loss of his union membership and his job?
Brief Answer Probably yes. Under Massachusetts law, a plaintiff has a claim for an intentional
infliction of emotional distress if all of the following elements are satisfied: (1) the defendant
intended, knew or reasonably have known that his conduct will result in the emotional distress; (2)
the defendant's conduct was extreme and outrageous, beyond all possible limits of decency and
utterly intolerable in a civilized community; (3) the defendant's conduct is the cause of the plaintiff's
distress; and (4) the plaintiff's emotional agitation was so severe and of a nature that no reasonable
person could withstand. Here, Murray intended to inflict emotional distress by harassing Taylor so
he would cooperate with the union, it was of extreme and outrageous manner, when he threatened
Taylor's and his wife's life, and caused the emotional agitation so severe, which no person could be
reasonably expected to endure, and as a result, Taylor withdrew his membership, quit his job,

Surfactant Replacement in Neonates with Respiratory...
Surfactant Replacement in Neonates with Respiratory Distress Syndrome Type The innovation of
surfactant replacement therapy in the treatment of respiratory distress syndrome has proven to
increase the survival and minimize the complications of the premature neonate. Replacing surfactant
has lessened time on ventilators, and allowing the neonate and parents an opportunity to grow
together earlier outside of intensive care. This paper will discuss the etiology of respiratory distress
syndrome type I, the treatment options and nursing care of the neonate during surfactant
replacement. Respiratory distress syndrome type I is a decrease production of surfactant, a
noncelluar chemical produced in the type II alveolar in the lungs ... Show more content on
Helpwriting.net ...
These include maternal hypertension, gestational diabetes excluding classes D, F, and R, intrauterine
growth restriction, preterm labor, and drug abuse. The neonate high risk factors are birth prior to 32
weeks, weighing less then 1300 grams and laboratory data suggesting poor lung maturity discussed
later. (Bower, Barnhart, betiti, Hendon, Masi–lynch, & Wilson, 825) The highest risk factor for RDS
type I is an insulin dependent diabetic mother, because boluses of insulin injections severely
decrease the fetus production of surfactant. (Porth, 1306)) Chronic hypoxic events during pregnancy
associated with mild to moderate maternal hypertension have shown however to sometime
accelerate fetal lung maturity and surfactant production leading to a decrease in neonatal respiratory
complications. (Kim, Vohr, & Oh, 39) This due to cortical steroid secretion that stimulate an
increased production of surfactant in response to the stresses of hypoxic events. (Porth, 1306) The
symptoms of oncoming RDS may at first not be present in a fetus greater then 28 weeks since they
have produced enough surfactant to thrive outside of uterine life for a short time. However the high
initial pressure to breathe the first breath remains constant with each subsequent breath causing
extreme effort for

Legal Memorandum on Intentional Infliction of Emotional...
Memorandum of Law
Statement of Assignment: You have asked me to prepare a legal memorandum on the question of
whether our client can gain relief from intentional infliction of emotional distress occurring from
witnessing a friend¡¦s child being injured by a vehicle that is out of control due to
being driven at a high rate of speed through a school zone. Pursuant to your request, this memo
includes an analysis of the relevant state and federal law.
Issue: Under Kentucky tort law, does intentional infliction of emotional distress occur when a
person suffers severe insomnia and anxiety as a result of witnessing a friend¡¦s child
being injured by a vehicle that is out of control due to being driven at a high rate ... Show more
She noticed that the car involved was local Bob Barton¡¦s who had had several
complaints and speeding tickets against his behavior. After recognizing the car, Ida then noticed that
two children playing on the seesaw were injured, one of whom is her best friend,
Karen¡¦s son, Tim. Upon realizing this she became extremely upset and has since
suffered from severe insomnia and extreme anxiety. Her doctor prescribed medication for her nerves
and to help her sleep, and he recently referred her to a psychologist.
Analysis:
The issue in this case as it relates to the Kentucky tort of negligence is governed by rules or
principles established by the courts. The elements of negligence are a duty the defendant owes to the
plaintiff, a breach of that duty by the defendant, a causal connection between the breach and the
plaintiff's injury, and actual injury. In the absence of any one of these elements, no cause of action
for negligence will lie.
The relevant case law for this situation comes from several cases from Kentucky: 761 S.W.2d 625,
597 S.W.2d 141, 147 S.W. 742, 112 S.W. 600, and 77 S.W. 361 among others. However, those are
the only cases that will be discussed. They are substantially relevant to our situation and provide a
clear picture as to the route we should take in regards to Ms. Carry.<p>,,± Wilhoite v. Cobb,
761 S.W.2d 625 (Ky. Ct. App.

Use Of Ecmo Versus Conventional Ventilation Patients With...
The Use of ECMO Versus Conventional Ventilation In Patients With Acute Respiratory Distress
Syndrome
Travis Day
Northwest Technical College
Extracorporeal Membrane Oxygenation is a medical modality that provides life support for patients
experiencing pulmonary failure, cardiac failure, or both. ECMO is able to maintain oxygenation and
perfusion to the body until the native lungs or heart function can be restored. According to Maj
(1990) "ECMO is a long term heart and lung bypass technique that has been successfully used since
1975." ECMO can be divided into two categories; Veno–venous ECMO (VV ECMO) which
supports the lungs by oxygenating the blood and returning the oxygenated blood to heart. This ...
It is important to recognize that ECMO is not a therapeutic intervention. ECMO provides cardiac or
respiratory support so that the patient is spared the harmful effects of mechanical ventilation such as
high airway pressure, high oxygenation, and perfusion impairment while reversible
pathophysiologic processes are allowed to resolve either by natural means or by medical or surgical
intervention.
One prospective randomized trial compared the effectiveness of ECLS with conventional
mechanical ventilation (CMV) in full–term newborns with severe respiratory insufficiency. This was
a randomized prospective study performed by O'Rourke (1989) which demonstrated a significant
difference in survival between neonates managed with ECLS (97%) and those managed by
conventional means (60%). Other studies have demonstrated a significant increase in survival
among pediatric respiratory failure patients managed with ECMO when compared to matched
patients managed with CMV.
The neonatal ARDS disease processes result in lung pathophysiology associated with pulmonary
hypertension and poor oxygenation. Conventional mechanical ventilation, surfactant administration,
and nitric oxide administrations are the first modalities used in order to increase the tissue perfusion
and respiratory insufficiency. When these interventions fail, ECMO will allow for lower ventilator
settings, preventing lung injury caused by the ventilator.
For optimal timing of

Examples Of Damsel In Distress
Sonia Piątek
CHAPTER I: TYPES OF REPRESENTATION OF WOMEN IN VIDEO GAMES
1.1. Damsel in distress One of the most widely used clichés in video games is Damsel in distress.
The word comes from French demoiselle, which means ''young lady''. Demoiselle en detresse
translates into "damsel in distress". "As a trope the damsel in distress is a plot device in which a
female character is placed in a perilous situation from which she cannot escape on her own and must
be rescued by a male character, usually providing a core incentive or motivation for the protagonist's
quest."
First known example of the Damsel in distress can be seen in the myth about Perseus and his wife
Andromeda, who is chained naked to a rock by the sea as a sacrifice, and is then ... Show more
The protagonist Booker DeWitt, is sent there to find a young lady called Elizabeth, who has been
held captive by her father Zachary Comstock in a tower for most of her life. The scenario sounds to
be the classic example of Damsel in distress, but when Booker reaches the tower, he realizes that she
is not so gentle, helpless and defenseless as he thinks. "She is unlike any character that I have seen
in a game, especially when you play through the entire thing and you see how she evolves." DeWitt
manages to rescue Elizabeth and they both get involved in the city's conflict, during which she
shows her strange, but strong superpowers. Her character is well rounded. Her backstory is
interesting and complex. Her flaws and the way she expresses emotions makes her more real and
human. "She's resourceful and quick–witted, with the ability to break codes and pick locks like
they're nothing (being locked in a tower with nothing but books means she's got a lot of hobbies)."
Elizabeth has no experience with shooting and fighting, but she effectively helps Booker. She looks
for ammunition and health kits and provides them to the main character. Her participation plays a
vital role during battles. Elizabeth even saves Booker life few times. "That time Elizabeth gave him
CRP on the beach when he almost drowned, or that time she caught him with a blimp to save him
from falling off the city, or that time she gave herself up to Songbird to save his life." Elizabeth is
essential to succeed. There is also no sexual undertone in her relationship with Booker. Creative
director of Irrational Games, said that "In terms of her body type, I think certainly people on the
Internet have spent way more time thinking about Elizabeth's chest than I have," he said. "It's
something I've barely thought about." Levine said it becomes "disappointing" for him when
Elizabeth's measurements become the topic of conversation, because this was

Symptoms And Treatment Of Infant Respiratory Distress...
Overview of Disease
Each day there are thousands of babies born, and families wait for their new loved ones to enter the
world. However, there are also many complications that may occur with child birth. "Approximately
50% of neonates born at 26–28 weeks ' gestation develop respiratory distress syndrome, whereas
less than 30% of premature neonates born at 30–31 weeks' gestation develop the condition"
(MedScape). Infant Respiratory Distress Syndrome, or IRDS for short, is a restrictive lung disease
that commonly occurs in premature babies. A common cause is a lack of surfactant that is
commonly found in developed lungs. Surfactant is a liquid that uses proteins and lipids to help
decrease the surface tension between the alveoli to create ... Show more content on Helpwriting.net
...
Pathophysiology
When premature babies are born they do not have fully developed lungs because the lungs are one
of the last organs in the body to be produced. The alveoli in the baby's lungs have not yet started
making surfactant, which is typically produced when the baby is 34–36 weeks' gestation. When the
alveoli do not have surfactant, the alveoli want to naturally collapse. Surfactant helps to keep the
alveoli open and create more surface area for gas exchange. If you were to look at the infant's lungs
using a microscope, you can see that lungs look as though they are solid from the areas where the
alveoli have collapsed, also known as atelectasis. To try to compensate for the atelectasis, "the
respiratory bronchioles, alveolar ducts, and some of the alveoli dilate to decrease airway resistance
and increase gas exchange" (Jardins 476). As the disease worsens, the walls of the alveoli become
lined with a hyaline membrane that is made up of dead cells and proteins that make it nearly
impossible for gas exchange to occur. It makes the lungs stiff and much harder to ventilate. With the
lungs being noncompliant, the baby starts to become hypoxic. When the infant becomes hypoxic,
blood is shunted away from the other organs in the body and venous return and cardiac output are
decreased. "Hypoxemia is common in pulmonary hypertension (PH) and may be partly related to
ventilation/perfusion mismatch, low diffusion

Essay On Acute Respiratory Distress Syndrome
For the past 50 years acute respiratory distress syndrome or better known as ARDS, has been an
issue in hospital intensive care units all around the world. The first "documented published scientific
description dates back to 1821 when Laennec described the gross pathology of the heart and lungs
and described idiopathic anasarca of the lungs; pulmonary edema without heart failure in a treatise
on diseases of the chest."1 Cardiac and non–cardiac issues were not taken into consideration as part
of the cause at that time. The first definition dates back to Ashbaugh and colleagues in 1967.2
Though modern medicine has been around for hundreds of years, it wasn't until hospitals designed
intensive care units and began using mechanical ventilation ... Show more content on
Helpwriting.net ...
Though many advances were made & multiple research done, in 2012 the medical community once
again got together. An expert panel agreed that ARDS is a type of acute diffuse, inflammatory lung
injury, leading to increased pulmonary vascular permeability, increased lung weight, and loss of
aerated lung tissue. "The clinical hallmarks are hypoxemia and bilateral radiographic opacities,
associated with increased venous admixture, increased physiological dead space, and decreased lung
compliance. The morphological hallmark of the acute phase is diffuse alveolar damage (ie, edema,
inflammation, hyaline membrane, or hemorrhage)."3 It was at this conference that the Berlin
definition was put into existence. Though it is to note that most research to date has been done using
the AECC definition, the Berlin definition removed what was known as acute lung injury. Under the
new Berlin definition patients with a PaO2/FiO2 ratio of 200–300 while on a PEEP of +5 would
now be classified as mild ARDS, while patients with a PaO2/FiO2 ratio of 100–200 would be
classified as moderate & anything under 100 would be classified as severe. With pulmonary
capillary wedged pressures under 18mm HG. The Berlin definition defined acute stating that the
maximum period between risk factor exposure and ARDS

Acute Respiratory Distress Syndrome ( Ards )
CLINICAL CLARIFICATION o Acute respiratory distress syndrome (ARDS) in neonates is a
heterogeneous syndrome most often caused by pulmonary surfactant deficiency in the lungs. [1,2]
CLASSIFICATION o Acute respiratory distress syndrome can be classified into three exclusive
categories based on the degree of hypoxemia: [1]
 Mild (200 mm Hg < PaO2/FiO2 ≤ 300 mm Hg)
 Moderate (100 mm Hg < PaO2/FiO2 ≤ 200 mm Hg)
 Severe (PaO2/FiO2 ≤ 100 mm Hg) DIAGNOSIS CLINICAL PRESENTATION History o Most
commonly affects prematurely born infants (< 7.35 o Hypoxemia: [1]
 Mild: 200 mm Hg < PaO2/FiO2 ≤ 300 mm Hg
 Moderate: 100 mm Hg < PaO2/FiO2 ≤ 200 mm Hg
 Severe: PaO2/FiO2 ≤ 100 mm Hg
Other diagnostic tools
 Not applicable DIFFERENTIAL ... Show more content on Helpwriting.net ...
o Diagnosis based on chest x–ray which shows hyperinflated lungs with streaky perihilar markings.
[2]
 This gives the appearance of a shaggy heart border with a clear periphery of the lungs. [2]
 Fluid is often seen in the lung fissures. [2]
 Other conditions to exclude include: o Persistent pulmonary hypertension o Aspiration o
Pulmonary edema o Congenital cardiopulmonary anomalies
Diagnostic groups
 Not applicable TREATMENT GOALS o The goal of management is to provide immediate
intensive care and early ventilation support. [1]
DISPOSITION
Admission criteria o All infants with breathing problems should be cared in hospital setting at birth.
Criteria for ICU admission o All infants who are premature or at high risk need to be treated at birth
at the NICU by specialists. [3] Recommendations for specialist referral o A medical team that
specializes in newborn breathing problems should be consulted or should be involved in care. [3]
TREATMENT OPTIONS o Treatment remains supportive and is aimed at improving gas exchange
and preventing complications. [1]
Drug therapy
 Surfactant therapy: o Intratracheal surfactant therapy may be helpful but more research is needed.
[1, 3] o Requires endotracheal intubation, which also may be necessary to achieve adequate

ventilation and oxygenation. [2] o Early surfactant therapy (within 20 to 30 min after birth) is
associated with: [2]
 Decreased duration of mechanical ventilation
 Lesser incidence of air leak

Reasons Why Couples Choose Not To In-Person Therapy
Many couples experiencing relationship distress choose not to seek therapeutic help. "Recent
estimates founded that only 19% of intact couples seek any type of counseling or therapy for their
relationship and that only 37% of divorced couples sought any couple therapy prior to divorcing"
(Cicila, Georgia, & Doss, 2014). Reasons why couples decide not to seek treatment are because of
the perceived stigma associated with therapy, financial burden, and logistical concerns, such as
difficulty scheduling appointments or finding transportation to appointments (Cicila et al., 2014).
These findings show couples would rather keep issues between themselves than talk to a therapist
who has the skills and expertise in marital discord. As an alternative ... Show more content on
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A limitation to this intervention is that it may not be efficient for distressed couples. Especially for
couples dealing with long–term issues in their relationship. For couple participating in this form of
intervention may not get enough out of the program. they may need more support and guidance. An
internet–based intervention does not provide the same level of therapy as in–person therapy. couples
may benefit from in–person therapeutic intervention more than the on–line program. Couples
struggling with the online program may get frustrated which can escalate the distress in their
relationship. Another limitation is due to the fact that therapy is online, couples may not take the
program seriously and not be fully committed. This leads to the program having a low completion
rate and may not be seen as an effective form of therapy. A limitation of the OurRelationship.com
program is that most of the activities are done individually. If couples are having problems in their
relationship, it would make sense if they performed activities together. If there were a few activities
that are required to be done individually that would be okay. But requiring activities to be done
individually does not seem like it would benefit the couple. activities presumed together allows
couples to communicate and actively work on their

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