Dilation and Curettage Procedure Essay Example

Dilation and Curettage Procedure Paper A dilation and curettage procedure, also known as a DC, is a surgical procedure in which the cervix (lower, narrow part of the uterus) is dilated so that the uterine lining (endometrium) can be scraped with a curette instrument in order to remove abnormal tissues. During the dilation and curettage procedure, the patient is placed in supine position of the body with the legs separated, flexed, and supported in raised stirrups. The doctor inserts a speculum into the vagina, as during a pelvic exam, in order to see the cervix. Then, the cervix is slowly dilated by inserting a series of thicker and thicker rods into the cervix until its adequately opened, usually to between 6 and 9 millimeters in diameter. After dilation, a curette is inserted to begin removing tissue. Although the DC involves no stitches or cuts, the cervix is cleansed with an antiseptic solution. A dilation and curettage can be done as day-surgery or may require an overnight stay in the hospital. It is recommended that before the surgery, the patient take nothing by mouth (food, water, etc. ) for at least 6 hours before the scheduled operation. We will write a custom essay sample on Dilation and Curettage Procedure specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Dilation and Curettage Procedure specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Dilation and Curettage Procedure specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Before surgery or during the previous night, a bath maybe is advisable since it helps lower the bacterial count and lessen the chances of any infection from surgery. The genital area is shaved in order to begin skin preparation. Skin preparation begins at the pubic symphysis and extends downward over the labia. Next, each inner thigh is cleansed. After, the vaginal vault and cervix are cleansed using three spongesticks. Spongesticks must be discarded after wiping the anus. The patient’s bladder is drained with a straight catheter to prevent the bladder from compromising the field. Once the patient has been prepared, a drape sheet is tucked under the buttocks, followed by leggings and a drape sheet over the abdomen. For a dilation and curettage procedure, a scrub tech sets up the instruments on the back table, but he/she is not needed during the procedure. The surgeons take the instruments, such as Overstreet Endometrial Polyp Forceps, Skene Vulsellum Tenaculum, Schroeder Braun Tenaculum, directly off the back table themselves. Besides a Dilatation and curettage tray, a small basin, water-soluble lubricant, a Telfa (for specimen), perineal pad and sanitary napkin belt will also be needed on the back table for the dilation and curettage procedure. An antiembolism hose may be requested. A dilation and curettage may be used as a diagnostic or therapeutic procedure for abnormal bleeding. A dilation and curettage procedure can also be performed to determine the cause of abnormal or excessive uterine bleeding, to detect cancer, or as part of an infertility investigation. Causes of abnormal bleeding include the presence of abnormal tissues, such as fibroid tumors (benign tumors that develop in the uterus, also called myomas) polyps, or cancer of the endometrium or uterus. Abnormal uterine bleeding may also be due to a hormone imbalance or disorder when approaching menopause or after menopause. A dilation and curettage may also be performed following a miscarriage to remove the fetus and other tissues if they have not all been naturally passed. Infection or heavy bleeding can occur if these tissues are not completely removed. Occasionally following childbirth, small pieces of the placenta remain adhered to the endometrium and are not passed, which can cause bleeding or infection. A dilation and curettage is used to remove these fragments so that the endometrium can heal properly. For the dilation and curettage procedure, there is general anesthesia, regional anesthesia and local anesthesia. General anesthesia is given through either a breathing mask or an intravenous (IV) catheter. The IV may be placed in a vein in the patients hand, arm or neck. The patient may have a breathing tube inserted through their mouth and into their windpipe to make sure they’re breathing properly. General anesthesia relaxes the muscles, which makes it easier for the doctor to perform a pelvic exam. Regional anesthesia is injected into the area around the spinal cord, blocking any pain during the procedure. Local anesthesia, which is most common, is injected directly into and around the cervix to numb the area. The patient also receives a sedative from an IV. The dilation and curettage procedure has a low risk of serious complications. The most common complication that can occur is perforation of the uterus with either the dilators or the curette. When this happens, as long as no internal organs such as intestines, bladder, or rectum, or large blood vessels are damaged, the hole will almost always heal itself without further surgery. The risk for this problem is increased in patients with a narrowed opening to the cervix (cervical stenosis) or in patients with distorted internal uterine anatomy. This risk is also increased if the uterus is infected or has undergone previous surgeries such as cesarean sections or myomectomies. Injury to the cervix is another possible complication. Tears or cuts in the cervix can usually be treated by application of pressure and application of local medications to stop bleeding. In some cases, stitches in the cervix may be required, but this is not common. Other complications, as with any surgery, include bleeding and infection. Most bleeding is mild and resolves on its own. Infection is also rare and can normally be managed with oral antibiotics. On occasion, in patients with certain heart defects, the surgeon may give the patient antibiotics before and after the surgery to prevent bacteria from the vagina from infecting the heart valves. It is normal to experience vaginal bleeding and/or pelvic cramping for a few days after a dilation and curettage procedure.

Essay Sample on Nibiru Planet Is It a Myth

Essay Sample on Nibiru Planet Is It a Myth Free sample essay on Nibiru Planet: A lot has been said about the Nibiru Planet and its association with end of the world myths. Since there are so many theories going around about what this Nibiru planet is, many people have been misled to believe that it is the humongous planet that will one day bring life on earth to a disastrous end. So what exactly is the Nibiru Planet? Nibiru is a word that was derived from Zecharia Sitchin’s ancient astronaut works. Doomsday believers believe that the world will end when a planet-size object from space will crash and destroy the earth. This idea was first propagated by Nancy Lieder, a self professed alien contactee. She said that she had been sent to warn humans of the impeding destruction by a gigantic Planet X, which many of her followers said was Nibiru. However there is no evidence that such a planet will come crashing on earths surface, or even that it exists. The idea that a planet sized extraterrestrial object will crash onto earth is one thing that has not been proven scientifically. When Nibiru theorists say that the planet is very close to the earth, it cannot be true since all planets that are close to earth are normally visible through the naked eye, or by use of a telescope. To counter this, the believers of Nibiru collision say that the planet has been hiding behind the sun waiting to fall on earth. However, this cannot be true because it would be difficult not to see the planet when the earth is orbiting around the sun. It is clear then that the Nibiru planet collision is just a myth that does not exist.

Ebay Essay Example | Topics and Well Written Essays - 500 words - 2

Ebay - Essay Example Marketing is a process that entails finding out what exactly the customers wants and needs, then providing customer with goods and services that meet or exceed their expectations, it is not merely â€Å"selling† and â€Å"advertising†. Some of the internal strength that facilitated success were, product being customer oriented this means finding out what the customer really wants and not what he/she can find an alternative and manage then provide it to them. Service orientation-that is, having an objective of customer satisfaction. A profit orientation is marketing the products in a way that will earn the business good profit to enhance its survival and facilitate its expansion to serve more customers (Blattberg and Scott, 385). Weaknesses that may have hindered complete meeting my objective; knowing what the customer needs its quite difficult because it is not easy to get to interact with all of them in person, finding means of quick delivery of products, constant change in technology constantly affecting customer’s preferences, therefore, need to monitor closer relationships with customers. Since it is marketing at global level one must adhere by all rules of all the countries he/she markets the product and the legality of the product, which is not easy. What came first, your product or your target market? Did you have a product you wanted to sell, find a target market for it on E-Bay, then analyze your environment and adjust your marketing mix-----or, did you analyze your environment, find a target market, and then find a product to market on E-Bay with a specific marketing mix? Explain your strategy. My strategy is by first scanning the environment to which I intend to market my products. By scanning the environment, I identify the factors that are likely to affect marketing my success (global, technological, social, economic influences) such as the availability of the product, demand of the product, competition, technology advancement in

WAREHOUSE AND INVENTORY MANAGEMENT Essay Example | Topics and Well Written Essays - 2500 words

WAREHOUSE AND INVENTORY MANAGEMENT - Essay Example It is that part of the firm’s logistics system that stores products at and between point of origin and point of consumption. It provides information to the management about the status, condition and disposition level. Warehousing provides the place utility and works as a balance between production and meeting customer needs. Warehouses also support manufacturing, mix products from multiple facilities for shipment to a single customer, break-bulk and are used as a ‘flow-thru’ point along with â€Å"hoarding† point. Warehousing functions include; material handling, customer services, information transfer, and storage. Other purpose is to identify goods, dispatch for storage, hold inventory, recall goods, dispatch the shipment and prepare records and advices. Warehouses also provide services like Co-packing kitting and repair to its customers. With advancement in information technology and changing needs of businesses, Warehouse Management Systems (WMS) have b een designed. These WMS are a key part of supply chain management and aim at controlling the movement and storage of materials within a  warehouse  and processing of associated transactions. Third-party Warehousing: Tompkins,A., Jerry, D (1998) wrote that third party logistics has gained considerable importance and recognition in today’s business world. ... A third-party, then, is a firm hired to do that which neither the first or second party desires to do. Third-part warehousing is defined as the warehousing services provided by a party other than the manufacturer, seller, buyer and receiver of the goods (Skjoett & Larson, 2007). A firm that provides outsourced logistic services to companies is called third-party logistics. These companies undertake all or a part of the supply chain management task of their client. Previously small warehouses were established in order to store the products mainly of food industry but with the passage of time manufacturing industry also started warehousing their material and products. Now warehousing is a vast area and short term contracts are now replaced with long term warehousing arrangements. Reasons: Drucker (1989) mentioned in an article that businesses today are outsourcing their warehousing function because of the following reasons: Now businesses are inclined towards having limited workforce i n order to reduce their cost and liabilities associated with these employees. Third-party warehousing reduces need of work force rather than employing people to manage personal warehouse. As warehouses are now operated with advanced information technology and warehouse management systems, it needs to have professional experts which ultimately raise work force and cost. Third-party warehousing help to maintain source of supply without breaking the chain of supply and provide goods in time to the customers. As the main focus of any business is on customer services, third-party warehouses support the policies designed by a business for customer services. As market conditions change rapidly in today’s

Feminism In England Essay Example | Topics and Well Written Essays - 5000 words

Feminism In England - Essay Example Feminist political activists support such issues as women suffrage, wage equivalency, and have power over reproduction. (O'NEILL, 1969) Feminism is not connected with any specific group, performance, or past occasion. Its foundation is the political understanding that there are rough power arrangements between groups, in conjunction with the faith that something should be done about it. Feminism has been described as a movement with many projects; there is not just one feminist view on everything, so not just one feminist legal theory. However, arguably feminist legal scholars have certain similar concerns. Although anthropologists suggest that many primitive societies were essentially matriarchal, historical evidence from the Roman era till the present time indicates that must legal systems have treated women in an unequal fashion in comparison with their male components. Feminists believe that until the recent past all writing on the social, political, economic, and other major issues affecting humanity have been done by males, from a male point of view and barring very few exceptions (e.g. J.S.Miller), do not reflect women's role in creating and shaping society. Male written works have created and perpetuated biases and injustices against womankind. Male's characteristics are take as the norm and female's characteristics as deviation from the norm. Instances can be quoted to show that the prevailing conceptions and applications of law continue to reinforce and perpetuate patriarchal power. Feminism arose to challenge to rectify these wrongs and the ground realities dictate that the struggle should go on. The 19th century English liberals were among the first jurists seriously to question the position of women in society. For example JS Mill questioned the traditional, to some extent religious view that women were inferior beings destined to obey th eir husbands. Then, towards the end of the century Marxist writers began also to question the way in which women were treated under the law and economically championing women as the oppressed clans. In Marxist eyes it is the male capitalist who is the villain. Women and workers are the oppressed and exploited victims. Modern writers such as Zaretsky attempted to show that male dominance was as much an evil as capitalist oppression (Dixon, 2001). Although most of the leaders of feminist movement were women, yet all women are not the supporters of feminism and not all feminists are women. A number of feminists dispute that men should not acquire positions of headship in the movement, but the majority believe or look for the support of men. The issue of Feminism in England has rose to alarming levels and needs to be addressed so that major revolutions by the women can be avoided. Feminism in England is totally different than that in America as it is based the rights of equality of women their fulfillment and their role in the prosperity of England. The media is playing a major role in influencing the role of women in England. It is portraying women as second class citizens and is

Measuring stress levels of staff

Measuring stress levels of staff There are several ways in which stress can be measured for example by self report, biochemical and physiological methods Self report methods Stressful life event scales measures stress prospectively through the reported life change for example Holmes and Rahes Social Readjustment Rating Scale (SRRS). They examined 5000 patient records and made a list of 43 life events that seemed to precede illness. Nearly 400 participants were asked to rate each item in terms of the amount of stress it produced, and an random value of 500 was assigned to marriage as a reference point. The results were averaged and divided by ten to get a measure of the individual events in terms of life change units representing the degree of stress caused by events. Their research using SRRS suggested that life events were associated with various physical illnesses. Self-perception of stress measures subjective feelings of stress associated with negative or positive life events for example Sarason et al.s (1978) Life experiences Survey (LES). The SRRS provides a relatively quick measure of a variety of stressor stimuli and the LES takes into account the subjective cognitive appraisal. This method however has a limitation in that subjective measures may be unreliable, change over time and confuse the causes and effects of stress. Biochemical methods This methods measure stress through chemical testing for example through blood and urine sample testing to measure changes in stress-related hormones, catecholamines (such as epinephrine) and corticosteroids (such as cortisol). For example, Kiecolt-Glaser (1984) studied human responses to stress using examinations where researchers took blood samples from 75 1st year medical students one month before their final examination and again on the first day of their final exams after they had completed two of the exams. Kiecolt-Glaser et al found that natural killer cell declined between the two samples confirming that stress is associated with a reduced immune response. These methods provide direct, reliable, objective and quantitative data on stress responses. There is a limitation however in that these methods are expensive, require specialist equipment/skill and ignore subjective perceptions (positive stress produces less cortisol). The measure can be affected by factors like caffeine or anxiety. Physiological methods There are many physiological responses that can be measured. This is done through monitoring of machinery like heart monitors and skin conductance polygraphs and stress is measured through its associated autonomic nervous system changes in heart rate and blood pressure. Change in heart rate measures the increase or decrease in the number of heart beats per minute. Heart rate can be measured with an electrocardiogram (ECG) which measures electrical activity across the skin associated with the electrical activity of the heart. It increases when a person is under stress and decreases as one relaxes. It is also affected by the intensity of the emotional response; it increases with position emotions and decreases with negative emotions . In response to unexpected stimuli, heart rate decreases, known as the orienting effect, and increases with defensive responses, i.e. fight-or-flight response. Change in skin conductance -measures the change in the conductivity of a persons skin. As stress increases, sweat increases on the palms hence increased conductivity. Higher levels of skin conductance have also been shown during learning and have also been shown to increase with the presentation of an unexpected stimulus. It is measured on the fingertips of the participant. Change in skin temperature -measures the change in temperature on the extremities of the body. As stress increases the temperature in the extremities decreases as heat moves to the bodys core thus the temperature measured on the fingertip decreases. Skin temperature reactions can be measured by placing a thermostat at the end of one of the fingers and holding it in place with thin porous tape. Other measures include EEG recordings of cortical activity, electromyogram measurements of facial muscle tensions, respiration rate and blood pressure. Physiological measures have an advantage in that they are more objective than subjective a continuous measure, so time-varying qualities of presence can be observed. They have some limitations however, in that several different stimuli could produce the same changes and physiological levels also vary widely from person to person. Skin temperature is slow to change and therefore one has to be exposed to the stimulus for several minutes. There is also the cost of the physiological monitoring equipment and trained personnel. I would recommend the company to use the self report method of measuring stress as it would be the most appropriate for a company because it is the least expensive and the staff would not need to take a day off to go and see a specialist. It would also take less time and it is convenient. Physiological and psychological methods of stress management that the company could introduce to its staff: There are many approaches which can be used to reduce stress levels. Psychologists distinguish two broad types of coping strategies; psychological and physiological. Physiological method: Biofeedback- This is a technique involving the use of recording electrodes and monitors to measure physiological responses like blood pressure and muscle tension in the head and neck. Signals are amplified and displayed to the client on a screen or through headphones. The client is trained on how to control involuntary muscles, or voluntary muscles that are not normally controlled using techniques like relaxation and meditation. This introduces autonomic nervous system activity thus the bodily sensations associated with stress and this would reduce the consequent effects of stress in terms of illness. strengths Biofeedback has produced significant long-term reductions in stress in everyday life. The use of monitors helps the person learn effective techniques to reduce arousal and they can use them independently of the technology (Holroyd et al., 1984) It does not have side effects unlike drugs It is voluntary and not invasive According to Attanasio et al. (1985), it helped teenagers and children with stress related disorders to gain control over symptoms of migraine headaches. They benefited more than adults possibly because they were more enthusiastic and less sceptical. Weaknesses There is cost of technology and time is needed by the trainer and client to learn how to reduce arousal. There is some doubt as to whether the feedback is actually necessary as some studies show that the benefits of biofeedback could be gained from other relaxation methods. It does not directly focus on causes of the stress-related problems but treats the symptoms. It is more successful with some people than others (individual differences), for example with children rather than adults. Psychological methods Stress inoculation training (SIT) Meichenbaum (1985) proposed a form of cognitive therapy to deal with stress. His stress inoculation training aims to manage stress using a cognitive-behavioural method of providing clients with strategies and skills to deal with the particular stressors in their lives. He suggested that an individual should develop a form of coping before the problem arises rather than afterwards. There are three main phases in stress inoculation training: Conceptualisation the therapist discusses the nature of the problem with the individual and a relationship is established. The client is educated about the nature and impact of stress so that he understands the effect of their existing coping mechanism. Self-defeating attitudes and coping mechanisms are identified through curious questions in order to guide the client to understand their cognitions and behaviour. Skills acquisition and consolidation The individual learns various techniques for reducing stress, such as relaxation and self-instruction by using coping self-statements, positive thinking, social skills, methods of attention diversion and time management. These are taught and practised in the clinic and then gradually rehearsed in real life. Application and follow through clients are given opportunities to apply the newly learned coping skills in different situations, which become increasingly stressful. Various techniques may be used for example imagery, modelling and role playing. The exposure to real stressors is graded and follow- through procedures employed to ensure that any warning signs of relapse are dealt with. Strengths It is very flexible, it consists of a wide variety of cognitive and behavioural techniques tailored to the individual needs of the client. It is fairly effective in reducing the stress experienced in moderately stressful situations, the stress of chronic pain, performance anxiety, specific phobias, work related stress, competition stress and stress before surgery. It deals with causes not symptoms, it offers a joint attack; skills to cope with current problems, and skills and confidence to cope with future problems. The focus on acquisition of skills provides long-lasting effectiveness as they are taught, practised and followed through and are tailored to the needs of the individual. Weaknesses This method is of less value when treating individuals who are highly stressed or exposed to very stressful situations. It is time consuming and requires high motivation. The training programme requires a lot of time, effort, motivation, money and the lengthy therapy would only suit a limited range of determined individuals. It is unnecessarily complex it is possible that the range of activities could be reduced without losing much of the effectiveness.

Roman Aqueducts :: essays research papers

Ancient Rome had eleven major aqueducts, built between 312 B.C. (Aqua Appia) and 226 A.D. (Aqua Alexandria); the longest (Anio Novus) was 59 miles long. It has been calculated that in imperial times, when the city's population was well over a million, the distribution system was able to provide over one cubic meter of water per day for each inhabitant: more than we use nowadays. For most of their length the early aqueducts were simply channels bored through the rock, from the water intake in the hills almost to the distribution cistern in Rome. The depth of the channel below ground varied so as to maintain a constant, very shallow gradient (less than 1/200) throughout the length of the aqueduct; vertical shafts were bored at intervals to provide ventilation and access. Only in the final stretches was the conduit raised on arches, to give a sufficient head for distribution of the water within the city. In order to keep the gradient constant, the aqueducts took a roundabout route, fol lowing the contours of the land and heading along spurs which led towards Rome. The most dramatic parts of a Roman aqueduct were—and still are—the bridges (also known as arcades) that carried the water over low spots in the terrain. Perhaps the best-known of these is the Pont du Gard, a part of the aqueduct that served the town in Nà ®mes in Gaul (today's France). The bridge stands on three tiers of arches and has a length of 274 m (900 ft). Built without the use of mortar, it stands 49 m (160 ft) above the Bornà ¨gre Ravine. Another famous Roman aqueduct is the one in Segovia, Spain; it still carries water, although it did need restoration in the 15th century. s time went on, Roman engineers became more daring in the construction of high arches to support the conduits across valleys and plains and some of the later aqueducts were as much as 27 meters (about 100 feet) above ground level in places. Closed pipes were occasionally used to cross valleys by the "inve rted syphon" method: the pressure forced the water down and up again on the other side, to a level slightly lower than before. But this system was costly, as it required lead pipes (lead had to be imported from Spain or Great Britain) and it was difficult to make joints strong enough to withstand the pressure; so arches were far more common.