Symptoms of Disseminated Intravascular Coagulation (DIC)

Symptoms of Disseminated Intravascular Coagulation (DIC) Pathophysiology Disseminated intravascular coagulation (DIC) is an acquired syndrome that occurs when a stimulus pathologically activates intravascular coagulation and fibrinolysis resulting in an unbalanced hemostasis (Cunningham, 1999; Huether McCance, 2008; Wada, 2008). The initiation of DIC starts with the release of tissue factor (TF) by the endothelial cells or white blood cells (WBCs). TF are present on many different cell types including lungs, brain, and placenta. The release of TF is subsequent to a variety of causes including trauma, ischemia, excessive metabolic stress, tumors, infectious organisms, exposure to cytokines and endotoxins (Baglin, 1996; Vinay, Abul, Nelson, Richard, 2007). The release of endotoxin is the means by which gram-negative sepsis triggers DIC (Vinay et al., 2007). These endotoxins are a structural component in gram-negative bacteria released when the bacteria are lysed. TF then reacts with coagulation factor VII leading to the common pathway and activation of co agulation factor X (Huether McCance, 2008, p. 498). This complex pathway leads prothrombin to convert to thrombin, which transforms fibrinogen to fibrin (Huether McCance, 2008, p. 542) Excess activation of the coagulation pathway results in an overload of circulating thrombin leaving numerous fibrin clots in circulation (Cunningham, 1999). Fibrinolysis is also decreased during DIC. The main component of fibrinolysis is plasmin, a fibrin-eating enzyme that is activated by the clotting pathway to control the fibrin clots in the vessels (Huether McCance, 2008). These micro-thrombi in the vasculature of organs cause tissue ischemia and dysfunction. Although fibrinolytic properties are present in the body, production is inadequate to control the systemic deposits of fibrin clots (Cunningham, 1999; Huether McCance, 2008). DIC also places the patient at risk for hemorrhage due the rapid consumption of platelets and coagulation factors result in primary hemostasis failure (Bliss Wallace-Jonathan, 2008; Huether McCance, 2008). The failure and dysfunction of both the formation and stabilization pathways of clots bleeding from multiple sites are seen (Bliss Wallace-Jonat han, 2008). Relevant Signs and Symptoms The signs and symptoms of disseminated intravascular coagulation present in a multitude of possibilities. In this specific patient with gram-negative sepsis leading to DIC may present with spontaneous bruising, prolonged bleeding from venipuncture sites, and bleeding from three different sites. There are also many other possible sites including the nose, gums, mucosa, eyes, arterial lines, or surgical wounds (Bliss Wallace-Jonathan, 2008; Wada, 2008). Depending on where the fibrin clots have deposited, other symptoms may manifest as ischemia or organ failure occurs such as in the kidneys, heart, lungs, or in the brain. There is a possibility of hemorrhaging into a closed compartment, which may lead to shock (Huether McCance, 2008). Lab values during DIC are also of great importance. There is no specific test for DIC but a combination of PT (prothrombin time), aPTT (activated partial thromboplastin time), fibrinogen, platelet count and d-dimmer are used to assist in the diagnosis of DIC (Cunningham, 1999). Since many disorders can cause an increase of each of these lab values, it is important to use the whole picture to make the diagnosis. Treatment Treatments for DIC focus on elimination of the cause, controlling the coagulation and formation of clots, and maintain or return organ function (Huether McCance, 2008). In this case study, the elimination of the gram-negative bacteria is one treatment. This essential treatment of antibiotic therapy has already started one hour ago. Another course of treatment is administration of blood products to resupply the body with the depleted clotting factor, platelets, thrombin, and plasmin in an attempt to reduce or eliminate the bleeding (Bliss Wallace-Jonathan, 2008). Administration of fresh frozen plasma (FFP) along with cryoprecipitate and platelet concentrates replaces the clotting factors in patients with active bleeding (Bliss Wallace-Jonathan, 2008). Research on heparin use in DIC found successful in the treatment of DIC in some patients in an attempt to reduce the coagulation pathway activation though not recommended in septic DIC (Huether McCance, 2008; Bliss Wallace-Jonathan, 2008). Clinical trials have made a case for the specific treatment of septic DIC. Antithrombin III appears to be an effective treatment (Bliss Wallace-Jonathan, 2008; Huether McCance, 2008). Organ function requires fluid resuscitation for restoration of blood pressure as well as urine and cardiac output. Outcomes Prognosis varies depending on the underlying disorder. The outcome also depends on the magnitude of thrombi in the vascular system. The patient has a 10%-50% chance of dying with the diagnosis of DIC (Wada, 2008). The rate increases in patients with sepsis though there still is a possibility of a positive outcome. With rapid detection and treatment, DIC can be reversed. Conclusion Disseminated intravascular coagulation (DIC) References Baglin, T. (1996, March 16). Disseminated intravascular coagulation: diagnosis and treatment. British Medical Journal, 312, 683-688. Retrieved from www.galegroup.com Bliss, T. T., Wallace-Jonathan, J. (2008). Hematological and coagulation changes in sepsis. In Competency-based critical care (pp. 17-25). doi: 10.1007/978-1-84628-939-2 Cunningham, V. L. (1999, July). A review of disseminated intravascular coagulation: presentation, laboratory diagnosis, and treatment. Medical Laboratory Observer, 31(7), 42-50. Retrieved from www.generalonefile.com Huether, S., McCance, K. (2008). Understanding pathophysiology (4th ed.). St. Louis, MO: Mosby Elsevier. Vinay, K., Abul, A. K., Nelson, F., Richard, M. N. (2007). Robbins basic pathology (8th ed.). St. Louis, MO: Saunders Elsevier. Wada, H. (2008). Disseminated intravascular coagulation. In Recent advances in thrombosis and hemostasis 2008. doi: 10.1007/978-4-431-78847-8

Ralph Lauren Strategic and Operational Plans Analysis Essay

Ralph Lauren Corporation Mission and Vision: â€Å"Mission- to ‘redefine American style, provide quality products, create worlds and invite people to take part in our dreams’. Vision- ‘to represent American style with a dash of British elegance and the comfort of natural fibers† (Ralph Lauren, 2013). The purpose of this analysis is to identify strategic and operational plans based upon current SWOT analysis, to include explanations and courses of action to achieve the related organization goals and the internal and external effects of our decisions to stakeholders. Ralph Lauren Corporation a Fortune 500 company headquartered in New York, NY is a leader in the design, marketing and distribution of premium lifestyle products in four categories: apparel, home, accessories and fragrances. For more than 45 years, Ralph Lauren’s reputation and distinctive image have been consistently developed across an expanding number of products, brands and international markets. (Enel SpA, 2013) Enel Group is responsible for the production and development of energy at a globally, with a vast majority of operations Europe and the Americas. The Enel Group produced over 29 billion kilowatts in 2013 from sun, the Earth’s heat and water enough to supply the energy needs of more than 10 million dwellings as well restrict the emission of over 20 million tons of CO2 in the environment. Enel Green Power is a world leader in the market thanks to its well-balanced product mix, providing volumes of energy well over the sector average. Enel Group has an installed capacity of 8,900 megawatts from a mix of sources including wind, solar, hydroelectric, geothermal, and biomass. (Alina-Florentina, C. 2011) Enel Group has 750 plants operating in 16 countries in Europe and the Americas. Strategic Plan: The strategic plan is geared toward generating cash flow in mature markets: In the current economic atmosphere, which is difficult, the strategic plan is designed to cut budget costs as well as increase efficiency. The Enel Group’s strategic plan, calls for a reduction in expenses of about 4 billion euros (based on 2013 controllable costs) for the 2013-2017 time frame. There mature markets are located primarily in Italy and Spain sectors. The strategic plan also provides for investment of 11 billion euros in other sectors of operation. Investments in assets will be reduced from 5.3 billion euros under the previous plan to 4.6 billion under the current strategic plan. Investment distribution assets will grow to 6.7 billion euros under the current strategic plan from around 6.2 billion euros under the previous plan. (Mills, Wiser, Porter 2009) The new strategic plan will see a 2.7 percent increase the cumulative capital expenditure compared to the previous 2013-2017 plan. Basically, the investment in research and development budget will increase to around 9.4 billion under the current strategic plan in comparison to 8.7 billion euros under the previous strategic plan. Installed capacity will rise from 38 gig watts in 2012 to 43 gig watts in the year 2017. (Alina-Florentina, C., 2011) During the implementation phase of the strategic plan period, the Enel Group expects to implement a structure simplification that will fuel minorities’ buy-out operations, when complete will increase the net income ownership at the Parent Company level from 65% in 2013 to 78% in 2017. Operational Plan: Ralph Lauren tries to uphold a very positive company culture and keep employees happy so they will stay long term. They like to promote from within and have many cases of employees starting at the bottom and working their way up to upper management. They not only offer pregnancy leave, but 3 months of parental leave as well for either parent whether having a child or adopting. They offer longer than average vacation time as well as many travel opportunities, and promotions to different locations within the company. It has been reported that although the salary is low with long hours and a highly stressful job, employees are given many rewards. Ralph Lauren offers its employees different rewards such as bonuses for attendance, employee discounts, and stock options. References Ralph Lauren Corporation SWOT Analysis. (2013). Polo Ralph Lauren Corporation SWOT Analysis, 1-8.

“In A Time Of War” Poem Essay

The title of Rothenberg’s poem â€Å"In a Time of War† seems to encapsulate the poem’s subject-matter, written with uncomplicated words of the English vocabulary makes the poem stand out in a stark manner. This method is used by Rothenberg to illustrate to readers exactly how he sees war, as it is. One outstanding feature of this poem is its structure. Rothenberg appears to want to isolate the first stanza from the rest of the poem. At a closer reading, the first stanza is concerned with the poet’s thoughts of war, while it is taking place, whereas the remaining stanzas talk about his feelings on the notion of war, irregardless of whether it is occurring or not. This distinction is further enhanced by the language and degree of imagery of the stanzas. Note that in stanza one, there is more emphasis on description, with the constant use of pastoral imagery, â€Å"daisies wilt† and â€Å"the war sucks up the dew.† The mood generated from it, is â€Å"dark†, gloomy and miserable. However, reading on, the mood apparently lightens up, especially from stanza three. The word â€Å"love† begins to appear. The pastoral imagery transforms to a more hopeful state, â€Å"a love that floats like butterflies† and â€Å"flowers in the endless night.† Rothenberg is probably telling the reader that all is not lost, â€Å"even a year of war won’t hide or tame [moon acacia water lily star].† There is hence, no predominant gloomy mood or atmosphere to this poem as there is a shift from a state of hopelessness to one with some optimism present. Even so, we cannot overlook the fact that Rothenberg is saying that since we can move on from the aftermath of war, we can then take war lightly. The poet, apart from telling readers not to lose faith when war comes, is also signaling to us that â€Å"war [is] waiting in the gateway to the hive.† The lesson Rothenberg is conveying to the readers that war may strike us anytime, and so we should prevent it at all costs if not things might return to how he describes it in stanza one. The structure of stanza one consists of many short lines, even a word alone  constitutes a line as seen in the tenth line â€Å"nightingales.† Rothenberg ‘compels’ the reader to pay attention to each and every line. He wants us to feel, as closely as possible of the horrific experiences that war can bring out. Wars sometimes take decades before it ends and the literal length of the stanza symbolizes this. And yet, as we move on the next stanzas, lengthwise, they grow shorter and the lack of commas causes the reader to move from one stanza to the next rather swiftly until we approach stanza seven where Rothenberg cautions us of the unpredictability of war. And if we fail to take his advice in hand, we return to the state that stanza one illustrates. The poem may have ended with stanza seven, but Rothenberg has cleverly twisted it. A vicious cycle is formed, if humans refuse to prevent war, â€Å"another war† will always emerge. The poem is overall an excellent portrayal of the world â€Å"in a time of war.†

Quality And Safety Education For Nurses - 1142 Words

Quality and Safety Education for Nurses Teamwork and collaboration are capable to effectively function within professional teams, remaining respectful, mutual decision-making, and developing open communication to attain the optimal quality of care for patients. To create a collaborative atmosphere, several characteristics must be involved; knowledge, skills, and attitude. Knowledge is a way to describe an individual’s strengths, weaknesses, and principles to collaborate within a group of workers. Skills, the awareness of the individual’s proficiencies as a team member. Attitude is the individuals potential to interact within a group. (QSEN Institute, 2014) Importance of Integration of Teamwork Integration of teamwork is important because it is essential in this profession. According to Cameron (2012), there is â€Å"a greater need for health and social services to work together closely and effectively to offer an integrated and evidence-based practice† (p.212). Health care is a constant changing envir onment; patient’s needs are prioritized, and collaboration is necessary because of this shift in the stability of care from hospital facilities to the community. Team effectiveness can be influenced by many things; structure, communication, leadership, attitude, values, skills, and education. (Cameron, 2012, p.212-213) Implications in Nursing Education Nursing education is not only based on our education that is attained through school, but also from gaining skills inShow MoreRelatedQuality And Safety Education For Nurses996 Words   |  4 PagesIn 2005, The Robert Wood Johnson Foundation developed the Quality and Safety Education for Nurses (QSEN) initiative in an effort to rectify alarming conditions illustrated by the Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System (Quality and Safety of Education for Nurses [QSEN], 2005). 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