Treatment Of Cirrhosis Of The Liver Nursing Essay

Treatment Of Cirrhosis Of The Liver Nursing Essay Jo is a 23-year-old undergraduate student. She is very sociable and admits to enjoying a drink fairly frequently. Six months ago she got involved in a scuffle while out and ended up in her local AE department. While there she had a blood test which showed abnormal liver function. Follow up tests revealed she had cirrhosis but with only a small part of the liver affected at present. Consequently, Jo has been advised to quit drinking completely and has been referred to her local community alcohol team. However, she has not attended any sessions with them. She did go to one session with the AA which she found out about on the Web but did not return as she felt the people attending were so unlike her Im not an alcoholic. Recently, Jo has been to see her GP and said that, as her condition is so mild, and is not causing her any problems at present, she doesnt see why she should totally give up drinking. She claims to have reduced her drinking slightly going out only 4 nights a week and reducing the alcohol she drinks at home, and believes that this is enough. She admits to not telling any of her family or friends about her diagnosis. Her GP has now referred her to her local psychology service to see if you can make her see sense. How might a health psychologist go about helping Jo? Issues Jo has been diagnosed with having cirrhosis of the liver and has been advised by her GP to stop drinking alcohol. During early stages of cirrhosis there can be very few symptoms (Wright, 2009), and Jo does not seem to have experienced any physical aggravation that would indicate problems with her liver function. Therefore her diagnosis initially seemed inconceivable for Jo to comprehend. After a chronic disease is diagnosed, patients can be in a state of crisis and psychological disequilibrium (Taylor, 2006). Moos and Schaefer (1984, cited in Bennet, 2000) suggested that following a diagnosis of a chronic illness an individual can feel that their future plans, social identity and support network is threatened. She has decided not to tell her friends or family, and is avoiding the implication of her health through denial (Taylor, 2006) until she is more accustomed to the diagnosis. After prolonged inflammation of the liver due to excessive alcohol abuse Jo has cirrhosis on the liver. This is when normal healthy liver cells are damaged and replaced by scar tissue, reducing the number of cells remaining to perform its many important functions (Wright, 2009). Cirrhosis is the final stage of alcoholic liver disease, which is an incurable, progressive and potentially fatal (Wright, 2009). Alcoholic cirrhosis is a multi-factorial disease and is not only a result of high dependency to alcohol (alcoholism) (Addolorato et al, 2009; Day, 2009). Research have found a low dependency of alcohol in patients with cirrhosis (Smith, 2006 cited in Addolorato et al, 2009), and it is known that gender, genetic and nutritional factors can influence the disease progression to cirrhosis (Addolorato et al, 2009). Therefore alcoholic cirrhosis could develop in susceptible individuals whose life style of heavy alcohol abuse has predisposed them to their illness. Jos dependency to alcoho l will be established and considered throughout her treatment process, as this could affect the length and stringency of the treatment approach to achieve the best response (Kadden, 1998). Due to the progressive nature of liver cirrhosis in is imperative that Jo eliminates her alcohol intake, as this would worsen her condition (Wright, 2009). The ability to maintain abstinence from alcohol requires a change in lifestyle, accepting the responsibility of ones actions and being aware of the consequences of drinking behaviour (Farid, Clark Williams, 1997). Once Jo establishes this belief and takes responsibility that her behaviour influences her health, she will hold an internal locus of control (Farid et al, 1997). However currently believing that she has reduced her alcohol consumption to an adequate level, and doesnt believe her behaviour has an influence on her health status, she currently ender an external locus of control. Without acknowledgment of this link to her health, Jo might lack the motivation to stop drinking (Farid et al,1997). To alter and educate Jos current beliefs the information and advice given will need to match the appropriateness for her needs (Br unt, 1993). After her diagnosis Jo could be feeling a great deal of anxiety, fear and uncertainty (Berry, 2003), which would make the processing of advice and treatment information difficult. There is a danger that the individual can be left uneducated, which then adversely affects her coping methods and adherence to treatment (Silverman, 2005). Careful consideration must be made to their treatment of individuals who suffer from alcohol related illness as they tend to differ in their ability to function due to depression (Bianchi et al, 2005), raised anxiety (Bolden, 2009; Kim et al, 2005) and fatigue (Blackburn et al, 2007; Sogolow et al, 2007). There are also multiple psychological factors that contribute to this difference such as elevated levels of stress, inadequate coping mechanisms and reinforcement of alcohol use from other drinkers (Bolden, 2009; Bianchi, 2005; Constant, 2005). Psychological support could help Jo overcome any avoidant coping style and associated psychological distress p reventing adverse response to illness (Taylor, 2006). As this could have a detrimental effect on the progression of liver disease (Jin-Cai Xu-Ru, 2002) and act as a predictor for depression (Bianchi, 2005). Majority of the side effects for cirrhosis are treatable with adequate medical management of the patients affected by alcoholic cirrhosis (Addolorato, 2009). Despite damage to the liver, the liver can still perform some of its functions. Jo currently only has a small part of her liver affected and complete abstinence of alcohol is the only way to prevent further damage that could lead to the gradual recovery of liver function (Addolorato, 2009). However it is likely that end-stage liver failure will result in the patient being assessed for a liver transplant (Georgiou, 2003). Therefore, it is imperative that Jo has documented evidence of the length of time she has been abstinence from alcohol, has sound psychological wellbeing and a strong support network, imperative whilst on the waiting list for a replacement liver (Georgiou, 2003; Pereia, 2000) all in which are considered to reduce the risk of relapse both before and after the liver transplantation. A health psychologist can help Jo to employ effective strategies into different aspects of her life to prevent further alcoholic liver damage. Her current psychological wellbeing will be considered as she is adapting to various lifestyle changes, and therefore psychological intervention will help avoid or reduce psychological suffering (Blackburn, 2007; Kim, 2005). A health psychologist will educate Jo to tackle her current beliefs and develop effective coping mechanisms (Taylor, 2006). Having a wider support network would greatly benefit her treatment process (Georgiou, 2003), which would require her to involve family and friends for extra social support. Together with suitable nutritional advice (Merli et al, 2009) and exercise programme (Petrides et al, 1997) could reduce the effect of liver cirrhosis and could lead to the gradual recovery of liver function. Intervention From the start of the intervention it is important that Jo feels like she is being treated like an individual and that her health psychologist understands the impact of having diagnosed with liver cirrhosis will have on her life (Kadden, 1995), and that they may feel that their identity will be defined by their disability (Charmaz, 1995). A good patient-doctor relationship is important for the adherence and success of the intervention (Kadden, 1995). To establish a good rapport Jos health psychologist must display empathy and belief with good interpersonal skills (Kadden, 1996). He or she must be familiar with the material and function as an active teacher to import the skills successfully (Kadden, 1995). To further strengthen a positive patient-doctor relationship Jo must be encouraged to be involved in the decision-making of her treatment, as this could increase the likelihood of Jo being motivated to comply (Longabaugh, 1999). Jo will complete a Patient Knowledge Questionnaire (PKQ) to assess the knowledge of her disease, and also a CAGE screening test for alcohol dependence (Kadden, 1995), which will set a guide line for the health psychologist of the problems being addressed. Her current beliefs and perceptions of how her illness will affect her life can be further be explored by using open-ended questions (Kadden, 1995). Together with constant emotional support (Kadden, 1995) would improve her psychological wellbeing. Once Jos beliefs have been established, meaningful information can be given and educational programs can be incorporated. Jo requires learning necessary skills to change her problem behaviour, for this reason the information should be given alongside cognitive behavioural therapy (CBT), which views alcohol abuse as a learned behaviour which can be reversed (Lonabaugh Morgenstern, 1999). Jo will need to be aware that any negative feelings towards the diagnosis are normal and reassured that following the intervention she will learn adequate coping skills that will help her take control of her illness (Taylor, 2006). The first part will gain acceptance of the purpose, content and plan of the therapy. Information will be presented about the severity of her liver disease, and abstinence of alcohol clearly identified as the desired goal. The patient should elect a person (family member, friend) willing to act as a source of support. A motivational interviewing style should be used to throughout to promote self-efficiency and better understanding in a nonthreatening fashion (Georgiou et al, 2003). Secondly it is important to identify and develop sufficient coping skills and plan how they can occupy their time with social activities that do not involve alcohol. Potential high-risk situations for drinking will have been identified, and the third part of the therapy would req uire the individual to identify how they will avoid and cope with relapse. Jos psychologist should use the PKQ and CAGE results as a guideline to predict the length and stringency of the treatment (3-12 weeks), depending on level of alcohol dependence (Kadden, 1995), which should be constantly reviewed. Jo has shown positive response to cope with her diagnosis by looking for support on the internet. This provides support for the CBT approach as the success of this therapy will require active participation from the patient (Kadden, 1995). Jo did not enjoy the AA meeting she attended, and may have had difficulty comprehending their belief that an individual is unable to alter their drinking behaviour without the aid of religious intervention (Longabaugh Morgenstern, 1999). This would provide further support for the CBT approach having an underlying assumption that it is within the individuals power to change (Longabough Morgenstern, 1999). Attendances to alternative support group will be encouraged as researches have associated this with positive drinking o utcomes (Longabough, 1999). Jo might benefit from a group who share the underlying assumption that alcohol is learned maladaptive behaviour that they can change (SMART cited in Longabough, 1999). Total alcohol abstinence represents the most effective strategy for alcoholic patients affected by cirrhosis (Tilg Day, 2007 cited in Addolorato, 2009). Even low doses of daily alcohol intake are associated with increased risk of cirrhosis. Continuing alcohol abuse can lead to compilations such as hepatocellular carcinoma (Addolorato, 2009). Consequently, achieving total alcohol abstinence should be the main aim in the management of Jos liver cirrhosis. This could become complex if Jo is diagnosed with alcohol dependence (Sussman, 2004). Medical recommendations and/or brief interventions may not be sufficient to achieve and maintain alcohol abstinence when a diagnosis of dependence is present. There may be a need to add pharmacological approaches, like naltrexone, acamproste and bacolfen which have been shown to reduce alcohol craving and intake (Addolorato, 2009), to prevent relapse and further damaging Jos liver. Malnutrition is frequently present in cirrhotic patients, and considered to be a predictive factor for increased morbidity and mortality (Merli et al, 2009). Exercise and nutritional intervention could improve and prevent inter-related conditions such as obesity, diabetes and insulin resistance (Catalano, 2008), which may worsen her condition. Good nutrition has been shown to improve liver regeneration, recommending an intake of about 2000 calories per day to correct deficiencies and promote hepatic repair (Addolorato, 2009). It is generally assumed that patients with chronic liver disease should be encouraged to engage in exercise, as this will maintain or improve their physical well-being. This could have beneficial effects on body composition, muscle strength (Andersen et al, 1998) and glucose tolerance (Petrides, 1996) and may reduce symptoms of depression (Rot et al, 2009) and fatigue (Blackburn, 2007; Sogolow, 2008). However strenuous exercise is not recommended as this might i ncrease risk of internal bleeding (Petrides, 1996). There arent many researches available on the long-term functional outcome of nutritional and physical well being, however malnutrition (Merli, 2009), depression (Bianchi, 2005) and fatigue (Blackburn, 2007) have been shown to increases complications in liver disease. In conclusion forming a good report with the health professional throughout the sessions will promote the underlying success of the intervention. Jos determinants and high risk situations that are likely to lead to alcohol will be assessed. It is important to incorporate healthy interests to her lifestyle and involve her friends and family throughout the cognitive behavioural treatment, where Jo will learn the necessary coping-skills to unlearn old habits associated with alcohol abuse. She should receive psychological support counselling for a long as required and be encouraged to maintain nutritional and physical well-being, which will overall reduce disability and psychological distress.

In the Mood for Love Essay

The quote by the author Drucker is a prime example of how non-verbal communication is most of the time more important than the actual answer itself. Body language is an essential element of everyday interaction amongst people. Based on simple hand gestures or a flicker of a smile, one can instantly change the syntax or structural meaning of a sentence. This change could turn a negative sentence into a positive outcome. Throughout the history of cinema body language is a tool that is applied to every movie. Movies by their very nature started of as any elaborate ploy on body language. The silent film era relies on nonverbal communication that is accompanied by visual elements and implanting a specific score in order to suspend disbelief that the audience is sitting an in a dark room watching various shades of light and color onto a screen. The movie In the Mood for Love directed by Kar Wai Wong is a prime example of how the characterization and plot of a movie doesn’t need to revolve around the construction of dialogue between the protagonist and other characters in the movie. To start off I would like to say the cinematographer Christopher Doyle and Pin Bing Lee did a great job in presenting a somewhat stale plot line into a visual masterpiece. There are many examples, of how the cinematography of this movie enables the audience to visualize the budding of a love that happened out of pain, spite, and loneliness. I would like to analyze the cinematography of a scene in order to bring more clarity to how body language is more important. The first scene I would like to examine is in the first act of the movie. Keep in mind during this scene there is no dialogue just a musical score. The faces of the two adulteresses remain obscured throughout the scene. Fade from black no picture in your minds eye the wife Su Li-Zhen is in her apartment with her husband while everyone is playing Mahjong. She takes the chair behind her husband and sits there. When she leaves for a brief instance to let another woman by which is the wife of Mr. Chow. Chow then proceeds to take his queue and exit the room looking troubled and deep in thought walks by and slightly grazes Mrs. Li-Zhen. Li-Zhen then goes to sit down next to her husband and puts her arm on his shoulder. This scene is jam-packed full of visual elements that make this scene very compelling and drives the movie forward with such palpable tension. First, the wife of Mr. Chow is dressed in a vibrant red dress that really pops out from all the dull whites and browns that are present in on the screen. This vibrancy of color and by the nature of all the skin that is revealed above her neck alludes to a characterization that is more sexual, more â€Å"desirable† in comparison to Mrs. Li-Zhen. She is wearing a dull white dressed that is cut in a more traditional and plain way. By the nature of the fabric and patterns on the dress it looks like she is blending in more than standing out. This direct comparison is between the mise en scene of the costuming foreshadows that the wife Mrs. Li-Zhen will become less desirable over time and this will present the problem of some kind of cheating. Also during this scene the very body language present between the two women towards Mr. Li-Zhen is very different. The wife of this man is sitting behind her husband she seems reluctant in showing her affections towards him. She doesn’t really act like they are together she only looks over his shoulder. The camera movement at this scene is very important when the wife walks into the room the camera pans out back to the doorway. Then, The adulteress wife walks from off the screen through the doorway. At this point the camera pans in. The woman in red then proceeds to walk in between the married couple sitting down, and drapes her arms across Mr. Chows back. Mrs. Li-Zhen gets up puts on an insincere smile and backs against the wall. The woman in red seems to push the faithful wife away. This scene is a metaphor down to a tee of what is happening to the Li-Zhen and Chows relationship. The initial distance between the first married couple shows that there is some discontent or rift between them. This body language is very subtle but its possible to see that they aren’t not entirely happy with each other. It’s not until she has her back against a wall and sees the discontent on Mr. Chow’s face do you really see the wife really warm up to her husband. The camera movement during this scene further supports my points on the relationship between the two couples. When the camera pans out it is signifying that even though Mrs. Li-Zhen is getting closer in reality she is quite distant from her husband. This distance is growing and impossible to reverse in this instance. This distance created by turning the shot from a medium, shot to a wide angle. Which sets up the next camera movement where Mrs. Chow comes from off the screen and the camera moves in and follows her as she makes her way towards MR. Li-Zhen. This shows that the there is a shift of desire going from the faithful wife to the new fling. This sexual shift is subtle but very evident once the adulteress pushes the faithful wife. The score during this scene is also very prominent during the entire movie. It is present every time we she a slight shift of the relationship status between the two couples. At first the music indicates that the physical, mental, and sexual attraction between the original couple is shifts towards a more negative outcome. During this scene the music is indicating that the once happy couples are now beginning to shift towards separation. The music cues as Mrs. Li-Zhen walks into the shot from off the screen. The tone and tempo of this piece directly correlates to the overall plot line of the film, and is key to this scene as well. The tone of the piece is a somber one; very little percussion is used in the score. There is a very prominent violin that is playing over other various strings. The tempo of this particular piece starts with slow staccato or â€Å"plucky strings† they start slow and there is able time between the notes to hears brief instance of silent. Then piece revs up to have a very mellow violin playing on top. The use of the tone in the piece reflects on the mood of the entire film and distress of the two that are faithful initially. The tempo of this piece shows that at first everything stress there is some kind of hidden element going on and then it quickens. The heartbreak comes, and now they have to live with it. As the movie progresses however the music becomes an indicator that new found couple having difficultly letting go, but they are making progress towards becoming whole again. When talking about this scene in particular the use of this music directly correlates to the action of what is going on in the scene. At the beginning of the piece the wife is walking into the room. This plucky string part signifies that there will be tension going on between Mrs. Li-Zhen and her husband. The violin is cued in as the camera movement stops and the adulteress wife walks onto the screen. The music is indicating that this woman spells trouble and she is bringing to the movie. Also, as the violin is playing the husband walks out of the room right after a brief pause between the violins solo. You hear a few plucks and silence of the violin at this instance. The silence of the violin signifies that he is not a problem but instead also in trouble from what is happening around him. He exits and the film cuts to the Li-Zhens being more affectionate, yet the sad music is still playing. This foreshadows that no matter what the relationship between these two couples is doomed even though the wife either remains ignorant or refuses to let go. At, which we find out later in the movie she tries to resist letting go the man she married because she cares so deeply for him. For example the original faithful protagonists are eating at a restaurant and both are trying to emulate the other’s old significant other. This movie very eloquently uses subtle metaphor through body language. The visual elements and the musical score help to strengthen the lack of dialogue in order to tell this story in a more compelling way. Body language is a necessary tool to understand in order to have a more in depth understanding of the characterization of the actors in well done films. Without strong body language is possible to sends confusing signals to everyone around you whether it be in the movies or in real life.

Analysis Of Carol Dweck s Article Brainology

There is a big difference living a life actively, and living a life passively. Once people start living a life passively, they tend to become too comfortable and committed to their life, which is devastating because they will never amount to their full potential. As for a life that is being acted-upon they are self – improving and opening new doors to experiences they never thought they could do. In Carol Dweck’s article â€Å"Brainology† describes two different mindsets students may have and how each can affect a student’s ability to reach a successful life. Also in connection with the mindsets based on Adrienne Rich speech â€Å"Claiming an Education† she argues about what receiving and claiming an education means. In the wake of these findings I come to learn that I had a fixed mindset, which only allowed me to receive an education. But now recognizing and understanding the â€Å"Growth Mindset,† I have decided to claim my education and se e how putting the concept and process can help enlighten my academics and life. High school is a big part of an individual’s life; it can change how people view themselves. From the beginning of high school I knew that I was going to community college because both brothers went, which influenced me to go. Since I new where my life would be after high school I discourage myself and was put into a fixed mindset. In Dwecks article Brainology she describes how students with a fixed mindset think which states† but those with a fixed mindset were most

Current Methods Used By Prisons Essay - 709 Words

Current Methods Used Over the years, prisons have relied on a series of deterrent methods. One popular method used is transferring known gang members to different prisons. When gang members are transferred it is usually in â€Å"higher security institutions† (Viano, n.d, p.176). The goal is to break down gangs by removing and separating key members. In a study of â€Å"the top methods† used in gang deterrence, inmate transfers were utilized â€Å"82.1† percent of the time (Viano, n.d, p. 175). Another, frequently used tool is â€Å"mail† and â€Å"phone monitoring† (Viano, n.d, p. 175). Which, has been a consistent feature for tracking gang activity thus far. For this reason, mail monitoring measures are used â€Å"81.5† percent by prisons and phone monitoring is used â€Å"72.8† percent (Viano, n.d, p.175). The other stats are as follows; â€Å"(72.8%) case dealings, (72.3%) segregation, and (64.1%) displ acing members to different facilities, interrupting communications, and isolating leaders in high security facilities† (Viano, n.d, p.175). Creating a New Plan In my opinion this problem cannot be eliminated, but measures can be taken to correct this issue. To start, I recommend that policy makers enforce anti-gang recruitment rules in all prisons. Which, prohibits gang members from soliciting and pressuring inmates to join. Equally important is, there must be punishments in place for inmates whoShow MoreRelatedCrime, Social Order And Control1385 Words   |  6 PagesReflecting upon the current prison regime in the UK, critically consider arguments and evidence related to the application of criminal justice policy This essay will discuss both prisons and the criminal justice system. 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