Friday, May 15, 2020

Reflective analysis on a case presented with minor injury - Free Essay Example

Sample details Pages: 6 Words: 1896 Downloads: 6 Date added: 2019/10/10 Did you like this example? History of presenting complaint and symptoms: Ian Ruther fell on icy path outside of house two days ago, putting her hand down to break the fall (i.e. FOOSH).   There was immediate pain in the left wrist below the thumb.   She is complaining of increased pain when trying to move wrist and pick up small objects.   Patient does not report any noticeable immediate swelling. Examination findings: Examination should start with observing the motion of the patient’s hand. This observation is helpful in making diagnosis on the whole limb dysfunction and injury that will help in giving valuable information about the function of the hand elbow complex. The patient’s hand should be observed from front to the back. Any kind of limitation hesitancy, symmetry or avoidance of any weight bearing should be noted. Some of the examinations should escape the notice of the patient since some of them occur gradually. (Bunnell, S., 1951) Don’t waste time! Our writers will create an original "Reflective analysis on a case presented with minor injury" essay for you Create order The entire upper extremity of the limb should be exposed and evaluated when examination is on-going. Elbow motion, active shoulder motion, pronation, and supination of the forearm should be assed effectively. The color of the forearm should be noted in order to conclude on the state of the blood circulation and even on the conditions of the radial and ulna pulses. The swellings and edemas existing edemas should be noted and even on the abnormal posture or position. Evaluation of the skin tenderness, moisture and sensibility should be done. After hand injury, there is a secondary stiffness and limited range of motion (ROM) of other joints of extremity together with the involved hand. Measurements and recordings on the range of both active and passive motion of the wrist, MCP joint, and IP joints of each digit should be done. Documentation of grip and pinch strength should be noted too. Evaluation on the patient ability to carry out simple functions should be evaluated. A simple sketch of the hand with appropriate notations and measurements should be done on the paper since it is usually helpful. (Campbell, D.A. and Kay, S.P.J., 1996) Differential diagnoses: The parts of the arm that should be investigated are: skin, the nail-bed and fingertip, the muscles, the nerves of the patient’s forearm sensibility and circulation of blood. (Flatt, A.E., 1979) Investigations further tests required: After these preliminary tests, there are specific parts of the hand where further analysis should be carried out. They are listed as shown below: Skin: The examiner should evaluate whether there is a presence or absence of swelling, wrinkles, moisture, scars, color and other surface irregularities. Normally, the palmer skin is thick, tethered, irregularly surfaced and moist to enable traction and durability. The dorsum skin is thin and mobile to permit the motion of various joints. (Frazier, W.H., Miller, M., Fox, R.S., Brand, D. and Finseth, F., 1978) The nail-bed and fingertip: When making examination on this part of the forearm, one should ensure that the tuft of the distal phalanx is well-padded by the adipose tissue and covered by highly inverted skin which is tethered to the distal phalanx through a series of fibrosepta. (Hammert, W. C. 2010) Muscles: The muscles of the fore arm are divided into various sections. Hence, examinations should be done on each part respectively as shown below and make the recordings on them. The first part is the extrinsic muscle. This part is composed of extrinsic flexor muscles, extrinsic extensor muscles and extrinsic extensor muscles. When analyzing the extrinsic extensor muscles, the flexor pollicis longus (FPL) muscle strength should be tested against the resistance supplied by the examiner. The flexor digitorum profunds (FDP) should be tested by asking the patient to bend the tip of his finger. The examiner should stabilize the PIP point as the distal point is actively flexed. The muscle should be tested against resistance too as each finger is being examined. The flexor digitorum superficialis (FDS) should be tested by asking the patient to bend his finger at the middle joint (Weiland, A. J., Rohde, R. S. 2009). The examiner should stabilize the other fingers so as to block the profundus function. Then the procedure should be repeated for the rest of the fingers. The flexor carpi ulnaris (FCU), flexor carpi radialis(FCR), and palmaris longus(PL) should be evalua ted by asking the patient to flex his wrist as the examiner keeps on palpating on the tendoms of these muscles.The PL will be noted as to be lying between the FCR radially and FCU ulnary on the volar surface of the wrist when maneuvering around the forearm. The extrinsic extensor muscles. It consists of the first dorsal wrist compartment, second dorsal wrist compartment, the third dorsal wrist compartment, fourth dorsal wrist compartment, fifth dorsal wrist compartment and the sixth dorsal wrist compartment. The first dorsal wrist compartment consists of the abductor pollicis longus (APL) and extensor pollicis longus.   These parts are evaluated by asking the patient to bring his thumb out to the side. The examiner should be palpating around the taut tendons over the radial side of the wrist that is going to the thumb. The second dorsal wrist compartment consists of the extensor carpi radialis longus (ECRL) tendons and the extensor carpi radialis brevis (ECRB) muscles. These parts are evaluated by asking the patient to make a fist and bring his wrist back strongly. The examiner should also provide resistance and palpation on thetendons over the dorsoradial aspect of the wrist. The third dorsal wrist compartment has the extensor pollicis longus (EPL) passing around the Lister’s tubercle of te radius. This muscle can be tested by placing the hand flat on the table and having the patient lifting the thumb off the surface. The fourth dorsal wrist compartment has the extensor digitorum communis (EDC) and the extensor indicis proprius (EIP) muscle tendons. They are examined by asking the patient to straighten his fingures and by making observations on the MCP joint extension. The EIP can be examined separately by asking the patient to bring his pointing finger out straight with the other fingers bent in a fist. The fifth dorsal wrist compartment has the extensor digit minimi (EDM) (Weinzweig, N., Weinzweig, J. 2005). This is tested by asking the patient to straighten his small finger with others bent in the fist. This will help in extending the MCP joint of the small finger. The sixth dorsal wrist compartment has the extensor corpi ulnaris (ECU). This is examined by asking the patient to pull his hand up and out to the side. The examiner can palpate over the ulnar side of the wrist at the distal point of the ulnar head. The extrinsic extensor tightness can be tested by maintaining the wrist in a neutral and passively extending the MCP joint and flexing the PIP point. The same test is repeated with the MCP joint when passively flexed. (Hill, E.J., 1963) The second part of examination is the intrinsic muscles. This part is composed of the thenar muscle group,   adductor pollicis (AdP), lumbrical, interrosseous muscles and the hpothenar muscle group. The thenar muscles are composed of the abductor pollicis brevis (APB), opponens pollicis (OP), and flexor pollicis brevis (FPB). These muscles can be evaluated by asking the patient to touch the thumb and small fingertips together for the nails to be parallel. They can be alternatively tested by asking the patient to place the dorsum of the hand flat on the table and raise the thumb of the surface by 90o. The examiner should be palpating the thenar muscles at this time to note wether they contract. The contralateral hand should also be examined in the same way to observe the variations in muscle mass and function. The AdP can be examined by making the patient to hold the paper forcibly between the hand and the radial side of the index proximal phalanx. The interosseous and lumbrical mus cles should be tested by asking the patient to spread the fingers apart as the examiner keeps on palpating the first dorsal interosseous to observe whether it is contracting. Another alternative test is to lay the hand of the patient flat on the table and elevate the middle finger and radially and ulnarly deviate it. The hypothenar muscles is composed of the abductor digiti minimi (ADM), flexor digiti minimi (FDM), and opponens digiti minimi (ODM). They are evaluated by asking the patient to bring the small finger away from the other fingers. The intrinsic muscle tightnesss can be tested by holding the MCP joint in extension while the PIP joint is passively flexed by the examiner. (Hunt, T. R., Wiesel, S. W. 2011) The third part of examination is the nerves. The nerves are composed of the median nerve, ulnar nerve, radial nerve, and the sensory branches. They should be also examined to ensure that they are functioning normally without any defect. Any abnormality noticed should be recorded appropriately. (Jacobs, M. A., Austin, N. M. 2003) The fourth part of examination is sensibility. The normal skin should be moist. The dysfunction of the nerves may cause loss in sympathetic intervention in most of the distribution areas. This makes the skin to become dry. The finger should be tested by tactile gnosis by the moving and static two-point light touch discrimination test. The hand should be positioned on a flat table and make the patient to close his eyes. A disk-criminator or a bent paper clip should be used to measure the innervation density. The examiner should begin at 6mm distance between the prong and this should be preceded to higher and lower distances to determine the critical distance in which the patient indicates pain. (Lawton, J. N. 2013) The fifth exercise is to test on the circulation. This should be done by noting the color of the skin and the fingernails as well as the blanching and flush of the nail-bed. The Allen test should be used in this case by following the following procedures: The ulner and radial arteries should be compressed first. The patient should be asked to make a fist, open and close it several times to exsanguinate the hand and then open the hand again into a relaxed position. The radial artery only should be released later. If the palm and fingers get filled with blood, then the radial artery is patent. Repeating the first and second steps, the ulnar artery should be released now. If the entire hand flushes, then the ulnar artery is pantent. (Miller, M. D., Hart, J. A. 2011) Working Diagnosis: The patient was diagnosed with a Bennet’s fracture. It has occurred from the ulnar base of the thumb metacarnal. (Sorock, G.S., Lombardi, D.A., Hauser, R.B., Eisen, E.A., Herrick, R.F. and Mittleman, M.A., 2001) Brief management issues/referrals: This condition requires surgery that should be performed by the specialist wrist and hand surgeon. This should be followed by 4-6 week period of immobilization in a plaster cast. This operation involves the reduction of the bones which is a medical speak by putting them back in the right place. Fixation of the fracture can be done by making use of wires. (Strickland, J. W. 2005) The therapist should mobilize the surrounding joints during the immobilization period to help in the restoration of the normal function of the other fingers. This should be followed by an exercise of wrist and hand strengthening.

Wednesday, May 6, 2020

The Self-destructive Relationship in Wuthering Heights Essay

On the face of it, it would seem that the relationship between Catherine and Heathcliff is self-destructive to an extreme. Due to the lovers’ precarious circumstances, passionate personalities and class divisions, it seems that fate transpires to keep them apart and therefore the hopelessness of their situation drives them to self destruction. However, although the relationship is undeniably self-destructive, there are elements within it that suggest the pain Heathcliff and Catherine put each other through is atoned for to an extent when they share their brief moments of harmony. Catherine is trapped between her love of Heathcliff and her love for Edgar, setting the two men down a path of destruction, a whirlwind of anger and resentment†¦show more content†¦The metaphor of â€Å"eternal rocks† is used to describe Heathcliff, never changing and powerful, whereas her loved for Edgar is â€Å"like the foliage in the wood.† This metaphor suggests that the fo liage could change, like her feelings, but the tree’s soar high, like his social class- he is after all, â€Å"handsome† and â€Å"rich.† Competing for Catherine’s love brings the two men into conflict, making Catherine feel desperately guilty and torn between the two. She tries to reconcile the two men, but when this is clearly impossible, she vows to â€Å"break their hearts by breaking her own.† Her vow is carried out, and as the â€Å"violent, unequal throbbing of her heart† stops she has truly completed the most horrific of self-destructions. Because Heathcliff and Cathy cannot be together, yet desire it so strongly, it seems inevitable they will blame the other, and push away from each other, while simultaneously being drawn together, wrenching their hearts impossibly painfully. Heathcliff says to Catherine â€Å"You loved me--then what right had you to leave me? What right--answer me--for the poor fancy you felt for Linton? Because misery, and degradation and death, and nothing that God or Satan could inflict would have parted us, you, of your own will, did it.† The power of the betrayal Heathcliff feels is represented in this quote, portraying his pain very successfully. Moreover, Cathy feels like she has been betrayed by Heathcliff too-Show MoreRelatedWilliam Shakespeare s Macbeth And Wuthering Heights 1199 Words   |  5 PagesEnglish 4 May 29, 2017 Destructive Love In Macbeth and Wuthering Heights The theme of destructive love within relationships in Shakespeare’s Macbeth and Bronte’s Wuthering Heights are presented through sexism, jealousy, and betrayal. How do women gain control in a relationship? Can men regain control in a relationship? What makes a good relationship? What makes a bad relationship? Can people be over ambitious? These questions are vital to understanding the complex relationships in these stories. WomenRead MoreEmily Brontes Wuthering Heights783 Words   |  4 Pagesborn in 1818 and published Wuthering Heights in 1847. Wuthering Heights, reflects her experience with both the Romantic Era, which existed from 1785 to 1830, and the Victorian Era, which took place from 1830 to 1848. 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Wuthering Heights was first ill received being too much removed from the ordinary reality in the mid-nineteenth-century;Read MoreThe Relationship Between Catherine And Heathcliff799 Words   |  4 Pagesromantic novel Wuthering Heights by Emily Bronte, the characters end up destroying themselves because of the feeling of revenge and affection towards one another. The relationship between Catherine and Heathcliff is self-destructive to a certain extreme. Due to their insecure and risky circumstances, passionate personalities and differences in class, their fate leads them to keeping them apart. That hopelessness of the love they couldn’t physically have, eventually leads them to self destruction. Although

Tuesday, May 5, 2020

Study Explains Mixed Fortunes At Dominos †Myassignmenthelp.Com

Question: Discuss About The Case Study Mixed Fortunes At Dominos? Answer: Introduction This study introduces management case study that explains mixed fortunes at Dominos. In this particular assignment, emphasis has been given on understanding background of Dominos Pizza (Sheth and Sisodia 2015). The case study on Dominos Pizza was presented in a way where several issues are identified that reveals that workers are not paid for overtime and there is exploitation of human resources. The current segment identifies issues that are faced by Dominos in its operations. Dominos is one of the Australian pizza chains with a network of franchises and over 600 retail stores globally. In addition, the shares of Dominos have surged and best performers and making a lot of people wealthy. In the year 2016, Dominos generated total revenue of $939,976,000. The reality of life inside the Dominos Pizza chain is not what is portrayed to the general public. Most The present study explains probable solution where Dominos can mitigate the issues as identified in the case study (Armstrong et al. 2014). Background Dominos has the biggest pizza menu in and across the world with more than 2,00,000 options that help in boosting the sales of Dominos that is more than 90 million pizzas on annual basis with a guarantee to deliver pizza within 15 to 20 minutes for an extra cost (He, Zha and Li 2013). The business model of Dominos is based on franchisees growing sales with head office taking a royalty from every sale where Australians chomp through 1 million of pizzas every week. In addition, stores are bought and sold on a multiple of these sales and not on profits. It is understood that more stores will help in generating more sales and that lead to gain profits for head office (Sheth and Sisodia 2015). Issue identification Poor Management Leadership- From the case study of Dominos, several issues was related that was hampering the reputation of the overall brand. To this, poor management leadership is one of the issues that were clearly identified from the case study. The business of Dominos relies mainly on franchisees where they take up stores and increase the sale of the brand. But, this was not the case with the one of the powerful franchises and member of Franchisee Advisory Committee named as Del Santo. The leadership style that was adopted by him was wrong and lead to harassing workers who are working for their stores. On the other hand, Managing Director (Meij) of Dominos follows leadership style where he actually thinks behalf of people where more concentration is given on training its workers so that they know how to work and learn each day. On the contrary, being a store franchisee, Del Santo asks his store manager to reduce labor costs by any means possible. The main issue was exploitation of human resources at Dominos Pizza where staff members are not paid for their work and force them to work more without pay. Other problem that was found at the time of audit of Dominos is the stores of the company give rise to wage fraud. Franchisees mostly blame the head of office system if anything went wrong and that lead to poor quality of food and delivery Possible solution Employee dissatisfaction- One of the possible solution that can be adopted by Dominos is to check over the facts whether employees are happy working for their stores. Human resource is one of the assets to the company that should be properly managed and efforts should be made to listen to their needs and expectations rather than only thinking of sales and profits. At Dominos, employees are highly dissatisfied with their pay scale where they are working for longer hours but not getting paid for extra hours even. Figure: Response to employee dissatisfaction (Source: Baker, M.J., 2014) Voice- The employee feels dissatisfied if they cannot voice or speak up their own opinion at workplace. Same is the case of Dominos where employees cannot have their own say or opinion regarding any of the company operations. Loyalty- It is condition where employees wait for better condition or improvements by trusting the organization and management to perform the right thing. Neglect- It is condition where employee feel worsen that include lateness,, reduced effort as well as increased error rate. Exit- It is the condition where dissatisfaction is expressed through behavior that is directed to leave any organization. Organization value or culture- The organization work culture if equally important for any employees who are working for Dominos. The managing director of Dominos believes in changing the business model frequently so that they are ahead of competition in the market. Organization value or culture is really important so that employee feel relaxed, composed and content while working at Dominos. Communication- Communicating the right information to the right employees is the best solution that needs to be adopted in the stores of Dominos. The management of these stores is only thinking how to increase profits by any means possible. The possible solutions are customer communication as well as job redesign. It is important to undergo the immediate issuing of press release for discussing the mishappenings, conducting aggressive advertising as well as communication and employee training. The Company should conduct interview via television as well as radio stations for discussing the events and reassuring the public what situation need to be handled. Promotion is one of the possible solutions that Dominos should adopt in their business operations. Embarking on vigorous promotions as well as giveaways for regaining rapport from the customers. Dominos has always been a company who based its offerings on convenience (Sheth and Sisodia 2015). The company is trying to gain competitive advantage over other companies by having both convenience as well as flavor lovers on their side. It will be difficult task to keep up both convenience and new recipe as it will be highly costly affair. The old famous deal of 30 minutes or free had been their trademark for several years. With the new developments of a recipe, it is noted that Dominos is swaying away from convenience as well as moving towards flavor (Brown and Churchill 2014). Proposed solution From the above listed possible solution, communication can be selected as the best proposed solution that can solve any major issue that prevails at Dominos. The proposed solution that should be adopted by Dominos is Job Redesign and this can be illustrated by use of Herzberg Two factor theory. Figure: Job Redesigning at Dominos Pizza (Source: Baker, M.J., 2014) Person marketing include activities that need to be undertaken for creating, maintaining or changing attitudes and behavior for targeting consumers towards specific people (Armstrong et al. 2015). Dominos Pizza does not pay much attention to the staff members and found to be not abiding by the policies and procedures. Most of the workers are underpaid and they are not even paid for extra hours worked by the employees. Employees work for longer hours for the company but they are not gets paid for that time or hours (Czinkota and Ronkainen 2013). This action gives rise to dissatisfaction in the minds of employees. Dominos Pizza faced problem in their operational activities such as loss of customers as well as profits. There are alternative solutions mentioned in the above question that is generated to solve problem of Dominos. Possible solution to the above problem is job redesigning of activities (He, Zha and Li 2013). A proper plan was formulated for implementation of probable solution. Therefore, contingency plan was put in place for any types of precautionary measures. Recommendations The first strategy that should be used by Dominos is treating each employee equally and paying for what they work. At stores, the employees who want to work for longer hours should be paid that lead to employee satisfaction. It is recommended to Dominos that Senior Leaders should meet every month for discussing the commodity market outlook as well as how to manage purchase and supplier relationships in an effective way. It is suggested that Dominos pizza should extend the menu as well as try to increase the taste as well. Dominos pizza should launch many national advertisements that highlight how they reinvented their entire business model. Dominos pizza should make use of technology like Online Pizza tracker as well as iPhone application and online ordering. It is suggested to Dominos for implementing the new flavor as well as also keeps the 30 minutes or less bargain guarantee. Both convenience and flavor is costly affair where the amount of large profit in sale at the beginning of the process. Both the convenience as well as new pizza together would make for a great solution. In addition, the break-even that could be obtained with this that would succeed over the previous pizza recipe. Transparent communication The next strategy that should be adopted by Dominos is enhancing transparent communication where each employee can speak up their thoughts, opinions and grievances to the upper level management or any level of management they desire to. Employee grievances should be addressed by the management so that they feel their importance in the company and that will make them work more for the organization and become a true asset to the company. Addressing employees grievances and complaints can solve a lot of major problem in the stores. References Armstrong, G., Adam, S., Denize, S. and Kotler, P., 2014.Principles of marketing. Pearson Australia. Armstrong, G., Kotler, P., Harker, M. and Brennan, R., 2015.Marketing: an introduction. Pearson Education. Babin, B.J. and Zikmund, W.G., 2015.Exploring marketing research. Cengage Learning. Baker, M.J., 2014.Marketing strategy and management. Palgrave Macmillan. Brown, T.J. and Churchill, G.A., 2014.Basic marketing research: Customer insights and managerial action. Cengage learning. Christopher, M., 2016.Logistics supply chain management. Pearson UK. Czinkota, M.R. and Ronkainen, I.A., 2013.International marketing. Cengage Learning. De Mooij, M., 2013.Global marketing and advertising: Understanding cultural paradoxes. Sage Publications. Hair Jr, J.F. and Lukas, B., 2014.Marketing research(Vol. 2). McGraw-Hill Education Australia. Hartley, S., 2015. Domino's dominate with digital design.Busidate,23(3), p.2. He, W., Zha, S. and Li, L., 2013. Social media competitive analysis and text mining: A case study in the pizza industry.International Journal of Information Management,33(3), pp.464-472. Sheth, J.N. and Sisodia, R.S., 2015.Does marketing need reform?: Fresh perspectives on the future. Routledge.