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Thursday, August 27, 2020
Mergers and Acquisitions free essay sample
Mergers and acquisitions have gotten a significant medium to grow item portfolios, entering new markets, which would empower the organization, contend on a worldwide scale (Yadav and Kumar, 2005). Be that as it may, there have been occurrences where mergers and acquisitions are been gone into for non esteem augmenting reasons I. e. to simply manufacture the companyââ¬â¢s profile and notoriety (Malatesta, 1983; Roll, 1986). In any case, note that mergers and acquisitions don't routinely make an incentive for investors. Numerous mergers and acquisitions bomb also. Disappointment happens and it disintegrates the abundance of the investors when the reconciliation procedure for mergers and acquisitions doesn't work in appropriate stream. Just about 66% of the organizations who go into mergers and acquisitions result into disappointment, which prompts divestures at a later stage (Schweiger, 2003). 1. 1 Definition of Mergers and Acquisitions While the terms mergers and securing are regularly utilized reciprocally, these two terms are unique. We will compose a custom article test on Mergers and Acquisitions or on the other hand any comparable theme explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page In the scholarly writing, there are various writers who characterize merger, securing and takeover in an unexpected way. A merger is said to happen when at least two organizations consolidate into one organization. (Sudarsanam, 1995). The investors of the consolidating firms frequently stay as joint proprietors of the consolidated element. In mergers, there is finished mix of the benefits and liabilities just as shareholdersââ¬â¢ interests and organizations of the combining organizations. Notwithstanding, as per Sherman and Hart (2006), a merger is a blend of at least two organizations in which the advantages and liabilities of the selling firms are consumed by the purchasing firm. Gaughan (2002) takes a gander at a merger as a procedure where two partnerships consolidate, just one endures, and the combined company stops to exist. Mergers or amalgamation tangle take two structures: Merger through retention and Mergers through solidification. Ingestion is a blend of at least two organizations into a current organization. All organizations aside from one lose their personality in a merger through ingestion; On the other hand, solidification is a mix of at least two organizations into another organization. In this type of merger, all organizations are legitimately broken up and another element is made. In a solidification, the procured organization moves its advantages, liabilities and offers to the new organization for money or trade of offers. A securing then again, is the acquisition of a benefit, for example, a plant, a division or a whole organization. Sudarsanam (1995) characterizes procurement as a ââ¬Ëarms-length dealââ¬â¢, where one organization buys the portions of another organization and the obtained organization is not, at this point the proprietor of the firm. An obtaining hence is a demonstration of procuring successful authority over resources or the board of an organization by another organization with no mix of organizations or organizations. While a merger is an exchange between equivalent accomplices, acquisitions are utilized to signify an exchange where a considerably greater organization (the bidder) assumes control over a littler organization (the objective). A generous securing happens when a getting firm gains significant amount of offers or casting a ballot privileges of the objective organization. Along these lines, at least two organizations may stay free, separate substance yet there might be change in charge of organizations. A qualification among takeover and obtaining is made. The term ââ¬Ëtakeoverââ¬â¢ is here and there comprehended to imply antagonistic vibe. As a rule takeovers implies acquisitions. At the point when a securing is a constrained or reluctant obtaining, it is known as a takeover. As per Gaughan (2002), a takeover happens when the gaining firm assumes control over the control of the objective firm. A procurement or takeover doesn't really involve full, lawful control. . In spite of this need to explain the qualification between these terms which is in accordance with basic practice in scholastic writing regarding this matter, Chiplin and Wright (1988) proposes that the terms ââ¬Ëmergersââ¬â¢ , ââ¬Ëacquisitionsââ¬â¢ and ââ¬Ëtakeoversââ¬â¢ can be utilized equivalently in a scholarly examination circumstance. Also, as Sherman and Hart (2006) proposes a comparative methodology contending that, toward the end, the distinctions in the significance may not so much issue since the aftereffect of these procedures is frequently a similar I. e. two organizations that had separate possessions are working under a similar rooftop, generally to get some key and money related targets. 1. 2Motives for Mergers and Acquisition Mergers and acquisitions are key choices prompting the expansion of a companyââ¬â¢s development by improving its creation and showcasing activities. The blend of two organizations encourages: 1. 2. Cooperative energy: Another generally refered to rationale in mergers is the quest for synergistic advantages. This is the new money related math that 2+2=5 (Pearson, 1999) That is, as the condition appears, the blend of two firms will yield a more important element than the estimation of the whole of the two firms if they somehow happened to remain free. (Sherman, 1998). Collaboratio ns can be additionally talked about as being monetary, working or administrative cooperative energies. * Operational Synergy: Operational cooperative energies allude to those classes of assets that lead to creation as well as authoritative efficiencies (Peck, Temple 2002).
Saturday, August 22, 2020
A Collection of Famous Quotations About Time
A Collection of Famous Quotations About Time Time and tide anticipate none. The amazing tide of time overwhelms everything: realms fall, underhanded bites the dust, connections change, seasons shrivel, and the new sun rises. Here is an assortment of acclaimed time cites. Recall that time is cash. - Benjamin FranklinNever leave that tillâ to-morrowâ which you can doâ to-day. - Benjamin FranklinDost thou love life? At that point don't waste time, for that is the stuff life is made of. - Benjamin FranklinAs however a rose should close and be a bud once more. - John KeatsYears of affection have been overlooked in the contempt of a moment. - Edgar Allan PoeKeeping time, time, time, In a kind of Runic rhyme, To the tintinnabulation that so musically wells, From the chimes, ringers, ringers. - Edgar Allen Poeï » ¿The universes an air pocket, and the life of man, not exactly a range. - Francis Bacon Histories make men shrewd; artists, clever; the arithmetic, inconspicuous; common way of thinking, profound; good, grave; rationale and talk, ready to fight. - Francis Bacon Sweet adolescent days that were up to twenty days are currently. - William Wordsworth Can anyone recall when the occasions were not hard and cash not rare? - Ralph Waldo EmersonLife isn't so short yet that there is consistently time enough for civility. - Ralph Waldo Emerson For he lives twice who can on the double utilize, The current well, and even the past appreciate. - Alexander Pope ï » ¿Tis with our decisions as our watches-none go simply indistinguishable, yet each accepts his own. - Alexander Pope ï » ¿To me each hour of the light and dull is a marvel, each cubic inch of room is a wonder. - Walt Whitman
Friday, August 21, 2020
Nursing Essay Examples
Nursing Essay ExamplesOne way to demonstrate a point in a nursing essay is to write about something you personally know or can relate to. These things can be true, but you may want to be very careful not to lie about it. In other words, don't plagiarize. You have been warned.Writers who do this will often get into trouble when the teacher catches them. This is because most teachers look for examples that come from some form of personal experience, and if you use something you've read somewhere, you may be in for trouble. If you need some inspiration to write an essay about something you know about, check out some of the examples below.Nurses, hospitals, and nursing care packages have become staples in today's society. There are a number of stories and examples that could be used as samples of your own nursing essay. However, the greatest thing to use are real examples. Be sure to use sources from reputable sources so that you don't get in trouble with your professor.You can also take some of these stories and incorporate them into the story line of a novel that takes place in the medical supplies industry. After all, these things can be very entertaining. One idea is to tell a fictionalized story that you know first hand.Another example is to use a real example that is on a website, book, or movie. For example, there is a scene in a movie where the character is in a room that has her bare feet on some box springs that are covered in mud. Using that example in your essay will show how life really is. Another one is the time in school when you wanted to be a doctor, but you felt you were too short.Examples like these are always helpful. If you look around at websites, you can find many more examples than you can ever hope to use in your nursing essays. These examples are very well known, and they will make your thoughts flow naturally. Your essay will also not seem dry and boring.Look for good references for you to use in your essay. A great source is your profes sor. Keep in mind that professors are not always the best source, so be careful of that. They may feel they already know everything about the topic, and they may not be able to help you with the specifics.These are the best nursing essay examples that I have found. You can see lots of other great resources by searching online, and keep in mind that the power of the internet is not to be underestimated.
Monday, May 25, 2020
Japanese Hiragana With Audio Files
To learn Hiragana pronunciation, the following tables contains the 46 basic sounds found in Japanese. Click the link to listen the pronunciation of each hiragana character.à If you want to learn more aboutà Hiragana, have a look at ourà lessons, which will teach you each character and the correct stroke order. Learning the stroke order is a great way to remember how to draw each character. (a) (i) (u) (e) (o) (ka) (ki) (ku) (ke) (ko) (sa) (shi) (su) (se) (so) (ta) (chi) (tsu) (te) (to) (na) (ni) (nu) (ne) (no) (ha) (hi) (fu) (he) (ho) (ma) (mi) (mu) (me) (mo) (ya) (yu) (yo) (ra) (ri) (ru) (re) (ro) (wa) (o) (n)
Friday, May 15, 2020
Text Analysis of Mice and Men - 1400 Words
In the excerpts George and Lennie are two friends, one smart the other intellectually disabled, both on a ââ¬Ëmissionââ¬â¢ to achieve the American dream. Their journey reveals a lot about the two. Lennie is a follower, in that he follows and imitates Georgeââ¬â¢s every move. Lennie also suffers from a mental disability. It is also understood that they are from a working class upbringing. In the case of Lennie, it becomes very clear throughout the novel that he is a ââ¬Ëfollowerââ¬â¢. He follows George everywhere he goes, even going to the extent of imitating George, ââ¬Å"Lennie, who had been watching, imitated George exactlyâ⬠, (11-17). This clearly and blatantly shows and supports the ââ¬Ëfollowerââ¬â¢ notion, while at the same time showing Lennieââ¬â¢s insecurity.â⬠¦show more contentâ⬠¦The mere fact, that the very character that plays the largest part in Lennieââ¬â¢s death and the ultimate demise of the American Dream for the two main characters, does not have a name goes to show the sexism of society at the time, thus promoting a patriarchal context. Finally it is seen through Curleyââ¬â¢s actions towards his wife. ââ¬Å"You can talk to people, but I canââ¬â¢t talk to nobody but Curley. Else he gets madâ⬠(92-97) shows the domination of the male figure. That Curley is able to control his wife in such a manner strongly r e-enforces the patriarchal view. Language plays a large factor in revealing the age of the context in which the novel is set. The language used in the dialogue plays the biggest part in this. The only swear words mentioned are ââ¬ËBitchââ¬â¢ and ââ¬ËBastardââ¬â¢, and while these words are still offensive in the novelââ¬â¢s context, they are the only words used, dictating a much older context. If the text were a modern one the characters would posses a much larger arsenal of swear words thus, the context is an older one. Other dialogue features that point towards an older society are the use of grammar, but more importantly the phrases and words used. Words such as ââ¬Å"Trampâ⬠and ââ¬Å"Jail-Baitâ⬠are not terms used today (instead replaced by ââ¬Å"Slutâ⬠and ââ¬Å"A ticket to the canâ⬠respectively) the former showing an older setting. The racism shown towards Crooks also displays the age of the context of the novel. When Crooks says ââ¬Å"I ainââ¬â¢t wanted in the bunkhouseâ⬠¦ ââ¬ËCause Iââ¬â¢m blackâ⬠Show MoreRelatedTrap-Ease America: the Big Cheese of Mousetraps1483 Words à |à 6 PagesStudy one: Trap-Ease America: The Big Cheese Of Mousetraps Presented To: Dr. Ziad Haddad Presented By: Shady Habboub Fall Semester 2009-2010 1- The Mission Statement of Trap-Ease America: ââ¬Å"We want to free your homes from mice. Fathers: you can protect your families easily and safely. Trap-Ease America is your state of the art solutionâ⬠2- The opportunities that arise in the environment, if successfully captured by firms or entrepreneurs could become a success storyRead MoreFriendship and Overcoming Adversity1200 Words à |à 5 Pages Topic: Friendship and Overcoming Adversity Story: ââ¬Å"Of Mice and Menâ⬠by John Steinbeck ( a story about the hardships of two diverse men and their friendship) Literary Text: ââ¬Å"Finding Nemoâ⬠by Andrew Stanton Introductory Claim: Of Mice and Men- Both ââ¬Å"Of Mice and Menâ⬠and ââ¬Å" Finding Nemoâ⬠both display an example of friendship and overcoming adversity within the novel and movie. Body 1: Of Mice and Men- Claim: Steinbeck displays the ideal of friendship and overcoming adversity within his novelRead MoreOf Mice And Men Rhetorical Analysis1458 Words à |à 6 Pages Of Mice and Men Rhetorical Analysis Adrian Blackstone Mrs. Adkins AP Lang Comp 3/5/15 In 1929 the effect of The Great Depression echoed throughout The United States. Forcing many farmers to sell their farms and give up on their pursuit of the widely sought after American Dream. Although in third person Steinbeck centers the novella around the two main characters George, and Lennie. Using strong rhetorical strategies such as diction, imagery, novel structure, and literary devices. SteinbeckRead MoreAnalysis Of Walt Whitman s I Hear America Poem1314 Words à |à 6 Pagespoem, and argumentative essays, like out The Raven analysis. We also gave speechesââ¬â that was the hardest for me, in my previous English classes, none of them made me go in front of the class and presentââ¬â, made infograph, and even a multigenre project. We also canââ¬â¢t forget the books weââ¬â¢ve read in class, like poems from Emily Dickinson, Walt Whitman, Edgar Allan Poe, and novels from F. Scott Fitzgerald, and we canââ¬â¢t forget novella like Of Mice and Men or short stories t hat we read in our English textbookRead MoreOf Mice and Men Literary Analysis1242 Words à |à 5 Pagesï » ¿Of Mice and Men Literary Analysis Of Mice and Men is a novel about two men and their struggle to reach their dreams of owning their own ranch. George Milton and Lennie Small are best friends, who despite of all their extremely difference personalities, but still manage to work together, travel together and get rid of anything that gets in their way. The friendship between George and Lennie is prevalent throughout the book, but it is shown most explicitly in their plan to live on a farm togetherRead MoreAnalysis Of Of Mice And Men 2046 Words à |à 9 Pagesknowing the facts. Reasons can be due to a certain trait, characteristic, ethnic background etc. This includes racism, sexism, and ageism to name but a few. I am exploring the issue of prejudice, in three different texts ââ¬ËOf Mice and Menââ¬â¢, ââ¬ËHalf Casteââ¬â¢ and ââ¬ËStill I Riseââ¬â¢. ââ¬ËOf Mice and Menââ¬â¢ is a novel published in 1937 by John Steinbeck, set in the 1920ââ¬â¢s. It follows George Milton and Lennie Small, two dis placed migrant ranch workers, who move from place to place in search of new job opportunities duringRead MoreAnalysis of The Cinematic Techniques That Are Used To Capture The Audiences Interest In The Opening Sequence Of The Film Of Mice And Men1357 Words à |à 6 PagesAnalysis of The Cinematic Techniques That Are Used To Capture The Audiences Interest In The Opening Sequence Of The Film Of Mice And Men In the first moments of a film, the director will attempt to capture the audiences imagination. He does this so that the audience maintains its interest. The Director will use a number of cinematic techniques to create a sense of urgency, suspense and dramatic tension. These techniques are often shown by fusing picture and sound. An exampleRead MoreOF MICE AND MEN ESSAY Libre2222 Words à |à 9 PagesOf Mice And Men Essay Of mice and men essay State of California. essay writers salt lake city research paper writing chattanooga buy college ruled paper. Of mice and men essay Metis-sur-Mer of mice and men essay Columbus, Leicestershire, Palmdale, Bakersfield of mice and men essay san antonio write essay for me, of mice and men essay Alexandria uploading essay to common app, Chester of mice and men essay Norfolk geometry and algebra 1 formula sheet Of mice and men essay State of Rhode Island andRead MoreJohn Steinbeck s The Loss Of Their Dream 1795 Words à |à 8 Pagesof the characters. Lewis Milestoneââ¬â¢s film Of Mice and Men is not only worthy of analyzing its cinematic resources, but its emphasis on the obstacles individuals encounter in achieving the American Dream. The historical event this film is based on is the Great Depression from 1929 to 1939, which started after the famous stock market crash happened in October 1929, this affected many investors and caused desolation in so many countries. Of Mice and Men not only conveys the obstacles of achieving theRead MoreAnalysis Of Of Mice And Men And Death Of A Salesman1810 Words à |à 8 PagesJohn Steinbeck and Arthur Miller elucidates the theme of hopelessness ingrained in the American Dream, through the analysis of the many characters in their texts(Of Mice And Men Death Of A Salesman).Of Mice And Men was set in 1937,it had been set in the event of the great depression , at this time unemployment rate had boosted up, thus leaving majority thoroughly poor, the text relates to this event as all characte rs are either working to escape poverty or had already failed to escape it. Death
Wednesday, May 6, 2020
The Media s Influence On Suicide Rates - 1885 Words
The Mediaââ¬â¢s Influence on Suicide Rates Over the years, the publication of deaths has changed. There has been a general increase of media coverage around deaths surrounding suicides due to the increasing growth of social media and technology. A critical review on literature will analyze how publicized suicides in the media have influenced societal suicide rates. The literature reviewed will be analyzed in comparison to models of suicide from Emile Durkheim and Edwin Shneidman. The large theoretical issue of suicidal deaths will be examined in comparison to current literature precise to suicide coverage within the media. The media is a strong outlet that can influence the attitudes of society. With an addition of celebrity media coverage, it provides an even stronger media outlet. The coverage of celebrity suicides broadcasted through mass media impactââ¬â¢s societies by having a negative impact on attitudes of individuals causing an increase in suicide rates. Models of Suicide The death of a role model can affect fans of a celebrity in many ways. Edwin Shneidman created a cubic model classifying the three factors that influence suicide. He believed factors he termed as press, psychache and perturbation to be predictors of suicidal behaviour (Hadad, 2008). The term press, referred to positive or negative events that can affect the individual. Negative events such as large exposure to a highly idolized celebrity suicide can interpret negative emotions to an individual, which canShow MoreRelatedYouth Suicide in Australia: A Report Essay755 Words à |à 4 Pagesdone enough to prevent youth suicide by showing the background and social significance of the issue. Furthermore, the participants involved and their controversial opinions related to the issue will be analyzed in this report as well. 2. The issue and the Background to the Issue Since the mid to late 1990ââ¬â¢s, youth suicide has become a common cause of death for young Australians (Carter 2010 para. 1). The government then acted and managed to reduce the suicide rate, which was a success (Carter 2010Read MoreThe Main Environmental And Emotional Causes And Crisis Intervention Of Teen Suicide Essay1643 Words à |à 7 PagesThis paper will discuss the main environmental and emotional causes and crisis intervention of teen suicide based on experimental facts and assessment studies. In todayââ¬â¢s society, suicide rates continue to rise amongst teens. In some suicide cases, family and friends are caught completely off guard as signs can be misinterpreted. Why does suicide come as a surprise to family and friends and what can be done to decrease the record high will be one of the points within this paper. Early recognitionRead MoreThe Effects Of Internet On Young People At Risk Of Suicide1171 Words à |à 5 PagesThere is concern that the Internet is pla ying an increasing role in suicide. Youth who self harm or are suicidal often make use of the internet. It is commonly used for helpful reasons such as searching for support or for coping mechanisms, but it can exert a negative effect, standardizing suicidal behavior or preventing disclosure or discouraging seeking help from metal health professionals. The internet has created online communities that can be used as support, and communities that can be misusedRead MoreJosee Young . Eng Iv B 1St Hr. May 19, 2017. Suicide1564 Words à |à 7 PagesJosee Young Eng IV B 1st hr May 19, 2017 Suicide One of the questions sociologists have attempted to answer is. ââ¬Å" What drives people to commit suicide? Most teens who have been interviewed after a suicide attempt say that what causes teen suicide are feelings of hopelessness and helplessness. Suicide is when a person end his or her own life. Studies show that at least 90% of teens who kill themselves have some type of mental health problem, suchRead MoreMexican Society in the eyes of Karl Marx and Emile Durkheim1118 Words à |à 5 Pagesto explore a current event in Mexican society and the influence of social media which we attempt to view through the eyes of both Karl Marx and Emile Durkheim. We will focus on Karl Marxââ¬â¢s conflict theory of capitalism and Emile Durkheimââ¬â¢s structural functionalism theory of dynamic density. Both theories remain relevant today, and a correlation exists regarding the effect of social media on egoistic versus altruistic states of anomic suicide in present society. In summation of the article, the MexicanRead Moreweb dubois1041 Words à |à 5 Pagessocial issues such as suicide? How does the psychological perspective view suicide? What is unique about the sociologist s perspective? On a social issue such as suicide, cultures differ because many people feel this is a personal problem whereas others feel that this can be a public issue. If a person commits suicide, it may have been as a result of his or her personal problems. In a larger society, this suicide is a public issue because the person who committed suicide is not the only one thatRead MoreMedia Eating Disorders1607 Words à |à 7 PagesIntroduction The aim of this literature review is to describe the main causes of eating disorders among teenagers aged 12 to 18 years old in high schools globally, and to also explain to what extend do some of these causes influence eating disoders. Recent studies have indicated a major increase in the eating disorder habits and body dissatisfaction in adolescence over the past few decades. This crisis seems most prevalent in females`` than males with 20 percent high school females exhibiting poorRead MoreGun Control Is Not Regulated Now Essay1418 Words à |à 6 Pagesour neighborhoods and environments to establish healthy relations within the community, to reduce the influence of firearms to children at a young age, especially by social and mass media and greatly reduce the rate of death around us by firearms. This can be achieved by establishing new laws within society, that will lead to a change in certain behaviors, thus reducing firearm influential rate. Some critics tend to argue that enforcing stricter laws such as on hand guns is a violation of theirRead MoreTeen Pregnancy Is A Convenient Excuse1152 Words à |à 5 Pageswith young people, at home, at school, in religious communities - and yes, even in the media - about sex and sexuality in ways that help them understand and believe that they have a choice: the choice to be teens before becoming teen parents.â⬠Neither the media content or country should be blamed for the influence of teen pregnancy. The rate of teenage pregnancy in the United States is often blamed on social media, whoever this is not the case. According to Elizabeth Schroederââ¬â¢s article Blaming TVRead MoreDo Western Diets and Lifestyle Negatively Affect Peopleââ¬â¢s Health?1489 Words à |à 6 Pagesexercise lead to the fact that people get disease like obesity, high blood pressure, and some cancers which are hazardous to peopleââ¬â¢s health. Another reason for the harmful effects of western diets and lifestyle is western lifestyle has passive influence on peopleââ¬â¢s mental health. First, high stress in work and bad habits like smoking and drinking may lead to more risk of mental illness. As everyone knows, it is the important identification of western lifestyle which includes intemperance, smoking
Tuesday, May 5, 2020
Spinal Cord Injury free essay sample
Spinal Cord Injury Spinal cord injuries (SCIs) most commonly occur as a result of falls, motor vehicle accidents, violence, sports injuries, or any other form of impact directed to the spinal cord. Over half of SCIs occur in the adolescent or young adult age group, although the elderly population is at increased risk for SCI because of normal degeneration of the delicate spinal cord (Nayduch, 2010). These injuries can be fatal, cause permanent damage, or have temporary or no effect to the individual at all. Spinal cord injuries occur when there is damage to the neurons of the spinal cord (Huether, 2008). They are usually classified by the type of injury and where it occurs along the spinal cord. Fractures of the bones along the spinal cord or dislocations or partial dislocations of the bony structures most commonly cause SCI. The patient can experience many types of SCI including: * Concussion- short term disruption of the normal anatomy of the spinal cord * Compression- pressure on the spinal cord * Contusion- bruising or local short term damage to the spinal cord * Laceration- a tear in the spinal cord tissue Transection- a complete severing of the spinal cord * Hemorrhage- bleeding into or around the spinal cord causing pressure and irritation on the cord itself or surrounding tissues * Damage to the blood vessels surrounding the spinal cord causing local damage where the bleeding occurs (Nayduch, 2010). We will write a custom essay sample on Spinal Cord Injury or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page All of these types of injury to the spinal cord can cause swelling, bruising, nerve damage, localized bleeding, inflammation, and/or tissue necrosis. These injuries can also be classified as complete or incomplete. A complete SCI indicates no motor function below the site of injury while incomplete SCIs can have some remaining level of sensory and/or motor function below the level of injury. Most vertebral injuries occur along the most mobile areas of the spinal cord, including C1-C2, C4-C7, and T10-L2 (Huether, 2010). All of these injuries have the potential to be devastating. Spinal shock can occur, resulting in complete loss of function. This is a temporary occurrence and usually lasts up to 3 months after injury. It involves paralysis, loss of reflex, loss of bladder/bowel control and sexual dysfunction. It can also cause systemic changes, such as loss of temperature control, decrease in blood pressure, and poor venous circulation. When function returns, it is usually demonstrated by return of movement, reflexes, and bowel/bladder control (Heuther, 2008). As function returns, an uncompensated cardiovascular response can occur called autonomic hyperreflexia. This is a life threatening emergency and must be treated immediately. If left untreated, the result is death. Autonomic hyperreflexia displays as a dramatic rise in blood pressure, pounding headache, excessive diaphoresis (sweating), nausea and bradycardia. This is caused by ââ¬Å"stimulation of the skin or pain receptorsâ⬠such as delayed bowel or bladder emptying and can be treated by first fixing the cause of stimulation (Huether, p. 379). Quick but thorough evaluation, diagnostic testing and treatment determined by findings is essential to sustain life in most patients with SCI. Airway, breathing and circulation must first be assessed followed promptly by full spinal immobilization including a cervical collar and long backboard. Immobilization can help decrease the chance of secondary injury (Nayduch, 2010). Continuous monitoring of blood pressure and temperature regulation must also occur. Nurses can also conduct a thorough neurologic exam which must be reassessed often to monitor for a change or worsening in condition. Movement including flexion and extension of body parts, pupil exam, muscle tone and vital signs must all be assessed to determine the extent of injury. Diagnostic evaluation leading to diagnosis includes physical exam, CT scan, MRI, radiologic studies and myelogram (Heuther, 2008). Treatment is aimed at reducing initial injury and preventing secondary damage. The patient must be closely monitored for spinal shock and automonic hyperreflexia. Patient education is a necessary nursing intervention for patients with SCI. All spinal cord injuries require close monitoring and therefore should be in an intensive care setting. Early stabilization (either in the field or in the ED) is key in treating SCI, and must continue on through the patientââ¬â¢s admission to the ICU and thereafter. Surgery to repair boney injury, decompress nerves and tissue, or insert long-term stabilization devices may be necessary. Some patients will need external stabilization devices that they wear for any amount of time up to one year. SCI patients are usually bedridden or severely limited in their activities, therefore the nurse must always be aware of the risk for skin breakdown, pneumonia, and deep vein thrombosis (DVT) or pulmonary emboli (PE) (Nayduch, 2010). Nursing interventions for these patients include frequent turning and change of position, instituting cough/deep breathing exercises, applying compression stockings, and monitoring any infusion of anticoagulants. Again, patient education is key in these patients.
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