Why bad projects are so hard to kill Essay Example | Topics and Well Written Essays - 250 words

Why bad projects are so hard to kill - Essay Example Bad projects are continued because of charismatic project champions who can easily influence key decision-makers in blindly supporting the project. Royer provides the example of Lafarge, where project members revealed that they immediately supported the project because the project champion believed it to be a future winner (53). When the â€Å"emergence of belief† in the project’s achievements is combined with strong management desire for success, the result is blind allegiance to a poorly-planned and assessed project (Royer 53). The power of charisma and grandeur visions of success can cloud the planning process and omit risk-assessment (Resch 41). Royer notes that some of the negative repercussions of bad projects are: large financial losses and resignation of exit champions. Lafarge lost $30 million (in 1992 dollars) and a new mineral-fillers manager who questioned the bad project’s feasibility (52). This manager represents exit champions who would have encour aged a critical approach in assessing the bad project. Widman provides some positive effects of bad projects, such as leading to new more promising projects. For instance, IBM 7030 or â€Å"Stretch† failed to be a feasible and profitable project, but resulted to the inventions of â€Å"pipelining, memory protection, memory interleaving and other technologies that have shaped the development of computers† (Widman 1). Thus, failed projects can lead to large losses of money and talent, but some can also lead to new

Legal advice to Bruce on his emergency leaves Essay

Legal advice to Bruce on his emergency leaves - Essay Example Legal Position Every employee has a right to emergency leave to take care of dependants across many labor law jurisdictions. Public and private employees have equal access to time allowance in order to take care of their dependants, usually in form of unpaid emergency leaves. According to Miller (2012, p. 419), the Family and Medical Leave Act (FMLA) of 1993 was enacted to provide protection to employees who require emergency leaves to take care of family or medical needs. The Act provides for emergency leave allowances of up to 12 weeks per year for general employment environment, which is accordingly extended in certain types of reasons for the dependant’s emergency need. For instance, if the dependant needs care following an injury while on a military duty, the Act provides for emergency leave of up to twenty six weeks a year. Under the details provided in the case facts, it is not clear what the cause is for the illness that Mary suffers from. The bottom line, however, is that Bruce as an employee is entitled to a certain amount of time for emergency medical attention for his wife. Within the restrictions under the Act for the number of weeks allowed within a twelve months working period, the question of how procedural Bruce was in taking leave may be the cause of the stand-off as opposed to whether he had a claim (McFarlane 2012, para4). It is not clear how many days Bruce took the emergency leaves as well as the reason for the illness that his wife suffered from. As explained above, there are certain causes of Mary’s sickness that could extend the days allowance. The size of the organization in which Bruce works may also bring the consideration of the length of time that he has claimed for emergency leaves into perspective. Ordinarily, the duration of the leave within the twelve month period is dictated by the size of the employee base, which is assumed to be 50 employees (Hunter 2009, p183). However, certain states do not have reservations in the limit of number of employees in the organization in order for the emergency leave to be allowed. It is only logical for the employees to be allowed to take an emergency leave if there is enough cover during the absence, presumably from the pool of colleagues. The danger to life of the dependant may, however, compel the situation to be stretched to accommodate emergency leaves. In order to qualify for an emergency leave, the employee must satisfy the basic requirements of an emergency under the Act. According to the case facts, Bruce’s relationship with Mary qualifies to access an emergency leave on family grounds. Perhaps more definitions of marital status and relationship would require visitation, but the low threshold on cohabitation may dispel such doubts. In case the employer requires proof of entitlement, Bruce will have to provide some form of evidence to support the argument that Mary is his wife (Hunter 2009, p24). Although certain circumstances may make it imp ossible to prove such a relationship immediately, the requirement of evidence reasonable under the circumstances is a sufficient proof. Legal Advice Bruce’s position in this case is that though he is entitled to a medical emergency leave for his spouse’s care, there are limitations in the allowable number of days. The sickness of Bruce’s wife is reportedly a lengthy one, stretching to over 15 years. However, it is not verifiable how many days

Analysis of the Reptile Garden Essay Example | Topics and Well Written Essays - 1250 words

Analysis of the Reptile Garden - Essay Example When viewed in retrospect, it becomes evident that the incident of Anais getting locked in the garden room was of central importance to the development of her character, and to the different events that befell her later in her life. Although she denies this towards the end of the story, her ingestion of the drug and getting locked in the garden room was a transition point in he life. The most intriguing feature of this episode is the appearances of reptiles, followed by amphibians, that led to Anais getting scared and crying. Since the title of the story is also related to this garden room full of reptiles, this episode is of central importance to the story, so it would be discussed first. There could be several interpretations of this incident. The focus on the appearance of reptiles, with a subsequent transition to amphibians could denote the process of evolution from one species to the next, higher level of species. The writer could have used this approach to make an analogy for t he development and evolution of the Anais’ personality and character. This could be a way of depicting her growth as a person, and her development into the individual that she was meant to be. So she came out of that room a changed and evolved person, who was now had different aims and a different approach to life. Another explanation could simply be that Anais got terrified and disturbed due to her experience in the garden room; her loneliness, her exposure to animals, insects and other reptiles, her unhealthy condition due to the ingestion of the acid that was given to her by her cousin, and her sheer sadness that led her to weep alone in the room. Being subjected to such adverse experiences, she came out of that room a terrified and weak person, who was paranoid and always scared for her safety, since she â€Å"couldn’t stop shaking at the slightest unexpected movement† (Erdrich). This deterioration of her personality could have been the reason for her extrem e attachment to Nonette later, and even made her wonder why she got so weak when her parent’s love for her was so strong (Erdrich). A third interpretation of the episode could be that the incident broke her free from her habits, her compulsive attitude_ the evidence of which comes from her uncontrolled habit of cleaning the bathroom, even at midnight_ and the self-absorbing shell that she had encased herself into to keep the world at bay; and led her to experience new activities and desires that she had perhaps not allowed herself to experience before. It made her more reckless and carefree, and more spirited to live life in a manner different from what she was accustomed to and had been trained for. Perhaps the best explanation is the combination of the former two. It is evident that she was frightened by her experience in the garden room. Considering the emphasis placed on the appearances of the different animals, and the writer’s special mention of the appearance of first reptiles and then amphibians, it can be deduced that the Anais, after emerging from the room, had evolved into a scared, weak, and overall different person from a focused, stable individual who went into the room. The next intriguing event is Anais’ statement about Nonette, when she muses â€Å"

Legal advice to Bruce on his emergency leaves Essay

Legal advice to Bruce on his emergency leaves - Essay Example Legal Position Every employee has a right to emergency leave to take care of dependants across many labor law jurisdictions. Public and private employees have equal access to time allowance in order to take care of their dependants, usually in form of unpaid emergency leaves. According to Miller (2012, p. 419), the Family and Medical Leave Act (FMLA) of 1993 was enacted to provide protection to employees who require emergency leaves to take care of family or medical needs. The Act provides for emergency leave allowances of up to 12 weeks per year for general employment environment, which is accordingly extended in certain types of reasons for the dependant’s emergency need. For instance, if the dependant needs care following an injury while on a military duty, the Act provides for emergency leave of up to twenty six weeks a year. Under the details provided in the case facts, it is not clear what the cause is for the illness that Mary suffers from. The bottom line, however, is that Bruce as an employee is entitled to a certain amount of time for emergency medical attention for his wife. Within the restrictions under the Act for the number of weeks allowed within a twelve months working period, the question of how procedural Bruce was in taking leave may be the cause of the stand-off as opposed to whether he had a claim (McFarlane 2012, para4). It is not clear how many days Bruce took the emergency leaves as well as the reason for the illness that his wife suffered from. As explained above, there are certain causes of Mary’s sickness that could extend the days allowance. The size of the organization in which Bruce works may also bring the consideration of the length of time that he has claimed for emergency leaves into perspective. Ordinarily, the duration of the leave within the twelve month period is dictated by the size of the employee base, which is assumed to be 50 employees (Hunter 2009, p183). However, certain states do not have reservations in the limit of number of employees in the organization in order for the emergency leave to be allowed. It is only logical for the employees to be allowed to take an emergency leave if there is enough cover during the absence, presumably from the pool of colleagues. The danger to life of the dependant may, however, compel the situation to be stretched to accommodate emergency leaves. In order to qualify for an emergency leave, the employee must satisfy the basic requirements of an emergency under the Act. According to the case facts, Bruce’s relationship with Mary qualifies to access an emergency leave on family grounds. Perhaps more definitions of marital status and relationship would require visitation, but the low threshold on cohabitation may dispel such doubts. In case the employer requires proof of entitlement, Bruce will have to provide some form of evidence to support the argument that Mary is his wife (Hunter 2009, p24). Although certain circumstances may make it imp ossible to prove such a relationship immediately, the requirement of evidence reasonable under the circumstances is a sufficient proof. Legal Advice Bruce’s position in this case is that though he is entitled to a medical emergency leave for his spouse’s care, there are limitations in the allowable number of days. The sickness of Bruce’s wife is reportedly a lengthy one, stretching to over 15 years. However, it is not verifiable how many days

Management of change Essay Example | Topics and Well Written Essays - 3000 words - 1

Management of change - Essay Example ctively utilize the employees as well as suggesting suitable human resource management strategy that can be used to manage and empower the employees within the organisation. Implementing a new order in an organisation is concerned with change of the current operational system and in most cases change is met with resistance by many employees as a result of many factors. For the initiative to be successful, there is need for re-orientation of the workers through provision of basic training and development which would be closely monitored upon implementation as going to be illustrated using the lessons learned from the case study of Image Makers. The Image Makers advertising agency was founded in Switzerland in 1990 by two graduates who studied together at University. Over the years, the agency has grown and has received recognition within the industry for its innovation and creativity, particularly in the use of information technology which continued to develop tremendously. Inspired by the positive growth of the organisation, the two directors recently embarked on an initiative to establish Image Makers as an international company with offices across the globe. This was also necessitated by the organisation’s good reputation for being an innovative as well as a renowned company for attracting and retaining talented workers. However, this initiative redefined its performance history as well as its operations. This meant that some of the skilled workers were to be relocated to other countries where the organisation intended to open up offices. This led to the resignation of two managers, loss of two accounts personnel as well as some form of resistance from other employees which has led to poor performance among other things. Thus, the major aim of this essay is to suggest strategies that can be adopted and give a critical analysis of the best structure, culture, and systems that are necessary to make the change initiative work. A reflection about the action plan

The Model Devil Essay Example for Free

The Model Devil Essay Humanity views Satan in different forms, having various ideas of his being. Each race and religion has different faces of what Satan is. However, the world universally associates him with one concept: evil. Lucifer – his alternative name – has been depicted in religious teachings, in films, in literature, and in music throughout the years. All of these depictions give him life, thus giving humanity a solid picture of what is evil. The face of evil has been portrayed in two of the most prominent works of literature. Christopher Marlowe’s Doctor Faustus has Mephistophilis as the main character for the devil. It was followed by John Milton’s Paradise Lost which gave a detailed account of Satan’s background. These two literary works shared notable descriptions of the devil and became the basis of most people on how hell and Lucifer was viewed. Doctor Faustus referred to the German academician, Faust, who sold his soul to Lucifer in exchange for power and knowledge. One of Lucifer’s trusted follower, Mephistophilis was summoned by the doctor’s practice of necromancy. Faust spent the remaining twenty four years of his life doing deeds that will acquire him power through Mephistophilis’ assistance. The doctor questioned about the world by having debates with the servant of Lucifer. The devil also acted as a guardian to the doctor to make sure that he will follow the oath. The devil was portrayed in Marlowe’s work as the messenger of Lucifer. He generously shared with Faustus the truths of hell and willingly participated with Faust’s debates. From their first meeting Mephistophilis transformed into a Franciscan friar because Faust was unable to bear the devil’s original appearance. I charge thee to return, and change thy shape; Thou art too ugly to attend on me: Go, and return an old Franciscan friar; That holy shape becomes a devil best. (Marlowe) It was more convenient interacting with the devil after Faustus asked Mephistophilis to change its hideous form. Mephistophilis can be symbolized as an Angel of Death during his companionship with Faust’s last twenty four years. The devil aided Faustus in fulfilling every worldly desire. On the other hand, he watched the doctor closely to make sure that every move will only be faithful to the oath with Lucifer. The devil was with him until the very last day he lived on earth. In the course of the story, some scenes may have given an impression that Mephistophilis was portrayed in a friendly manner with some of the conversation with Faust. O, Faustus, leave these frivolous demands, Which strike a terror to my fainting soul! (Marlowe) Mephistophilis have been helping Faust because of the duty that was bestowed on him. On the other hand, the words that the devil uttered had an impression of allegiance with the doctor. The very moment that Dr. Faustus repented by the end of the story, that was the time that Mephistophilis had taken his life. The devil may have become a servant of Faust however; its loyalty still remained with Lucifer. Mephistophilis was able to claim Faust’s soul and the devil made sure the pact will be accomplished. This literary work of Marlowe became a model for the depiction of evil specifically in poetry. John Milton came out with an epic entitled Paradise Lost that has a brief similarity with Marlowe’s character. Milton’s work offered what the Catholic bible has forgotten to explain. He related a detailed account of Satan’s origin and how the formation of evil and hell came about. The dearest angel of God had begun to take pride into him and desired to be as powerful as the Almighty. Satan gathered all the other angels who shared the same view or who were persuaded by him, until a battle erupted in heaven. Defeated by God, all of the rebels were thrown out of heaven and fell into a burning lake. From this event, Satan took the role as the leader and started formulating strategies to defeat God. More than can be in Heaven, we now return To claim our just inheritance of old, †¦Whether of open war or covert guile, We now debate. Who can advise may speak. (Milton Book II)   The beginnings of Satan’s kingdom inflicted an inner conflict for the fallen angel. The defeat made him realized more of God’s superior power. The debates of whether to wage war or not, posed his hesitations of seeing his chances of winning but shortly, his pride and narcissism earned his confidence. To battle Heaven directly, he knew that the chances were slim but he was able to find a possible target to fight God. In Book II of Milton’s Paradise Lost, Satan was informed of the new world being built by God. †¦There is a place (If ancient and prophetic fame in Heaven Err not)—another World, the happy seat Of some new race, called Man, about this time To be created like to us, though less In power and excellence, but favoured more Of him who rules above; (book II) He found the new world as a vulnerable environment. Satan saw the vision inside him that if this world will be destroyed, he can persuade man to join his forces to fight God.   This particular work of Milton showed an evolution of an important character in humanity. Satan was given an established identity by relating his origin. The rest of Paradise Lost narrated the fallen angel’s quest for the downfall of man. When he succeeded with his plans with Adam Eve, he was able to create his own kingdom called Pandemonium. This place, in the eyes of the readers, became the physical location of hell. The depiction of these two characters has made a striking impact on how people of today view evil. Mephistophilis and Satan shared attributes that made them identifiable with the concept of evil. Somehow, these fictional devils became real in the eyes of the people. Marlowe and Milton were able to create a solid image of the devil that prompted society to view evil according to what the authors made. From the two literary works, the concept of hell was the first aspect that was discussed. Mephistophilis and Satan both narrated that hell cannot be found in a physical territory. Hell was viewed as a state of mind. A torture that cannot be determine unless it is felt. Within the bowels of these elements, Where we are tortur’d and remain for ever: Hell hath no limits, nor is circumscrib’d In one self-place; but where we are is hell, And where hell is, there must we ever be: †¦Ay, think so still, till experience change thy mind. (Marlowe) The Hell within him; for within him Hell He brings, and round about him, nor from Hell One step, no more than from himself, can fly By change of place: Now conscience wakes despair. (Milton Book IV) The above citations from both books pertain to the same views of the two devils regarding the concept of hell. It can be said that this particular notion of hell suggested that to see hell is to be emotionally tormented. The devils both interacted closely with humans with the intent of man’s destruction.   It was seen from both literature that man was seen as a weapon to battle God. Man as God’s creation was made vulnerable to temptations. This was used by the devil to lure man to commit sin and to disobey God. Both of the devils’ pursuit to lure man into disobedience was accompanied in the form of disguise. The transformation of Mephistophilis into a friar can symbolize Faustus’ desire to mock religion. Faustus was portrayed as a highly ambitious man who excelled in all academic areas and disregard religious laws. As Mephistophilis changed, this helped Faustus to interact with the devil without feeling intimidated and even gaining a sort of camaraderie in some of their outtakes. MEPHIST. †¦Here, take this book, peruse it well: The iterating of these lines brings gold; †¦Pronounce this thrice devoutly to thyself, And men in harness shall appear to thee, Ready to execute what thou commandst. FAUSTUS. Thanks, Mephistophilis, for this sweet book: This will I keep as chary as my life. (Marlowe) On the other hand, Satan changed into a serpent to blend with the nature of Adam and Eve’s habitat. It was easier for him to tempt Eve in the form of a creature that was made by God as well. God created the world and placed Adam and Eve in paradise, where animals were created to aid the couple in taking care of the land. The serpent being part of that creation, posed no threat to Eve. From Milton’s Book IX, it was easy for Satan to tempt Eve in the form of a serpent to serve as evidence that the beast did not die after eating the fruit. Thus, it made his lie more convincing. Whose rigid threats of Death; ye shall not Die: How should ye? by the Fruit? it gives you Life To Knowledge, By the Threatner, look on mee, Mee who have touchd and tasted, yet both live, †¦Shall that be shut to Man, which to the Beast Is open? or will God incense his ire For such a petty Trespass, and not praise Rather your dauntless virtue. (Book IX) In the course of events from both literary works, Mephistophilis and Satan shortly expressed a desire to re-experience the joy of heaven. Why, this is hell, nor am I out of it: Thinkst thou that I, that saw the face of God, And tasted the eternal joys of heaven, Am not tormented with ten thousand hells,   In being deprivd of everlasting bliss? (Marlowe) Mephistophilis described to Faust that heaven is an eternal joy. The devil was completely aware that by being damned together with Lucifer, it entailed a never ending unhappiness of the spirit. Me miserable! which way shall I fly Infinite wrath, and infinite despair? Which way I fly is Hell; myself am Hell; And, in the lowest deep, a lower deep   Still threatening to devour me opens wide, To which the Hell I suffer seems a Heaven. O, then, at last relent: Is there no place Left for repentance, none for pardon left? None left but by submission; (Milton Book IV) On the other hand, Satan shortly reflected of his previous stature from heaven. It can be considered that the particular text above gave a shadow of regret from Satan’s rebellious action. This desire of wanting to go back to heaven was depicted in the two literatures very briefly. In the end, both devils were overpowered by their decision to do evil deeds and battle God. Mephistophilis and Satan were associated in the same concept of evil. However, both of them were shaped and portrayed differently in the development of each story. They differed in creating impact and affecting changes in the flow of events. Christopher Marlowe’s Doctor Faustus already had an existing concept of evil where his characters and plot revolved around it. But it was Paradise Lost by John Milton who related the origin of evil. Taking that into account, it can be seen why Satan was portrayed as a political leader and Mephistophilis as Lucifer’s messenger. Milton made Satan navigate the direction of events in Paradise Lost. Being the central character, Satan’s actions created huge effects on other characters. On the contrary, though Mephistophilis was only described as a follower, he was the cause of the downfall of the central character when he ended Faustus’ life. The story of the origin of evil provided Satan’s character with depth. It entailed that evil has a reason why it exists, that somehow it can be justified. Unlike Mephistophilis who interacted with Faustus out of sheer pleasure for doing evil, Satan had progression with his character. The approach with evil was more personal and Paradise Lost showed the inner workings of Satan’s mind which was beyond unimaginable in Marlowe’s poetry. Satan can be seen either as a protagonist or a villain. He was bounded with a purpose, his character behaved as such because of that purpose. Mephistophilis’ dialogue was similar to the evil angel urging Faust not to repent. He was consistently persuasive and encouraging to Faust in fulfilling every worldly desire and denouncing God. Satan, on the other hand, exuded more of an emotional tone in his words. His despair and anger reflected the vengeance that he wanted to achieve against God because of his downfall. Here we may reign secure; and, in my choice, To reign is worth ambition, though in Hell: Better to reign in Hell than serve in Heaven. (Book I) Centuries have passed after Marlowe and Milton created these notable literary classics. The modern society still perceives evil as similar from the characters that were drawn in the poetries. Mephistophilis and Satan became prominent figures especially in the aspects of religious issues. These two created recognized features of the devil which were once incoherently described by religious entities. The devil may have been derived from fictional creations but it became part of human reality.

Case study of a man with parkinsons disease

Case study of a man with parkinsons disease Mr Henderson has arrived in hospital after a history of falls at home and has just commenced a new medication regime. It is very possible that he may be anxious, worried, frightened as a result of falling at home which also may result in loss of confidence. He may also be apprehensive about his new medication regime. Having been diagnosed with Parkinsons for 5 years, he more than likely knowns the importance of getting his medications on time, in reducing the symptoms allowing him to maximise his independence. However, it is not for the nurse to presume this and she/he must sit down, talk to him, allowing him time to talk and express his worried and anxieties. This was help to establish a relationship and Mr Henderson will understand that you are there to support him throughout his journal of care. The nurse should also make sure that all members of the multidisciplinary team are aware of Mr Hendersons condition and if they are not aware of the importance of getting medication on time out with normal drug rounds then they should be informed of its importance and understand the significant consequenc es resulting from not getting the drugs on time such as reduced independence and prolonged hospital stay. As medications are a large part in maximising independence and mobility and it may be suggested that Mr Henderson receives his medications before getting out of bed in the morning. This will allow time for the drugs to work and therefore enabling him to get out of bed more easily. Freezing, a symptom of Parkinsons disease can be distressing for patients. It affects gait initiation, turning and moving through small spaces, such a doors and busy areas. Anxiety can exacerbate freezing and it is vital that the nurse can firstly recognise anxiety, this may be achieve through effective communication and listening skills and secondly developing strategies to reduce anxiety levels such as allowing him time to talk, listening and taking on board his expressions allowing for a trusting relationship to be developed, helping him to build in confidence and preparing him psychologically for going home. Various strategies have been suggested to assist with freezing. Alexander, Fawcett and Runicnan (2006) suggest cognitive techniques in breaking down movement. They suggest breaking down the task of getting out of bed in the morning and describe that patients should bend their knees so that feet are flat on the mattress and they the patient should swing knees in the direction that he wants to turn. The next stage involves clasping both hands and lifting them straight up, straightening the elbows, then turning the head and swinging the arms in the same direction as the legs. Finally the patient can grip the edge of the mattress and adjust his position until comfortable. When Mr Henderson is mobilising then it is important that he does not have any distractions and the nurse or other members of staff should not disturb or interrupt if at all possible as this could lead to freezing. The Parkinsons Disease Society describe cueing strategies as external meaning visual, auditory or preprioceptive or internal meaning cognitive. Visual cues could be stepping over a cue in the floor, for example tape can be placed on the floor in strips to help initiate in confined spaces when freezing has taken place. Tape can also be placed on the edges of stairs. Mr Henderson may also find useful to imagine he is taking steps up stairs and this may prompt movement. The nurse should ensure that the area is clutter free and this can exacerbate freezing. Auditory cues as the name suggests would indicate sound used to enhance movement. Metronomes have been described as a useful tool in support gait initiation. Counting out rhythms or singing and walking in time to this can be beneficial. Proprioceptive cues which means taking a step back before starting to walk; rocking gently from side to side or marching on the stop before stepping. The nurse should ask Mr Henderson if he has experienced falls in the past year and frequency, obtaining as much information as possible about the falls, this can form part of the patients assessment namely a Falls Risk Assessment. Nice (2004) provides clinical guidance on falls risk assessment and suitable referrals should be initiated to the physiotherapist who will help to improve balance and the occupational therapist can help to make Mr Hendersons home safer place to live by attending a home visit and suggesting suitable aids that can improve safety, maximising independence. One of the most devastating consequences of falling in older people is a fractured neck of femur which can have significant impact on independence and quality of life. The nurse may suggest to Mr Henderson about wearing a hip protector, this again can improve confidence and also help to protect the hip if her were to fall. A full explanation as to why this is being suggested should be provided allowing for in formed choice. Falls can be as a result of loss of balance and posture, freezing, only being able to take small steps, or dyskinesia and it is important to use techniques such as cues to minimise the risk of falls. Also physiotherapy input will help with exercise, improving balance and posture. Multidisciplinary collaborating is essential in proving effective care. The nurse can find out what strategies are being taught to Mr Henderson and the nurse can encourage continuation of these exercises within the ward environment. It is important to continue to communicate with Mr Henderson allowing for evaluation in care and understanding what strategies are working and ones that are not. Once evaluated alternative strategies may be considered. Postural hypotension should be monitored/assessed for patients with Parkinsons as this increases the risk of falls as a result of dizziness or fainting in the drop in blood pressure. The patient should be supine for at least 10 minutes before taking a supine blood pressure reading. Then another reading should be taken within 3minutes of him standing up from the supine position. The nurse should be aware the dizziness the patient may experience when standing up should be standing next to him when she does the reading. If there is a significant fall in systolic blood pressure, by 20mmHg or goes below 90mmHg then this would indicate that the person has postural hypotension. Strategies can be adopted to improve the deficit before considering pharmacological methods such as recommending gradual compression stockings to improve venous return and therefore blood pressure. For them to work efficiently they much be measured and fitted to ensure the correct pressure is applied to the legs and ensuring that Mr Henderson is achieving recommended fluid intake of 1500-2000ml per day. If Mr Henderson is in a bay of beds for example 6 beds, then his location within the room should be considered in relation to the toilet. The bed should be relatively close to the toilet, if his fluid intake perhaps is being increased then frequency to micturate will potentially be increased. Mr Henderson is experiencing reduced mobility then bed position should be definitely considered to minimise the risk of unnecessary bowel or bladder incontinence. A commode may be considered and placed discretely closer to his bed for the evening or provision of urine bottles and buzzer placed in a position that is easily available. Appropriate footwear should be consider, the nurse should ensure that the are well fitted and not falling off increasing the risk of falls. The nurse should also check his feet or ensure there are no problems such as ingrown toe nails or blisters. The nurse should also ensure that Mr Hendersons vision is examined or glasses should be worn at all times if required as this could result in unnecessary falls. 1299 words Parkinsons Disease Question 2b Within the substantia nigra and basal ganglia there is progressive degeneration of cells which produce the neurotransmitter dopamine. The substantia nigra is a strip of dark pigmented cells located in the midbrain and the basal ganglia are collections of nerve cells located in near the base of the cerebrum. When motor impluses are initiated in the motor cortex, they need to be modified by the basal ganglia and substantia nigra by modifying motor activity, posture and making fine adjustments to movement. This is contained within the extrapyramid motor system and within the system there is normally a fine balance of neurotransmitters dopamine and acytylcholine. Dopamine is inhabitory and acytylcholine is excitatory. Due to the reduction in dopamine there is excess of the excitory neurotransmitter acytlecholine resulting in excitable muscle tone and the symptoms associated with Parkinsons disease. Mr Hendersons has begun a new medication regime using co-careldopa used to regain and maintain the balance between dopamine and acytlecholine. Dopamine cannot be given on its own as it will fail to cross the blood-brain barrier (BBB). The BBB is a physiological barrier that prevents substances from getting across from the blood stream and into the brain. Instead of dopamine, the drug levadopa is used which can cross the blood brain barrier and is then converted into dopamine. The dopamine then acts on dopamine receptors in the extrapyraminal motor system to maintain the neurotransmitter balance and therefore control the Parkinsons disease symptoms. When levadopa is administered it is broken down in the gut and liver by an enzyme called dopa decarboxylase, therefore combined with levadopa is a drug that inhibits the enzyme from breaking down levadopa is used which will lengthen the effects of levadopa meaning that less drug is required. This drug is called dopa decarboxylase inhibitor (cardidopa) This combination of levadopa can be provided as a preparation of one drug called co-careldopa or Sinemet (the brand name) There may be side effect such as nausea and vomiting, postural fall in blood pressure, constipation, and red stained urine. Mr Henderson must be made made aware of these side-effects and should inform the nurses when he is experiencing them. Domperidone can be used as an anti-emetic to stop the side-effects of nausea and vomitting. Blood pressure should be monitored for signs of postural hypotension and if required a medication review may be required, the nurse may ask the patient not to sit up or stand up too quickly. Parkinsons Disease 2c