Ethical Dilemmas in Intensive Care Unit (ICU) - Free Essay Example

Introduction To provide an insight into the ethical issues that affect admissions into the ICU as well as the process of discharging, the objective of this research if to explore and identify ethical dilemmas that face professionals in the healthcare sector. The main hypotheses is therefore based on the problems that are ethical in in the admission as well as discharge context in the ICU, which are divided into various problems that concern occupancy in full, of the beds as well as problems that are related to decisions on treatment (Ulrich et al, 2010). Body Research background/ context Only few empirical studies into the factors that are non-medical, and affect nurses and physicians in making decisions about the process of discharging and admitting patients in the ICU.Information relating to the healthcare professionals attitude about such process can be utilized in enhancing the process of decision making about intensive care resource allocation. The ICU is an environment of high pressure, where there is delivery of expensive health-care by personnel who are highly to patients that suffer from diseases that are potentially life-threatening (Ulrich et al, 2010).There is limited bed availability, which makes high throughput for patients quite important. Such a throughput usually depends on new patients admission as well as discharging to general wards of the ones whose care equipment for ICU is meant to have ended. The societal financial pressure and higher management keeps increasing. Care services that are critical give a representation of a proportion of net hos pital costs that keep increasing, up right from 1980s 8% to the 2006s 20% in the United States for example. In addition, in Netherlands, ICU department costs have been estimated to give a representation of close to 20% of the total budget for the hospitals. The ICU bed number that is limited as well as the ICU care pressure on the total budget for the hospital, makes it necessary for ICU beds optimal use as well as flow of patients from the emergency room, general ward and operating theatre to the ICU and the opposite is applicable (McLeod, 2014). Literature Review This study was quite descriptive and explorative at the same time as it used qualitative methods, both focus and individual group interviews. Face to face interviews that are semi-structured are quite useful in exploration of topics that are sensitive in depth. In the focus groups that are subsequent, the interaction and group dynamic among participants helps a greater deal in further exploration as well as clarification of views for participants. Those included nurses and physicians in Dutch hospitals, who work either in the ICU department, or regularly in the general ward through admitting of patients from the ICU (McLeod, 2014). Sampling 19 individual interviews were conducted as well as 4 focus group interviews accompanies with physicians and nurses that work in the general ward or ICU of 10 Dutch hospitals. Before the study was started, there was establishment of contact through telephone with physicians in the ICU in six different hospitals; two of them being general, two academic and two teaching hospitals. Through all these six contacts for hospitals, nurses and physicians were recruited by use of interviews face-to-face. Criteria for inclusion was basically involvement in care for patients that is post-ICU; working as a nurse or physician in either the general ward or ICU regularly doing admissions for post-ICU patients. All participants who were prospective were informed through email on the studys objective as well as being invited for participation. The interviews were conducted at the work place for the participants. The number of total interviews highly depended in the saturation point. There was also d evelopment of interview guide with questions that are open-ended as well as a pilot testing (McLeod, 2014). Presentation of Data and Data Analysis Coding of the focus group and interview transcripts was done by use of ATLAS.ti 6.2. Such analysis was conducted by use of an approach of grounded theory where, the codebook and codes are emerged from the data, contrary to the previous way of formulating tested hypotheses against data that is qualitative. The interviews done on first five individuals were coded as NvS, AO and MZ. After that, any discrepancies that occurred were discussed in depth till consensus was arrived at. A double analysis (MZ and AO) as well as subsequent discussions were also done for interview transcript of the first group. Coding of the entire transcripts was done by one of the researchers (AO). The guideline for COREQ was used for research that is qualitative for both analysis and design. The obtained datas implications for nursing are that the focus and individual interviews for groups showed that in the admission and discharge process of discharge in the ICU context, ethical problems come up at various points in time. When making decision about patient admissions to the ICU right from the emergency room, general ward or operating theatre (A); During the stay of a patient inside the ICU(B) and, when making decision about a patient discharging from the ICU (Gregory et al, 2004). Implication of the Data on Nursing It is very important for general wards and ICUs to do good communication and cooperation, as there is a mutual dependency that is on patient flow that is optimal between the various departments. There is need for interventions that help in improving the cooperation as well as understanding between such wards as it helps in mitigation of problems that are ethical. The environment nature of the ICU makes it quite important for professionals in the healthcare field to be aware of the over-treatment risks, do a reflection of the reasons as to why they do that which they do, as well as being mindful of an imminent negative impact of patients over-treatment. Patients wishes early discussion in regard to options of treatment is quite important in the prevention of over-treatment. The study identified various problems that are ethical at three various instances during the process of discharge and admission; that which surrounded the admission at the ICU, during stay at the ICU and around di scharge at the ICU. They can further be subdivided into two different categories, those that are related to full occupancy of the bed and those that have to do with decisions on treatment (Gregory et al, 2004). Limitations of the study The studys limitations included; any study that is qualitative has the risk of giving responses that are eliciting false and social desire from the interviewees, particularly when inquiries are being made after all topics in the ethics field. Through asking the various participants to do a description of the examples of problems that themselves went through, the risk is hoped to have been diminished. However, in future, there is need to require more of the quantity of focus group and interview participants ,especially when putting to consideration the qualitative researchs labor-intensiveness as well as the number of interviews that is suggested in the literature (Gregory et al, 2004). Conclusion It is very important for general wards and ICUs to do a good cooperation, given that there exists a mutual dependency for the patient flow that is optimal between the various departments. Interventions that aim at improving the cooperation as well as understanding between such wards may go a long way in helping to mitigate problems that are ethical-based (Gregory et al, 2004). References Gregory, K, et al. (2004). Ethical Issues in the Intensive Care Unit : Hospital Physician Board Review Manual, Tuner White Communications, Wayne, PA.. McLeod, A., (2014) . Nurses Views of the Causes of Ethical Dilemmas During Treatment Cessation in the ICU: A Qualitative Study in British Journal of Neuroscience Nursing. USA. Ulrich, C.M et al.,(2010). Moral distress: a growing problem in the health professions? Hastings Cent Rep.

The Ethical Dilemma Of Artificial Nutrition And Hydration...

In this paper the writer will describe the ethical dilemma of artificial nutrition and hydration in terminally ill patient. Artificial nutrition is very important in terminal ill patients in their end stage of life. It is very helpful to provide nutrients and fluids to the patient who is unable to take it by himself. In palliative units, AHN help to enhance the comfort and quality of care of patient. The purpose of this paper is to narrate how ethical issues can become challenging for health professional, patient and their family members. In following paragraph the writer will explain the ethical dilemma in relation to Islamic view, patient with advance stage of Alzheimer’s disease, permanent vegetative state, nurses and physician opinion on AHN, nurses and physician provide AHN according to their culture beliefs. The theme of following literatures is that to stop or discontinue the artificial nutrition and hydration because it is not much beneficial for patient with advanced disease conditions. In first finding, there are many factors that influence decisions about withholding and â€Å"withdrawing artificial nutrition and hydration include the attitudes, religious beliefs, and cultural identity of the patient, family, and healthcare providers; the cost of treatment; legal issues; and ethical and moral considerations† (Sami, 2014). In this, ethical issues occur between health professional and Islamic patient family member. In the palliative care unit doctors mainly focus toShow MoreRelatedThe Effects Of Artificial Nutrition On Health Professionals981 Words   |  4 Pagesand water. 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In 1990, Congress passed the Patient Self-Determination Act (PSDA)Read MoreShould Scientists Create Artificial Living Things?1939 Words   |  8 PagesShould Scientists Create Artificial Living Things? My personal opinion is, no. I feel as if scientist should not create artificial living things. Artificial designed machines usually wear out with use, especially if you keep them running for so long without maintenance. In humans organisms, they will typically renew their parts until death (Douglas, et.al,2013). The creation of artificial living things need to be designed to benefit others for it to be considered ethical. Depending on your beliefRead MoreThe Dilemma Of Children With Critical Condition1709 Words   |  7 PagesTragic Dilemma in Children with Critical Condition Despite of the increasing knowledge in healthcare and bioethics, care for critically ill children remains understudied in Canadian contexts. 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Child Development Reflection - 908 Words

Reflection #3 Many people fail to understand the importance of the environment they raise their children in. Raising children in the proper environment is just as crucial as feeding and caring for them. If we do not provide children with an appropriate environment, their development could be affected negatively for the rest of their lives. During a study, infants were placed in orphanages who were later exposed to family rearing and confirmed how important a generally stimulating environment is for psychological development. (Berk, Chapter 5, 2014) Another investigation was done where children were transferred between birth and three and a half years old from deprived Romanian orphanages to adoptive families in Great Britain. When the†¦show more content†¦I would then give them a project that required both the eighth and first grade student to work together. For instance, each pair of students could be given a map of the United States. The first-grade student would be responsible for co loring the map in and the eighth-grade student would be responsible for labeling the states. This project would force the first and eighth grade students to work together and talk with each other. This would expose the students to the different language of older students compared to younger students. It would be beneficial for all the students. As a teacher, I believe you should make the most of the resources you are provided and take advantage of having older, mature students in the building. When children are growing up, most of what they learn comes from what their parents say and do. Therefore, it is important for parents to serve as good role models and be aware that their children are always watching. Research was done in a laboratory that found deferred imitation is present at six weeks of age. (Berk, Chapter 6, 2014) This was surprising to me because that seems very young. 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Tootsie Roll Business Plan free essay sample

Tootsie Roll Tootsie Roll The Tootsie Roll Industries Incorporated began in Chicago 117 years ago. The founder of the business was a gentleman named Leo Hirschfield. He began making and selling the Tootsie Roll. Today the famous product is still being made according to the original recipe and formula. However, since its inception, the business has become incorporated. The primary production and consumption areas include the United States, Canada, and Mexico. However, the company sells its products in over 75 countries. While the Tootsie Roll is the oldest and perhaps the most well-known product, Tootsie has a fairly wide product range. Other products include Junior Mints, Charleston Chew, Dubble Bubble, and Dots to name a few (Goldberg, McDonell, Santhakumar, Wood, Marquardt, 2010). The purpose of this business proposal is to obtain a $17 million dollar loan to support a global marketing campaign for Tootsie Roll to stimulate growth and capture market share. This proposal provides an attached worksheet containing an income statement, cash flow statement, and balance sheet. We will write a custom essay sample on Tootsie Roll Business Plan or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Additional information available is industry analysis and trends, strategic plan, risk assessments, technology plan, marketing plan, SWOT analysis, competition, management, and community plans. Industry Analysis and Trends Tootsie Roll Industries Inc. is in the confectionary industry. In the U. S. alone the industry averaged nearly 15 billion dollars in sales. Experts predict that the industry will increase to over 17 billion by 2015 (Goldberg et al. , 2010). Tootsie Roll claims approximately three percent of this market share. The confectionary industry has been very slowly increasing. However, the growth is consistent and quite predictable. Certain trends have been arising in the industry. Tootsie should be aware of, and adapt to the trends. Imported chocolate is more available and cheaper, and the demand overseas is slowly increasing. However, the price of sugar has been increasing in the recent years as well. Important trends in the industry include a demand for chocolate with health benefits. The demand for premium chocolate options is increasing. However, with an unconfident economy, people want to spend less money on non-necessary things such as candy. Tootsie Roll Strategic Position and Risk Assessment â€Å"The company has grown to become an exclusive candy company building on its brand name in its niche market of hard candy. Tootsie Roll accounts for approximately 3% market share in a candy market that has slow, predictable growth with U. S. industry sales rising 3. 9% in 2009. Strong consumer awareness of its brand name, line extensions, holiday offering, and periodic acquisitions allow Tootsie Roll to stay well-positioned and grow off its existing infrastructure† (Goldberg, McDonnel, Santhakumar, Wood, Marquadt, p. 2, 2013). Risk Assessment and SWOT Analysis of Tootsie Roll A SWOT Analysis shows the strengths of Tootsie roll as a strong reputable brand of candy, strong balance sheet, strong stable supply and demand of ingredients, and paid dividends over the past 65 years. Its weaknesses are a strong dependence on domestic sales, not investing cash back into the company, and a failure to disclose succession planning. Opportunities include and international expansion, new innovative products, and the use of organic chocolate. Threats consist of an increase in commodity prices, competition, and oral health care. Operations Tootsie Roll operations include legal requirements of their employees and contracts. They deal with established vendors, suppliers, and they comply with all applicable laws regarding employment practices. Technology Plan Technology trends domestic or international markets should be the same. The technology for making the Tootsie Rolls is domestically developed and applying these technologies to the international markets are keys to the name brand of the company. The products quality is catching the consumer’s eye as this product is steering to lower, midrange, and higher paid consumers. The way the technology is in place currently and the name recognition of our company will bring customers our way. Research and development of the domestic product to be the best quality product with continued development benefits the international companies globally. It does not stop there. Monitoring the competitor’s advancements keeps the development of our product through technology will keep this company on their toes to stay the leader in market. Marketing Plan The marketing plan for Tootsie Roll is to keep the strong company’s brand name. Production and expansion to serve multiple countries is a goal to keep and expand their competitive advantage. The increased spending in advertising will keep their brand name in the market. The prices have stayed the same to be competitive to keep their market shares Tootsie Roll is a mature product and will show the competition that they can keep their market shares while entering new markets to be available to more customers. The loyal customers have shown Tootsie Roll what a good product it is and help bring new customers to Tootsie Roll. The parents are the candy buyers for the children so they are marketed to make the sale. Competition Tootsie Roll Industries has been producing the same products with the same formula for over 100 years. Tootsie is also well-known for candies such as Andes mints, Junior Mints, Charleston Chew, Mason Dots, and Sugar Daddy. The Tootsie Pops made  the company  one of the largest lollipop producers in the world. However, during 2007 Tootsie Roll Industries’ profits declined meanwhile its competitors Wrigley, Hershey, Nestle, and Mars continue to increase their profits. Wrigley, Hershey, Nestle, and Mars were the three major companies that account for 60% of the industry. Tootsie Roll’s perceived value in its brand is a superior advantage that the industry holds against its competitors. As a consumer product company, Tootsie Roll Industries face intense competition for both retail shelf space and consumers’ dollars. Tootsie Roll has â€Å"done a masterful job, go into a Wal-Mart or Target and youll see incredible shelf space given to Tootsie products, similar to that of Hershey or Mars, both much bigger companies† (Hughlett, 2008). Management and Organization Tootsie Roll Industries started as a family run organization and has continued to try to remain in that type of an environment for their employees. They have combined a family-run corporate culture and a progressive management style. This type of style has been able to embrace an entrepreneurial spirit, setting the industry standard at delivering the highest quality product at the lowest possible price (How Tootsie Does It, paragraph 1). Community Involvement and Social Responsibility Being part of the community has long been a strong emphasis for the Tootsie Roll Industry. They have become involved with national concerns and have always been willing to help out with charities. Their products have been favorites among charitable fundraisers and have generated revenues that help sustain a variety of public and private causes. Conclusion Tootsie Roll has a long-standing reputation for being the oldest candy company in the United States. Tootsie Roll’s ability to keep up with candy trends has kept it in close competition with other companies such as Hershey Corporation, Mars, and Nestle. Reference Hughlett, M. (2008, May  4). Tootsie rolls along. Chicago Tribune. Retrieved from http://articles. chicagotribune. com/2008-05-04/business/0805030026_1_tootsie-roll-industries-wrigley-melvin-gordon Goldberg, M. , McDonnell, K. , Santhakumar, N. , Wood, J. , Marquardt, M. (2013). Tootsie Roll Report. Business Wise. Retrieved from http://business. library. wisc. edu/resources/kavajecz/10_Fall/Tootsie%20Roll_Report. pdf Kimmel, P. D. , Weiygandt, J. J. , Kieso, D. E. (2009). Accounting: Tools for Business Decision Making (3rd ed. ). Retrieved from https://portal. phoenix. edu/classroom/coursematerials/acc_561/20130312/OSIRIS:441986 33. Score. (2011). Business Plan Template Small Business. Retrieved from http://www. score. org/resources/business-plan-startup-pdf U. S. Small Business Administration. (2013). SBA Loan Application Checklist. Retrieved from http://www. sba. gov/sba-direct/article/2953 U. S. Small Business Administration. (2013). How to Prepare a Loan Application. Retrieved from http://www. sba. gov/content/business-loan-checklist# Tootsie Roll Industries. (2012). How Tootsie Does it. Retrieved from http://www. tootsie. com/comp_who. php

s Republic - Gender Equality

Plato’s Republic was perhaps one of the more controversial pieces of writing from its time. In this book, Plato attempted to immortalize the ideals put forward by his teacher and mentor, Socrates the Sophist. Most of Socrates’ beliefs went against Athenian tradition and convention, and as such was subject to great disapproval from influential Athenian superiors. Essentially, Socrates disagreed with virtually every aspect of the way Athens was run. He had his own ideas about the way in which an ideal city should be run, and voiced his opinion on diverse topics of discussion including the role of Athenian women in society. On examination of Socrates’ discourse, as he put forward his viewpoint on a woman’s place in the ideal city in Plato’s Republic, it was glaringly obvious that his opinion would not be embraced open-heartedly by Athenian readers of that time. It was customary in ancient Greece that women’s activities were held completely separate from those of the men. In the time of Homer, women were seen as possessions, as was demonstrated throughout the Iliad, where they were awarded to men as prizes. Their status in society did not improve by very much in later years. In Thucydides’ account, one of the few mentions of women was made by Pericles, in his funeral oration, where he advocated that they should be â€Å"least talked of among the men, whether for good or for bad† (Thuc. 2.45). In essence, women lived in the shadows, unseen, and unheard, with their primary purpose being to bear heirs for their husbands. The proposition put forward in Plato’s Republic was in complete disagreement with this long-standing view of society’s females. The concept that women and men should be treated equally was totally foreign, and the presentation of this idea to any ancient Athenian male would have been immediately scorned. It would have been viewed as totally unacceptable, because this was simply not the way things were do... 's Republic - Gender Equality Free Essays on Plato\'s Republic - Gender Equality Plato’s Republic was perhaps one of the more controversial pieces of writing from its time. In this book, Plato attempted to immortalize the ideals put forward by his teacher and mentor, Socrates the Sophist. Most of Socrates’ beliefs went against Athenian tradition and convention, and as such was subject to great disapproval from influential Athenian superiors. Essentially, Socrates disagreed with virtually every aspect of the way Athens was run. He had his own ideas about the way in which an ideal city should be run, and voiced his opinion on diverse topics of discussion including the role of Athenian women in society. On examination of Socrates’ discourse, as he put forward his viewpoint on a woman’s place in the ideal city in Plato’s Republic, it was glaringly obvious that his opinion would not be embraced open-heartedly by Athenian readers of that time. It was customary in ancient Greece that women’s activities were held completely separate from those of the men. In the time of Homer, women were seen as possessions, as was demonstrated throughout the Iliad, where they were awarded to men as prizes. Their status in society did not improve by very much in later years. In Thucydides’ account, one of the few mentions of women was made by Pericles, in his funeral oration, where he advocated that they should be â€Å"least talked of among the men, whether for good or for bad† (Thuc. 2.45). In essence, women lived in the shadows, unseen, and unheard, with their primary purpose being to bear heirs for their husbands. The proposition put forward in Plato’s Republic was in complete disagreement with this long-standing view of society’s females. The concept that women and men should be treated equally was totally foreign, and the presentation of this idea to any ancient Athenian male would have been immediately scorned. It would have been viewed as totally unacceptable, because this was simply not the way things were do...

How to Make a Marijuana Tincture

How to Make a Marijuana Tincture Making a marijuana tincture is an easy way to extract THC and cannabinoids from Cannabis. A tincture is an alcohol-based solution, used to extract organics from herbs and other plants. Tinctures are useful because they isolate certain compounds better than soaking or boiling herbs in water, the alcohol acts as a natural preservative, and medicinal tinctures often take effect more quickly than other administration routes, like eating, drinking, or smoking. Marijuana Tincture Materials A typical ratio of plant matter to alcohol would be 1 gram to 1 fluid ounce (35 ml) of alcohol. Up to 6 grams of Cannabis can be used, depending on your resources and how concentrated you want the end product to be. Do not use any other type of alcohol besides ethyl alcohol or ethanol (e.g., isopropyl alcohol or methyl alcohol), as these chemicals are toxic. Cannabis sativa bud, fresh or driedHigh-proof ethanolFlavoring (optional)Small glass jar with lidBrown or blue glass dropper bottle Everclear is a popular source of ethanol because it is so high in alcohol. 151 rum also works. Be sure to use food-quality ethanol, not denatured alcohol. Denatured alcohol contains contaminants that make it unsafe to drink. Lower concentrations of alcohol will not be as effective for the extraction or preservation. Basic Steps To Prepare a Cannabis Tincture Place the marijuana in the bottle.  Pour alcohol into the bottle, making certain to cover the plant matter.Seal the bottle. Place it in a warm location, out of direct sunlight.Give the alcohol mixture at least a day, but preferably longer than a week to soak. You can shake the bottle from time to time to ensure a good extraction of  the THC and other cannabinoids.Filter the liquid through a coffee filter to remove the solids and reserve the liquid in a dark-colored glass dropper bottle. Avoid using plastic, as the liquid may leach some undesirable compounds from the plastic into the tincture over time. Flavoring may be added to improve the taste of the tincture, if desired.A typical dose would be 3-5 drops, depending on how strong you made the tincture. Start with the minimum amount and see what works best for you. Fast Marijuana Tincture Recipe While the classic tincture instructions are fine, you can prepare a tincture much more quickly if youre willing to put in slightly more preparation time. Also, this method uses less source material (although the tincture is also less potent). This recipe produces an effective tincture in as little as an hour. The disadvantage of the method is that it uses heat, which can damage some of the many cannabinoids in Cannabis if you get carried away. Dont exceed the recommended temperature. Dry about 4-5 grams of a Cannabis sativa bud.Grind the material to increase surface area (speeds extraction).Bake the marijuana is a 240 F over (set for just under 250 F) for 30 minutes. This decarboxylates the matter, improving the extraction of desirable compounds while helping to eliminate unwanted chemicals. Both heat and alcohol can convert  the THCA molecules in the plant matter into active THC.Place the marijuana in 2 ounces of alcohol. Make sure it is covered and seal the container to prevent gas exchange with air.Place the container in a cool, dark location. The longer you allow for the alcohol to extract the cannabinoids, the more potent your tincture will be. You can watch the extraction progress as the color of the liquid changes from clear to green. Once the color is stable (up to 2 or 3 hours), filter the liquid using a coffee filter or cheesecloth. Of course, you can consider the tincture done sooner, but you may lose potency.Store the tincture in a dark glass droppe r bottle. While the alcohol preserves a tincture at room temperature, its fine to refrigerate it to further reduce the chance of mold or fungal growth. How to Use a Marijuana Tincture The ideal way to use this tincture is to apply drops sublingually (under your tongue). Use a few drops and then wait to determine the effect. Cannabinoids are quickly absorbed across the mucosa of the mouth into the bloodstream for distribution to the brain and other parts of the body. If the desired effect is not achieved after the initial dose, a few more drops may be applied.

Complex Care Nursing Essay Example | Topics and Well Written Essays - 2500 words - 1

Complex Care Nursing - Essay Example ) Hb Haemoglobin 130g/L. 140-174 g/L WCC White cell count 12.89x 109/L 4-10 X 109/L Table 1 Investigation results of Mr. Smith Chest X-ray showed right middle lobe pneumonia. Being a non-smoker, Mr.Smith had not travelled overseas and had no exotic pets. Clinical assessment Mr Smith had scored 15 on the Glasgow Coma Score (Trauma-org). This indicated that Mr. Smith was having the best score and that he was in a good clinical condition where his neuropsychological status was concerned. This meant that he had his eyes open and they were responding. He was oriented, answering questions and obeying commands. Mildly febrile, he had accompanying tachycardia and his pulse had changed from the normal 72 beats per minute to 98 per minute. This could be partly due to the raised temperature and partly due to the progression to acute pulmonary oedema. The middle lobe had an anatomy which predisposes it to frequent involvement. The narrowness of the lobar bronchus and the acute angle at which it took off made it prone to difficulties of drainage. Pneumonia formed one cause of non-obstructive middle lobe syndrome (Bordow et al, 2005). The isolated position of the middle lobe also produced an impairment of collateral ventilation from the neighbouring lobes. Clearance of secretions was simultaneously defective. Inflammations constituted 47% of middle lobe syndrome in researches (Bordow et al, 2005). The history of symptoms of cough, fever with chills and the expectoration that Mr.Smith presented with correlated to the middle lobe pneumonia. Frontal and lateral chest X-rays provided the best pictures of the middle lobe. The Blood Glucose level was a little raised from the normal. He could be a borderline diabetic who needed to be watched and advised for a sugar-free diet. The stress due to the illness also could raise the glucose level. Investigation at intervals could help in the diagnosis. The electrolyte levels were slightly less than normal. Due to the fever and illness of the past five days, he could have reduced his food intake. Potassium reduction could also have been due to dehydration through excessive sweating following the fever. Serum creatinine was just above normal level. The glomerular filtration rate was however near normal. Repetition of the investigations would help in deciding whether the patient was going in for other complications. Haemoglobin level was slightly less suggesting again that dietary intake could have been less. Caution must be taken to prevent anaemia. The high CRP level at 287 mg/L was indicative of the previous history of MI in Mr.Smith. It could also be an accompaniment of the middle lobe pneumonia, an infectious process. BP was slightly raised. Respiratory rate was 20/min. with shallow breathing. The saturated oxygen level was 98% using a 6-litre Hudson mask and it was the percentage of hemoglobin saturated with oxygen at the time of the measurement. The 98% was a favorable level but the best was the 100% saturation. An indwelling catheter had been inserted. An IV access was also found. Subsequent assessment In the assessment after one hour, the condition of the patient had