Evidence based case study on hyperosomar hyperglycaemia state patient Essay

Evidence based case study on hyperosomar hyperglycaemia state patient - Essay Example Hyperosomar hyperglycaemia state is a state whereby alteration of sensation may often be present without comma, and it may consist of moderate to variable degrees of clinical ketosis. Therefore, Emergency Department nurses should be keen when assessing for diabetes because older patients may in hyperosomar hyperglycaemia condition. This paper reflects the aspects of care that were provided to a patient, Mr. B, in the Accident and Emergency department, while applying triage, A-G assessment, ECG and fluid management competencies. Triage Triage involves the separation of a patient who requires prioritized care because of the severity his or her condition. This applies most in the Emergency Departments, where doctors and nurses have to determine who gets care first. According to the English Dictionary, the term triage refers to the process of determining the most important people or things from among a large number that requires attention (Oxford University Press, 2013). In medical use, triage is the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties. Since every day, Emergency Departments have to attend to a large number of patients who suffer from a wide range of problems, it is essential to have a system that ensures that these patients are seen in order of their clinical need, rather than in order of attendance. Triage manages a patient flow safely when clinical needs exceed capacity. It involves identification of the problem, determination of the alternatives and selection of the most appropriate alternative (Manchester Triage Group, 2008, p, 7). Identification of the problem involves obtaining information from the patients, their careers and any pre-hospital care personnel. (Manchester Triage Group, 2008). The Emergency Department acts as a transfer station through which the casualties should pass, as quickly as possible, on their way to surgery, intensive care, or a ward (Nutbe am & Boylan, 2013, p, 181). In this case, the patient was triaged by an experienced emergency nurse who has undergone specialist training. In the problem identification phase, information was collected from the patient’s son who provided past history of the patient. From the history, it was established that the patient experienced sudden onsets of lethargy, strange behaviour such as waking up at three in the morning to have a shower, reduced frequency in mitcuration and reduced drinking. When the patient was examined, it was found that the patient was alert, did not exhibit limb weakness, and was quiet, which is unusual. Besides, the patient was not clammy or sweaty. The vital signs awarded an early-warning score of 1, given that a tachycardia of 112 beats per minute was exhibited. Consequently, the patient was placed into priority category three, as per the Manchester Triage System. This required the patient to see the doctor within one hour. However, the patient was seen by a doctor, four hours after triage, which is against the requirements of priority three allocations, at triage. Furthermore, due to lack of trolleys and large volume of patients in the department, the patient was allocated on majors’ chairs instead of trolley. A-G Assessment A-G assessment is essential in facilitating the diagnosis and administration of severe and chronic primary health problems that are found in adult clients, especially the aging

Controllers for Marine Engineering Systems Essay - 1

Controllers for Marine Engineering Systems - Essay Example Time was calculated with that device by regulating the water level in a vessel and ascertaining the quantum of its flow out of it. (Australian Maritime College, department of maritime time engineering lecture notes on instrumentation and process control. (http://academic.amc.edu.au/hnguyen/IPC/IPC01-06.pdf, viewed on 23rd August , 2007) Development of instrumentation and control systems were very slowly till the Second World War. It progressed and accelerated with tremendous speed after the war. Initial progress was in single loop control systems. These contain a single feedback channel and this technology was elaborated since then for acquiring multi-loop systems In recent years marine vehicles are designed in swift progression. There are unmanned underwater vehicles, surface ships and high-speed crafts with integrated bridges. These marine vehicles and their engines are controlled with the aid of computer science. But designing and producing a computer-based automatic control system were challenging in marine control engineering till recently. Several types of control are used now. They are control applications in marine and offshore systems like CAMS (Control Applications in Marine Systems) and MCMC (Maneuvering and Control of Marine Crafts), maneuvering, control and ship positioning systems, robust and reliable control systems, optimization methods in marine systems and modeling, underwater vehicles and robotics, offshore systems, traffic guidance and control systems, fault tolerant control, detection and isolation in marine systems, engine and machinery control systems, machinery surveillance, condition monitoring and quality control systems, networking and IT for marine control. (http://academic.amc.edu.au/hnguyen/IPC/IPC01-06.pdf, page 1, viewed on 23rd August 2007). The history of automatic process control reveals that the PID controller heralded all the mechanical devices used in the marine engineering. Earlier these mechanical controllers used a lever, spring and a mass. Compressed air activated the system and 2 such pneumatic controllers were treated as the industry standard. Times have changed then and likewise the techniques. Proportional Integral Derivative, abbreviated to PID controller is a generic control loop feedback mechanism. It is extensively applied in industrial control systems. This controller rectifies errors occurred between a measured process variable and a set-point by calculating and outputting corrective action which could adjust the process. (http://en.wikipedia.org/wiki/PID_controller, viewed on 23rd August, 2007). The calculation is based on three elements viz., the Proportional, the Integral and Derivative values. The first one considers the reaction to the present error, while the second regulates the reaction on the sum of recent errors and the third determines the reaction to the rate of error change. The sum of these three is taken as output to a control element. By adjusting the proportional, the integral and the derivative values, the PID can give control action for specific requirements.