Leading Innovation At Kelvingrove (A), Case Study Essay...

Kelvingrove Art Gallery and Museum in Glasgow, Scotland; a Victorian era museum established in 1901 to express the pride, wealth, and cultural ambitions of the industrial city of Kelvingrove, was in need of change in the late 1980’s to be more relevant to modern audiences. Starting in 1990, when Mark O’Neil joined the Kelvingore Museum, Mark was tasked with bringing innovation to the entire museum by the then director Julian Spalding. After an initial start by O’Neil into implementing some of Spalding’s radical innovative ideas, O’Neil was side tracked into a separate project at the St. Mungo’s Museum of Religious Life and Art. The St. Mungo’s work provided some insight and allowed experimentation with some of the innovative ideas†¦show more content†¦After closing for three years from 2003 to 2006 for the renovations to the building and to fully implement the storytelling approach Kelvingrove Museum has become the most pop ular touristy destination even surpassing Edinburgh Castle. What makes something innovative? In the context of the Kelvingrove Museum innovation the innovations employed took the traditional course of innovations similar to the typewriter, â€Å"how an innovation often draws from existing technologies and models for its application but uses these elements creatively in combination with new ones to form a uniquely different product.† (Utterback, 1996, p. 2) O’Neil used this concept at his first museum at Springburn rather than doing the history of locomotive building, for example, the staff created an exhibition on the history of work. â€Å"It covered all the important history, but it came right up to date and engaged with unemployment and training and what work meant where so many were unemployed,† (Liedtka Salzman, 2009, p. 4) O’Neil and his staff at Springburn did not throw out the traditional museum model of locomotive building history but used in packaging together with the current issues of unemployment in the community for a more differe nt but richer museum experience that is relevant to today. Using the experience from Springburn O’Neil then continued this similar innovative process at Kelvingrove Museum where he applied Spalding’s desire of using

Crohn Disease Patient Care for Pethidine - MyAssignmenthelp.com

Question: Discuss about theCrohn Disease Patient Care for Pethidine. Answer: Priority Nursing Responsibilities and associated rationales related to the administration of pethidine to Harry. Pethidine (meperidine hydrochloride) is an opioid agonist analgesic. It acts as an agonist at specific receptors in the CNS to produce analgesia, euphoria and sedation. Its therefore used as preoperative medication, support of anesthesia and obstetric analgesia. Nurses have the responsibility to watch the use of other medications when pethidine has been administered, this include medications (depressants) that affect the central nervous system i.e. anxiolytics, hypnotics antidepressants, alcohol, general anesthetics and other analgesics. They should also note respiratory rate, depth, and rhythm and size of pupils in Harry (Lewis et al., 2015). If respirations are 12/min or below and pupils are constricted or dilated or breathing is shallow, or if signs of CNS hyperactivity are present, the physician shold be informed; Monitor vital signs closely. Heart rate may increase markedly, and hypotension may occur. Meperidine may cause severe hypotension in postoperative patients and those wi th depleted blood volume; Chart patient's response to drug and evaluate continued need.the nurses shold be aware of other effects as follows.CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex. CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope. Dermatologic: Pruritus, urticaria, laryngospasm, bronchospasm, edema. GI: Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm, increased colonic motility in patients with chronic ulcerative colitis.GU: Ureteral spasm, spasm of vesical sphincters, urine retention or hesitancy, oliguria, antidiuretic effect, reduced libido o r potency.Local: Tissue irritation and induration (subcutaneous injection).Major hazards: Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest. Other: Sweating, physical tolerance and dependence, psychological dependence (Bright et al., 2003). Describtion of the structural and functional changes that occur in the pathogenesis of Crohns disease that led to Harrys weight loss and the development of the stricture and fistula in Harrys ileum. Crohns disease can have several patterns of involvement: jejunoileitis, ileitis, ileocolitis and colitis. Each subtype has a distinct clinical presentation and typical course. Patients with inflammation of the jejunum and ileum often present with cramping abdominal pain after meals and eventually develop diarrhea. These patients, many of whom are teenagers or young adults, may have prominent extraintestinal manifestations including arthritis, fever, skin lesions, and delayed growth. Ileitis causes discomfort 12 hours after meals. Patients lose weight because they eat less to avoid discomfort, thus Harrys weight loss (Karamanakos et al., 2008). The inflammation in the ileum can extend transmurally into adjacent structures as tracks or fistulae, or can cause perforation of abscesses adjacent to the bowel. This form of Crohns disease is known as fistulizing or perforating. It has the worst prognosis of all the forms and often requires surgical resection after three or four years. Other patients with ileitis develop intestinal obstruction 810 years after the onset of disease because muscle hypertrophy and fibrosis narrow the lumen of the bowel. This form of Crohns disease is known as stricturing or stenosing. This explains the presence of stricture and fistula in Harrys ileum (Cosnes et al., 2013). Crohns disease in the colon causes diarrhea and may be difficult to distinguish from ulcerative colitis. Characteristics of the intravenous fluid that was ordered for Harry, and the rationale, related to Harrys specific fluid balance status, for the administration of this intravenous fluid to Harry. In vitro measurements of the net transport and simultaneous bidirectional flux rates of water and electrolytes across the human colonic epithelium demonstrates that in CD there is a reversal of Na+ and water flux, and K+ secretion was increased (Barkas et al., 2013).Notable seasonal variations in vitamin D status and bone turnover markers have been reported in CD patients. Specifically, the 25-hydroxyvitamin D becomes significantly lower (up to 65%) in CD patients compared to healthy people, potentially due to reduced intestinal absorption, disturbed enterohepatic circulation and reduced nutrient intake of vitamin D. Infliximab is an intravenous fluid used in tretment of Corhons disase.It works by targeting a protein called tumour necrosis factor-alpha (TNF-alpha), which is believed to be responsible for the inflammation associated with Crohn's disease. Infliximab can be used for children over six years old and adults.Infliximab is given as a drip into a vein in your arm (known as an infusion). Treatment with tumor necrosis factor (TNF)- antibodies is very successful as it helps in downregulating the inflammatory process (Sands et al., 2004). References Barkas, F., Liberopoulos, E., Kei, A., Elisaf, M. (2013). Electrolyte and acid-base disorders in inflammatory bowel disease. Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology, 26(1), 23. Bright, E., Roseveare, C., Dalgleish, D., Kimble, J., Elliott, J., Shepherd, H. (2003). Patient-controlled sedation for colonoscopy: a randomized trial comparing patient-controlled administration of propofol and alfentanil with physician-administered midazolam and pethidine. Endoscopy, 35(08), 683-687. Cosnes, J., GowerRousseau, C., Seksik, P., Cortot, A. (2011). Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology, 140(6), 1785-1794. Karamanakos, S. N., Vagenas, K., Kalfarentzos, F., Alexandrides, T. K. (2008). Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Annals of surgery, 247(3), 401-407. Lewis, S. L., Maltas, J., Dirksen, S. R., Bucher, L. (2015). Study guide for medical-surgical nursing: Assessment and management of clinical problems. Elsevier Health Sciences. Sands, B. E., Anderson, F. H., Bernstein, C. N., Chey, W. Y., Feagan, B. G., Fedorak, R. N., ... Rachmilewitz, D. (2004). Infliximab maintenance therapy for fistulizing Crohn's disease. New England Journal of Medicine, 350(9), 876-885.