Reflective analysis on a case presented with minor injury - Free Essay Example

Sample details Pages: 6 Words: 1896 Downloads: 6 Date added: 2019/10/10 Did you like this example? History of presenting complaint and symptoms: Ian Ruther fell on icy path outside of house two days ago, putting her hand down to break the fall (i.e. FOOSH).   There was immediate pain in the left wrist below the thumb.   She is complaining of increased pain when trying to move wrist and pick up small objects.   Patient does not report any noticeable immediate swelling. Examination findings: Examination should start with observing the motion of the patient’s hand. This observation is helpful in making diagnosis on the whole limb dysfunction and injury that will help in giving valuable information about the function of the hand elbow complex. The patient’s hand should be observed from front to the back. Any kind of limitation hesitancy, symmetry or avoidance of any weight bearing should be noted. Some of the examinations should escape the notice of the patient since some of them occur gradually. (Bunnell, S., 1951) Don’t waste time! Our writers will create an original "Reflective analysis on a case presented with minor injury" essay for you Create order The entire upper extremity of the limb should be exposed and evaluated when examination is on-going. Elbow motion, active shoulder motion, pronation, and supination of the forearm should be assed effectively. The color of the forearm should be noted in order to conclude on the state of the blood circulation and even on the conditions of the radial and ulna pulses. The swellings and edemas existing edemas should be noted and even on the abnormal posture or position. Evaluation of the skin tenderness, moisture and sensibility should be done. After hand injury, there is a secondary stiffness and limited range of motion (ROM) of other joints of extremity together with the involved hand. Measurements and recordings on the range of both active and passive motion of the wrist, MCP joint, and IP joints of each digit should be done. Documentation of grip and pinch strength should be noted too. Evaluation on the patient ability to carry out simple functions should be evaluated. A simple sketch of the hand with appropriate notations and measurements should be done on the paper since it is usually helpful. (Campbell, D.A. and Kay, S.P.J., 1996) Differential diagnoses: The parts of the arm that should be investigated are: skin, the nail-bed and fingertip, the muscles, the nerves of the patient’s forearm sensibility and circulation of blood. (Flatt, A.E., 1979) Investigations further tests required: After these preliminary tests, there are specific parts of the hand where further analysis should be carried out. They are listed as shown below: Skin: The examiner should evaluate whether there is a presence or absence of swelling, wrinkles, moisture, scars, color and other surface irregularities. Normally, the palmer skin is thick, tethered, irregularly surfaced and moist to enable traction and durability. The dorsum skin is thin and mobile to permit the motion of various joints. (Frazier, W.H., Miller, M., Fox, R.S., Brand, D. and Finseth, F., 1978) The nail-bed and fingertip: When making examination on this part of the forearm, one should ensure that the tuft of the distal phalanx is well-padded by the adipose tissue and covered by highly inverted skin which is tethered to the distal phalanx through a series of fibrosepta. (Hammert, W. C. 2010) Muscles: The muscles of the fore arm are divided into various sections. Hence, examinations should be done on each part respectively as shown below and make the recordings on them. The first part is the extrinsic muscle. This part is composed of extrinsic flexor muscles, extrinsic extensor muscles and extrinsic extensor muscles. When analyzing the extrinsic extensor muscles, the flexor pollicis longus (FPL) muscle strength should be tested against the resistance supplied by the examiner. The flexor digitorum profunds (FDP) should be tested by asking the patient to bend the tip of his finger. The examiner should stabilize the PIP point as the distal point is actively flexed. The muscle should be tested against resistance too as each finger is being examined. The flexor digitorum superficialis (FDS) should be tested by asking the patient to bend his finger at the middle joint (Weiland, A. J., Rohde, R. S. 2009). The examiner should stabilize the other fingers so as to block the profundus function. Then the procedure should be repeated for the rest of the fingers. The flexor carpi ulnaris (FCU), flexor carpi radialis(FCR), and palmaris longus(PL) should be evalua ted by asking the patient to flex his wrist as the examiner keeps on palpating on the tendoms of these muscles.The PL will be noted as to be lying between the FCR radially and FCU ulnary on the volar surface of the wrist when maneuvering around the forearm. The extrinsic extensor muscles. It consists of the first dorsal wrist compartment, second dorsal wrist compartment, the third dorsal wrist compartment, fourth dorsal wrist compartment, fifth dorsal wrist compartment and the sixth dorsal wrist compartment. The first dorsal wrist compartment consists of the abductor pollicis longus (APL) and extensor pollicis longus.   These parts are evaluated by asking the patient to bring his thumb out to the side. The examiner should be palpating around the taut tendons over the radial side of the wrist that is going to the thumb. The second dorsal wrist compartment consists of the extensor carpi radialis longus (ECRL) tendons and the extensor carpi radialis brevis (ECRB) muscles. These parts are evaluated by asking the patient to make a fist and bring his wrist back strongly. The examiner should also provide resistance and palpation on thetendons over the dorsoradial aspect of the wrist. The third dorsal wrist compartment has the extensor pollicis longus (EPL) passing around the Lister’s tubercle of te radius. This muscle can be tested by placing the hand flat on the table and having the patient lifting the thumb off the surface. The fourth dorsal wrist compartment has the extensor digitorum communis (EDC) and the extensor indicis proprius (EIP) muscle tendons. They are examined by asking the patient to straighten his fingures and by making observations on the MCP joint extension. The EIP can be examined separately by asking the patient to bring his pointing finger out straight with the other fingers bent in a fist. The fifth dorsal wrist compartment has the extensor digit minimi (EDM) (Weinzweig, N., Weinzweig, J. 2005). This is tested by asking the patient to straighten his small finger with others bent in the fist. This will help in extending the MCP joint of the small finger. The sixth dorsal wrist compartment has the extensor corpi ulnaris (ECU). This is examined by asking the patient to pull his hand up and out to the side. The examiner can palpate over the ulnar side of the wrist at the distal point of the ulnar head. The extrinsic extensor tightness can be tested by maintaining the wrist in a neutral and passively extending the MCP joint and flexing the PIP point. The same test is repeated with the MCP joint when passively flexed. (Hill, E.J., 1963) The second part of examination is the intrinsic muscles. This part is composed of the thenar muscle group,   adductor pollicis (AdP), lumbrical, interrosseous muscles and the hpothenar muscle group. The thenar muscles are composed of the abductor pollicis brevis (APB), opponens pollicis (OP), and flexor pollicis brevis (FPB). These muscles can be evaluated by asking the patient to touch the thumb and small fingertips together for the nails to be parallel. They can be alternatively tested by asking the patient to place the dorsum of the hand flat on the table and raise the thumb of the surface by 90o. The examiner should be palpating the thenar muscles at this time to note wether they contract. The contralateral hand should also be examined in the same way to observe the variations in muscle mass and function. The AdP can be examined by making the patient to hold the paper forcibly between the hand and the radial side of the index proximal phalanx. The interosseous and lumbrical mus cles should be tested by asking the patient to spread the fingers apart as the examiner keeps on palpating the first dorsal interosseous to observe whether it is contracting. Another alternative test is to lay the hand of the patient flat on the table and elevate the middle finger and radially and ulnarly deviate it. The hypothenar muscles is composed of the abductor digiti minimi (ADM), flexor digiti minimi (FDM), and opponens digiti minimi (ODM). They are evaluated by asking the patient to bring the small finger away from the other fingers. The intrinsic muscle tightnesss can be tested by holding the MCP joint in extension while the PIP joint is passively flexed by the examiner. (Hunt, T. R., Wiesel, S. W. 2011) The third part of examination is the nerves. The nerves are composed of the median nerve, ulnar nerve, radial nerve, and the sensory branches. They should be also examined to ensure that they are functioning normally without any defect. Any abnormality noticed should be recorded appropriately. (Jacobs, M. A., Austin, N. M. 2003) The fourth part of examination is sensibility. The normal skin should be moist. The dysfunction of the nerves may cause loss in sympathetic intervention in most of the distribution areas. This makes the skin to become dry. The finger should be tested by tactile gnosis by the moving and static two-point light touch discrimination test. The hand should be positioned on a flat table and make the patient to close his eyes. A disk-criminator or a bent paper clip should be used to measure the innervation density. The examiner should begin at 6mm distance between the prong and this should be preceded to higher and lower distances to determine the critical distance in which the patient indicates pain. (Lawton, J. N. 2013) The fifth exercise is to test on the circulation. This should be done by noting the color of the skin and the fingernails as well as the blanching and flush of the nail-bed. The Allen test should be used in this case by following the following procedures: The ulner and radial arteries should be compressed first. The patient should be asked to make a fist, open and close it several times to exsanguinate the hand and then open the hand again into a relaxed position. The radial artery only should be released later. If the palm and fingers get filled with blood, then the radial artery is patent. Repeating the first and second steps, the ulnar artery should be released now. If the entire hand flushes, then the ulnar artery is pantent. (Miller, M. D., Hart, J. A. 2011) Working Diagnosis: The patient was diagnosed with a Bennet’s fracture. It has occurred from the ulnar base of the thumb metacarnal. (Sorock, G.S., Lombardi, D.A., Hauser, R.B., Eisen, E.A., Herrick, R.F. and Mittleman, M.A., 2001) Brief management issues/referrals: This condition requires surgery that should be performed by the specialist wrist and hand surgeon. This should be followed by 4-6 week period of immobilization in a plaster cast. This operation involves the reduction of the bones which is a medical speak by putting them back in the right place. Fixation of the fracture can be done by making use of wires. (Strickland, J. W. 2005) The therapist should mobilize the surrounding joints during the immobilization period to help in the restoration of the normal function of the other fingers. This should be followed by an exercise of wrist and hand strengthening.

Censorship and Book Banning Essay - 1817 Words

Censorship cannot eliminate evil. It can only kill freedom. We believe Americans have the right to buy, stores have the right to sell, authors have the right to write and publishers have the right to publish constitutionally protected material. Period. (â€Å"Banned Books and Authors†). Harry Hoffman, president of Walden Book Co., Inc., is accurate in this aspect. When books are censored or banned, they are not eliminated from society; however, their message emanates to create an impact. Even if the public conceals the content in these books, the victims that these censors sequester from these works are rarely unexposed to what is being censored to them. By challenging or attempting to ban a book, more attention is drawn to that distinct†¦show more content†¦In United States v. Random House, Inc., they ruled that the book â€Å"Ulysses† provided a new literary method, even given the vulgar language that it contains. Also, in Stanley v. Georgia, they ruled that states cannot limit what anyone wants to read or watch. (Agrawal) Nonetheless, there is a separation between challenged and banned books. Challenging a book is an attempt to remove the book in question, based on a person’s opinion of it (ALA). To challenge a book from a library or a school, a committee must be formed, made up of a principal, librarian, teacher, complainant, parent and/or student who would discuss the book, file a recommendation, and notify the compliant with the superintendent (Simmons). An actual banning is the removal of the book from library shelves and a school’s curriculum, in the attempt to restrict a group of people from having access to it. Each year, hundreds of books are challenged. In 2007, over 420 books were either challenged or banned, the lowest it had been for a while (Pitner). Censorship Violates the First Amendment For starters, the First Amendment states â€Å"Congress shall make no law†¦abridging the freedom of speech, or of the press;† if this is true, how does that make censorship legal? Censorship is the almost exact definition of abridging freedom of speech. â€Å"Freedom of speech† is an essential right for any human to help preserve a kind of peace and order. The idea of being free to express opinions and viewpointsShow MoreRelatedEssay on Censorship and Book Banning1838 Words   |  8 Pages Censorship is a concept with several different meanings. To each individual censorship has its own meaning. Is it a violation of our rights or is it a protection for our well being? Censorship in the generic sense refers to the suppression of information, ideas, or opinions. It occurs in all forms of communication from technological media to print media. Each society, culture, or individuals belief is violated by the codes of cens orship that our society instills. Book banning is aRead MoreEssay on Censorship - The Negative Consequences of Book Banning1501 Words   |  7 PagesThe Negative Consequences of Book Banning If you were to ask a teacher what they thought the most important source of knowledge was they would probably answer: reading. When I think back to every classroom I sat in at school, I remember at least one poster on the wall promoting reading. Throughout my school years, teachers have pounded into my head how important it is to read. In high school I had a list of books that I was required to read over my summer break so that I would continuouslyRead MoreBanning Books in Schools Essay983 Words   |  4 PagesThe practice of the censorship of books in schools has been prevalent due to the explicit content of them. Parents have been complaining to schools about books that count as required reading because they disapprove with the points made in the book. If a book consists of offensive or sexually explicit material, then parents would challenge the schools about them in order to prevent their children from reading them. Censorship in general has been an intensely debated is sue because it is consideredRead More The Controversy Around Banning Books Essay852 Words   |  4 Pages The subject of censorship is a very controversial one, especially the banning of books. Many people believe they must protect themselves and others from the quot;evilsquot; of many classic books and works of art because they can be deemed quot;indecentquot; in one way or another. Many believe that this is absurd and censorship in its current form is a violation of our First Amendment right to free speech. Personally, I align myself with the latter, however I do feel there are occasions whereRead MoreThe Controversy Around Banning Books889 Words   |  4 PagesThe subject of censorship is a very controversial one, especially the banning of books. Many people believe they must protect themselves and others from the evils of many classic books and works of art because they can be deemed indecent in one way or another. Many believe that this is absurd and censorship in its current form is a violation of our First Amendment right to free speech. Personally, I align myself with the latter, however I do feel there are occasions where censorship is justifiableRead MoreIts Time to STOP Banning Books Essay1383 Words   |  6 Pagespast to make it easier for people to talk about sex in a more mature manner. Banning books that contain sexual content, vulgarity, and violence give children and young adults a reason to snicker about these topics when discussed in class because we are taught that these topics are not appropriate to talk about publicly. There are many factors that play a major role in how an individual perceives certain topics in books. If taught at an earlier age that these topics are suitable for mature discussionRead MoreLiterature Be Banned1227 Words   |  5 Pages Literature shouldn’t be banned because literature inspires, advocates, unites, entertains, and informs. By banning books from the classroom, we prevent students from learning about controversial topics in a safe environment. The Menifee school district banned the dictionaries from the students because of one parents complaint. I believe this was a terrible idea because many students need a dictionary to look back at when they think they’re wrong. Dictionaries are helpful in many ways such as learningRead MoreThe Banning of Certain Books in School Libraries/ Classrooms848 Words   |  4 Pages People read books about dystopians all the time, you know those books that have everything possible go wrong. Books like The Hunger games, or Fahrenheit 451, Ect. Some people look at them as just stories, just fictional books. Those books are all about censorship and having the government controlling and watching your every move. What most people dont realize is that there is censorship happening right now, every time you send a text or make a phone call, the government can see/hear itRead MoreBook Burning in Nazi Germany1237 Words   |  5 PagesB ook burning is the ceremonial destruction of books or any other written works by fire. And it is done in public. Also it is a representation of censorship. The drive behind such acts can either be political, cultural, or religious resistance to the material in question. The purpose of the Nazi book burning was to destroy all ideologies that were considered to be un-German. In 1933, university students were on a mission to cleanse Germany of Jewish intellectual ideas (Fishburn, 2007). They believeRead MoreEssay on Is Censorship Unconstitutional?919 Words   |  4 Pages Censoring knowledge is unconstitutional. Censorship had been going on since the beginning of the written word. This means that is not hard to say that it has been used as a manipulation tactic since the first man, or woman, placed their coal to a piece of dried goat skin. So does this make it wrong? To understand censorship, you have to start at the beginning. Censorship, no matter the definition, is when people who have power, wish to limit the knowledge of what we are receiving, or

Compare Heaneys presentation of his father in Digging and the Follower Essay Example For Students

Compare Heaneys presentation of his father in Digging and the Follower Essay The two poems Digging and Follower are very similar. As evidence both poems refer to the earth and the different job that are related with the earth. Digging is about Heaney digging into his memories about his father and grandfather. Follower is ambiguous as Heaney followed his father literally and metaphorically in his memory. In both of the poems the child compares himself to his father and grandfather. There are several developed metaphors that compare the father and his work to the ocean in the Follower: His shoulders globed like a full sail strung Heaney looks at his father from a childs point of view as children see everything as being bigger than them. The quotation is a reference to the fathers shoulders being large like the billowing sail of a ship. Mapping the furrow, tells the reader that it is like navigating a ship. This tells the reader that his eyes are excellent so that he is able to plough in straight lines. As the father ploughs the sods roll over without breaking like a wave and if the child stumbles in his wake the father puts him on his back as the dips and rises on his fathers back. The reader feels that son admires his father and the way he worked. The person in the poem Digging feels pride in both his father and grandfather as they started to dig the peat: My grandfather cut more turf in a day Than any other man on Toners bog. This poem has a looser structure that the Follower as it looks at two memories the first memory is of his father as he was digging the potato drills the second memory was of his grandfather as he was digging the turf for which he was famous as the best digger on the peat bog. The word My is interesting because it shows how the grandchild has pride in the way that his grandfather dug. In both the poems the poet does not celebrate their strengths but their expertise at digging. The poet explains in detail the knowledge and the skill of the father digging in both of the poems: Coarse boot nestled on the lug, the shaft against the inside knee was levered firmly. In this quotation the poet explains the diggers technique in a lot of detail. The phrase Coarse boot nestled is appealing as he describes in detail that the rough boot was firmly placed on the spade. This is relevant as it shows the reader that his father is also securely located in his mind. His was in awe when he saw his father use the spade, as he was amazed he could use a spade as well as his father. Heaney feels that he was too inadequate to ploughing as he was always stumbling and was always clumsy: I wanted to grow up and plough, To close one eye, stiffen my arm. Heaneys view of farming is of imitating the fathers actions as the title of the poem Follower tells the reader that he is a child impersonating his father. The child recalls his fathers admiration of him when he was younger, but now his father walks behind him. This metaphor runs through the poem, but now the positions are reversed. Stumbling behind me, and will not go away his father is not literally behind him, but he is troubled by his memory perhaps because he feels guilt at not carrying on the tradition of farming, or he feels he can not live up to his fathers example. .u614e6f40c4319781bb99ad40086a8e45 , .u614e6f40c4319781bb99ad40086a8e45 .postImageUrl , .u614e6f40c4319781bb99ad40086a8e45 .centered-text-area { min-height: 80px; position: relative; } .u614e6f40c4319781bb99ad40086a8e45 , .u614e6f40c4319781bb99ad40086a8e45:hover , .u614e6f40c4319781bb99ad40086a8e45:visited , .u614e6f40c4319781bb99ad40086a8e45:active { border:0!important; } .u614e6f40c4319781bb99ad40086a8e45 .clearfix:after { content: ""; display: table; clear: both; } .u614e6f40c4319781bb99ad40086a8e45 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u614e6f40c4319781bb99ad40086a8e45:active , .u614e6f40c4319781bb99ad40086a8e45:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u614e6f40c4319781bb99ad40086a8e45 .centered-text-area { width: 100%; position: relative ; } .u614e6f40c4319781bb99ad40086a8e45 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u614e6f40c4319781bb99ad40086a8e45 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u614e6f40c4319781bb99ad40086a8e45 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u614e6f40c4319781bb99ad40086a8e45:hover .ctaButton { background-color: #34495E!important; } .u614e6f40c4319781bb99ad40086a8e45 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u614e6f40c4319781bb99ad40086a8e45 .u614e6f40c4319781bb99ad40086a8e45-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u614e6f40c4319781bb99ad40086a8e45:after { content: ""; display: block; clear: both; } READ: Compare Contrast: Venetian Renaissance Art Versus Roman Florentine ArtWhen the child compares himself to his father and grandfather he is very negative in both of the poems: Once I carried him milk in a bottle Corked sloppily with paper. In the poem Digging the child compares himself to his grandfather who sliced the soil so neatly, when the child opened a milk bottle and left bits of the cork around the inside. This shows the read that the child was clumsy at doing physical things. The grandfather wastes no time while drinking of digging he is almost robotic as he makes sharp movements as his spade digging into the ground. Heaney uses onomatopoeic to give the audio imagery of the father making the noise: clickingpluck These words are frequently used at the end of the line on a rhyming word. The rhyme is in quatrains with eight syllables. An expert is a phrase written without a verb in the sentence because it makes an impact on the reader. It also tells them that a farmer is not seen as simple but highly skilled. The regular beat of the rhythm indicates there is no impact on him when he puts the child on his back whilst ploughing. The child compares himself to his father and grandfather in the poem Digging: But Ive no spade to follow men like them. The second stanza is about how he sees his father straining to dig the flowerbeds in his memory he is in his prime, digging potato drills and even earlier his grandfather was digging peat. The child thinks that he is unable to match men like them with a spade, but he sees that the pen is mightier for him, and with the pen he will dig into his past and celebrate them. As he honours how skilfully they worked as the father is still digging in his old age and his grandfather barley stopped to drink in his memory. There is a one main metaphor, which has been extended throughout the whole poem: When the spade sinks into gravely ground: This central extended metaphor of digging and roots shows how the poet in writing is digging back into his roots finding his identity and where his family comes from. The poem is just beginning when it ends, but only at the end does he see the pen as a weapon for digging not literally but metaphorically in his mind. The main theme in both of the poems is the child looking back into his past and watching his father work on the farm. The child presents his father as a man who is hard working and he never feels tried even if he does have his son on his back. The child presents himself as clumsy and a nuisance as he was always yapping away. I enjoyed the poem Digging because I liked how he begun and ended the poem with the same line. I also liked the way that he said that he could use the pen as a weapon the write the truth.