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Sample Middle School Research Paper - ProfEssays com
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Having white space between sections adds balance. If a section on your resume involves a list (such as a “Skills” section), you will want to choose a template with bullet points. These make your resume look organized and research, easy to read. There’s nothing wrong with a classic font like Times New Roman, but a simple resume often looks best with a clean, modern, sans-serif font like Helvetica Neue. If you choose to use font colors to dress up your resume, use them sparingly. Pick just one or two colors to highlight aspects of your resume. For example, you might choose a conservative color, like gray or dark blue, for barn symbolism resume headers. Make sure any font color you choose is easy to read. School? Avoid pink, yellow, and lighter shades, which look unprofessional and are hard to notice. Always be consistent. Have your “Objective” header in the same color as your “Education” header.
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Size: 183 B Downloads: 6473 Filename: industry-lifer.docx Uploaded: 2014-05-08 15:49:00 / 6041. Dark black section dividers complement light green and blue fonts and bullets. Large, three-columned Core Skills section for many key attributes. Serif font type completes mature, professional feel. Size: 183 B Downloads: 5795 Filename: cosmopolitan.docx Uploaded: 2014-05-08 15:41:00 / 6032. A traditional format that portrays a simple elegance. An initialed ribbon provides a smart touch which can be personalized with you initials, your highest qualification or your most prestigious award. Help Writing? Bullet points help you to squeeze in a lot more information without making your resume too long. Size: 183 B Downloads: 5628 Filename: elegant-traditional.docx Uploaded: 2014-05-06 11:35:00 / 4958. Two-page, one-column layout with red and orange for research paper headings and titles.
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Service and labour workers take a look here. Size: 183 B Downloads: 4083 Filename: breezy.docx Uploaded: 2014-05-08 15:35:00 / 6026. Colour contrast and different font types dictate the style and research, impact of this resume. The use of the red always pulls you back to the name of the applicant. Size: 183 B Downloads: 3990 Filename: simple-red.docx Uploaded: 2014-05-06 18:02:00 / 5655.
Oversized captions for key words or job titles. Small profile photo with blue shaded section headers. Excellent use of space for intern experience, new graduates, and creative professionals. Size: 183 B Downloads: 3942 Filename: caption.docx Uploaded: 2014-05-08 18:00:00 / 6144. Want a different way to distinguish your sub-headings from your headings? This layout shows how different shades of the same colour can do this.
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Sample Business School (MBA) Application Essays. Let#146;s face it. The term #147;globalism#148; has become overused, and often misused. In fact, we might say that it has actually been devalued to paper the level of the everyday language of buzzword-brandishing marketing pundits. Such freewheeling usage has perhaps prompted many a CEO (or future CEO) to burning symbolism launch into a global plan or strategy without proper consideration of the research paper, demands and dynamics of the international marketplace. Many would-be globetrotters neglect the dissertation, acquisition of language skills, knowledge of foreign trade and tax laws, accounting standards, etc., all of which are necessary to effectively #147;go global.#148; Superficial knowledge only leads to failure. This has, indeed, happened, and while there is no doubt that neglecting to capture the gains achievable in research, overseas markets is equally suicidal, misguided attempts at competing globally (along with rapidly developing opportunities in the global marketplace) have placed a dramatic premium on individuals who take the a grant, time to properly train themselves in international business. For me, the Columbia MBA is research paper a significant component of this training. I foresee my own career moving in dissertation demand, the direction of European/American business, initially from an advisory perspective (i.e. investment banking or consulting) and ultimately from in middle school a leadership role within a manufacturing entity, preferably a start-up venture.
This prophecy, in part, has evolved from my past experiences in western and eastern Europe which, in araby literary analysis essay, turn, have formed my opinions about certain opportunities that should emerge in the future: there should be, with a good degree of certainty, immense windfall gains and comparative advantages for US-trained/thinking business leaders and managers in the European markets in research in middle, the coming years. Faulkner Barn Burning? This foresight along with my personal entrepreneurial bent and an affinity for finance will play a large role in the evolution of my career. There is a theory that states that students who travel and paper in middle study overseas return greatly transformed in outlook and perspective. I am no different, and it is easy to dissertation phd health imagine how witnessing first-hand the paper, revolutions in Eastern Europe (while studying in Budapest in in the 21st essay, the fall of 1989) would impact my future plans. The overall ramifications of the fall of the in middle school, #147;Red Empire#148; were at that time to me quite apparent (i.e. the end of the bi-polar global political structure, etc.), and it was quite obvious that lacking any kind of international capabilities (languages, experience, etc.) would greatly hinder anyone#146;s career in the long run. Therefore, since graduating in 1991, I have tried to maintain a balance of technical knowledge accumulation and international work experience.
Thus far, I think I have been quite successful. My year at Kidder, Peabody had its compulsory eighty-hour weeks which, indeed, provided a solid technical foundation in corporate finance and capital markets. However, the scope of the company was somewhat limited internationally, hence my job change to Deutsche Girozentrale -Deutsche Kommunalbank- (street name, #147;DGZ#148;) in Frankfurt, Germany. Ib Deadline Essay? This was a career shift that was a bit off the beaten path but was international and provided excellent exposure to the European capital markets and to the internal management/corporate culture of a staunch and traditional German institution. Paper? The job was also naturally conducive to is trade unionism century essay achieving full-fluency in research in middle, German.
My current position has allowed for a continuum of help writing international corporate finance exposure (about 90% of Vereinsbank#146;s clients are central or eastern European) as well as solid technical and quantitative training in corporate finance. Over the course of my experiences both in the US and Europe I have made a discovery that, while nothing new, creates a macro rationale for my career plans. As most of us know, there exists today a seemingly unalterable persistence of research in middle school bureaucracy, risk-aversion and essay on nurture nature time consuming decision making procedures amongst European enterprises, a fundamental difference to their aggressive American counterparts. For any American-trained business leader, this represents an opportunity. The now-ending world recession in tandem with rapidly increasing global competition (both of paper in middle which, incidentally, have prompted a restructuring of US industry) has forced European governments to strongly consider more open markets. That#146;s also nothing new.
However, it seems that the recession was not long enough to force a concurrent inward reflection amongst European business leaders. As a result, many European private sector entities have maintained their bureaucratic habits, but ultimately face increased competition in faulkner barn, their own domestic markets. Research Paper In Middle School? Unfortunately for ib deadline extended essay them, they are losing and should continue to lose (the recent utter domination of research in middle US investment banks in Germany over ib deadline 2011 the long-standing domestic #147;superbanks#148; as a result of the recent liberation of the financial markets is a case in point). This is, obviously, an opportunity. As more and more Europeans continue their tradition of bureaucracy management, there will be an ever-increasing demand for US-trained business operators (who, by the way, traditionally perform well in laizes fairre market environments) as more and school more international companies (US and non-US) move into Europe.
My objective is to on nurture capitalize on research in middle school this opportunity. However, just from essay simple observation, I have discovered that an MBA provides a distinct advantage over those without. There is an paper in middle school, analytical nature inherent to MBA#146;s which I believe is duplicable only by committing two years to the academic study of business. A Grant? And, in light of my international bent, there is no doubting that Columbia is quite appropriate for my purposes. My father once told me, #147;life, like baseball, is a game of inches. So practice, practice, practice before stepping onto the field, life included.#148; I guess he meant prepare before embarking upon the real thing. The MBA, for me, would be a source of #147;practice, practice, practice,#148; and based on my observations of paper in middle Columbia MBAs in action and on the reputation of the school internationally, a Columbia MBA would be perfect #147;spring training,#148; so to speak. My parents divorced when I was two years old. On Nurture? After some judicial haggling (or so I#146;ve been told), I ended up with my father and in middle consequently rarely knew my mother.
Despite this rather unorthodox family setting, my dad and I had one of those father/son relationships that one might see idealized on television; he coached my little league teams, taught me to drive, the dissertation phd health demand, works. To me, my father was my family and, what I liked to coin many years later, my #147;backstop#148;. A couple of months after I left for my first year of college, my father and I had a falling out. If I remember correctly, it involved a speeding ticket. In any case, my dad and I did not speak to one another at all after that lethal day in research paper in middle school, November, despite his repeated attempts to contact me. You see, one thing that my father lacked was ambition; as a California hippie in the 1960#146;s, my dad maintained many of the 60#146;s ideologies of dissertation phd health peace, love and paper in middle school understanding. In other words, the establishment, rules, and the conventional way of doing things he avoided adamantly. Help? For some reason, growing up, I grew to resent this. In fact, it angered me so much that after an argument that hit the very nerve of this resentment, I swore to make it on my own. After all, I was focused.
I had my career to research paper in middle take care of. I had my studies, my athletic activities, my money making schemes, my clubs, my fraternities -- I had my future in unionism in the 21st century, front of paper school me. I, indeed, intended to make up for years of ambition that my father squandered. But a couple of years later upon arriving back to my room after my last final exam before Christmas, I received a message that my father had died of a heart attack. My #147;backstop#148; was gone. As mentioned elsewhere in this application, I am stubborn. I sometimes allow my belief in my own correctness to do more harm than good. Most times, I don#146;t realize it. In this case, the realization of necessary in the 21st essay my stubbornness was like a brick in school, the face.
I had allowed my own goals, objectives and beliefs to come between myself and probably the most important and influential individual my life has seen, and, to barn burning symbolism this day, I only regret it. Undoubtedly ambition is always commendable. Blind ambition with neglect of humanism, however, only leads to dismay. By looking to boldly forge my future, I forgot my father, my family. Sew the seeds of life and happiness, despite what society deems as the norm of such matters. This I forgot. This I learned. 1) OK, I#146;ll admit it -- my college experience was no piece of cake.
In fact, I think I had it harder than most others I knew at research paper in middle school, UCLA. Most others came from wealth. Ib Deadline Essay 2011? So did I, sort of. My family was known for research paper school its wealth of knowledge. Unfortunately, the invisible hand of the free market does not handsomely reward intellect for intellectualism#146;s sake. More specifically, my father was a high school and college instructor, and although he was quite gifted intellectually, didn#146;t make enough to help me out through school. He did, unfortunately, earn enough for me not to qualify for many state grants. I was, as my contemporary peers put it, in the #147;gray area#148;. Having been rudely awakened to the idea that I would be financing the vast majority of my education, I opted for the #147;first two years at burning symbolism, cheap university, last two years at expensive university#148; plan, instead of in middle entering UCLA as a freshmen as I had originally intended.
In the long run, however, this did not hinder my chances of success at UCLA or otherwise. In fact, I think it enhanced it. As anybody#146;s granddad tells him or her at is trade 21st century essay, a young age, there is nothing like spending a dollar that you#146;ve earned on your own. Likewise, graduating at the top of your class at a world class university and paying for school it on your own, to boot, evokes a similar feeling. Necessary Century Essay? I also pegged a very lucrative job as a GIC broker my junior year and managed my own real estate business my last two years of college.
Upon graduation, I was one of research four graduates at UCLA that year to receive an offer from a #147;bulge bracket#148; investment banking firm. Literary? Having done all this and having maintained over a 3.9 grade point average while paying for nearly 90% of my academic costs does, indeed, make me proud. Research Paper? I think anyone in my shoes would feel the necessary, same. 2) Languages are curious creatures. Unlike any other knowledge or skill which improves with learning intensity, languages require time, lots of time. School? That means that while one may learn the nuances of Chinese history in one night of cramming, learning a foreign language requires a bit by bit learning and cognative assimilation process that, for those of us who are impatient, can be quite frustrating. Extended Essay? One can#146;t #147;cram#148; a language. Now, as many of us know, Germans are known for their long vacations. One late August while at DGZ, my immediate superior who, with me, covered Scandanavia (and Northern Germany, from research in middle school time to time) was on a four-week vacation. During his absence one of our German clients needed to araby analysis issue a Schuldscheindarlehen, a type of paper in middle German fixed-income financing instrument. This was fine and dandy, but, unfortunately, our client spoke only German, and extended 2011 I was left to conduct the entire transaction (including documentation).
The transaction lasted a couple of paper in middle school weeks, involved an interest rate swap, and was, without a doubt, one of unionism century my most challenging career experiences to date. Research School? The success, however, did not derive from closing the transaction as would seem on the surface. Indeed, of greater significance was the fact that I had actually mastered and conquered the araby analysis, German language. Big deal, you say? Lots of paper school folks learn foreign languages, right? But, impatient ones rarely do -- it#146;s against their nature, and I include myself amongst them. So although to literary the outside observer this may seem a bit hum drum (especially to consider as one of research paper in middle school my two most admirable successes), the mastering of the German language is truly a triumph and one that only I and my easily-frustrated self will ever truly appreciate.
Europe is essay on nurture for future a small place in terms of land area. It, however, has an immense history. Paper In Middle School? At times, these two simple facts clash as the reality of progress and historical progression sets in within many European cities. The end result is that while Europe is ib deadline extended essay littered with historical monuments, the private sector calls for additional space for growth. Europe, however, has only so much space to go around -- something has to research school give. Now, I am a bit of a history buff, and I have always tended to help writing a grant side with the preservation of historical monuments in the face of progress. During my sixteen-month residence in Frankfurt I joined an organization called Verein zur Pflege der Frankfurter Tradition e.V which is devoted to preserving the handful of historical monuments in research in middle, the Frankfurt area.
I had originally joined it with an interest in discussions about German history with Germans directly (something, you might guess, Germans rarely do), but later discovered that the organization was a sort of militant group of Hessens storming around the region demonstrating against private acquisitions of historically significant properties. Considering my personal beliefs about the a grant, free market and where it should and should not be appropriately utilized, I became heavily involved in the group#146;s activities. The Union was organized into sub-committees which were to oversee resistance against the demise of specific monuments. After assimilating myself in research school, the organization for faulkner some few months, I was elected to oversee the committee which was to focus on preventing a private entrepreneur from buying and converting into a casino/restaurant the Sachsenhausner Warte, a building which was the southernmost outpost of the Franks who inhabited the area some 1000 years ago. Over the paper school, course of eight months, I oversaw a group of seven to ten individuals. We demonstrated, gathered signatures, filed petitions, and ultimately presented the topic before the German version of the City Council. Although the matter is essay nature for future under further discussions by local officials, I was recently informed that the Warte still stands -- unconverted.
I am a native Californian, yet have lived all over the world. I speak foreign tongues, yet am quite American in nature and thinking. I possess the ruthlessness of a free-marketeer, yet the humility of a good standing Irish-catholic. Research School? It may, therefore, come as no surprise that I view myself as unique -- who doesn#146;t. But, unlike many of my counterparts, my uniqueness derives not from a particular uniqueness, but indeed, from writing a grant a lack of uniqueness, a balance. As has become prevalent since the Cold War bound us against a common enemy, many of us have retreated to our own particular unique qualities. We are either #147;something - American#148;, from poverty, a foreigner, pro-life or representative of school some other specific niche. Global leaders, global unifiers of the literary analysis, 21st century will not be from niche groups, but representative of the whole, able to relate to people from all walks of school life.
Leaders, today more than ever, must be able to satiate the needs of the extremes, the voices of the many few as well as identify with a more diverse populace. I come from a background that has taken me from rather humble beginnings in a poor urban setting in Los Angeles to is trade unionism necessary essay New York and paper school Europe. I have lived, walked and shared life with wealthy as well as poor, black as well as white, foreign as well as American. I have risen from the poorer areas of California to the wealthy areas of Manhattan and have survived and adapted along the way. The end result has been a life experience that allows me to understand the rites and morays of all levels of burning symbolism society. Research In Middle School? I can wine and dine the captains of analysis industry, drink beer and shoot pool with steel workers. My achievements are obvious, as is indicated in in middle school, other sections of this application. But if I could lay claim to my greatest achievement it would be the understanding of people.
Put yourself in their shoes and faulkner burning act accordingly. This has been advantageous for me professionally as well as personally. With the end of the Cold War and the ever-increasing emphasis on research in middle economic power over political power, now more than ever-private sector leaders will bear more and more burden for social responsibility. The era has come for a new business leader: aware of profit maximization yet equally aware of the community in which he operates. Increasing competition will prompt governments to free up markets to allow for araby literary essay increased competitiveness for their domestic enterprises. It will then be up to enterprises to research in middle school assume the role of self-policing its activities, environmentally, ethically. As a result, business leaders must be objective yet political. The information and content on Infozee site has been prepared carefully and with best efforts.
However, Infozee will not be held liable or responsible for faulkner burning symbolism any loss, damage or other. inconvenience caused as a result of research in middle school any inaccuracy or error within the is trade necessary in the 21st century essay, pages of this website. None of the trademark holders are affiliated with this web site.
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Writing A Research Paper Middle School
A for and against essay about the internet. Research. Look at the essay and do the faulkner barn burning symbolism, exercises to research improve your writing skills. Do the preparation exercise first. Then read the text and do the faulkner barn symbolism, other exercises. What's your opinion? Do you think the internet is bad for young people? For young people it is. Paper. They shoud be surervised while accessing the internet, because they might find pornographic content, violent content and such. Internet, an extended invention which still amazes people in research in middle is own way, is not always good. It has really bad side effects on young adults.
As in the essay, the young people get addicted to online games and they become addicted to the internet quickly. As we can see, there are many more online games being made like Pokemon Go, etc. is really dangerous for young people. I think it really should have a age limit. And also we must be strict about the rules of ib deadline extended, age limit on research paper in middle internet too. Dissertation Demand. I#039;m also a young adult but I find internet uninteresting and dangerous so I approve of it having age limits. For YOUNG PEOPLE yes it is. I think Internet is very useful in schools and in work. It#039;s also handy when you need to communicate. Paper In Middle. On the other hand a lot of unionism in the, people are addicted from sites like facbook, twitter or instagram. I also agree that learning on the internet (like here ont the british council ;) ) is very usefull . So in conclusion internet is possibly the most usefull thing that we ever invented. :) I agree with all of you, but what about learning how to play a musical instrument? I think internet can be very good for teenagers because it helps them a lot especially for essays, projects and homeworks, but it can be also very bad because children spend too much time online.
I like internet because I can listen to songs onYouTube and I use British Councile:) Hi BigBen6464. I'm glad to hear that you enjoy practising English here :) Is there anything in research in middle particular that you like on essay nature for future the site? Jonathan (LearnEnglish Teens Team) Thanks! I like your reading skills practice, stories about UK and What is it? in Study Break. British Council really helps me with my vocabulary. I love it!
I think the internet is an amazing tool which can be used for equally amazing things, but only in the hands of the research paper school, right person. One bad aspect of necessary in the 21st, internet is that anyone could acess anything anytime. That means there is a lot of paper in middle school, inappropriate content out there, but a good person is able to avoid it. Is Trade Unionism Essay. In my opinion, though internet is paper school very good and useful, but some young people use it for bad things. Such as playing computer games and get addict with it.
Many parents has banned the children not allowed to play forever,1 week or a day or so. But they never keep their word because, of course, parents love their kids, that is literary analysis why after just a while,they let their children play AGAIN with their games, so really though, I think internet is useful with good children,and it is bad with bad children. I totaly agree. It all depends from parents. Research In Middle. If they let children to spend too much time online children will get a bad habit when they grow up. You#039;re quite right! I agree with your good comment in point: #039;I think internet is useful with good children, and it is bad with bad children#039;. !! :) In my opinion, Internet is one of the ib deadline extended essay, greatest people created.
You have an access to billions of libraries from your computer, you are able to speak with your friends even if they are on the other side of the world. Paper In Middle School. Many people work using the a grant, Internet. Now let#039;s mention disadvantages of the Internet and web-technologies. Firstly, many people nowadays become addicted and can#039;t survive for more than an hour without computer or smartphone. They need to publish their photos in social networks, chat with 7 people in one moment and research paper in middle read new posts in their favourite online communities. Young people sometimes find their online-life better than the real one. The second disadvantage is that nobody can guarantee the safety of your personal data. Everyone has heard stories about hackers that published private and scandal photos of data base of the big company. It#039;s not really pleasant to know that somebody can easily find out writing all your secrets. To sum up, Internrt is a wonderful tool for searching the necessary information, but social networks is quite tricky part of World Wide Web. I think the internet very useful for us .bcz we can get anything without spend alot of time in looking it . everything when we use it excessively and research in middle more than usually #039;it will be badthing.
Well, we must admit that on phd health demand this perfectly imperfect planet nothing entirely good or entirely bad exists. Internet is included. Surely it was meant for connecting people from all continents, but as the research paper school, human mind has no border line we found out help writing a grant how to research paper use it for different things that provide us either with information or amusement. For Future. It is said that the research school, Internet is ib deadline essay 2011 a good servant but a bad master. Therefore, we can see that the problem isn#039;t in the Internet itself but rather in the humans, as it is us who are using it and who are asked FOR WHAT we are using it. So for paper in middle our irresponsibility we shouldn#039;t blame the Internet but ourselves as we are unable to use a powerful tool for our own improvement but we use it for our own unwanted degradation. I think that#039;s quite right!! Nowadays, Internet has been the most important thing in mutimedia life. Personally, l consider that the internet is bad or not,which depends on users. I think the Internet is something that we have to know, and we should know what is good and bad for us, and keep ourselves away from what can damage ourselves in any way.
I think it is the same for young people, we have to be responsible, because the Internet is ib deadline extended 2011 a tool that helps us either with the school, or with any ordinary situation. i think internet is useful for everyone. If it was a bad thing, something awful, it would have changed instead of paper in middle, reaching the faulkner burning symbolism, whole world. Is something crazy, used 24hrs a day, everyday of the week, a lot of information, and a lot of research paper school, people online. About teenagers who are addicted to games, that depends on each family. Parents could create rules, so no one would be in a bad position. And that also depends on the teenager#039;s sense of what he or she can or can#039;t do. Dissertation. It#039;s impossible to live without internet in a society like nowdays, it#039;s just so easy to make a research, work on a project. c#039;mon, does anyone here wants to paper in middle school spend hours and hours looking for few informations? Internet is on nurture for future useful for everyone, for research school young and old people.
There#039;s a lot of sites that can help us a lot. But, today Internet ha gone too far away. Almost, there#039;s no home without the internet(more than 70% in whole world are with internet). Yes, there are a good and phd health demand a bad sites on paper school the Internet. We have different web-sites(Facebook,Tumlr, Twitter, Instagram. ) that shows us a different world. We can learn a lot of things (English, French. ) and a grant a lot of other things.
But we all know that Internet isn#039;t so much safe.Even if we think that we have good hide it our information, we don#039;t. There#039;s a lot of research paper school, dangerous people in the world. To sum up, I completely agree with essay. No, i don`t thing internet bad for young people, because there is many information in the internet. Barn Burning Symbolism. In my opinion, I dont think Internet is bad for people. Without the Internet, I cannot learn language (English) by myself and I wouldn#039;t be able to access to lots of useful information that school doesn#039;t teach me. On the other hand, internet is bad only when people dont know how to use it wisely. If young people use the Internet for studying and relaxing in proper way, internet would be very useful. To me, the internet#039;s the most wonderful tool that human had created. In my own perspective, the Internet plays an in middle important role in the communicating barrier.
As you can see, people all around the world are using the Internet, including the ib deadline, elderly. We communicate with each other using the internet and it really helps us to stay connected with one another. Besides, without the research in middle, internet, how are the countries going to develop? Our knowledge and help the view to the outside world, the perspective to the outside of our comfort zone will be just limited, like a frog in research paper school the well. So, why not? The internet is the dissertation phd health, best connection between an individual to the whole wide world. It#039;s definitely a boon. Internet is very usefull for us. Internet is particularly useful for everyone, nearly all things are on the internet, you can get anything by only searching on it. Internet seems becoming really important nowadays, it helps people a lot, for example i use internet for learning English, reading news and research paper school doing research for essay on nurture nature for future my tasks. Research In Middle. However, internet also can give many bad effects, people become so fanatical on social media and often forget about time and help writing everything they should do.
I completely disagree that internet is bad for teenagers, internet can be useful or useless, it depends on the way people use the paper in middle, internet. How does this photo make you feel? Can you write a caption for it? . Look carefully. What's this everyday object? Play Wordshake and see how many points can you get in 3 minutes. © British Council The United Kingdom's international organisation for faulkner barn burning cultural relations and educational opportunities.
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case study on asthma Department of Pediatrics, University of school Hawaii John A. Burns School of Medicine. Chapter VIII.2. Asthma. Return to Table of Contents. A three year old comes in with a complaint of coughing for 2 weeks.
Coughing is present every night. Burning. He has also had a mild fever, but his temperature has not been measured at home. His parents have been using a decongestant/antihistamine syrup and albuterol syrup which were left over from a sibling. Initially the cough improved but it worsened over paper in middle school the next 2 days. He is noted to have morning sneezing and dissertation demand nasal congestion. There are colds going around the pre-school. He has had similar episodes in the past, but this episode is worse. He has no known allergies to foods or medications. His past history is notable for eczema and dry skin since infancy. He is otherwise healthy and he is fully immunized.
His family history is notable for a brother who has asthma. In his home environment, there are no smokers or pets. Exam: VS T 38.1, P 100, RR 24, BP 85/65, oxygen saturation 99% in room air. He is alert and research paper in middle cooperative in minimal distress if any. His eyes are clear, nasal mucosa is boggy with clear discharge, and his pharynx has moderate lymphoid hypertrophy. He has multiple small lymph nodes palpable in help his upper neck. Paper In Middle School. His chest has an increased AP diameter and it is tympanitic (hyperresonant) to percussion.
Rhonchi and occasional wheezes are heard on auscultation, but there are no retractions. Heart is in a regular rhythm and no murmurs are heard. His skin is dry, but not flaky, inflamed or thickened. He is initially felt to demand, have moderately persistent asthma and possible asthmatic bronchitis. Paper In Middle School. He is initially treated with nebulized albuterol and nebulized corticosteroids for bronchospasm and bronchial inflammation. He is also treated with an antihistamine at night to reduce his morning allergy symptoms. In follow-up, his cough does not improve and he is still having fever (T 38.2C, 101.0F). A chest X-ray is obtained, but no radiographic evidence of pneumonia is present. On Nurture Nature. His cough persists, but only with exercise and drinking cold juice.
His chest now sounds clear in paper in middle the office. After one week of no night cough, his nebulized albuterol+corticosteroid is reduced to 2 times a day. His exercise induced cough gradually resolves. His nebulized corticosteroid is replaced with nebulized cromolyn twice a day and oral montelukast (a leukotriene inhibitor) is added. He enrolls in a soccer league and plays with minimal coughing. His routine nebulized albuterol+cromolyn is stopped and is used only pre-exercise to essay nature for future, prevent exercise induced bronchospasm. No cough is observed at night or with exercise. Research Paper In Middle. He is continued on analysis, nightly antihistamines, pre-exercise albuterol+cromolyn nebs, and once daily montelukast. He is given an asthma treatment plan which gives his parents clear instructions on school, which medications to start based on his symptoms and severity. Asthma is by far, the most frequent respiratory diagnosis for children admitted to hospitals.
It causes 5000 deaths annually in the United States despite the essay 2011, availability of school excellent medications. Historically, asthma was characterized as a psychological illness, a surgical illness treated by removal of the carotid body, an environmental illness aggravated by air pollution, and an allergic illness or infectious illness. An allergy role in asthma, was legitimized by the discovery of IgE in 1965. Since then, inflammation has been identified as the primary pathologic process in chronic asthma. Because of the is trade in the 21st, variety of asthma triggers, such as exercise, exposure to smoke, weather changes, and allergies, asthma is now considered to paper school, be a syndrome consisting of bronchospasm, airway hyperirritability, and inflammation. The popular term ROAD (reversible obstructed airways disease) or RAD (reversible airway disease) is not entirely accurate since this is only part of the disease process and reversibility may not always be evident. This is because obstruction of the airways may be secondary to mucous plugging or inflammatory changes decreasing the caliber of the dissertation phd health demand, airways, in research in middle school which case, beta-2 bronchodilators are ineffective. Currently the NIH Guidelines (1) have served as a standard for writing a grant, diagnosing and treating asthma.
NIH guidelines provide: 1) An objective means of measuring asthma via the research paper school, peak flow meter. 2) A way of objectively categorizing severity classes of patients based on dissertation phd health demand, symptoms and/or peak flow measurements. 3) A comprehensive pharmacologic plan primarily designed to treat inflammation, inclusive of paper school provisions for dissertation phd health, acute and maintenance care, for each severity level. Research In Middle. 4) For the faulkner burning symbolism, identification and removal of (or control of exposure to) known triggers. 5) The direction for forming a partnership with the physician who uses education as a primary basis of this relationship. The realization that IgE existed and could be found in allergic individuals propelled the field of allergy and understanding of asthma into a renaissance of elucidating the actual pathophysiology of allergic diseases. Asthma is now understood to be a chronic inflammatory disease condition with periodic exacerbations. This is in contrast to viewing asthma as a purely bronchospastic condition. An acute asthma exacerbation is a biphasic process.
Understanding the paper in middle school, inflammatory process of asthma came about when it was observed that 4 to 8 hours following allergen exposure, wheezing would occur that was not responsive (or less responsive) to beta agonists but it was ablated by cromolyn and corticosteroids. Help Writing A Grant. However, beta agonists could easily neutralize the immediate reaction, occurring within minutes of the allergen exposure. This created a picture of a biphasic reaction to allergen (or infection) induced wheezing. The first phase was described as the immediate (bronchospastic) phase and the second phase as the late phase inflammatory response. In the early phase of allergic inflammation, preformed mediators such as histamine and rapidly formed mediators such as leukotrienes are released and cause bronchospasm. Other mediators signal the late phase inflammatory cells.
These cells (e.g., eosinophils) recruit other cells such as epithelial cells to participate in in middle school the resultant inflammatory damage of the airways and subepithelial structures. These events eventually result in extensive restructuring of the normal histology of the airways. This damage is not restored by beta-2 bronchodilators. An important immunologic occurrence is the activation of the Th2 helper cell, which is pivotal in the progression of the essay on nurture, allergic immunologic process. The other helper designated Th1 cell does not enhance the allergic inflammatory process. Asthma, whatever the research paper in middle, severity, is a chronic inflammatory disorder of the airways.
The characteristic features of asthmatic inflammation are: mast cell activation, inflammatory cell infiltration, eosinophils, macrophages, neutrophils (particularly in sudden-onset, fatal exacerbations), lymphocytes (TH2-like cells), edema, denudation and disruption of the bronchiolar epithelium, collagen deposition beneath the basement membrane (this is an irreversible process), goblet cell hyperplasia, mucous hypersecretion, and smooth muscle thickening. The primary clinical components of asthma include: bronchospasm, inflammation, airway hyper-reactivity, increased mucous production, and end expiratory hyperinflation (air trapping). There are many presentations of asthma. Asthma is present 24 hours a day, 7 days a week. It may not be in araby an easily identified form (i.e., there may be no obvious symptoms present). Research. The most recognizable form is the acute episode in which the patient presents with acute shortness of writing a grant breath. Depending on the underlying degree of inflammatory damage of the airways, the episode may have been festering with persistent cough and occasional bouts of shortness of breath for weeks. Failure to attend to these soft signs of research in middle school asthma in transition may lead to an acute case of status asthmaticus. Unionism Century. Hence, paying attention to signs of research paper silent asthma (asthma not in a grant an acute phase), can prevent costly and life threatening consequences. In Middle School. Asthma may appear solely as an event associated with work or exercise.
Most asthma in childhood occurs as a result of encounters with respiratory viruses. If the asthmatic is already unstable because of a poor maintenance regimen of the existing chronic asthma, the acute phase will begin simultaneously with the first signs of a cold. If the asthma is managed well, then the cough and wheezing may occur several days after cold symptoms. Hence, early recognition of asthma in transition is a major point of cooperation involving the physician and patient. An asthma management plan should include a maintenance plan and essay provisions for acute onset wheezing. Asthma in its most manageable state, is outpatient asthma, as opposed to hospital status asthmaticus. For most medical professionals, the school, first and everlasting impression of asthma is in hospital status asthmaticus. By far, the more common situation is asthma outside the hospital, in its non-acute form. Therefore, it is highly desirable that medical professionals familiarize themselves with the other faces of asthma to facilitate diagnosis and treatment.
The type of medication used to treat asthma reflects the mechanism of airway obstruction: bronchospasm versus inflammation. Essay For Future. This is an extremely simplified version of what really goes on research in middle, and new pieces of the intricate mechanism are being uncovered. However from a pragmatic standpoint, the faulkner barn symbolism, logic for research paper school, appropriate use of individual medications for dissertation, asthma can be understood by recalling the biphasic reaction. Based on this brief description of the mechanism of asthma, it is now possible to create an asthma treatment program. Genetics aside, elimination of triggers and research paper aggravators of asthma such as allergens, cigarette smoke, and environmental and industrial pollutants, can prevent acute exacerbations of asthma and serve as the first line of defense. Conditions such as weather changes and respiratory infections fall outside of the readily controllable factors. Approach to Asthma. . . . . . 1. Diagnose asthma and classify severity. Nature. Identify aggravating and triggering conditions. . Paper School. . . . Dissertation. . 2. Prepare an research in middle school, initial treatment plan to stabilize the acute condition. Instruct patient and parents on signs and symptoms which help to monitor the barn, effectiveness of treatment.
If practical, treat other aggravating and co-morbid conditions concurrently. . School. . . . Faulkner Barn Burning. . 3. When asthma is paper in middle school stable, proceed to a maintenance plan to allow healing of the damaged airways. Dissertation. This may take weeks to research in middle school, months. Prepare an asthma action plan for up-regulation of medications for help, unexpected exacerbations. . . . . . 4. When there are no signs of breakthrough cough or wheezing, indicating that the paper in middle school, airway hyper-reactivity has subsided and is controlled, switch to dissertation phd health demand, a long term maintenance plan. This might be PRN use of bronchodilators, or pre-exercise use of preventive medications, or pulsing of paper in middle medications for cold symptoms in araby analysis essay short bursts. . . . . . 5. Monitor asthma with periodic evaluations and reminder messages of avoidance and check on patients' inhalation technique of paper medication administration. Inflammation in asthma contributes to: airway hyperresponsiveness, airflow limitation, respiratory symptoms, coughing, wheezing, shortness of breath, rapid breathing, chest tightness, persistent symptoms, and pathologic damage, even when symptoms are not present. It is often thought that periodic control of faulkner barn symbolism acute symptoms is paper in middle school sufficient, but this is suboptimal. Literary Analysis. Utilization of chronic anti-inflammatory agents result in better long term outcomes for all but the mildest asthmatics.
Co-morbid conditions such as allergic rhinitis, sinusitis, eczema, and gastroesophageal reflux have profound influence on asthma. Their presence makes asthma extremely difficult to control. Research In Middle School. The main goal is to keep the patient functional and dissertation phd health demand free of side effects from medications. With this approach, asthmatics have been able to research paper, participate in a normal life style. Asthma is more than an acute process. A large part of treating asthma successfully is to be able to recognize asthma in its early stages and to formulate an appropriate treatment plan before the asthma advances to a critical stage. It is essay 2011 simple to diagnose asthma when the patient is wheezing, displaying intercostal retractions and turning pale or blue. Great clinical skill is required to make a diagnosis of asthma when sub-clinical and/or non-acute asthma is present. A careful detailed history and physical exam are crucial to this end. Asthma is not the acute episode of wheezing as popularly described in lay journals and magazines, but a chronic condition of the research in middle, airways of the barn symbolism, lungs which exhibits recurrent bronchospasm. Research Paper In Middle. These chronic symptoms may present itself as cough with exercise, cough with colds, cough with laughter, or cough at night.
A peak flow meter can consistently record airflow readings compared against normal values for sex and age. Signs of extended 2011 silent asthma (when no wheezing is heard) include: persistent cough at night, cough with exercise, cough with laughter, cough when consuming cold foods or drinks, prolonged cough following or accompanying a cold, feeling of paper in middle tight chest or difficulty breathing. The peak flow measurement and FEV1 (forced expiratory volume over help a grant one second) are effort dependent measures. Full pulmonary function testing is desirable; however, the equipment is expensive compared to an inexpensive peak flow meter. The ultimate objective measurement for research in middle, asthma is by body plethysmography (body box), which can measure the end expiratory residual lung volume as well as resistance to analysis, airflow. For those patients unable to perform peak flow measurements, clinical history is all you may have to base your conclusions. This includes a major group of paper in middle school younger asthmatics from infancy to 4 or 5 years old. Many children in this age group are unable to nature, reliably perform peak flow measurements. Often, patients will have no symptoms when brought to your examining room. The identification of the role of allergic diseases in asthma relies heavily on patient history.
Physicians trained to respond to research school, record what they feel, see, and hear may have a problem forming conclusions based on writing, history alone. Soft signs indicating that asthma is out of control include: frequent overt wheezing episodes, increasing frequency of using rescue medications (i.e., acute use of albuterol), a previously stable asthmatic now having signs of silent asthma, reduction or termination of activities, patient who had exposure to known trigger, persistent cough following bronchitis or pneumonia. The National Institutes of Health (NIH) guidelines, list as one of several key objectives, forming a partnership with the patient to facilitate treatment of asthma. Good communication and availability to answer questions and research concerns are basic to the partnership. Part of your efforts as the treating physician should be focused on getting the patient to respond in a logical manner to cope with changes in his/her clinical state. This is based on the patient understanding the is trade 21st century essay, principles of: triggers and research in middle school aggravators, bronchodilation, inflammation, airway hyper-reactivity and healing. Patients must also understand mucous mobilization and is trade necessary in the 21st signs and symptoms of research paper asthma out of control which may lead to an acute asthma attack.
For example, should the peak flow fall or cough increase, the patient is writing instructed to upgrade their medications according to research in middle, a prearranged plan. As the araby analysis essay, acuteness of the situation resolves, the patient is advised to downgrade their medications back to their maintenance program. Should there be an unanticipated episode of wheezing, immediate activation of the action plan and paper in middle school consultation with the physician for additional treatment schemes is the next step. This up and down regulation of medications can be done without a physician visit. Phone calls, informing the physician's office of unionism necessary 21st century these maneuvers, are all that is normally required.
Obviously, recurrent wheezing episodes, even if reversed easily might indicate the presence of an unstable condition requiring an adjustment in the basic asthma management plan. Hence, the research paper in middle, physician should be apprised of these changing conditions regularly. All asthma management plans should have common goals. Asthma management plans depend on the severity of the asthmatic. Higher severity levels warrant greater use of corticosteroids and prophylactic medications such as leukotriene inhibitors and inhaled corticosteroids.
The NIH guidelines categorizes severity levels into steps as follows: Step 1 (mild intermittent): Day symptoms two days per week or less and night symptoms two nights per month or less. Chronic peak flow is 80% of expected or higher. Step 2 (mild persistent): Day symptoms greater than two times per week, but less than once per day or night symptoms greater than nights per month. Chronic peak flow is still 80% of faulkner burning symbolism expected or higher. Step 3 (moderate persistent): Day symptoms occur daily or night symptoms occur more than once per week. Chronic peak flow is 60% to 80% of expected value. Step 4 (severe persistent): Continual day symptoms or frequent night symptoms. Chronic peak flow is research in middle less than or equal to 60% of expected value. The use of peak flow in the above classification is not required in children 5 years and under. Peak flow data is useful but not required for classification in older age groups, but most children in this age range are capable of performing peak flows.
The major goal is to dissertation demand, allow the child to paper in middle school, express and achieve his or her maximum natural potential by not allowing the asthma to control him or her. This is a good way to dissertation phd health, view the end point in asthma management. Along the way, it is crucial to cradle the impressionable self image so that the child does not have a negative view of himself or herself. The very impressionable years are from about 3 to 10 years of age, when children form their life-long mental image of themselves. Discussions involving asthma management should, therefore, be handled cautiously with this in mind. Asthma should be viewed as a chronic illness which may continue to adulthood. In 1896 Solis-Cohen published, The use of adrenal substances in the treatment of asthma (adrenalin or epinephrine is a fast and potent bronchodilator). Epinephrine (most commonly administered subcutaneously, but it could be inhaled as well) was the first line of treatment for acute asthma from the 1950s through the 1970s and early 1980s.
In 1924 ephedrine was isolated from Ma Huang (a Chinese root extract). For the next forty years, ephedrine would be the mainstay for asthma treatment in research paper in middle the USA. Ephedrine in combination with theophylline, as products called Marax and Tedral, were used extensively in the same period. Interestingly, the ancient Chinese boiled the ephedra root in strong tea for their concoction to treat asthma. The tea contained theobromine, a methylxanthine.
Although methylxanthines such as theophylline are effective bronchodilators, they have been largely replaced by beta-2 agents (e.g., albuterol) which have a faster onset and less toxicity. Adding theophylline does not appear to is trade unionism in the century essay, acutely benefit most patients who are receiving high therapeutic doses of albuterol. Theophylline's main use is in long term chronic administration for research in middle, more severe asthmatics. This change in therapeutic approach from methylxanthines to dissertation phd health, beta-2 agents did not further our understanding of the true pathophysiology of asthma, as bronchodilation was the only target of treatment. Bronchodilators can be administered via several inhaled routes: metered dose inhaler (MDI), dry powder inhaler (DPI), nebulizer (Neb, also known as aerosol, updraft and wet nebulizer), parenteral IV, parenteral subcutaneous injection (SC), and orally (PO). In general, inhaled medications have a faster onset, greater potency and research paper in middle school less side effects.
Bronchodilators Used in Asthma. A. Phd Health. Beta-2 Agonists: . . . albuterol (Ventolin, Proventil, also called salbutamol outside the USA) - MDI, Neb, PO. . Research Paper In Middle School. . . L-albuterol (Xopenex - active isomer only) - Neb. . . . terbutaline - MDI, Neb, PO, SC. . . . formoterol (Foradil - very long acting) - DPI. . . . salmeterol (Serevent - used for maintenance therapy) - DPI, MDI. . . . epinephrine (alpha and beta) - MDI, Neb, SC. . . . ipratropium bromide (Atrovent) -MDI, Neb. . . . oxitropium bromide (Oxivent) - MDI.
. Help. . In Middle School. . aminophylline - PO, IV. . . . theophylline - PO, IV. Other drugs with bronchodilator effects include ketamine, calcium channel blockers (e.g., nifedipine), and diuretics, however these drugs are not used routinely in acute asthma. Based on the biphasic mechanism, an anti-inflammatory drug (i.e., corticosteroids) is necessary for the complete treatment of asthma. Corticosteroids (steroids for short) can be administered systemically (PO, IM, IV) or inhaled (MDI, nebulizer, etc.).
For asthma of a chronic nature, such as allergic asthma to burning, house dust, a daily regimen of a long acting bronchodilator coupled with a steroid by inhalation would be effective. Steroids take hours to research paper in middle, become engaged in its active phase. Their action does not take place directly on writing a grant, the inflammatory tissue but by modulating DNA production of pro-inflammatory cytokines. Research In Middle. Their effects are very broad and araby literary analysis nonspecific. Steroids affect virtually every phase of the inflammatory process. They have an array of impressive and undesirable side-effects, which cause hesitation in research paper in middle their use by physicians as well as patients. As in the use of any medication or therapeutic agent, the employment of steroids is subject to weighing the desired effects against the undesirable effects (benefit vs. risk).
If the positive effects of using steroids have an overwhelming advantage over not using the drug, then it is justified to be used on barn symbolism, a regular basis. This especially applies to children where growth suppression (in the order of 0.5 to 1.0 cm per year) is the major side effect of chronic inhaled corticosteroids. Catch-up growth occurs in school most instances, if the child's condition improves to faulkner burning symbolism, the point at which inhaled corticosteroids are no longer needed. Research Paper In Middle School. Many patients require more medications during the fall/winter/spring, and fewer medications during the summer. Occasional bursts of systemic corticosteroids have no significant long term side effects, but chronic or long term use of extended systemic steroids have major side effects (refer to research paper in middle, the chapter on nature, corticosteroids). Corticosteroids used in Asthma. . . Paper In Middle. . beclomethasone (Beclovent, Vanceril) - inhaled. . Araby Literary Analysis. . . Research Paper. triamcinolone (Azmacort) - inhaled, IM.
. . . budesonide (Pulmicort) - inhaled. . . . Araby. fluticasone (Flovent) - inhaled. . In Middle. . Araby Analysis Essay. . flunisolide (AeroBid) - inhaled. . . . mometasone (Asmanex) - inhaled. . . In Middle. . prednisolone (Pediapred, Prelone, Orapred) - PO. . . . Unionism Necessary Essay. methylprednisolone (Medrol, Solumedrol) - PO, IV. . . Research. . dexamethasone (Decadron) - PO, IV.
In addition, one might consider adding a leukotriene inhibitor, also called leukotriene receptor antagonists (LTRA). These leukotriene inhibitors were developed to counteract the all important late phase inflammatory reaction caused by SRS-A (slow reacting substance of anaphylaxis), a compound which was eventually identified as leukotrienes. Their side effects are minimal. These are all given orally. Leukotriene receptor antagonists (LTRA) *(Some sources spell the suffix as leukast instead of lukast. Roche and Astra Zeneca spell it as lukast.) Cromolyn type drugs stabilize mast cells (inhibit mast cell degranulation). They have less potent anti-inflammatory properties, but they have minimal side effects. Cromolyn (Intal) is available via nebulizer and MDI. Nedocromil (Tilade) is available via MDI.
Goals of Asthma Treatment. . . . 1. Prevent chronic and troublesome symptoms (e.g., cough or breathlessness in the night, in the early morning, or after exertion). . . . 2. Maintain (near) normal pulmonary function. . Phd Health. . Paper In Middle School. . Phd Health Demand. 3. Research. Maintain normal activity levels (including exercise and other physical activity). . Is Trade Unionism In The 21st. . Paper In Middle. . 4. Prevent recurrent exacerbations of ib deadline essay 2011 asthma and minimize the need for emergency department visits or hospitalizations. . . Paper In Middle. . 5. Provide optimal pharmacotherapy with minimal or no adverse effects. . . . 6. Meet patients' and families' expectations of and satisfaction with asthma care. Specific asthma therapy measures to achieve these goals are based on the NIH severity categories.
Step 1 (mild intermittent) requires no daily medications. Dissertation Phd Health. ALL of the other categories (i.e., any category with the school, word persistent), requires a chronic controller anti-inflammatory medication. Step 2 (mild persistent) recommends a low dose inhaled corticosteroid. Alternatively, a cromolyn medication or a leukotriene receptor antagonist may be used. Theophylline is help another option, but only in children older than 5 years. Step 3 (moderate persistent) recommends a low dose inhaled corticosteroid plus a long acting beta-2 agonist (salmeterol or formoterol).
Three other alternatives exist: 1) A medium dose inhaled corticosteroid. 2) A low dose inhaled corticosteroid plus an LTRA. 3) A low dose inhaled corticosteroid plus theophylline. Step 4 (severe persistent) recommends a high dose inhaled corticosteroid, plus a long acting beta-2 agonist. In addition to the above chronic (long-term) recommendations, acute exacerbations are treated with quick relief (or rescue) medications, which is research paper in middle most commonly prn albuterol and optional short bursts of systemic corticosteroids. Albuterol can be given: 1) Orally at literary analysis 0.1 mg/kg per dose every 6 to 8 hours. Research School. 2) Via nebulizer 2.5 mg unit dose every 4-6 hours. 3) Via metered dose inhaler (MDI) 2-4 puffs every 4-6 hours (however, most studies suggest that 5 to 10 puffs is faulkner barn more equivalent to the 2.5 mg nebulizer treatment). Systemic corticosteroids are commonly administered as: 1) Oral prednisolone at paper 2 mg/kg/day given once daily or divided BID. 2) IV methylprednisolone 2 mg/kg, then 1 mg/kg every 6 hours.
Systemic corticosteroids are usually given for extended essay, 4 to 5 days and then discontinued if the patient improves. Systemic corticosteroids administered for longer than 7 days require a gradual taper of the medication. If the patient is on inhaled corticosteroids, these should be resumed once systemic corticosteroids are stopped or tapered. Some physicians continue inhaled corticosteroids during systemic corticosteroid bursts to avoid the confusion caused by modifying their chronic medications. All patients should have a written asthma management plan that describes their chronic medications and a plan for the initiation of a rescue plan based on their symptoms and peak flow (if age 5 years). More detailed plans can include recommendations to step up or step down their chronic medications as their chronic symptoms worsen or improve. If dyspnea still persists, despite rescue medications, then the asthma management plan should refer the paper in middle school, patient to a source of immediate medical care (doctor's office during office hours, or emergency room after hours). Serial treatments with beta-2 agonists (usually albuterol or L-albuterol) with or without ipratropium are most commonly given. Inhaled beta-2 agonists can be given continuously for severely ill patients, or serially based on severity. Systemic corticosteroids can be started.
Parenteral corticosteroids do not have an is trade unionism in the 21st century, onset time advantage over oral corticosteroids; however, very ill children have a higher likelihood of vomiting oral prednisolone. Mild intermittent asthmatics can often be treated without corticosteroids. Research Paper. The decision to start systemic corticosteroids is based on their response to beta-2 agonists and ib deadline essay their previous history which indicates their severity level. Those who do not respond well to beta-2 agonists should be started on systemic corticosteroids because, poor response indicates the presence of significant bronchial inflammation Those who have required systemic corticosteroids in the past or who have other markers of more severe asthma should also be started on systemic corticosteroids. Characteristics of good asthma control in children include: no coughing, no shortness of breath or rapid breathing, no wheezing or chest tightness, no waking up at night because of asthma symptoms, normal activities including play, sports, and exercise, no episodes of asthma that require a doctor visit, emergency room visit, or urgent care, no absences from school or activities, no missed time from research in middle work for the parent or caregiver, normal or near normal lung function, and a healthy self image (i.e., nothing can stop me attitude).
Unfortunately, the death rate from asthma is not yielding to the introduction of many excellent and powerful treatments. This condition remains a challenge to the medical care team at all levels from physicians, nurses, emergency technicians, and essay nature for future respiratory therapists to psychiatrists and social workers. Family, school personnel, coaches, club leaders, and after hours activity supervisors, are all involved in delivering care to the asthmatic. Risk factors for death from asthma include: . In Middle School. . . Past history of sudden severe exacerbations. . . . Prior intubation for asthma. . . . Unionism Necessary. Prior admission to intensive care unit for asthma. . . . Greater than 2 hospitalizations for asthma in the past 12 months. . . . Greater than 3 emergency room visits for asthma in research in middle past 12 months.
. Is Trade Unionism Necessary In The. . Research Paper School. . Hospitalization or emergency care visit for asthma in the past month. . . . Use of more than 1 canister per month of inhaled short-acting beta 2 agonist. . . . Current chronic use of oral corticosteroids. . Dissertation Phd Health Demand. . . Difficulty perceiving airflow obstruction or its severity. . . Research. . Low socioeconomic status and urban residence. . Ib Deadline Extended Essay 2011. . . Illicit (illegal) drug use. . In Middle. . Essay On Nurture Nature For Future. . Serious psychosocial problems. Acute signs of severe asthma and paper in middle potential impending respiratory failure, warranting admission to an intensive care unit include: 1) Oxygen saturation less than 100% despite the administration of supplemental oxygen. 2) Persistent respiratory distress and poor aeration despite aggressive beta-2 agonists. 3) A pCO2 of 40 or greater on a blood gas. The treatment of severe status asthmaticus bordering on respiratory failure is writing controversial.
It is reasonable to begin with high dose beta-2 agonists; such as a nebulizer treatment with concentrated albuterol, or continuous albuterol. In severe patients, aeration is poor, so inhaling albuterol by itself is usually insufficient. Subcutaneous epinephrine or terbutaline can deliver additional beta-2 receptor stimulation systemically. Other therapeutic options include: inhaled isoproterenol, IV or inhaled magnesium, IV ketamine, inhaled heliox or anesthetic agents. Such patients should be treated aggressively from the onset to prevent respiratory failure. If the patient fails to improve and respiratory failure ensues, positive pressure ventilation should be directed at maintaining oxygenation above 90% saturation if possible.
Severe status asthmaticus results in air trapping, therefore ventilation (air exchange) is difficult (almost impossible). Although such patients have very high pCO2s because of air trapping and poor ventilation, the priority should focus on maintaining oxygenation. Attempting to normalize the pCO2 with aggressive positive pressure ventilation will increase the likelihood of in middle a pneumothorax which will worsen the ib deadline extended 2011, hypoxia. This strategy is known as permissive hypercapnia because hypercapnia is not as deadly as hypoxemia. Permissive hypercapnia is more likely to avoid a pneumothorax and thus, oxygenation is preserved, improving the overall outcome. While the NIH asthma treatment guidelines do not recommend chest X-rays (CXR), it should be noted that these are treatment guidelines for research school, asthma. These are not guidelines for pneumonia, tracheal anomalies, bronchial foreign bodies, etc.
Thus, the in the 21st, CXR may be necessary in the process of paper in middle evaluating some patients to be certain that the help writing, patient has asthma and NOT some other condition which can only in middle school be identified on CXR (i.e., to rule out other conditions). Environmental measures to reduce asthma severity focuses on elimination of household smoking and the reduction of exposure to dust mite and cockroach microantigens in the environment. Wrapping mattresses with plastic casings, conversion of carpeted floors to essay, tile floors, replacing drapes with blinds, and selecting home furnishings which avoid antigen accumulation, may result in improvement. Allergy testing and subsequent immunotherapy to desensitize a patient may be beneficial in some asthmatics. In summary, asthma is a condition of multiple factors. It can be looked upon as a syndrome of multiple but related elements. It is basically a chronic condition with biphasic components which both result in airflow obstruction by different means. Research School. The treatment should take into phd health demand, account the various triggering factors, occupation, age, psychosocial, and economic factors. 1. Research School. How can you best describe asthma? 2. Can you describe the various medications to treat asthma?
3. Can you describe the parameters that are used to classify severity of asthma? 4. Describe clinical findings signifying the severity of an ib deadline essay 2011, acute asthma exacerbation. 5. Discuss the research, approach to an asthmatic in relationship to araby analysis, formulating an acute asthma treatment plan. What questions do you ask, what physical findings do you look for, and what laboratory parameters are measured? 6. Research School. Formulate an asthma maintenance plan. 7. Describe various triggering factors and mechanisms by which they might exert their action. 8. Describe the immunologic chain of events that ultimately leads to bronchospasm and inflammation. 9. Discuss the pros and cons of corticosteroid use in children and literary analysis essay compare them with use in adults. 10. How would you convince parents of asthmatics to use medications when their children are not openly symptomatic?
1. National Institutes of Health. NAEPP Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma-Update on Selected Topics 2002. 2. Busse WW, Lemamske RF. Advances in Immunology Asthma. New Engl J Med 2001;344(5):350-363. 3. Kay AB. In Middle School. Advances in Immunology Allergy and Allergic Diseases Part 1. Is Trade Unionism In The 21st. New Engl J Med 2001;344(1): 30-37. 4. Kay AB. Paper School. Advances in Immunology Allergy and Allergic Diseases Part 2. New Engl J Med 2001;344(2):109-114.
5. Marone G, Austen KF, Holgate ST, Kay BA, Lichtenstein LM (eds). Help. Asthma and Allergic Diseases: Physiology, Immunopharmacology, and Treatment. 1998, San Diego: Academic Press. 6. Barnes PJ, Grunstein MM, Leff AR, Woolcock AJ (eds). Asthma. 1997, Philadelphia: Lippincott Raven.
7. Pearce N, Beasley R, Burgess C, Crane J. Asthma Epidemiology, Principles and Methods. 1998, New York: Oxford University Press. 8. Brenner, BE (ed). Research Paper In Middle. Emergency Asthma. 1999, New York: Marcel Dekker. 9. Murphy S, Kelly HW (eds). Pediatric Asthma.
1999, New York: Marcel Dekker. 10. Kotses H, Harver A (eds). Self Management of Asthma. 1998, New York: Marcel Dekker. 11. Szefler SL, Leung DYM (eds). Severe Asthma: Pathogenesis and on nurture for future Clinical Management. 2001, New York: Marcel Dekker. 12. Sheffer A (ed).
Fatal Asthma. Paper School. 1998, New York: Marcel Dekker. Answers to questions. 1. Asthma is best thought of as a chronic inflammatory condition consisting of obstruction of the airways of the lung caused by spasms of the smooth muscle surrounding the airways which, in writing some cases, can be easily reversed by beta adrenergic bronchodilators. Paper In Middle. In other cases, corticosteroids may be necessary to reverse the airway obstruction by reducing the inflammatory changes responsible for the airway narrowing. These changes may be caused by a variety of different stimuli.
2. Medications are divided into groups directed towards relaxing bronchial smooth muscles (relievers) and reversing the inflammation (controllers). 3. This answer can be divided into two parts. The first is essay on nurture nature used to describe the degree of severity of the acute asthmatic episode. These would include rate and effort of respirations, ability to move air through a peak flow meter or spirometer, and oxygen and carbon dioxide concentration in the arterial blood. The second parameter involves the paper in middle school, sensitivity of the airways (i.e., the demand, chronic severity classification described in the chapter).
Day symptoms, night coughing episodes, peak flow, coughing with exercise, prolonged coughing after upper respiratory infections, and coughing with drinking ice-cold beverages help to school, categorize the severity of asthma. 4. Wheezing may be heard but if the attack is very severe there may be no wheezing at all (due to poor air exchange). Aeration is a good indicator of dissertation demand acute severity. Evidence of respiratory distress (retractions, tachypnea) indicates increasing severity until respiratory failure occurs (at which point, the patient may tire and exhibit seemingly less respiratory distress). Hypoxemia is also indicative of severity. Peak flow is typically low for acute exacerbations. For mild cases, cough may be present at any phase of an paper school, asthmatic episode and may be the nature, only sign that bronchospasm is occurring.
A peak flow meter reading before and after a challenge of research school inhaled bronchodilator may reveal an increase in the airflow indicating the presence of bronchospasm. 5. Always consider the triggering event in formulating the treatment plan. Avoidance of the trigger can be very cost effective. Preventive use of medications can be very useful such as preemptive use of medication with first sign of a cold. Analysis of the writing, symptom's response to initial treatment can guide you in up regulating or down regulating medications. Use of the research paper, peak flow meter can serve as an objective means of adjusting medications. If cough and wheezing occur often and there are signs/symptoms of chronic asthma, a maintenance plan of daily medication should be initiated.
Efforts should be made to approximate the degree of faulkner barn burning inflammation in the airways. This estimation can serve to guide you in the type and dosage of anti-inflammatory medications to use. A contingency plan of what medications to use during an acute episode can be helpful and may help to avoid an research paper in middle, unnecessary emergency visit to the hospital. 6. The asthma maintenance plans are dependent on the patient's severity class (step 1, 2, 3, or 4). For all persistent levels, a daily plan will usually involve a long-acting bronchodilator and corticosteroid, LTRA, cromolyn and/or theophylline two to three times a day. Essay. Regular monitoring with peak flow meter readings can help to determine if the treatment is helping to return the lungs to normal function. A rescue plan using short acting bronchodilators with optional systemic corticosteroids may be needed for breakthrough wheezing. 7. Paper. Allergen exposure is writing a grant mediated through IgE with resultant immediate and research in middle school late phase reactions.
A variety of mediators are released and cause a cascade of immunologic events culminating in tissue edema, increased mucous production, and sloughing of the epithelial layer of the inner lining of the airways. This affects the ib deadline 2011, free and easy movement of air to the alveoli, which affects air exchange and causes atelectasis as the smaller air ways are completely plugged by the thickened mucous. 8. Triggering mast cells cause release of mediators, which can cause immediate effects on the lung tissue and smooth muscles. Other mediators are formed and released later and serve primarily to attract inflammatory cells. Some of research in middle these late mediators help to capture the incoming cells. Other mediators recruit epithelial cells and transform then into participants of the reaction causing them to faulkner, release more mediators (biologic amplification). 9. The critical issue of steroids in children is that of linear growth. It is now well established that the use of inhaled steroids has significantly less effect on growth than systemic corticosteroids. The length of steroid use (inhaled or systemic), may have some effect on growth but its effect is temporary and in many studies final growth of asthmatics is generally no different than in non asthmatics (i.e., catch up growth occurs if the corticosteroids can be stopped for research paper school, a period of time long enough for unionism essay, this to occur).
Chronic inflammatory suppression (long term use of inhaled corticosteroids) improves the paper in middle school, long term outcome of asthma (i.e., less severity in the future). 10. This is where your ability to practice medicine is tested. You need to educate and persuade the a grant, parents that your recommendations are in paper the best interest of the child and that it is based on considering the risks against the benefits. This is ideally done without making the parents feel guilty or intimidated by dissertation, the potential for paper school, fatal outcomes. Analysis. While our goal may be to maintain the patient's lifestyle and lung function, patients may see their goal as getting off medications as soon as possible.
For persistent asthmatics, they should be convinced that this is a chronic disease and long term medications will be required. Long term use of medications is generally very safe and not addictive.