Shale Gas Free Essays

Shale gas is natural gas formed from being trapped within shale formations. Shale gas has become an increasingly important source of natural gas in the United States over the past decade, and interest has spread to potential gas shale’s in the rest of the world. In 2000 shale gas provided only 1% of U. We will write a custom essay sample on Shale Gas or any similar topic only for you Order Now S. natural gas production; due to rising oil prices gas prices have also been affected by the rise therefore there was big demand for gas in the US which in 2010 it was over 20% and the U. S. government’s Energy Information Administration predicts that by 2035 46% of the United States’ natural gas supply will come from shale gas. I would like to mention that Chesapeake energy is the leading US company in producing Shale gas with a market cap of 13. 6 Billion US $ (which I think it’s a good choice of adding it to your investment portfolio). Starting as early as 2017 the USA will start to export LNG to other world markets. Recently a company called Freeport LNG Development LP, which opened a facility on the Gulf Coast to import liquefied natural gas four years ago, signed a 20-year contract with two large Japanese power companies (Osaka Gas Co. ; Chubu Electric Power) to export natural gas from it instead. Freeport LNG is in advanced talks with Royal Dutch Shell PLC for a similar export deal that would allow the energy giant to ship out natural gas to foreign end customers. The emergence of vast new supplies of natural gas from dense shale rocks has upended expectations that the U. S. would become a major importer of liquefied natural gas, or LNG, from overseas. Now, many industry officials believe the U. S. could emerge as a major exporter, a development that could have a significant impact on the U. S. trade deficit. Drilling Shale Gas wells is not an easy task thanks to introducing new technologies like the Horizontal drilling technology which is used to drill the shale gas wells, with lateral lengths up to (5,000 m) within the shale, to create maximum borehole surface area in contact with the shale. How to cite Shale Gas, Papers

Academic Goals Essay Example For Students

Academic Goals Essay Outline1 Introduction2 Setting your academic goals3 How are academic and career goals linked?4 Set and measure your goals5 Characteristics and traits of good goals6 Overcome failures and stay determined7 Conclusion Introduction Every student wants to achieve the highest percentage in class and has set realistic academic goals that have to be achieved during the session. In order to boost your performance and results in your school years, there are several important factors that need to be focused. The scenario for high school  is more complex as they have to select their future path of and the field in which they wish to continue their studies. In our society, there has always been a tough competition amongst students as a pupil from all over the world are given the opportunity to  send applications for scholarships and admissions into prestigious institutes. Mostly, students are not able to make into their dream colleges or high schools, but they should never stop their struggle and efforts in any case. Setting your academic goals The study is a crucial phase in our lives, and we have to deliver our best in order to ensure a financially stable future. Taking the example  of the world’s most influential and successful people such as Bill Gates or Steve Jobs, we can follow in their footsteps and enhance the value of our lives without any hassle. This is only possible if you are planning for the coming years instead of only thinking about short term  goals. Taking my own life as an example, my employer  always motivates me to utilize my skills and abilities to complete each given project. Not only this act helps me to deliver my best, but I keep on learning new approaches and techniques to accomplish everyday tasks in a better way. Same is the scenario for graduate school  students as they have to explore the wide marketplace to find out the best suitable job for themselves. How are academic and career goals linked? Academic goals and career goals are absolutely linked together in multiple ways because if you can never compromise in any one of them to live a successful life ahead. I agree that I have got several opportunities and aspects which will help me to  shape my personal  lifestyle and living standards for which starting with a positive approach can help in great means. Furthermore, individuals who are ready to face their opportunity to  step into the job market are more likely to change jobs, get relocated and meet new people  as well. However, for some graduates earning a particular title or position in an organization is the ultimate career goal. Although it is a positive approach and gives students an opportunity to  utilize their skills, there are several complications and difficulties that need to be solved. Taking pride in showcasing academic designations and accomplishments on the resume is a beneficial approach for college students  as it will certainly increase their chances of getting accepted in a renowned organization or company. Set and measure your goals Setting my goals  that are hard or impossible to achieve can end me up in great stress and anxiety. As everything a student dreams of getting is not possible in some cases, I believe  that consistency and hard work will eventually make my employer  lead me towards success. The university  or high schools offering full bright scholarships and awards have a predefined set of rules that need to be followed in order to increase the acceptance rate of our application. Taking the example of the University of Phoenix, there are several departments including Social Sciences, Information Technology and Business where students can select the courses of their choice. This allows students to measure the benefits of any personal  or academic goals as they get to meet new people and explore further dimensions as well. .u51fb04306697585ce831c7a110bd2820 , .u51fb04306697585ce831c7a110bd2820 .postImageUrl , .u51fb04306697585ce831c7a110bd2820 .centered-text-area { min-height: 80px; position: relative; } .u51fb04306697585ce831c7a110bd2820 , .u51fb04306697585ce831c7a110bd2820:hover , .u51fb04306697585ce831c7a110bd2820:visited , .u51fb04306697585ce831c7a110bd2820:active { border:0!important; } .u51fb04306697585ce831c7a110bd2820 .clearfix:after { content: ""; display: table; clear: both; } .u51fb04306697585ce831c7a110bd2820 { 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; } .u51fb04306697585ce831c7a110bd2820:active , .u51fb04306697585ce831c7a110bd2820:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u51fb04306697585ce831c7a110bd2820 .centered-text-area { width: 100%; position: relative ; } .u51fb04306697585ce831c7a110bd2820 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u51fb04306697585ce831c7a110bd2820 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u51fb04306697585ce831c7a110bd2820 .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; } .u51fb04306697585ce831c7a110bd2820:hover .ctaButton { background-color: #34495E!important; } .u51fb04306697585ce831c7a110bd2820 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u51fb04306697585ce831c7a110bd2820 .u51fb04306697585ce831c7a110bd2820-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u51fb04306697585ce831c7a110bd2820:after { content: ""; display: block; clear: both; } READ: Hard Rock Operations Management and Productivity of the Staff EssayCharacteristics and traits of good goals In the society  of challenges and hurdles, just stay realistic and stick to the facts whenever you are setting your academic goals. Hoping for A+ grade in a course you are completely unable to understand is certainly not a good idea as not every field is suitable for all students. As each of us has a differing mindset and thinking capabilities, I believe  this is my personal  experience and sincere advice for college graduates that they should only select their field of interest and focus on achieving good goals. My goals  and objectives are only valuable if they are positive and approachable. No matter what the scenario is, encourage yourself to participate in group discussions and hope to  learn new lessons through class activities. Furthermore, I think that my hard work and positivity will always make my employer  satisfied with my efforts for each assigned project. Overcome failures and stay determined I agree with the fact that setting positive goals will help me to  improve my academic performance, meet new people  and explore various perspectives during my academic years. Students must always try to excel in any kind of school  projects or co-curricular activities the university  is offering as they are a great way to sharpen your mind and improve thinking capabilities as well. When studying various college application samples, you can read how clearly students have defined their goals and objectives which play a key role in the acceptance from renowned institutions such as the university of Phoenix. Conclusion Setting up any personal  and positive goals can bring great advantages for graduate school  students as they are on the point to decide their future educational path. Apart from struggle, hard work and determination, students should also hope to  make this world a peaceful and friendly place to survive for people of all backgrounds and education fields.

Joseph McCarthy Essay Research Paper Throughout the free essay sample

Joseph McCarthy Essay, Research Paper Throughout the early 1950? s, the state was profoundly engrossed in frights of a Communist coup detat. At a clip when America? s frights were at their really height, Joseph McCarthy, a Republican Senator from Wisconsin pushed America? s frights to an extreme. As a gambit to acquire himself re-elected, and to do America detest Communism every bit much as he did, the Senator devised a oblique strategy. McCarthy, while giving a address, held up a piece of paper and exclaimed, ? I have here a list of 57 known Communists who are presently employed by the U.S. State Department? ( Fried, 89 ) . A few yearss subsequently, McCarthy raised the figure of people on the list from 57 to 205. The reaction to McCarthy? s proclamation was absolute terror. Until that clip, the state had a sense of security. Now all peace of head was lost, and America wanted these people that were on McCarthy? s so called? Blacklist? ( Fried, 65 ) . We will write a custom essay sample on Joseph McCarthy Essay Research Paper Throughout the or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page So began a long-run hunt by Congress to seek these persons. One group that was extensively looked at was Hollywood. By Joseph McCarthy mistreating his powers, he non merely destroyed many people? s lives, but he besides wronged the American populace. To get down with, the type of individual that Joe McCarthy was must be considered. McCarthy was a hardline Republican who played along rigorous party lines. By all considerations, he was an extremist or a reactionist. By keeping a piece of paper, and stating that the enemy who everyone feared was so close, McCarthy diminished all ideas that America was genuinely safe. The existent piece of paper was clean ; McCarthy had no composing on the paper at all. He knew that by stating the people of the U.S. that the enemy was so near, he could eventually see a war erected against Communism. He merely used the people? s aspirations and frights to do a mountain out of a molehill. Communism in America before McCarthy? s fiasco was merely a cant. Everyone knew about it, but no one of all time talked about it. The first cognition many American? s had of Communism came from Winston Churchill? s? Iron Curtain Speech? ( Matusow, 45 ) . Churchill fundamentally said in his address that the Soviet Unio n was forcing frontward a planetary Communist coup detat. And Churchill besides said that he believed, ? We should non allow such a force loose on the planet? ( Matusow, 46 ) . That was the first clip many American eyes were opened to Communism, and McCarthy made certain it was non the last. The full pandemonium that Senator McCarthy caused had become jointly known as? The Red Scare? ( Feuerlicht, 34 ) . McCarthy used this full? Red Scare? thought to hike his hopes for re-election. But an elective functionary is supposed to be a representative of the people. All McCarthy did was mistreat his power and draw the wool over the people? s eyes. McCarthy did non work for the benefit of the people. He merely worked for the benefit of himself. Next, the people whose lives McCarthy destroyed must be looked at. In the immediate wake of McCarthy? s address came many accusals. America wanted the people that McCarthy said were on his list. But when asked for the list, McCarthy said he lost it, and he could non retrieve which persons were on the list. But he said he did see some cardinal Hollywood figures on it. That was when the focal point shifted to all of Hollywood. If anyone thought that an histrion or actress seemed leery, they would merely get down chitchat about them. Finally, the particular Congressional commission appointed to look into the issue would hear of it. And when they did, they would convey the person in inquiry before Congress, and they would fundamentally rupture them apart. They would inquire them about their life styles, their fellow employees, and their friends. And so they would find if the person in inquiry were guilty or guiltless. But it truly made no difference if they were guiltless or non. Once they were brought before Congress, their callings were fundamentally ruined. Movie companies refused to engage them. They were afraid that the people would boycott any films they made, if they hired? Communist sympathisers? ( Matusow, 88 ) . And when the accused did acquire occupations, the people did non desire to travel see? Dirty Communist assholes? ( Fried, 67 ) . All these histrions and actresses worked for old ages to construct their reputes, and now Senator McCarthy stepped on every individual one of them. Finally, the manner the tests were conducted has to be looked into. When all these esteemed histrions and actresses were brought before Congress, they did non have a just test. Some persons were brought before Congress with perfectly no grounds against them. Congress overstepped its boundaries by puting people they knew had nil to make with Communism on the base. All that Congress wanted to make was look busy. So when they had no leads on anyone, they made them up. When a informant did non be, one cryptically appeared. They called some people merely to acquire them to advert other people. What was really traveling on was a elephantine cringle. Nothing was acquiring done. All they were truly making was indiscriminately picking people whose lives would be ruined. Most members of Congress knew it was a witch-hunt. That was when Arthur Miller came into the image. Miller himself knew a batch of the people involved in the tests. He was one time married to Marilyn Monroe, and he besides dir ected a few noteworthy movies. Miller found a high degree manner of knocking Congress. The Crucible was Miller? s word picture of what was traveling on in America at the clip. Miller wrote a drama in which the Salem enchantress tests of the 1600? s were brought to visible radiation. He straight compared the witch-hunts of the yesteryear, to the congressional proceedings of the present. It was a superb thought, until Congress called him in for oppugning. During the test, Miller made every effort to knock Congress and their handling of the proceedings. He was finally jailed. Once once more this is another illustration of how Joe McCarthy ruined the life of another guiltless individual. McCarthy had the full state in an tumult and all he had to state about it was? Vote McCarthy? ( Fried, 104 ) . In summing up, Joseph McCarthy ruined many lives and caused general terror in America. McCarthy was the type of individual that would make whatever it took to acquire what he wanted. By all agencies he was an self-seeker, and he merely disregarded the wake of anything he did. The people who had their lives destroyed in this full state of affairs lost old ages of work, fundss, household, and places. Many dark of slumber were lost over that Single blank piece of paper. Many callings were besides lost over that same piece of paper. And in McCarthy? s head, that piece of paper should hold said? chumps? . Merely since McCarthy played the full state for saps. It is astonishing how simple chitchat can go so much more. In most ways this state of affairs was indistinguishable to what happened in Salem. Congress conducted a modern twenty-four hours witch-hunt. The full state was left aghast and scared. They had more frights of an atomic bomb being dropped by the Soviet Union now so they of all time had before. In some ways, a bomb was dropped. McCarthy fundamentally dropped his ain bomb on the state when he held up that piece of paper.

Symbolism In The Awakening Essays - The Awakening, Edna, Free Essays

Symbolism In The Awakening Essays - The Awakening, Edna, Free Essays Symbolism In The Awakening The Awakening contains many symbolic features, such as the way Edna uses art, the birds (the parrot and the mockingbird), sleep, music, and the houses Edna Pontellier lives in, but perhaps two of the most significant symbols are the clothes in the novel, not only of Edna, but also the other characters, and the water, whether it be the ocean, the gulf, or the sea. These two symbols are possibly the most significant because of their direct relationship to Edna Pontellier. Both the water and her clothes have the power to not only emphasize, but help show exactly how and what Edna is feeling. Clothes appear to have significant meaning in The Awakening, enough so that they are mentioned at almost every description of the characters. Edna Pontellier starts the novel fully dressed and appropriately dressed for a woman of her responsibilities, however, at her final moment, she is naked on the beach. Other women in the story also represent their position and the way they feel in the way they dress. For example, Madmoiselle Reisz never changes her clothes. This could possibly symbolize her physical detachment from anything around her, including nature and any suppressed feelings. In contrast, Ednas clothes represent her physical attachment to society. She sheds her clothes the way a snake sheds its skin when it is time for a new one and it does not fit into the old one any longer. Edna doesnt feel like she can fit into society any longer. Madmoiselle Reisz, on the other hand, does not seem to have any desire to be more than what she has been given in the society in which she lives. Therefore, she does not change her clothes, because she does not feel the need for change in her life. Other characters, such as Madame Leburn always have new clothes to cover their bodies. This could, perhaps, represent the constant need to cover their sexuality as women in suppressed roles as wives and mothers. Ednas nakedness at the end of the novel symbolizes her freedom from any claims her children may have on her and shows how her lack of clothes is equal to her lack of responsibility, of her family and the 1890s society. The Ocean is a clear symbol of freedom for Edna. The water is where Edna feels replenished and she begins to realize that she is not satisfied with her life and roles as wife and mother. This happens on the day she learns to swim, which is something she had wanted to accomplish all summer. By learning to swim, she is empowered and becomes more self-aware, of not only her sexuality, but also of who she is and not who society says she should be. The water in The Awakening could be seen to symbolize Ednas rebirth into a more assertive woman. Every time she enters the water, she gets stronger, until finally her strength is more powerful than her love for her children, or her life. At this point she goes so far out to sea, that the water takes back the strength it had geven her. Both the water and the clothes in the novel are very important symbols, both helping to emphasize Edna Pontelliers new life. She starts the novel as a very suppressed woman (fully clothed) and covered by society and its strict roles, and then ends naked as if she is escaping the restricted boundaries of her clothes and of society. The water is a constant source of new life for Edna, and as her clothes are removed to go into the water, they are replaced by a more greater sense of power and energy, the freedom that the water has helped her realize.

Reaction Time of Firefighters Research Paper Example | Topics and Well Written Essays - 1500 words

Reaction Time of Firefighters - Research Paper Example Similarly, the reaction time of night shift is comparatively higher than that of 10-hours shift (table 3). Thus, the results demonstrate that the firefighters working in 24-hours shift with are more efficient to respond to any emergency call. Further this hypothesis was tested using the anova test in order to see if there was any equality of variance across the shifts in which the firefighters were performing their job. This test also confirmed the assumption previously discussed that the reaction time increased with 24-hours shift as compared to the day shift and night shift (table 4). Thus, the performance level improves with the increase of shift timing. It is imparative to describe that in order to eliminate any wrong conclusion, these tests were recorded separaely in the beginning of shift as well as at the end of the shift. The above table shows the response from the beginning of shift while table 5 shows the test recorded at the end of the shift. However the results are consistant as these indacte the same standard deviation and standard error statistics which prove that the with the increase of shift-timing, the response time increases. The above results show the tests recorded for word identificaiton in the beginning of shift as well as at the end of the shift. ... 4 99.2500 7.80491 3.90246 86.8306 111.6694 89.00 108.00 24 hour shift 4 90.7500 15.30523 7.65261 66.3960 115.1040 68.00 101.00 Total 12 97.2500 10.93888 3.15778 90.2998 104.2002 68.00 110.00 It is imparative to describe that in order to eliminate any wrong conclusion, these tests were recorded separaely in the beginning of shift as well as at the end of the shift. The above table shows the response from the beginning of shift while table 5 shows the test recorded at the end of the shift. However the results are consistant as these indacte the same standard deviation and standard error statistics which prove that the with the increase of shift-timing, the response time increases. Table 5 RT word identification end of shift N Mean Std. Deviation Std. Error 95% Confidence Interval for Mean Minimum Maximum Lower Bound Upper Bound day shift 4 98.7500 6.55108 3.27554 88.3258 109.1742 93.00 107.00 night shift 4 98.7500 6.18466 3.09233 88.9088 108.5912 95.00 108.00 24 hour shift 4 76.7500 19.37997 9.68999 45.9121 107.5879 48.00 90.00 Total 12 91.4167 15.55318 4.48982 81.5346 101.2987 48.00 108.00 Color identification Test The above results show the tests recorded for word identificaiton in the beginning of shift as well as at the end of the shift. In orer to see how the firefighters would respond to the color test. In order to further illustrate the assumption, an other test was recorded in which the participants were required to answer to the color identification test. The result are consistant again as the it is confirmed from the table 6 that as the shift-timing increases the response time aslos increase. The same Table 6 Color Identification RT color identification beginning of shift N Mean Std. Deviation Std. Error 95% Confidence

Frederic Chopin And Polonaises Essay Example | Topics and Well Written Essays - 1000 words

Frederic Chopin And Polonaises - Essay Example The Polonaise first appeared in Poland around the sixteenth century as a court dance that is sort of a procession where all the company passes in a stream and then defiles in pairs with movements. He left eighteen works in the genre with sixteen piano Polonaises, one for piano and cello and one for piano and orchestra. Their style changed over time evolving from conventional salon miniatures to some expansive dance poems. Chopin started a new chapter in the history of the genre with the Polonaises, Op. 26. Henceforth, he abandoned conventional stylizations. Each of the seven works has its own distinctive shape, pianistic expression, and style. The features of an authentic polonaise are 3/4 time, typical rhythmic formulas, a moderate tempo and a distinguished character (Ted, 22). He completed 2 Polonaises in 1835, Op. 26, in C sharp minor and Polonaise in E flat minor, marked by strong dramatic elements. In 1838-1839 he composed 2 Polonaises, Op. 40in A major and C minor. The A major has features of the heroic polonaise while the C minor is elegiac and tragic in expression. The other three polonaises are grand dance poems which are removed from earlier conventions of the genre and form. In1841 he composed Polonaise in F sharp minor, Op. 44. It is close in its epic-dramatic gesture as to the idea of Romantic fantasy as well as it is unusual in the appearance of a mazurka in its middle section which is a contrasting lyrical passage. In 1842-1843 he composed Polonaise in A flat major, Op. 53.

Evaluating The Congestive Heart Failure Nursing Plan Nursing Essay

Evaluating The Congestive Heart Failure Nursing Plan Nursing Essay As defined by Phipps (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007) congestive heart failure occurs when, the myocardium of the heart is unable to uphold a sufficient cardiac output to meet the bodys metabolic needs. Heart failure can result from either systolic or diastolic dysfunction (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007). Assessment tools that will be used in the assessment of Mr. Toscana include, head to toe, physical, and systems assessments. A risk assessment will also be done on Mr. Toscana to insure that he is safe in hospital (Berman, A, Kozier, B, Erb, G.L, 2008,). As Mr. Toscana suffers from congestive heart failure a wide range of education and psychosocial support is available to help with his condition (Heart Foundation, 2010). A nursing care plan has been made to show four nursing diagnoses and interventions to reduce the impact of the diagnosis. These nursing diagnosess can be solved through a variety of diagnostic tests to make sure that ev ery possible outcome is looked at (Berman, A, Kozier, B, Erb, G.L, 2008). Mr. Toscana is taking a few medications at the present time to manage his cardiac issues along with other medical conditions he suffers from, these medications are, Lasix, digoxin, aspirin, warfarin and perindopril. (Tiziani, A, 2010), (Better Health Channel, 2010) PATHOPHYSIOLOGY OF CONGESTIVE CARDIAC FAILURE Both systolic and diastolic heart failure are second to myocardial injury. Progression of heart failure is highly dependent on the level of ventricular remodelling, this occurs after myocardial injury (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007). The changes in ventricle shape and dimension will cause a decrease in its effectiveness as a pump. An increase on diastolic pressure possibly will further change the shape of the left ventricle, thus resulting in papillary muscle rearrangement and mitral insufficiency. It is more common for congestive heart failure to begin in the left ventricular systolic dysfunction. Some of the common causes for decreased left ventricular stenosis include that of, CAD, systemic hypertension, and aortic stenosis. CAD by diminishing the oxygen supply to the myofibrils decreases contractility. Hypertension causes the left ventricle to contract more with more force to eject blood into the aorta. (Monaha n, F, Sands, J, Neighbours, M, Marek, J.F, 2007) Over a period of time hypertrophy of the muscle fibres happens and an increase in myocardial oxygen consumption occurs. Aortic stenosis, the left ventricle must increase its pumping force to deliver blood through the tight valve. Heart failure will be the result when the hearts need of oxygen cannot be met and blood remains at the end of systole. (Mccance, K, Huether, S.E, Brashers, V.L, Rote, N.S, 2010,) CLINICAL MANIFESTATIONS OF CONGESTIVE HEART FAILURE As stated in Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007, Page 814, the clinical manifestations of heart failure occur secondary to elevated filing pressure and tissue hyperfusion Clinical manifestations of congestive heart failure can be broken down into the systems in which they affect the respiratory, cardiovascular, gastrointestinal systems and show effects in both cerebral and psychosocial. Clinical manifestations in respiratory are, dyspnoea, orthopnea, a persistent cough, crackles in the lungs. The cardiovascular system is affected by, the onset of angina, tachycardia, increase of systolic blood pressure and an increase in systolic blood pressure. Gastrointestinal clinical manifestations include that of, enlargement of the right upper quadrant of the abdomen, nausea and vomiting, pain in the epigastric region, anorexia and bloating. Confusion and restlessness can be seen as manifestations of cerebral, and anxiety is associated with manifestations to psychosocial. Generalised manifestations include oedema; either pitting or peripheral, weight gain and fatigue. (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007), (Mccance, K, Huether, S.E, Brashers, V.L, Rote, N.S, 2010,), (Better Health Channel, 2010) NURSING ASSESSMENT OF MR. TOSCANA For Mr. Toscana a variety of nursing assessments will be done upon admission. As well as the usual monitoring of vital signs, assessments such as, head to toe, physical and systems assessments, need to be completed. A head to toe assessment will be performed to give a detail initial assessment studying the whole body to see if there is any other factors that may cause harm or pain, in a head to toe assessment circulatory problems, pressure areas, existing wounds, can all be seen as well as gaining an in depth assessment of the skin. A physical assessment will be done on Mr. Toscana will also be performed, a physical assessment includes, inspection; which is the visual inspection of a person, palpation; the examination done by touch, auscultation; a form of examination by listening to the sounds made by the body (heart, lung and bowel), percussion; the examination done by tapping, percussion is done to listen for abnormal sounds and detect issue (Berm an, A, Kozier, B, Erb, G.L, 2008,). A systems assessment of Mr. Toscana will be beneficial because, along with the other forms of assessment a systems will be able to give a base mark of where he is, a systems assessment covers, central nervous (CNS), cardiovascular (CVS) assesses, respiratory (RESP), gastrointestinal (GIT), renal (RENAL), skin integrity (SKIN), and psychosocial (PSYCH). Together these forms assessment will provide a detailed amount of information to create a nursing care plan for Mr. Toscana, including interventions that need to be made, and things to implement to further his recovery and aid in his discharge. (Berman, A, Kozier, B, Erb, G.L, 2008,). NURSING CARE PLAN Please refer to appendices one for full nursing care plan. (Berman, A, Kozier, B, Erb, G.L, 2008,). (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007), (Heart Foundation, 2010), (Holmesglen, 2009), (Better Health Channel, 2010) DIAGNOSTIC TESTS For Mr. Toscana there are a number of diagnostic tests that will help with the assessment, management and detection of underlying issues. Tests that can be performed on Mr. Toscana are as follows, a chest X-ray to see if there are any problems with his lungs, or vascular congestion, or congestion of the liver (this can suggest right sided failure) (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007), a full blood test including electrolytes, an ECG to check the rhythm of the heart, and determine the causes for Mr. Toscanas symptoms. The use of urine analysis to see if infection is present, function of kidneys, traces of blood in relation to fluid build up. The combination of these tests will provide a baseline for assessment, guide the nursing care, and rule out all other possible causes of the symptoms that Mr. Toscana has presented with. (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007) RISK ASSESMENT From the history of Mr. Toscana a risk assessment can be done. Assessments such as falls, and pressure care. A falls risk assessment will be done on Mr. Toscana to determine the risk he is of falling, and if further measures need to be implemented to insure that he is safe while in hospital, a suitable framework for a falls risk is the FRAT tool, (Falls Risk Assessment Tool), (Department Of Human Services Victoria, 2005) a FRAT tool will show the level of risk that Mr. Toscana is, and risk factors. A pressure area risk check can be done by using the Braden risk assessment tool (Berman, A, Kozier, B, Erb, G.L, 2008,), (South Australia Health, Date Unknown). this will help minimise the risk of Mr. Toscana developing pressure areas where possible. Things at home can also be deemed a risk, things such as; not being compliant with his medications can lead to poor health, and stress can all affect his general wellbeing and lead to further the progression of medical condition s. EDUCATION AND PSYCHOSOCIAL SUPPORT For Mr. Toscana education is a must, education about the maintenance of his congestive heart failure, about the importance of taking medication on a regular basis. How to manage the affects of his congestive cardiac failure, and avoid the effects, support for Mr. Toscana is also imperative to aid in his recovery things such as providing strategies to minimise the health problems, referral to a social worker to help with issues that are affecting him at home. Support groups set up by the heart foundation of Victoria will help with the emotional issues related to having this condition. (Heart Foundation, 2010) The importance of education and psychosocial support will be seen through less medical admissions or problems, increased quality of life and will give Mr. Toscana the ability to be able to deal with small problems before they grow into something much bigger. (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007) , (Berman, A, Kozier, B, Erb, G. L, 2008,) (Better Health Channel, 2010) MEDICATIONS Mr. Toscana is taking a number of medications including, warfarin and digoxin. The action of Digoxin is, it increase the myocardial contraction force in the failing heart, decreases conductivity of the heart in particular the A-V node, increase on vagal activity this results in the slowing of the sinoatrial nodal rate, increases myocardial excitability this can result in ectopic beats this happens mostly through high doses of digoxin, oral digoxin effective in an approximate time frame of 1 hour, maximal effect is reached between four and six hours. The use of digoxin for Mr. Toscana is, to treat his congestive heart failure. Digoxin may produce a false ST-T wave change on an ECG if tested during exercise. Digoxin can cause the following adverse effects, gastrointestinal issues including, anorexia, nausea, vomiting, diarrhoea, and pain in the abdomen. Cardiovascular effects, ectopic beats, bradycardia, heart block. Tachycardia (ventricular). The adverse effect of toxicity is a decrease on appetite, nausea, vomiting, diarrhoea, severe stomach pains, weakness and tiredness, a slow and irregular heartbeat, blurred vision, drowsiness, mental depression or confusion, fainting and headaches. Nursing points/precautions which should be followed are that the tablet should never be halved; neither IM nor SC routes are recommended due to unpredictable absorption, because prolonged or intense pain and necrosis of the muscle to the client (Intramuscular), severe irritation may occur when given via a subcutaneous injection. A rapid IV administration should be avoided as it may cause hypertension and vasoconstriction. The action of warfarin is a suppressant of vitamin-K dependant synthesis of prothrombin in the liver, this prevents the extension of a clot that is already established of the formation of a new one, warfarin has an anticoagulant effect that is produced after 36-72 hours and can persist for between 4 and 5 days after the discontinuation of therapy. Th e use of warfarin is, as a prevention and management of the following, deep vein thrombosis (DVT) or pulmonary embolism, thromboembolism in atrial fibrillation, and can be used as an adjunct to therapy for coronary occlusion. For Mr. Toscana there is no relevant interaction with this drug. The adverse effects of warfarin are fatal or non fatal bleeding, nausea, vomiting, diarrhoea, alopecia, fever, hypersensitivity reaction, an overdose is seen by bleeding from the gums and haematuria, in rare cases skin necrosis is also seen. Some of the nursing points and precautions with warfarin are, that all intramuscular injections be avoided, and subcutaneous injection sites should be closely monitored for haematoma, make sure that the does is given the same time daily to Mr. Toscana, observation for the early signs of overdose things such bleeding especially important from the gums.( Tiziani, A, 2010) CONCLUSION Through a range of assessments, diagnostic testing, education and the development of a nursing care plan Mr. Toscanas condition should improve as well as his general wellbeing. Goals set out in the care plan will be achieved by interventions put in place insuring a quicker recovery for Mr. Toscana. Education is particularly important for Mr. Toscanas medication regime, support strategies will help with the improvement of overall health and wellbeing.