| Big Five Traits | Your Score | Facebook Average | This means you are.. |
| Extroversion | 92 | 64 | Very Extroverted. You are very sociable, outgoing, energetic, and lively. You prefer to be around people most of the time. |
| Agreeableness | 94 | 65 | Very Agreeable. You have a strong interest in others' needs and well-being. You are very pleasant, sympathetic, and cooperative. |
| Conscientiousness | 58 | 63 | Somewhat Free-Spirited. You enjoy living for the moment but are reasonably reliable, organized, and self-controlled. |
| Emotional Stability | 38 | 57 | Neurotic. You can be upset by what most people consider the normal demands of living. People consider you to be sensitive and emotional. |
| Openness to Experience | 98 | 73 | Very Open. You love novelty, variety, and change. You are very curious, imaginative, and creative. |
| Your Good Side: Tolerant Tolerant Types are open to, and accepting of, differences in other people. They care about the feelings of others and tend to take their opinions into account when making decisions. Their social skills are reasonably well-developed and they normally relate well to others in both co-worker and supervisory roles. They are described by others with such terms as good-natured, empathic, genial, tactful, diplomatic, calm, and poised. | Your Bad Side: Moody Moody Types tend to report experiencing many negative emotions and few positive emotions. They are described by others as complex, changeable, worried, depressed, tense, impatient, moody, anxious, irritable, nervous, quitting, unenergetic, unambitious, introverted, cold, unreliable, self-centered, negligent, and stubborn. |
This one is great too - I couldn't resist blogging it as well! Nick's play with tones and lighting is fantastic. The background was processed to fade behind to make my body pop forward, but otherwise this is pretty much untouched from the camera.
^ Rock star photoshoot with Nick Franklin ^
Much more going on in my life than just posing, but in all sincerity it's too overwhelming to blog. Number one priority is directing a theatre program for under-privileged kids in Lincoln Village. The performances are Saturday and I need to focus on all the details until then. Caoi!
Browse Nick's Flickr page for more pics from this series - and see all his own fabulous photos.
It was a casual study day at the Crabtrees...until John dragged me into a golf cart and off we ride to a hidden waterfall where faeries frolic and a green umbrella is the only prop you need...
Client: #327
Diagnosis: right lung mass
DATA :
Assessment: Client did not demonstrate orientation or alertness but responded to direct questioning about pain by raising hand. Client in semi-fowlers position, eyes unfocused with left eyelid dropping, head arched back into pillow, mouth open, chest heaving, vesicular breath sounds, bloody sputum, crackles and wheels identified, neck veins extended, capillary refill +3, yellow concentrated urine output 25 ml, no bowel sounds noted, skin flushed, very warm, very dry with flaking, turgor loose, severe cachexia with visible skeleton and large darkened patches on both arms. Patent catheter line and morphine IV drip running. Client is DNR.
VS 93/59 151pulse 44resp 83 96axillary
Medications: Atrovent 0.02% NEB 0.5, Decadron 4mg/ml, Levaquin 500mg/100ml, Protonix 40mg, Proventil 2.5mg, Reglan 10mg, Ativan 0.5, Compazine 10mg, Morphine carpuject 1-2mg, Morphine 100mg, Zofran 8mg
PLAN : The client is a 55-year old white male with a right lung mass in end-stage cancer, MI in 2005, history of multiple illnesses. Daughter at beside. Comfort measures to be provided.
Nursing Diagnosis: none
IMPLEMENTATION :
0720 IV Morphine drip dosage increased to maximum allowable per physician’s order
0830 Daughter left room to tell nurse that her dad the client had passed away. Declared dead by attending physician at 0840. Post mortem care provided, including removing all lines and cleaning body, arranged client for family viewing.
Advair 500/50mcg, one puff twice daily
314.99 (60.24 w/ insurance)
Maxair Autohaler 400 puffs total, two puffs four times daily, fifteen minutes prior to exercise and PRN
177.99 (23.64 w/ insurance)
Ocella tablet, one daily
173.89 (35.84 w/ insurance)
Prednisone 20mg tablets, one tablet three times daily for twenty days
11.99 (0.65 w/ insurance)
SMZ/TMP tablets, one daily
32.89 (2.34 2/ insurance)
MyMy parents began home schooling me at age seven, and I remained home schooled until my graduation at age 16. Throughout my education, my parents always emphasized the primary importance of learning and understanding, not just rote memorizing. They instilled in me the desire to comprehend new material so I can better utilize it later in life. I enrolled in Calhoun Community College’s dual enrollment program my senior year so I could complete my high school course requirements and also receive college credit. I loved the college experience and enjoyed all my classes.
I have many varied interests which include, but are not limited to, USTA tennis, local community theatre, TeenPact for Alabama, Alabama Music Teacher's Association statewide piano competitions, YMCA exercise classes, Huntsville Times Teen Page, sewing societies, dance instruction, and Kingdom Life Fellowship Church. I have volunteered extendedly at Constitution Village, Fantasy Playhouse, Lincoln Village ministries and on governmental campaigns. I know these hobbies and pursuits will benefit me in my academic major and in pursuing a well-rounded outlook on life.
In May of 2006 I graduated high school from Excalibur Christian Home School Group with a high school GPA of 4.0 and a college dual enrollment GPA of 3.5 and 18 college credit hours. I was accepted as a member of Phi Theta Kappa and the Dean's List. I received Redstone Arsenal's Calhoun Community College $2000 scholarship and continued my education at Calhoun until Spring 2007. I transferred Fall 2007 to University of Alabama at Huntsville. Now I have completed 84 academic hours and maintain a GPA of 3.4.
My declared field of study is Nursing, with the possibility of continuing education in graduate studies. Since I was young, I wished to enter a vocation where I may communicate with people and assist them all I can. Nursing is a field I feel called into as a career and way of life, and working on a pediatric floor is my first career goal. Receiving a scholarship can set that goal within reach through financial assistance. In the following two years I will strive to receive a Bachelor of Science in Nursing from the UAH Nursing Department.
Thank you for your consideration!
Who cares what we’ve earned?
Somebody’s sold all the truth that you’ve yearned.
Remember when we used to shine?
And had no fear of sense or time.
When it creeps up on you
You can’t cry when there’s nothing to feel
No one’s noticed our loneliness
Remember when we used to tease
And made us scream eternal joy
I believed that you’d always be here
‘Cause once you promised a life with no fear
Please don’t break my ideals
And say what’s fake was always real
I was the one and only
Take me back again
-Muse
When deciding to vote for a candidate, there are numerous topics to research. Most Americans scrutinize the topics they consider personally important, or that would significantly influence their culture, lifestyle and habits. When I approached the candidates from a health care perspective, it became very confusing. This topic directly affects my future career as a nurse. Health care problems are being addressed through several different policies, according to each candidate’s position. Yet since I agree with a couple of policies from each candidate, it was necessary to sort through which policies I consider important and effective for the problems.
Health care for everyone is fundamental in my worldview. I desire for all people of all ages to have access to healthcare. McCain specifically states that every American deserves healthcare, including alternate treatment settings and cost-effective measures. Obama stresses healthcare for the underprivileged and children, requiring mandatory health insurance for minors in particular.
Regulation of healthcare safety is also a concern. Obama emphasizes hospital responsibility with compulsory federal regulations, including RN/patient ratios. McCain emphasizes consumer knowledge on treatment options and outcomes, and providing Medicare payments for diagnostic visits and disease prevention measures.
Healthcare would only be effective if it were affordable. Obama revealed a detailed plan for affordable healthcare that incorporated national public health insurance with income-related subsidies called the National Health Insurance Exchange. Also, he desires to expand Medicaid, and would require employers to offer an insurance program to all employees. McCain addressed the issue through a Guaranteed Access Model that is state-based, with financial assistance for lower-income peoples and premium-limitations on insurance companies. McCain’s approach to employer insurance is to drop favorable tax treatment of businesses, and instead provide a tax refund to individuals and families for private insurance coverage.
In considering healthcare professionals education, Obama supports loan-repayments, reimbursements, training grants, and $4000/yearly tuition credit for all student nurses. Although tuition credit would be a great assistance to student nurses, I consider it an inequitable neglect towards other students who are pursuing engineering, biology, chemistry, and other fields that contribute directly to healthcare in our nation.
When deciding which candidate’s policies would be best for nursing only, Barack Obama demonstrates the most supportive policies for the nursing profession. However, the majority of his healthcare strategy incorporates a national infrastructure that requires enormous government funding. Obama does not address how this funding will be obtained, presumably from increased federal taxes.
When considering the candidates’ political policies regarding general healthcare, I am supportive of McCain’s course of actions. Limiting insurance premiums, emphasizing prevention of disease through testing and education, providing state insurance plans, and a tax refund for private insurance coverage are the strategies I wish to see implemented. These would allow for freedom of individual responsibility with support for the underprivileged, without the formation of a national healthcare insurance set up.
References:
American Nurse’s Association (2008, August 18). Documents. ANA Policy and 2008
Presidential Candidates Obama & McCain. Retrieved http://nursingworld.org/MainMenuCategories/ANAPoliticalPower/Election2008/2008Presidential/PresEndorseProcess/ANAPolicyand2008PresidentialCandidates.aspx
McCain, John (2008, October 12). Healthcare. Straight Talk on
Health System Reform. Retrieved
http://www.johnmccain.com/content/default.aspx?guid=8475c713-a541-4b97-a2aa-800e35da37bb
Obama, Barack (2008, October 12). Healthcare. Obama-Biden Health Care Plan.
Retrieved http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf
-K R
| Current Program | |
|---|---|
| Bachelor of Science in Nursing | |
| Level: | Undergraduate |
| Program: | BSN in Nursing |
| Admit Term: | Fall 2007 |
| Admit Type: | Transfer |
| Catalog Term: | Fall 2007 |
| College: | Nursing |
| Major and Department: | Lower Division Nursing, Nursing |
| Academic Standing: | Good Standing |
| CRN | Subject | Course | Section | Course Title | Campus | Final Grade | GPA Hours | |
|---|---|---|---|---|---|---|---|---|
| 11559 | BYS | 314 | 01 | ANATOMY & PHYSIOLOGY II | Main | B+ | 4.000 | |
| 10833 | NUR | 306 | 02 | ETHICAL/LEGAL ASPECTS HLTH CAR | Main | B+ | 3.000 | |
| 11677 | NUR | 450 | 01 | ISSUES IN TRANSPLANTATION | Main | A | 3.000 | |
| 10689 | PHL | 202 | 03 | INTRODUCTION TO ETHICS | Main | A- | 3.000 |
| Attempted | Earned | GPA Hours | Quality Points | GPA | ||
|---|---|---|---|---|---|---|
| Current Term: | 13.000 | 13.000 | 13.000 | 45.000 | 3.462 | |
| Cumulative: | 25.000 | 25.000 | 25.000 | 85.000 | 3.400 | |
| Transfer: | 0.000 | 38.000 | 0.000 | 0.000 | 0.000 | |
| Overall: | 25.000 | 63.000 | 25.000 | 85.000 | 3.400 | |
Peripheral neuropathy (PN) involves a disruption of the action potential transmission in peripheral nerves, either through the deterioration of the axon, axonopathy, or the deterioration of the myelin sheath, myelinopathy. This causes tingling sensations, numbing, temperature disparity or pain in the digits and limbs of the patient. The first form of genetic PN includes genetic code mutations, and the second form of PN is acquired by chemicals, toxins, nutritional deficiency, and tumors. Although many acquired causes can be identified for PN, diabetes mellitus is the most frequently diagnosed (Daousi et al 2006). “Peripheral Neuropathy can be the result of genetics, chronic disease, environmental toxins, alcoholism, nutritional deficiencies, or side effects of certain medications. Among chronic diseases, diabetes mellitus is the most common cause of PN” (Head, 2006). The focus of this paper is to explore axonopathy and myelinopathy within the context of acquired diabetic peripheral neuropathy, which, according to Koopman et al 2006, represents “a serious public health concern.”
Nervous tissues consist of highly-specialized cells that conduct action potentials to and from the central and peripheral nervous systems. A neuron is the basic cell of the system and it is composed of a neural cell body that extends into an axon. This axon is swathed in a myelin material from Schwann cell membranes that facilitate the conduction of an action potential. “During the wrapping process, the cytoplasm is squeezed from between the adjacent layers of Schwann cell membranes, so that when the process is completed a tight coil of plasma membrane material (protein-lipoid material) encompasses the axon” (Marieb and Mitchell, 2007). This axon and myelin have an exact composition and overall proportion for optimum conductivity, “maximum insulating ability, and maximum protection. Myelin is composed mainly of lipid, but also contains a number of myelin-specific structural proteins” (van Gemert &
Acquired PN develops during a continuous or intermittent exposure to a damaging substance or nutritional deficiency through vasoconstriction. A damaging substance such as a radical or toxin can attack the axon first and myelin secondary, causing axonopathy, or attack the myelin alone, causing myelinopathy. Axonopathy and myelinopathy are distinguished by the specific effects of the attacking substance, or by the specific effects of a hindrance on the neuron’s health. A tumor growth can cause nutritional and vascular deficiency in axonopathy and myelinopathy, which stymies the neuron’s ability for action potential conduction.
Axonopathy and myelinopathy are jointly involved in diabetic neuropathy. Both disorders inhibit the proper conduction of an action potential leading to neuropathic symptoms, and the effects are acute. Symptoms are pain, numbness, loss of temperature differentiation, loss of reflex, loss of balance, inflammation, erectile dysfunction, and inability to distinguish small objects by touch are commonly exhibited. These issues, especially the pain, greatly affect the patient’s quality of life. Seventy-five percent of diabetic patients report moderate to severe pain as a primary symptom of diabetic neuropathies, according to Cocito et al 2006.
In diabetic axonopathy, demyelination is a secondary event to the destruction of the axon. “Axonal degeneration is the primary event, and this eventually results in fiber loss with the attendant removal of the myelin sheath” (Spencer and Shaumburg, 1978). The axon destruction is caused by vasoconstriction, and soon neuronal hypoxia and ischemia develops. Also, osmotic stress caused by free-floating polyls and metabolic toxins develops around the axon during the diabetic hyperglycemic state.
Diabetic myelinopathy affects a broad spectrum of distal nerves at a time, demonstrating that “primary demyelination would be scattered. . . not limited to any one nerve fiber.” (Spencer and Shaumburg, 1978). There are two basic types of primary demeylinators that cause myelinopathy. “Some demyelinating chemicals seem to leave intact the myelinating cells (Schwann cells), while others damage the myelinating cells as well as the myelin. The significance between the two is that with the myelinating cells still intact, repair of the myelin sheath is possible. “Regeneration of the myelin layers can occur, and in some cases occurs at the same time other axons are undergoing toxic demyelination” (van Gemert &
Regeneration of axons and myelin sheath relies on length of exposure, what factors were attacked to cause the neuropathy, and the “trophic support” that remains intact. “Trophic support in a general sense encompasses any proteins or group of proteins that could influence the survival of the axon” (Madison, Robinson and Chadaram, 2007). Proteins include growth factors such as neurotrophin-3, glia-derived neurotrophic factor, and fibroblast growth factors. “Recent studies have shown the development of oligondendrocytes and the synthesis of myelin are extensively controlled by growth factors” (van Gemert & Killeen, 1997). Research involving growth protein supplementing in diabetic patients that could improve the regeneration of deteriorated or un-functional neurons.
Diabetes mellenitus affects 20.8 million, or 7%, of children and adults in the
According to Jarmuzewska et al 2006, hypertension serves as the primary inducer of diabetic neuropathy, and diabetes duration and metabolic imbalance are involved in its progression. According to Sawant et al 2007, oxidative stress on neurons by free-radical formation and a defect in antidioxidant defenses will induce also neuropathy. “An imbalance between the generation and savaging of these free radicals leads to ‘oxidative stress’, which may be associated. . . with nerve damage leading to diabetic neuropathy” (Sawant et al 2007). The accumulation of glucose and glycosylated proteins can produce damaging toxins which generate up to 50 times the nerve-damaging free radicals. “Not only are nerve cells more likely to be destroyed in a hyperglycemic environment, but repair mechanisms are also defective” (Head, 2007).
Diabetic control is paramount in maintaining nerve function and staving off extensive peripheral neuropathy. Glucose-level management through insulin therapy and hypertension reduction through anti-depressant therapy are two primary methods. Maintaining both these factors in a diabetic patient should be accompanied with a nutritious diet to improve the immune-system’s ability to irradiate free-radicals, states Jarmuzewska et al 2006. Metabolic control is stressed by Janghorbani et al 2006 as a necessity for PN prevention by not allowing the hyperglycemic environment to thrive. In regards to the patient’s quality of life, Dousi et al 2006 maintains that the pain in diabetic PN remains under-treated due to the reluctance of medical staff to prescribe the appropriate strength of pain-killers for the patient’s relief.
In chronic diabetic neuropathy, symptoms improved over five years of therapies and diabetes-controlling medicine in 23% of diabetic patients (Daousi et al 2006). Diabetic patients with PN are treated with a variety of antidepressants, anticonvulsants, antiarrhythmics, opioid and non-opioid analgesics, and aldose reductase inhibitors to preempt the many symptoms of PN. Cocito et al 2006 maintained that pain was the primary symptom that lowered the patient’s quality of life, and recommended that appropriate pain-killers should be administered. The quality of life increased overall when diabetic patients complied with rigorous glucose-control and a strict diet that fostered the immune-system’s ability to eradicate free radicals and damaging substances while improving neural vascularation.
PN proves to be a complex medical issue, primarily due to the myriad of ways the neural tissue can be damaged, particularly by diabetes mellitus. Simplistically stated, the neuron with its action potential pathway in the peripheral nervous system can be effortlessly destroyed in the glucose-saturated and immune-deficient diabetic host – what remains undetermined are the precise causative factors and the interplay between each other and the neuron. Regeneration of the neuron and reacquisition of neural function after deterioration is a delicate process that can occur only if the myelinating cells and trophic support remain intact. The quality of life for diabetic patients can be promoted through a stringent medical and dietary regimen that manages glucose levels and through minimizing the PN symptoms by sufficient pain-killing drugs.
Dr. Bishop of the
References
American Diabetes Association. Data retrieved
http://www.diabetes.org/about-diabetes.jsp.
Bishop, A. (2008). Professor of Biology,
Cocito, D., Paolasso,
Pain affects the quality of life of neuropathic patients. Neural Science, 27, 155-160.
Daousi, C., Benbow, J., Woodward, A., MacFarlene, I (2006). The natural history of
chronic painful peripheral neuropathy in a community diabetes population. Diabetic Medicine, 23, 1021-1024.
Head, K (2006). Peripheral Neuropathy: Pathogenic Mechanisms and Alternative
Therapies. Alternative Medicine Review, 11, 294-320.
Janghorbani, M., Kachooei, A., Ghorbani A., Chitsaz, A., Izadi, M, et al (2006).
Peripheral neuropathy in type 2 diabetes mellitus in
risk factors. Acta Neurol Scand, 114, 384-391.
Jarmuzewska, E., Ghidoni, A., Mandoni, A (2007). Hipertensión and Sensorimotor
Peripheral Neuropathy in Type 2 Diabetes. European Neurology, 57, 91-95.
Koopman, R., Mainous, G III, Liszka, H., Colwell, J., Slate, E., Carnmolla, M. et al
(2006). Evidence of Nephropathy and Peripheral Neuropathy in US Adults with Undiagnosed Diabetes. Annals of Family Medicine, 4, 427-431.
Madison, R., Robinson, A., Chadaram, S. (2007). The specificity of motor neurone
regeneration (preferential reinnervation). Scandinavian Physiological Society, 189, 201-206.
Marieb, E., Mitchell, S (2007). Human Anatomy and Physiology Laboratory Manual.
Pearson-Benjamin Cummings, Ninth Edition, 257-259.
Spencer, P. and
Neurotoxic Lesion. Environmental Health Perspectives, 26, 97-105.
Sawant, J., Vhora, U., and Moulick, N. (2007). Association of Poor Glycemic Control
with Increased Lipid Peroxidation and Reduced Antidioxidant Vitamin Status in
Diabetic Neuropathy. Internet Journal of Endocrinology, 3(3), 2-2.
Van Gemert, M., and
International Journal of Toxicology, 17, 231-275.
I'm not the one that you want, I'll only let you down.
And I'm pretty sure that you've caught on.
And you can say that 'Oh, I'm just feeling sorry for myself.'
I think it's every time I walk into a room
a silence so sudden that I seem to hear it (smiles turn to frowns)
Or maybe it's all eyes on him, in love with ego and intention.
The eyes that are just begging me for more -
This is gone and I can see it.
Your head is full of words, full of words that don't mean anything.
I'm not the one that you want, I'll always let you down.
And I'm pretty sure that you've caught on.
And you can say that 'Oh, I'm just feeling sorry for myself'
(If that's how you feel, then what's there to do?
I'll keep this feeling in my heart
but when you look in my eyes, you will know the truth.)
Spelled out your name and list the reasons.
A million hours left to think of you.
I can't untangle
I can't untangle what I feel and what would matter most
I can't get close and I, I can't get close
And now there's just no point, in reaching out for me
In the dark, I'm just no good at giving relief
In the dark, It won't be easy to find relief
And I'm not proud that nothing will seem easy about me
But I promise this I won't go my whole life telling you "I don't need..."
I'll tell you now, I guess like I should have told you then
Without you is how I disappear.
-Such a paradox, isn't it, isn't it?
I dropped all of my lovers.
I stood up and screamed 'I'm in love!'
You gave it to me through the eyes, hatred.
Centuries deep and true. I was wrong, graceless, and sick.
All of the things that I had learned had been wasted.
There was no living creature as foul as I,
and all of my poems were false.
I could feel my soul, dropping down through the mattress.
I had to leap up before it hit the floor.
and I'm so alone.
Illumination held out in front of my reaching arms.
The darker things get the better I see.
I'm so alone and so are you,
we all live and die that way.
I feel weak.
Thrown in wide open spaces.
We turn ourselves inside out,
expose what we're afraid to see.
You haven't seen how far down I can sink.
Tell me that you know another way to get it done
It's not me or how I would be but it's a different situation
You lay awake in the night
Just staring at the ceiling above
Pulling pieces of it out is such a waste of time
Keep on fighting to remember that nothing is lost in the end
When you burn burn burn your life down
Get me to the door
Out of bed on the track
I'm not sure starting over
It's a different situation
Undeserving of your sympathy
'Cause there ain't no way that I'm sorry for what I did
Through it all, could you cry for me?
'Cause I don't feel bad about it
So shut your eyes, kiss me goodbye
And sleep.
The hardest part is letting go of your dreams.
So nothing will be lost in the end
And you burn burn burn your life down
I break my heart around this
Break my heart around this
-Chiodos, My Chemical Romance, Tegan and Sara
Abstract: Living-donor versus Non-living-donor in Liver Transplantation
What is the viability of continuing partial-liver lobe transplants (PLLT) from the living donors taking into consideration the scarcity of quality brain-dead liver organs and the ethics behind the living donation process? This procedure could have a significant impact on liver transplantation in the
The regenerative properties of the liver were known by the Greeks over 2,500 years ago, but it wasn’t until 1987 that PLLT was first attempted. The first successful PLLT was in 1987 in
The main issue relating to successful transplantation is to ensure the graft given to the recipient is large enough to maintain proper blood flow in order to achieve full functioning and regeneration (Jabbour 2004). The liver is anatomically divided into eight segments, where three different grafts can be formed for liver transplantation (Florman, et al 2006). Donor assessments includes blood and HLA typing, liver biopsy, compatibility of hepatic artery size through anteriograms, and testing liver size through Chromotagraphy (CT) Scan (Abougergi, et al 2006). When liver graft is sufficient and transplant is successful, near-complete regeneration and functioning of the liver returns in 1-2 weeks while the patient remains in the hospital (Florman, 2006).
The main argument in favor of PLLT involves gaining additional transplant resources for end-stage liver failure patients. PLLT grants more opportunities for patients suffering from liver failure to embrace a healthier lifestyle. Split-liver (cadaver) and whole liver (cadaver) transplantable organs are not plentiful enough to supply the liver-organ demand, and partial-liver lobe donors would increase the availability. Recipients have the advantage of receiving a liver transplant as soon as diagnosed with end-stage liver failure, which also prevents the body from experiencing further deterioration. Ischemia time is minimized and the liver received is of better quality coming from a healthy, living donor (Jabbour, 2004).
The main argument against PLLT is the experience of the donor during the donation process and recovery. To compromise the life of a healthy individual to save the life of an end-stage liver failure patient has its ethical concerns. The informed consent from patient may be motivated by obligation and a sense of duty to relative or friend, especially in an emergency situation. The donor is affected by the surgery recovery time, which involves on average one to two weeks of hospitalization and several more weeks for regaining pre-donation health (Florman, et al 2006). There are several potential medical complications for donor, including difficulties regenerating the liver, blood clotting, bile-duct blockage or leakage, and severe scarring of the abdominal wall and skin. Also, the procedure of PLLT is more costly than cadaver liver donation (Abougergi, et al 2006).
The PLLT has a significant and direct impact on the nursing practice. Nurses need to consider the ethnicity and culture of the patients when approaching the topic of assigning a liver donor, considering factors that affect potential donor decision (Abougergi, et al 2006). They must provide emotional support to both recipient and donor during the process and have sensitivity toward donor obligation and recipient guilt. Informed consent of the donor should be obtained only after being thoroughly explained by the nurse. Nurses must understand the psychosocial origins of the disease causing liver failure in the patient (Abougergi, et al 2006). Nurses should remain the patient advocate as well as the donor advocate in maintaining a neutral, unbiased help to both sides.
Further research needs to be conducted to prevent donor complications post-surgery focusing on correct graft sizing to enhance regeneration and functioning (Humar, et al 2004). Research should be conducted concerning the ethics of nonmaleficence towards the donor and recipient, focusing on the psychiatric state of donors in post-operation. UNOS needs to regulate the PLLT testing process for quality control between transplant centers (Brown, et al 2003). Also, improved cadaveric donation to minimize the need for PLLT altogether, including more public education conducted by UNOS.
Undoutedly, issues regarding retarded or quadriplegic individuals will be raised - perhaps the law-makers will decide that they maintain a low quality of life, therefore they can be allowed to request a suicide. How would that demonstrate the value of life? If patients who meet a certain criteria can be aggressively euthanized by the medical profession, what is to stop that criterion from expanding? Where do you draw the lines regarding the appropriateness of suicide? Or do we simply believe that suicide through the administration of a physician becomes acceptable by affiliation?
In consideration of the Natural Law Theory, PAS stands in opposition to its values. Natural Law Theory (NLT) states that life should be preserved and fostered in every individual, regardless of their state of health. Performing suicide for reasons of declining health or impending death would never be supported, espcecially injecting a patient with a lethal dose. Although PAS is morally wrong, and inconsistent with NLT, refusal of medication should always be a patient’s right. Although firm on the subject of suicide, NLT does not ignore the importance of quality of life, and is only adverse to its artificial termination. Modern technology has expanded until life can be preserved beyond that of natural stamina, supported by medical machines and high-dosage prescriptions. The patient may choose to let the disease run its course uninhibited by medicine, knowing it would lead to certain fatality. This is within the full moral compulsions of the patient, and does not endanger the rights of other humans.
I find that the provisions already enacted within the United States regarding patient’s rights and medical procedures allows for decent and comfortable deaths without necessitating Physician-Assisted Suicide laws. End-of-life quality can be facilitated through non-invasive pain-killing medication and establishments such as Hospice care. Legalizing suicide is morally wrong, regardless of medical situation or of support from medical and governmental agencies.
Links: Access to Oregon’s Death with Dignity Act: http://www.oregon.gov/DHS/ph/pas/Following official document retrieved from Oregon's Death with Dignity Act:
REQUEST FOR MEDICATION
TO END MY LIFE IN A HUMANE
I, ________________, am an adult of sound mind.
I am suffering from _______, which my attending physician has determined is a terminal disease and which has been medically confirmed by a consulting physician. I have been fully informed of my diagnosis, prognosis, the nature of medication to be prescribed and potential associated risks, the expected result, and the feasible alternatives, including comfort care, hospice care and pain control.
I request that my attending physician prescribe medication that will end my life in a humane and dignified manner.
INITIAL ONE:
_____ I have informed my family of my decision and taken their opinions into consideration.
_____ I have decided not to inform my family of my decision.
_____ I have no family to inform of my decision.
I understand that I have the right to rescind this request at any time. I understand the full import of this request and I expect to die when I take the medication to be prescribed. I further understand that although most deaths occur within three hours, my death may take longer and my physician has counseled me about this possibility.
I make this request voluntarily and without reservation, and I accept full moral responsibility for my actions.
Signed: ___________
Dated: ___________
