How Napoleon Became Emperor of France

How Napoleon Became Emperor of France Napoleon Bonaparte first took political power in France through a coup against the old government, but he had not instigated it: that had principally been the plotting of Sieyes. What Napoleon did was to capitalize on the situation in order to dominate the new ruling Consulate and gain control of France by creating a constitution which bound his interests to many of the most powerful people in France: the landowners. He was then able to use this to leverage his support into being declared Emperor. The passage of a leading general through the end of a revolutionary series of governments and into an emperor was not clear and could have failed, but Napoleon showed as much skill in this area of politics as he did on the battlefield. Why the Landowners Supported Napoleon The revolution had stripped the land and wealth from the churches and much of the aristocracy and sold it to landowners who were now terrified that royalists, or some sort of comprise government, would strip them of it, in turn, and restore it. There were calls for the return of the crown (small at this point, but present), and a new monarch would surely rebuild the church and aristocracy. Napoleon thus created a constitution which gave many of these landowners power, and as he said they should retain the land (and allowed them to block any movement of land), ensured that they would, in turn, support him as leader of France. Why Landowners Wanted an Emperor However, the constitution only made Napoleon First Consul for ten years, and people began to fear what would happen when Napoleon left. This allowed him to secure the nomination of the consulship for life in 1802: if Napoleon didn’t have to be replaced after a decade, land was safe for longer. Napoleon also used this period to pack more of his men into government while debasing the other structures, further increasing his support. The result was, by 1804, a ruling class which was loyal to Napoleon, but now worrying what would happen on his death, a situation exacerbated by an assassination attempt and their First Consul’s habit of leading armies (hed already nearly been killed in battle and would later wish he had been). The expelled French monarchy was still waiting outside the nation, threatening to return all ‘stolen’ property: could they ever come back, such as had happened in England? The result, enflamed by Napoleon’s propaganda and his family, was the idea that Napoleon’s government must be made hereditary so hopefully, on Napoleon’s death, an heir who thought like his father would inherit and safeguard land. Emperor of France Consequently, on May 18th, 1804, the Senate – who had all been chosen by Napoleon - passed a law making him Emperor of the French (he had rejected king as both too close to the old royal government and not ambitious enough) and his family was made hereditary heirs. A plebiscite was held, worded so that if Napoleon had no children – as he hadn’t at that point – either another Bonaparte would be selected or he could adopt an heir. The result of the vote looked convincing on paper (3.5 million for, 2500 against), but it had been massaged at all levels, such as automatically casting yes votes for everyone in the military. On December 2, 1804, the Pope was present as Napoleon was crowned: as agreed beforehand, he placed the crown on his own head. Over the next few years, the Senate and Napoleon’s Council of State dominated the government of France – which in effect meant just Napoleon – and the other bodies withered away. Although the constitution didn’t require Napoleon to have a son, he wanted one, and so divorced his first wife and married Marie-Louise of Austria. They swiftly had a son: Napoleon II, King of Rome. He would never rule France, as his father would be defeated in 1814 and 1815, and the monarchy would return but he would be forced to compromise.

How Post-World War Ii Technology Changed America Essay Example

How Post How Post-World War Ii Technology Changed America Essay How Post-World War Ii Technology Changed America Essay How Post-World War II Technology Changed America 5/3/2012 AMH 2020- Yellow Class Angelika Vasquez Professor Brian Milner During the post-World War II era everything in our nation seemed to change. The post-World War II era had significant technological advances that changed politics, the economy, and the way people interacted with one another. Three of the biggest technological advances during this era were the introduction of the atomic bomb, television, and space race technology. 945 to 1949, the Atomic bomb changed politics and introduced the military industrial complex. Television, in the 1950’s, changed the way people thought. During the 1960’s there were many new space race technologies introduced that changed the way Americans received information. The atomic bomb, television, and space race technology significantly changed America. Atomic Bomb Cold War- Julius and Ethel Rosenberg After Dwight D. Eisenhower left office, he warned about the growing influence of th e military-industrial complex, in American government and life. The military-industrial complex was first coined by Eisenhower, during his farewell address in 1961. This complex defines the combined effort of big business and the military to press for an ever-increasing share of national resources for the development of new weapons. Many politicians during this time believed that the military-industrial complex promoted policies that were not in the best interest for America, and that the growth of the military-industrial complex could perhaps undermine American democracy. The Cold War had created a warfare state. Because of the atomic bomb, civil defense drills required people to crawl under their desks at work or school; high schools named their football teams The Atoms; and songwriters wrote about the end of the world. Movies warned of the dangers of the bomb or made grim jokes about the fate of humanity. In the late 1940’s, faced with the possibility of a nuclear war, Americans began building bomb shelters. Bomb shelters were built in either your backyard or your basement that were meant to offer substantial protection. Television By the late 1950’s, almost ninety percent of American homes had a television set. Television transformed the way Americans did politics. During the Kennedy versus Nixon election, television played a key role in their election campaigns. During the Kennedy-Nixon debates, Kennedy had more of an appeal than Nixon. Although campaigns were already relying less on political parties and more on money before the introduction of the television, television helped accelerate this idea. John F. Kennedy emerged with a disputable national vote plurality over Richard M. Nixon by a razor’s edge of . 7 percent in popular vote (49. 72% to 49. 55%) that converted into a 303 to 219 Electoral College victory. Some historians believe that without the television, Kennedy would not have won the 1960 election. In fact, John F. Kennedy himself stated that, â€Å"we wouldn’t have had a prayer without that gadget. † Besides affecting politics, television also transformed American cul ture. The average American viewer spent a little over five hours a day in front of a television screen. American television was paid for by private enterprise, unlike Europe’s government financed television. During the mid 1950’s advertisers spent an estimate ten billion dollars to push their advertisements on the air. Television transformed American culture into a consumer culture. Television also changed the way Americans live, and the ideology which Americans lived by. Popular television series, such as Leave It To Beaver, portrayed the ideal family as a male breadwinner, a woman full-time homemaker, and three or four children. On television, married women did not have paying jobs and depended on their husbands. Americans began getting married at a younger age and the birthrate soared. Space Race Technology Microwaves Cell Phones Home Computer Bibliography Atomic Culture. Social Culture. centennialofflight. gov/essay/Social/atomic_culture/SH23. htm (accessed May 3, 2012). Renka, Russell. The 1960 Kennedy v. Nixon Election. The Modern Presidency. cstl-cla. semo. edu/renka/ui320-75/presidents/kennedy/1960_election. asp (accessed May 3, 2012). Roark, James L.. Understanding the American promise: a brief history. Boston, MA: Bedford/St. Martins, 2011. [ 1 ]. Roark, James L.. Understanding the American promise: a brief history. Boston, MA: Bedford/St. Martins, 2011. 717. [ 2 ]. Atomic Culture. Social Culture. centennialofflight. gov/essay/Social/atomic_culture/SH23. htm (accessed May 3, 2012). [ 3 ]. Renka, Russell. The 1960 Kennedy v. Nixon Election. The Modern Presidency. cstl-cla. semo. edu/renka/ui320-75/presidents/kennedy/1960_election. asp (accessed May 3, 2012). [ 4 ]. Roark, James L.. Understanding the American promise: a brief history. Boston, MA: Bedford/St. Martins, 2011. 765. [ 5 ]. IBID, 764.

The definition of Al Qaeda group Research Paper Example | Topics and Well Written Essays - 500 words

The definition of Al Qaeda group - Research Paper Example I. Introduction †¢ The definition of Al Qaeda group ïÆ' ¼ The meaning of the Al Qaeda group ïÆ' ¼ How many groups join to make the Al Qaeda group (Alexander 50) †¢ A brief history of the Al Qaeda group ïÆ' ¼ The year of formation ïÆ' ¼ The location of the group ïÆ' ¼ The leader of the group ïÆ' ¼ The approximated number of members ïÆ' ¼ Organization of the group ïÆ' ¼ Religion of the group ïÆ' ¼ How many attacks the group has claimed since formation ïÆ' ¼ Current leader II. Al Qaeda and the truth about Osama bin laden A. Section one †¢ Early Life of Osama Bin Laden ïÆ' ¼ Where he was born (Gauvain 713) ïÆ' ¼ The year he was born ïÆ' ¼ His childhood, family, and upbringing ïÆ' ¼ His level of education ïÆ' ¼ Occupation before joining Al Qaeda †¢ Osama Bin Laden and the Pan-Islamlist Idea ïÆ' ¼ His religion ïÆ' ¼ The political beliefs of Osama Bin Laden ïÆ' ¼ He became a follower of Abdullah Azzam in the 1970s (Di Giovanni 12) ïÆ' ¼ In 1979 the Sov iet troops carried out an invasion in Afghanistan ïÆ' ¼ Bin Laden and Azzam moved t Peshawar, Pakistan ïÆ' ¼ Azzam, Bin Laden, and the Afghan rebels ïÆ' ¼ The organization served by Azzam and Bin Laden †¢ Osama and the building of Al Qaeda ïÆ' ¼ Al Qaeda created in 1988 by Bin Laden ïÆ' ¼ The group focused on symbolic acts that regard terrorism as opposed to military campaigns ïÆ' ¼ Bin Laden’s return to Saudi Arabia in 1989 ïÆ' ¼ The first bombing †¢ Osama the worldwide Jihad ïÆ' ¼ Bin Laden and associates ïÆ' ¼ Bin Laden and American servicemen in 1993 in Mogadishu ïÆ' ¼ The New York WTC bombing in 1993 ïÆ' ¼ Attempted assassination President Hosni in 1995 ïÆ' ¼ The US NGTC bombing in 1995

COMMUNICATION IN BUSINESS Essay Example | Topics and Well Written Essays - 2750 words

COMMUNICATION IN BUSINESS - Essay Example This is complemented by the low salaries in the country which would be effective in saving cost of the firm. An overview of the situation has been provided with regard to the culture barriers and differences between the two countries using Hofstede’s cultural dimensions. This is important to know the behaviour of people in the country where the company wants to operate. Based on the cultural differences, suitable recommendations have been provided to remove or utilise the differences. Lastly, the future of India’s outsourcing industry has been analysed and presented. Terms of Reference The project discusses about an outsourcing firm based in India. It is an IT company operating from USA. The company is named as ABC IT Solutions. The company has entered into partnerships with the local firms in India to take up their outsourced activities. The company has partnered with the outsourcing firm to take assignments on the IT enabled services. The firm has also taken up the bu siness process outsourcing activities of the company. The IT services that have been outsourced by the company are data mining, data warehousing, IT consulting, e-Commerce, and software development. The business process outsourcing includes such crucial activities like Customer Relationship Management (CRM), Supply Chain Management (SCM) and Enterprise Resource Management (ERP). The main purpose of outsourcing the above activities is to save cost of the company. Since India’s labour cost is lower than that in USA, the company has set up its outsourcing operations in the country. The BPO market in India has been expanding at a fast rate. It is estimated that the BPO market in India would grow by 19% in 2013. The sector has become extremely organised and has become the focus of a number of multinational companies (India Current Affairs, 2010). Overview of the Situation It is critical that a globally integrated organisation shapes its management, operations and strategies in a g lobal way. This company has been facing crisis implementing its strategies in the BPO on India. Firstly, the managers are confronted with the problem of coordinating resources like material, human and finance in meeting its business objectives successfully (Wursten, 2008, p.1). They are also faced with the problem of combining the culture differences prevailing between the two countries. The effective means of combination in USA may not necessarily be effective in India. The culture clash may take place between the client and the service provider at two levels; the corporate culture and the national/regional culture. With regards to the corporate culture, the speed with which a service is provided, or the norms followed with regard to decision making, style or organisational structure may be different between the client and the service provider (McCray, 2008, p.6). Another potential cause of clash could arise out of the fact that the process of outsourcing represents commercial rela tionships between two completely different entities. Organisations could take inflexible and extreme positions which could create a sense of distrust or tension between the two (McCray, 2008, p.6). Among the national or regional inhibitors, there could be language barriers which could create communication problems. Also the expectations regarding open debates, acknowledgement of problems or willingness to adopt different work techniques to

Urban Crime in Early Modern London Research Paper

Urban Crime in Early Modern London - Research Paper Example She regularly stole various kinds of goods, broke into houses to steal them, and often lied to escape conviction and punishment. She was extremely poor, which is perhaps one of the most prominent reasons for her crimes. She used the alias "Trolly Lolly" in an attempt to hide her previous convictions. She was described as a 30 year old woman, who came to London when she was fairly young, married a butcher and earned an honest living selling meat and other eatables on the streets of London. However during the year 1713, she turned to stealing, since she lived in extreme poverty, and was often mistreated by her husband. Thus in order to secure a safe livelihood for herself and her children, she took to stealing, robbery and burglary and committed various felonies during her lifetime. However, she was convicted for the crimes committed and on account of lack of proper evidence in her favour, was held guilty and charged with felony. She was hanged on 21st September 1715. Analysis of crimes: London, during the eighteenth century characterized a vibrant society which was abuzz with the introduction of world trade, the development of manufacturing industry, and a simultaneous rise in crime. During the year 1715, London underwent mixed feelings with regard to the socio-political status, characterized by enthusiasm and cheerfulness on account of crowning of the new King George I, on one hand and extreme economic unrest followed by the South Sea Bubble. Furthermore, there was a steady rise in the population, which further increased the rates of poverty and unemployment resulting in widespread destitution. The period marked the beginning of the "gin craze" in London, and was highly plagued with increased infant mortality rates, poor hygiene, cramped and inadequate living conditions, and constant migrations (Old Bailey Online, 2011). Thus, on account of this background, the types of criminal activity largely witnessed during the year 1715 (and most of the ea rly eighteenth century) included theft, burglary, embezzlement, and prostitution to a certain extent. The incidences of murder were far and few in between, but a significant proportion of the criminal activities were aimed at amassing wealth. Most of the thefts and petty crimes such as pick-pocketing, involved women as well since they were mainly responsible for taking care of their children. The following table shows the various categories of crimes committed during the chosen period. This analysis is based on a careful study of the documents posted under â€Å"City of London sessions† on the London Lives project website. Table 1: Analysis of crime during the year 1715 Case# Date Description of the criminal Type of crime Other details 1 5th Aug, Male Theft Stole a horse 2 17th Dec Female Theft Stole a box with valuables worth more than hundred pounds 3 Jan, 1715 Female Pick-pocketing Mary Sound – a notorious pick-pocketer stole money at London bridge 4 20th Jan Male & Female Theft Stole stuff from an acquaintance and believed to have pawned the same at a higher price 5 Jan, 1715 Male Theft Stole sacks of mault, from someone’s house and sold them for a price 6 Jan, 1715 Female – Elizabeth Young, a single woman Theft Stole several times from several people and regularly sold it for a price 7 13th Feb Female Theft Francis Pitchell – a house maid, stole several bed sheets and pawned them for a price 8 16th Jan Male Forgery Fraudulently changed the

Guns and school violence Essay Example | Topics and Well Written Essays - 1500 words - 1

Guns and school violence - Essay Example that any profile of a student shooter would fit too many students, since it has emerged that while some are children of divorcees, others are loners while still others are children of an ideal American family (Cavanaugh, et al, 317). However, the fundamental aspect of the Guns and school violence is the fact that; as opposed to the act of shooting the students being a snap action, the acts of shooting other students have been found to be premeditated and planned, since the student shooters were found to acquire the weapons well in advance, and even follow a considerable public path of violence (Redding and Sarah, 297). While some of the student shooters were found to plan their acts quietly, others were found to make their plans well known over a period of time, through consistent threats that eventually turn into the actualization of the violent act of shooting. The major concern is the motivating factors that drive the gun violence to increase at such a significant rate in schools. While it is worrying to think that guns can find way into schools and be used for violence perpetration, the truth is that the case is affirmative, and the incidences are even higher than could be anticipated. In fact, such occurrences have made many students and parents fear schools, preferring to undertake their learning at homes or in different private settings. According to the indicators of school crime and safety 2011 report by the Bureau of Justice Statistics, 6% of high school students in the USA stayed home for the feeling of being insecure either at school or on their way to school (Cavanaugh, et al, 322). This fact serves to indicate how the gun and school violence have affected the education sector in the USA, and it is threatening to paralyze public learning, especially in areas where crimes and gang violence are rampant. The report also indicated that around 7% of students in school between 9th and 12th grade admitted to have been threatened with a weapon within the

Nursing Process Essay Example for Free

Nursing Process Essay The client is a 70 year old, Caucasian male who is a retired siding salesman from Riverside, IA, who has an extensive history with Paralysis agitans (Parkinson’s disease). The client was first admitted to the long term care facility in December 2012. The client explained that he came to be at this facility after â€Å"already being in two places like this†. He was removed/discharged from the last long-term care facility for being what he called â€Å"disruptive†. The client described the staff at the last facility as not very kind to the residents. There was an incident where the drugs that were prescribed to the client made him hallucinate and he became unruly with the staff and was restrained and taken to the hospital for evaluation. He was then transferred to this long term care facility. Wanting to gather the client’s health history, an interview was scheduled. In starting the interview with the client, he was asked if he would be comfortable with being asked some questions and was informed that he did not have to answer any questions that he was uncomfortable with. Due to the client’s paralysis agitans and his muscle weakness he is primarily in a wheelchair. The client was asked if there was anything that he needed before starting and if he would prefer the door be closed or the curtain be drawn for privacy, he stated that wasn’t necessary. It was observed that the client had tremors in his right hand and arm. A few minutes after sitting down, the client asked for help moving his hand that was resting on the bed to the arm of his wheelchair; in doing this it seemed to help calm the tremors. When speaking with the client, he is of sound mind and has a sense of humor. This indicates that the client’s paralysis agitans has not affected the area in the right hemisphere of the brain that controls personality. The client noted that he was in respectable physical health until 1996. He then explained that in the spring of 1996, while he was running he suffered from a TIA (Transient Ischemic Attack). The client sought out professional answers from 5 specialists and was diagnosed with Paralysis agitans. The client conveyed this was a concern he had because his father also had Paralysis agitans. The client describes that the Paralysis agitans has  progressively become worse over the past 18 years. It was observed that his speech was slow and monotonous. The client spoke in a low and discreet volume. A lack of facial expressions was also noticed. The client can walk with the assistance of a walker but is generally in a wheelchair. Name of Drug Dosage Route Time Related to Carbidopa-Levo 25 100 tab Orally TID Paralysis agitans Comtan 200 mg tablet Orally TID Paralysis agitans Seroquel XR 50 mg tablet Orally In the afternoon Nonorganic psychosis He is prescribed 3 tablets to be taken orally 3 times a day Carbidopa-Levodopa 25-100 (25 mg of Carbidopa and 100 mg of Levodopa) for paralysis agitans. He is also prescribed 200 mg of Comtan to be taken orally 3 times a day for paralysis agitans. These drugs raise the level of dopamine in the brain. A side effect of having elevated levels of dopamine in the brain is psychosis. The client is also given 50 mg of Seroquel XR orally in the afternoon to alleviate his nonorganic psychosis. It is documented in the client’s chart that there are symptoms of sleep apnea. When asked, the client stated that he was unaware of having that condition. The client does not use a continuous positive airway pressure (CPAP) machine  while sleeping at night. When talking more in depth about sleep patterns and concerns the client stated that he gets approximately 8 hours a sleep a night, this is without any help from sleep aids. When speaking of his bedtime rituals he said that he does have two beers, back to back, at night right before bedtime, while watching television. He does not have difficulty falling asleep but did claim that he sometimes has a hard time staying asleep at night. When questioned about taking occasional naps throughout the day he stated â€Å"depends on if I’ve been up all night†. The client then explained that it is the noise level at the long term care facility that keeps him awake. When inquiring about the client’s family he stated that he has been married for 48 years and has two children, a son who is 44 years old and a daughter that is 39 years old. The client also has seven grandchildren. When asked what he likes to do in his spare time he replied that he loves spending time with his wife and children. He stated that before coming to this long term care facility he enjoyed playing card and gambling. He now plays computer games for fun, when his wife is there to help him. The client explained that he has a â€Å"little bit† of high blood pressure and it was noted in his chart that he is given an 81MG Aspirin daily for atrial fibrillation. Aspirin 81 mg Orally o.d. A-fib Acetaminophen 325 mg Orally Every 6 hour Pain He has no history of heart surgeries or surgeries of any kind. The client reported that he has never had rheumatic fever. When asked about blood clots, the client responded that he believes that his TIA in 1996 was a result of arterial emboli. The client claims that sometimes he has numbness in his legs and his hamstrings tighten up and it can be painful. He stated that he will ask for his prescribed 650 MG of acetaminophen for the pain. When speaking about everyday stresses with the client, he stated that he doesn’t have a lot of stress but gets irritated when that staff turn on the lights every morning at 6:30 am. When asked if there was anything that he does when he notices that he is stressed, the client mentioned that when he was younger he would travel to Vedic City in Iowa and practice with the Maharishi meditating. He says that meditating has been very helpful in his adult life. The client also mentioned that he liked to follow the Maharishi lifestyle and eat only organic foods but it is not possible to follow that when residing at a long term care facility. Other things that he does to distress are look at his pictures that he has on his shelf in his room. The one that helps him the most is a black and white picture of him in a small airplane with his flight instructor standing on the wing. The client use to pilot planes when he was younger. When the client was asked if he was religious and he explained that he is Methodist but hasn’t been to church in about 5 years. He did state that he does pray occasionally. The client stated that is not afraid of dying but he is afraid of falling. He then joked that maybe it’s not so much the falling but maybe it’s the landing. When assessing the client’s vitals it was noted that he has slightly elevated blood pressure of 129/84 and could be cause for concern of pre-hypertension. Metoprolol tartrate 25 mg Orally BID Hypertension It is noted in his chart that the client is given a 25 mg tablet of metoprolol tartrate orally twice a day for hypertension. His respirations were within normal range at 18 respirations per minute. SaO2 was at 86%. The client’s temperature was taken orally and was 97.6  °F. The client is 6 feet and 1 inch tall and weighs 257 lbs. The client has a BMI of 33.9. The client received a vaccination for influenza on 10/16/13. The clients chart states that he requires assistance with many daily activities. He is dependent on help with dressing, and bathing. When asked, the client stated that it is challenging to get dressed and undressed due to the stiffness in his arms and legs. The client is on a regular diet and states that he  doesn’t have any difficulty swallowing foods and doesn’t require help with feeding. When asked about appetite he said that sometimes he doesn’t have much of an appetite but he believes that is due to the medications that he is taking. The client explains that he is not aware of having any food allergies. He also stated that after eating he does not experience sensations of nausea/vomiting, but does encounter heartburn/indigestion occasionally, which he takes 30 ml an antacid suspension. He is also given one multivitamin orally daily for supplement. Antacid Suspension 30 ml Orally Every 6 hours Supplement heartburn Multivitamin 1 tablet Orally o.d. Supplement When the client was asked about dentures he stated that he does not have dentures even though dentures were noted in his chart. He states he needs aid in transferring from bed to a chair and with toileting. When asked about the character of his stools he explained that both consistency and color were normal. The client also stated that he does not need the help of laxatives. Noted in the client’s chart he is given a 100 mg capsule of Docusate sodium orally 2 times a day to help with constipation. Docusate sodium 100 mg capsule Orally BID Constipation The client does not have any history of kidney or bladder disease. He claims that the frequency, amount and color of his urine are normal. He also claims that he does not have any difficulty voiding and there is no pain or burning while urinating. According to the CNA, the client is able to stand,  holding the hand rails, while urinating. It is noted in the clients care plan that he is urinary incontinent which is related to impaired mobility and PRN straight catheter needed for intermittent retention secondary to BPH. The client is given one 0.4 mg of Tamsulosin HCL orally a day for BPH (benign prostatic hyperplasia). Tamsulosin HCL 0.4 mh Orally o.d. BPH The client needs assistance with bathing as well. The client also has a DNR order. Parkinson’s disease (paralysis agitans) is a progressive disorder of the nervous system that affects ones mobility. According to Hubert and VanMeter, Parkinson’s disease is a â€Å"dysfunction of the extrapyramidal motor system that occurs because of progressive degenerative changes in the basal nuclei, principally in the substantia nigra.†(UMMC, 2012) The substantia nigra is the primary area of the brain that is affected by Parkinson’s disease (PD). (UMMC, 2012) The substantia nigra is comprised of a specific set of neurons that send chemical signals, called dopamine. Dopamine then travels to the striatum, responsible for balance, control of movements, and walking, by means of long fibers called axons. (Okun, 2013) These regular body movements are controlled by the activity of dopamine on these axons. With PD the neurons in the substantia nigra break down and die causing the loss of dopamine, which in turn causes the nerve cells in the striatum to trigger excessively. The excessive firing of neurons makes it impossible for one to control their movements, a sign of Parkinson’s disease. (Okun, 2013) According to the Parkinson’s disease Foundation (2014): As many as one million Americans live with Parkinsons disease, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrigs disease. Also approximately 60,000 Americans are diagnosed with Parkinsons disease each year, and this number does not reflect the thousands of cases that go undetected. An estimated  seven to 10 million people worldwide are living with Parkinsons disease. Incidence of Parkinson’s increases with age, but an estimated four percent of people with PD are diagnosed before the age of 50 and men are one and a half times more likely to have Parkinsons than women. (p 1) Since PD is a progressively degenerative disease the signs and symptoms change over time and vary from person to person. A widely used clinical rating scale is the Hoehn and Yahr scale (HY); this helps to identify signs and symptoms in the various stages of Parkinson’s disease. (MGH, 2005) Early stages, like HY’s stage one, of Parkinson’s disease the symptoms are usually mild and appear unilateral. There may be changes in facial expressions, posture and locomotion; these symptoms are usually untimely and bothersome but not disabling. As the disease progresses, into stage two of the HY scale, it may begin to affect ambulation and be noticeable bilaterally with minimal disability. (MGH, 2005) As symptoms worsen, as in stage three of the HY scale, there is considerable slowing of body movements, early impairment of equilibrium with walking and standing and generalized dysfunction that is moderately severe. The Hoehn and Yahr scale’s stage four explains that signs and symptoms are severe but the person can still walk to a limited extent. (MGH, 2005) Rigidity and bradykinesia become factors in mobility. In stage five the person is unable to walk or stand so is bedridden or confined to a wheelchair. This stage is referred to as the â€Å"cachectic stage †. Constant nursing care is required in stage five (Costa and Quelhas, 2009). There are many complications that are associated with PD; one can be difficulty swallowing (dysphagia), likely due to the loss of control of muscles in the throat. (UMMC, 2012) Drooling can occur since saliva may accrue in the mouth due to dysphagia. Difficulty swallowing can also lead to malnourishment, but also poses a risk for aspiration pneumonia (Leopold and Kagel, 1997). Constipation can be another complication as to the slowing of the digestive tract. Parkinson’s disease can also cause urinary retention and urinary incontinence. Dementia and difficulty thinking comes in later stages of PD. (University of Maryland Medical Center, 2012) Depression is very common in patients with Parkinsons. The disease process itself causes changes in chemicals in the brain that affect mood and well-being. Anxiety is also very common and may be present along with depression (University of Maryland Medical Center, 2012). Sleep problems  and sleeping disorders are also associated with PD, with this comes fatigue. Some patients may experience feeling light headed when standing due to the drop in blood pressure (orthostatic hypotension). Pain can also be another symptom related to Parkinson’s disease (Okun, 2013). There is not yet a cure for Parkinson’s disease but there are treatments that can help alleviate the symptoms. The most commonly used is drug therapy. Medications can help with difficulty with movement, walking and controlling tremors by increasing the brains amount of dopamine. (University of Maryland Medical Center, 2012) The most common and most effective Parkinson’s disease drug is Levodopa. This is a natural chemical that passes into your brain and is converted to dopamine (Okun, 2013). There is also surgical procedures available, deep brain stimulation. With this procedure the surgeon implants electrodes into a specific location in the patient’s brain. A gen erator is implanted in the patient’s chest, which is attached to the electrodes. This generator sends electrical impulses to the patient’s brain, which may lessen the symptoms of Parkinson’s disease. (University of Maryland Medical Center, 2012) Other ways that help control the effects of PD is a healthy diet. Constipation is a complication associated with PD, so a diet that is balanced with whole grains, fruits and vegetables helps to manage this complication. Balance, coordination, flexibility and muscle strength deteriorate with PD so, exercise is encouraged. Exercise also helps with decreasing anxiety and depression. The client exhibits many of the discussed signs and symptoms of Parkinson’s disease. The client experiences resting tremors, bradykinesia, mask like face (hypomimic), slowed speech and is in a wheelchair. He scores very poorly according to the Hoehn and Yahr scale. The client is on medications to help diminish the signs and symptoms of Parkinson’s disease. Impaired physical mobility level 3, related to bradykinesia, ak inesia, neuromuscular impairment motor weakness, pain and tremors. (Berman Snyder, 2012) Evidenced by lack of decisive movement within physical environment, including movement in bed, transfers, and ambulation. Limited range of motion (ROM). Decreased muscle stamina, strength and control. Limitation in independent, purposeful physical movement of the body and impairment unilaterally on the right side. Due to the muscular and neuromuscular weakness related to Parkinson’s disease, evidenced by it being difficult for the patient to ambulate. The client has a defect of extrapyramidal tract, in the basal ganglia, with loss of the neurotransmitter dopamine. (Berman Snyder, 2012) Classic triad of symptoms: tremor, rigidity, bradykinesia (Jarvis, 2012). Tremors associated with paralysis agitans make it difficult maneuver. Tremors cease with voluntary movement and during sleep (VanMeter and Hubert, 2014). Immobility is an expected human response to Parkinson’s disease. The client’s immobility puts him at risk for thrombophlebitis, skin breakdown, pneumonia and depression. Immobility impedes circulation and diminishes the supply of nutrients to specific areas. As a result, skin breakdown and formation of pressure (decubitus) ulcer can occur (Berman and Snyder, 2012). Immobility also promotes clot formation. Self-care deficits related to neuromuscular impairment, immobility, decreased strength, and loss of muscle control and lack of coordination, ridgity and tremors. Self-care deficits, dressing, hygiene and toileting, evidenced by tremors and motor disturbance. The client lacks the ability to cleanse his body, comb his hair, brush his teeth and do skin care. . The client is also unable to dress himself satisfactory. He does not have the capability to fasten his clothes. The patient is assisted with ADL’s. Patient is incapable to bathe, dress or brush teeth without aid. Patient occasionally needs assistance with feeding. Assistance is also required with toileting. Aid is needed with ADL’s because of the lack of coordination and for safety. This nursing diagnosis is important because it ensures hygiene, improves quality of life, and promotes dignity, self-worth, independence and freedom. Risk for falls related to decreased mobility, a nd unsteady gait secondary to sedentary lifestyle and Parkinson’s disease. Patient uses a wheelchair and ambulates with a walker. Patients gait is impaired due to Parkinson’s disease. Festination, or a propulsive gait (short, shuffled steps with increasing acceleration), occurs as postural reflexes are impaired, leading to falls (VanMeter and Hubert, 2014). Falls also result in psychological implications for the patient with a decrease in self-confidence and a fear of further falls. This contributes to a decrease in mobility and culminates in a significant reduction in quality of life (Jarvis, 2012). Impaired bowel elimination/constipation related to medication, physical disability and decreased activity. Evidenced by the client not passing stools daily. Medications prescribed to patient for Parkinson’s disease attribute to constipation. The patients experience with immobility is also a  contributing factor for constipation. This nursing diagnosis is important because it allows nursing staff to monitor the patient’s bowel movements and avoid fecal impaction. Imbalanced nutrition less than body requirements related to tremors, slowing the process of eating, difficulty chewing and swallowing. Evidenced by the client occasionally needing assistance with eating. Pressure sores develop more quickly in patients with a nutritional deficit. Proper nutrition also provides needed energy for participating in an exercise or a rehabilitative program. The goal is to optimize the client’s nutritional status. Impaired verbal communication related to decreased speech volume, decreased ability to speak, stiff facial muscles, delayed speech, and inability to move facial muscles. Evidenced by lack of expression on the client’s face, client’s hindered speech. Loss of dopamine can affect the facial muscles, making them stiff and slow and resulting in a characteristic lack of expression. Speech impairment is referred to as dysarthria and is often characterized as weak, slow, or uncoordinated speaking that can affect volume and pitch. Difficulty speaking and writing because of tremors, hypophonia, and â€Å"freeze† incidents. This is an expected consequence of Parkinson’s disease. Nursing Care Plan- Alteration in impaired physical mobility- Parkinson’s disease Related to: Goals Intervention Bradykinsia Client will use a walker to go to breakfast in the mornings and not need assistance with transfers. Client will be able to perform all active ROM by 3 months Examine current mobility and observation of an increase in damage. Do exercise program to increase muscle strength. Perform passive or active assistive ROM exercises and muscle stretching exercises to all appendages. To promote increased venous return, prevent stiffness, and maintain muscle strength and endurance. Without movement, the collagen tissues at the joint become ankylosed (permanently immobile) (Berman Synder, 2012) Akinesia Client will gain power of voluntary movements. Joint contractures will not occur. Assess the possibility of deep brain stimulation. Refer to physical therapy. When the muscle fibers are not able to shorten and lengthen, eventually a contracture forms, limiting joint mobility (Berman Synder, 2012) Tremors Client’s tremors will decrease. Encourage deep breathing, imagery techniques and meditation. Encourage holding an object in hand Suggest holding the arm of the chair. Stimulating the brain by concentrating on breathing may cease tremors. (www.theparkinsonhub.com) Pain Client will not experience pain 4 on a scale of 0-10 Before activity observe for and, if possible, treat pain. Assess patients willingness or ability to explore a range of techniques aimed at controlling pain. Administer pain medication per physician orders. Encourage/assist to reposition frequently to position of comfort. Pain limits mobility and is often exacerbated by movement. (www.ptnow.org) Nursing Care Plan- Alteration in Skin Integrity, Impaired: Risk for Pressure Sores; Pressure Ulcers, Bed Sores; Decubitus Care Related to: Goal Interventions Rationale Neuromuscular impairment Client will be free of any pressure ulcers for length of long term stay. Monitor site of skin impairment at least once a day for color changes, redness, swelling, warmth, pain or any other signs of infection. Pay special attention to high risk areas and ask client questions to determine whether he is experiencing loss of sensation. Apply barrier cream to peri area/ buttocks as needed. Use ROHO cushion on wheelchair. Checking skin once a day will ensure that skin stays intact. (Jarvis, 2012) Immobility Client will be able to express s/s of impaired skin. Teach skin and wound assessment and ways to monitor for s/s of infection, complications and healing. Use prophylactic antipressure devices as appropriate Early assessment and interventions may help complications from developing. To prevent tissue breakdown. (Jarvis, 2012) Nursing Care Plan- Self Care Deficits Related to: Goal Intervention Rationale Immobility Client will assist with bathing, grooming, dressing, oral care and eating daily. Assist client with bathing, grooming, dressing, oral care and eating daily. Use high back wheelchair. The effectiveness of the bowel or bladder program will be enhanced if the natural and personal patterns of the patient are respected. Loss of muscle control and lack of coordination Client will improve muscle control and coordination in all extremities for the length of long term stay. Client will walk to dining room and in hallways- 5 mins a day 5 days a week. Use consistent routines and allow adequate time for patient to complete tasks. Assist client with ambulation. This helps patient organize and carry out self-care skills. Tremors Client will be able to assist with dressing. Provide appropriate assistive devices for dressing as assessed by nurse and occupational therapist. Encourage use of clothing one size larger. Teach and support the client during the clients activities Apply extensions on breaks with ball grips The use of a button hook or of loop and pile closures on clothes may make it possible for a patient to continue independence in this self-care activity. Ensures easier dressing and comfort. Grips will be easier to grasp with tremors. Neuromuscular impairment Client will be clean, dressed, well groomed daily to promote dignity and psychosocial well-being. Assist with shower as needed. Assist with daily hygiene, grooming, dressing, oral care, and eating as needed. This promotes dignity and psychosocial well-being. Nursing Care Plan- Falls, risk for Related to: Goal Intervention Rationale Decreased muscle tone Client will express an understanding of the factors involved in possible injury. Educate the client about what makes them at risk for falls. Bed should be in lowest position. Provide assistance to transfer as needed. Reinforce the need for call light. If the client is educated and shows an understanding of the factors involved with falls, they are less likely to fall. Prevent fall. Nursing Care Plan- Impaired Bowel elimination/constipation Related to: Goal Intervention Rationale Inactivity, immobility Client will have soft formed stool every other day that are passed without difficulty. Encourage physical activity and regular exercise. Adjust toileting times to meet client’s needs. Report changes in skin integrity forum during daily care Ambulation and/or abdominal exercises strengthen abdominal muscles that facilitate defecation. low-fiber diet Evaluate usual dietary habits, eating habits, eating schedule, and liquid intake. Initiate supplemental high-protein feedings as appropriate. Change in mealtime, type of food, disruption of usual schedule, and anxiety can lead to constipation. Proper nutrition is required to maintain adequate energy level. Diminished muscle tone Encourage isometric abdominal and gluteal exercise Apply skin moisturizers/barrier creams as needed To strengthen muscles needed for evacuation unless contraindicated. (http://www.gutsense.org) Medications Encourage liquid intake of 2000 to 3000 ml per day To optimize hydration status and prevent hardening of stool (VanMeter Hubert, 2014) My thinking about my resident has definitely changed since the initial day when I conducted a health history assessment on him. I knew that first day that I was going to appreciate getting to know this resident because of how smoothly the conversation flowed. This resident had some amazing stories to tell. I absolutely adore that fact that he and his wife have been married for 48 years. I enjoyed listening to him remember what life was like before being diagnosed with Parkinson’s disease, it appeared to lighten his spirit. I feel very fortunate to have been given the opportunity to care for such a genuine soul. My whole clinical experience was a positive one. I realized that if I lacked the knowledge about a particular task to ask for help. I liked the fact that clinicals was hands on and that I gained experience in a long term health care facility. Another thing that this clinical rotation  taught me was that it takes an exceptional type of person to go into geriatric nursing. Probably the number one thing that I’m going to take away from this clinical experience is the total importance of dignity. I too will be old someday and I applied the golden rule to this experience. I treated others as I want to someday, and hopefully, will be treated. What a fantastic learning experience. References: Berman, A., Snyder, S. (2012). Kozier Erbs Fundamentals of Nursing: Concepts, Process, and Practice. Upper Saddle River: Pearson Education. Coleman, J., (September 1, 2013) Meditation Mitigating Parkinsons Symptoms. Retrieved from http://www.theparkinsonhub.com/your-quality-of-life/article/meditationmitigating-parkinsons-symptoms.html Costa, M. Quelhas, R. (2009). Anxiety, Depression, and Quality of Life in Parkinson’s Disease. The Journal of Neuropsychiatry and Clinical Neurosciences 2009; 21:413-419. Jarvis, C. (2012). Physical Examination Health Assessment. St. Louis: Elsevier Kegelmeyer, D., (July 1, 2013) Functional Limitation Reporting (FLR) Under Medicare: Tests and Measures for High-Volume Conditions. Retrieved from http://www.ptnow.org/FunctionalLimitationReporting/TestsMeasures/Default.aspx Leopold N., Kagel M. (1997). Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia 1997; 12:11–18 Massachusetts General Hospital (MGH) (May, 2005) Hoe hn and Yahr Staging of Parkinsons Disease, Unified Parkinson Disease Rating Scale (UPDRS), and Schwab and England Activities of Daily Living. Massachusetts General Hospital. Retrieved March 2, 2014, from http://neurosurgery.mgh.harvard.edu/functional/pdstages.htm#HoehnandYahr Okun, M. (2013). Parkinsons Treatment: 10 Secrets to a Happier Life. CreateSpace Independent Publishing Michael S. Okun M.D. Parkinson’s disease Foundation (2014, March) Understanding Parkinson’s. Parkinson’s Disease Foundation. Retrieved March 2, 2014, from http://www.pdf.org/en/understanding_pd University of Maryland Medical Center (2012, September) Parkinson’s disease. University of Maryland Medical Center. Retrieved March 2, 2014, from http://umm.edu/health/medical/reports/articles/parkinsons-disease#ixzz2upFLCggw VanMeter, K. C., Hubert, R. J. (2014). Goulds Pathophysiology for the Health Professions. St. Louis: Elsevier.