Discovery Museum Gold Rush History Center Free Essays

The visit I made to the Discovery Museum Gold Rush History Center in Sacramento, California, end up being profoundly enlightening, engaging, and a two-hour very much spent. The experience managed me a great deal of learnings from the Gold Rush time frame that I didn’t know previously. Before I made the voyage through the four exhibitions inside the structure, I previously went to the visitors’ data focus, wherein a presentation in regards to the building’s development has been appeared in a nine-minute film cut. We will compose a custom paper test on Revelation Museum Gold Rush History Center or on the other hand any comparative subject just for you Request Now In light of the clasp appeared, I discovered that the historical center is a copy of the first structure that was worked in 1854 that recently housed the City of Sacramento’s city corridor, residence for the local group of fire-fighters, prison, police headquarters, and court. The first structure had experienced auxiliary issues and was announced dangerous numerous years after the fact. It was at last annihilated around sixty years after the fact in 1913. The copy building has been adjusted on certain sides in accordance with its being a historical center exhibiting history, science and innovation. The Gold Rush Center’s shows are in The Lure of Gold exhibition. The museum’s game plan of occasions is efficient and one of a kind. From that point, I had the option to see gold chunks in plain view and ancient rarities and actualizes utilized by excavators from the Gold Rush time. The Gold Rush in California was a vital crossroads in history that changed Sacramento until the end of time. Sacramento turned into the focal point of that occasion in 1849. Individuals from everywhere throughout the world went to this city wanting to make themselves rich. Beforehand, this exhibition has displayed an average miner’s travel and way of life. Beside the displays, there are likewise active exercises for youngsters and intuitive projects to enable the current age to improve comprehension of the past. The most effective method to refer to Discovery Museum Gold Rush History Center, Papers

Waters Unique Characteristics Essays

Waters Unique Characteristics Essays Waters Unique Characteristics Essay Waters Unique Characteristics Essay Paper Topic: One of a kind Water, with its irregular clinging to hydrogen, is a significant asset to the Earth, natural life, and the earth. Because of waters hydrogen holding, it has created numerous remarkable attributes that numerous different fluids don't have. A portion of these qualities are the accompanying: attachment, union, and surface pressure. These three qualities alone take into consideration the connection of water to its self and to different particles for the development of water it self.Cohesion is simply the capacity of water to append to itself to move inverse the power of gravity. While bond is the capacity of water to join to some different option from water particles, this takes into account water to move with out needing a power behind it. Surface strain is the proportion of the fact that it is so hard to break the outside of a fluid. Water has an outstandingly high surface strain because of the way that water particles are intermixed with air and attached to other water atoms underneat h it; in this manner, causing a practically imperceptible shield.Other characteristics that water has are high explicit warmth, evaporative cooling, and a high breaking point. A high explicit warmth implies that it requires some investment for one gram of water to warm up by one degree Celsius. Because of this, water will change its temperature less when it ingests or loses heat. Evaporative cooling happens on the grounds that hot particles leave, or departure into a fluid or vaporous state, before cool ones and along these lines forestalls overheating. Additionally, another significant trait of waters is its thickness while in strong and fluid structures. Contrasted with different fluids, water is less thick in its strong state than in its fluid state.This happens in light of the fact that when the hydrogen bonds are being solidified they bond with four different atoms at an a safe distance as opposed to nearer to the hydrogen. This takes into consideration the ice, or strong type of water, to be 10% less thick than the fluid stage. Be that as it may, one of the most significant promoters of water is its all inclusiveness. It very well may be utilized to break down pretty much any substance. Thus, arrangements have been wore either hydrophobic, water dreading, or hydrophilic, water adoring. In these two occasions, the arrangement either can break down in water, hydrophilic, or is insoluble in water, hydrophobic.These novel attributes permit water to be one fluid with its own capacities; in any case, it is the thing that these capacities permit in nature and in the condition that make water so special. The motivation behind bond and union essentially needs to manage the watering and supporting of plant frameworks. Attachment is utilized to pull the water up the stems of plants to the top to sustain; then again, bond is utilized to help keep the water set up despite the fact that it is being pulled somewhere around gravity. Another case of how grip is utilized is in the vessels of human blood frameworks; attachment is utilized to pull the blood up versus the quality of gravity.Surface strain is utilized to permit bugs or different creatures to stroll over the highest point of water to take into consideration escape or for the catch of food. Waters high explicit warmth takes into account it to assimilate a lot of warmth without changing its temperature much. This considers in the late spring months, the sea shores to be chilled and in the winter a long time to be warmed up. This likewise, balances out sea temperature, making an increasingly steady life for marine life, and it takes into account temperature variances ashore yet keeps the water inside limits that grant life.Evaporative cooling of water adds to the strength of the temperature of the lakes and lakes and furthermore forestalls creatures, and different instruments, from over warming. Evaporative cooling additionally assists with vegetation; it shields the tissues in the leaves f rom getting excessively warm in the daylight. In addition, waters thickness is a superior ascribe to the earth. As a strong, waters thickness is not as much as when it is a fluid this takes into account just the highest points of lakes, and so forth to become solidified as opposed to the bottoms. On the off chance that a lake were to freeze from the base up, at that point for all intents and purposes the entire Earths water framework would freeze up in just a matter of time.However, in light of the fact that this doesn't occur, the solidified layer on top protects the base bit of water and takes into account marine life to live throughout the winter months instead of pass on. Waters comprehensiveness, notwithstanding, is its greatest resource. This trademark permits water to be an effectively open lab accomplice all around the globe. Without water as a widespread dissolvable, researchers would need to make a dissolvable that might be too expensive cash and just take into account con strained tests. Nonetheless, in light of the fact that water is modest, and promptly accessible, researchers have no issue with directing the examinations they feel are fundamental.

How Daily Rewards Can Help You Quit Smoking

How Daily Rewards Can Help You Quit Smoking Addiction Nicotine Use How to Quit Smoking Print How Daily Rewards Can Help You Quit Smoking for Good By Terry Martin facebook twitter Terry Martin quit smoking after 26 years and is now an advocate for those seeking freedom from nicotine addiction. Learn about our editorial policy Terry Martin Updated on July 13, 2018 Morsa Images / Digital Vision / Getty Images More in Addiction Nicotine Use How to Quit Smoking After You Quit Nicotine Withdrawal Smoking-Related Diseases The Inside of Cigarettes Alcohol Use Addictive Behaviors Drug Use Coping and Recovery For most of us, the early days of smoking cessation involve quite a bit of  work. Nicotine withdrawal and the associations we have between the activities in our lives and cigarettes can be consuming. Thoughts of smoking are incessant and uncomfortable. We wonder if well ever be free of the urge to smoke or doomed to be forever enslaved  to  nicotine addiction. While this phase of recovery is challenging, the good news is that the discomforts are all temporary. Better days are ahead, as long as you find ways to manage nicotine withdrawal successfully. As smokers, we all know how big a deal it is to not smoke for an entire day. So, early on, its important to celebrate each and every smoke-free day we complete. Doing this achieves  more than positive reinforcement, although that certainly plays a part. Lets take a closer look. Life is hectic enough as it is without the additional tension that smoking cessation throws into the mix. Daily rewards  help us in a few important ways. Daily Rewards Can Reduce Stress While its true that smoking cessation will eventually help us to live a less stressed life, initially, quitting tobacco tends to increase stress. Learning to navigate the day without smoke breaks is hard. We have leaned on cigarettes for everything from waking up in the morning to relaxing after a meal and dealing with anger. Now we have to learn to manage the activities in our lives without smoking, and we feel the tension that creates. At the end of each smoke-free day, choose rewards that help release the stress of the day and recharge your batteries for the day ahead.  Think time alone with a good book and a cup of tea, devoting an hour to a favorite hobby, a long soaking bath or going for a walk on the beach with the dog. Activities like this can work wonders for rejuvenating body, mind, and soul. Daily Rewards Provide a Replacement for the Instant Reward of Nicotine Smoking gives us an instant hit of nicotine, causing a release of dopamine in our brains. Dopamine makes us feel good, and researchers believe that its this chemical reaction is why some drugs are addictive. Over time, we come to expect this little feel good hit numerous times a day.  Its called instant gratification, and when we quit, we miss it.  Giving ourselves a small daily reward helps to relieve some of those pleasure hits we miss.  While its not an instant reward were receiving multiple times a day, it does give us positive feedback on a daily basis.  Its also training us to wait for rewards in a gradual way. Daily Rewards Motivate Us We all need to hear that were doing well and that the task were working so hard to accomplish is worth it.  It inspires us to keep going until weve overcome the temptation to smoke. For most of us, that takes a year of smoke-free living, but dont worry.  The angst of nicotine withdrawal fades and with every passing month, we are stronger and more motivated to make the change a permanent one. Healthier ... Wealthier, Too Speaking of rewards, lets not forget the money saved when we quit smoking. With cigarette prices reaching upwards of $10 to $15 per pack here in the United States, the money adds up quickly. Why not collect the cash you would have spent on cigarettes in a jar and use it every so often to reward yourself with something special? Monthly smoke-free milestones are a great time to splurge on yourself. Save up for a trip or some other luxury when you reach a year smoke-free. Think about it: a pack a day smoker will save $ 3650 in one year at $10 per pack. You deserve to have  tangible rewards that were purchased with cigarette moneyâ€"and think what powerful motivators they are. Final Thoughts Make a list of simple rewards that you can use to help motivate you, along with some ideas for special rewards for bigger non-smoking milestones. Feed your health and well-being with a daily reward that has meaning for you, and keep your quit program at the top of your priority list for as long as it takes. Its worth the work, and easier to accomplish with a few well-deserved rewards sprinkled in along the way.

The Basic Design Of An Exercise Prescription - 1420 Words

Exercise Prescription The basic design of an exercise prescription should be based on a person’s age, fitness level, and health status including mental and physical health as well as the goals they are looking to acheive. Once the assessment is complete this is used to help determine how to develop the exercise program specific to that individual. The American College of Sports Medicine (2014)’s FITT principle is a good way to start the development process for any individual and should be the foundation of the exercise program. This principle includes four basic components to be followed including: frequency, intensity, timing, and type of exercises to be used. Appropriately applying these to an exercise program will help meet the individual goals of each client. Frequency of Exercise Determining how often an exercise session from a particular program should be performed is important and will help with gaining the benefits and results wanted. Too many or too few sessions in a week may have opposite, negative, or no effects on any individual. The frequency of exercising should be considered at an individual level and where a certain client’s motivation may be at with their willingness to start a program. However, a good place to start is with a frequency of 2-3 times per week. This can optimize the beneficial results someone with osteoporosis is looking for. Kemmler Stengel (2014) performed an extensive 12 year cohort study observing the effects of exerciseShow MoreRelatedHealth and Wellness Education841 Words   |  4 PagesHWE 100 HUMAN NUTRITION 3 CREDITS Introduces basic principles of nutrition with emphasis on personal nutrition. Satisfies nutrition requirement of students entering healthcare professions. HWE 108 WEIGHT LOSS 1 CREDIT Focuses on combining a healthy diet and exercise to shed unwanted pounds and inches. The course will include online sessions that will focus on personal habits including diet that lead to weight gain and exercise session appropriate for the student. *HWERead MoreCritique Of The Last Physical Assessment801 Words   |  4 PagesCritique of the last Physical Assessment Physical Environment and Comfort The physical environment and the design of a health facility has significant impact on comfort, safety, human performance and increased effectiveness of care (Reiling, Hughes, Murphy, n.d.). Evidence based designs are called healing environment, in other words, they are smart investments since they promote patient satisfaction through less stressful environment ,reduce hospital stay as well save money, increase staff efficiencyRead MorePersonal Preparedness Plan For Emergency Preparedness777 Words   |  4 PagesPersonal preparedness is basic components of any group or association s emergency planning. Regardless of different helpers, for example, real occasions and open data, people and families remain to a great extent ill-equipped to react to crisis and debacle circumstances (Rumbach and Foley, 2014). The emergence of public wellbeing dangers measles episodes, pandemic flu, bacillus anthracis, extreme climate – have impelled more noteworthy planning investment by public wellbeing authorities, includingRead MoreInternational Association On Computer Science888 Words   |  4 Pagesdid scientists and society become increasingly aware that we can integrate this data and computer processes with real life processes to create new ideas (Computer). As such, it is the computer science field that truly leads to innovative engineering design systems that allow for the research already discussed such as computerized performance analysis. 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Specifying reveals arrangement bungles, can trigger notification, and backings the scattering of a culture of safe practice. Audit is a for the most part clear instrument for evaluating bona fide execution and in masterminding remedial exercises to diminish the peril of arrangement goofs. Reckoning MedicationRead MorePhysical Assessment On The Basis Of Comfort, Health Promotion And Health Prevention924 Words   |  4 Pagesaddressed and resolved. Critique of the last Physical Assessment Physical Environment and Comfort The physical environment and the arch technic design of a health facility has significant impact on comfort, safety, human performance and increased effectiveness of care (Reiling, Hughes, Murphy, n.d.). Evidence based designs are called healing environment in other words they are smart investments since they promote patient satisfaction through less stressful environment ,reduce hospitalRead MoreSwimming pool medical expense deduction Essay1106 Words   |  5 Pagescrowded. 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In addition to providing a summary of the exercise itself, I would also hope to explore the relationship between the clinical audit process and the wider framework for quality improvementRead MoreA Good Health System Successfully Delivers Treatment And Prevent Disease1599 Words   |  7 Pagesdecisions which are made in the community or individual practitioner about appropriate intervention of prescription or investigation of problems. Epidemiology also defined as the characteristics and determination of disease and health conditions. The knowledge of epidemiology deals with age an d sex distribution of disease and also risk factors, which includes cigarette smoking and lack of physical exercise. Primary health care epidemiology includes utilization of patterns like economic, organizational

Essay about Designing for Social Sustainability - 1459 Words

Socially sustainable development : †¢ satisfies basic human needs such as food, water, shelter, education, jobs and safe conditions to live and work in; †¢ is fair and impartial, distributing its benefits fairly among all levels of society; †¢ promotes, or at least does not inhibit, the well-being of the community - physically, mentally and socially ; †¢ encourages culture, educates, creates and contributes to the development of human potential within the population; †¢ recognizes and preserves communal heritage, instilling and strengthening connections to history and environment; †¢ supports good interactions and relations, emphasizes harmonious living and people support; †¢ is inevitably democratic, allows full societal participation†¦show more content†¦Efforts of this kind foster a sense of ownership and participation among urban residents. Building on them will help cities to leverage their immense potential to alleviate poverty and to create shared economic growth. (SSIReview, 2013) Intensive research and extensive studies have been conducted to gather much information for urban planners. However, much of this knowledge and practical experience is recorded and analyzed but hardly put into practice. Planning strategies are designed to cope with these implications but many still remain theoretical solutions with little probability of immediate implementation. Every community is different in their make up and background, so understanding what each settlement needs, which is crucial to proper planning, is often difficult to predict and harder to measure. What works in one community may or may not work the same way for another. Social sustainability is all encompassing. It has to cater for everyone; for different groups of people with dissimilar lifestyles at multiple earning levels, at numerous points of their lives, who have individual needs and abilities both physically and mentally. If there are people who are left out, then it is not fulfilling its mission. The subjectivity and unquantifiable nature of social sustainability also makes it difficult to identify suitable measures of success - well-being and sense of identity cannot be measured like standards forShow MoreRelatedTransformation Is Run By Ceo Carole Anne Hilton1551 Words   |  7 Pagescommunity development and the social and economic capacity among First Nations communities. Their entire development and business goal is to establish governing structures, managing systems, and business development for First Nations people in order to establish a bright and structured future. Transformation is run by CEO Carole Anne Hilton who is driven by her ancestry and her passion to help struggling people. Hilton built the company off of the foundation of social and economic needs. ConventionallyRead MoreEnvironmental Sustainability And Global Warming1249 Words   |  5 Pages Sustainability ‘Sustainability’ and all its connotations have become the term of the millennium thus far, although it was an idea introduced in the 1980’s. It encompasses many interpretations, and has taken on a very loaded and preconceived meaning. Many have a vision of green initiatives and global warming-based issues, but what does it mean to the in today’s society? Even when narrowed to the disciplines of architecture and planning, it is a multifaceted and loaded concept. Kenny and MeadowcroftRead MoreThe Results of My Testing Indicates That: Blood from Suspect Number701 Words   |  3 Pagesbegun to realize their influence on the natural world and have decided to change the way they think of design and designing. This new approach has become known as sustainable design. Sustainable Design is a design philosophy that seeks to maximize the quality of the built environment, while minimizing or eliminating negative impact to the natural environment. In others wor ds designing physical objects with the idea of creating under the principles of ecological sustainable compositions. This typeRead MoreThe Government Of Hong Kong Essay1123 Words   |  5 Pagesjustifying the demand in adopting sustainability within high-density cities. ‘Energy efficient designs and renewable energy sources in buildings have become a world trend in striving for a sustainable future.’ (Lo, 2005) The inevitable growing capacity of population and urbanization leads to perceiving high-density cities as a problem. However the sustainability integration will help reduce the energy usage, diminish the use of fossil fuels and develop new ways to designing architecture. 4. ‘Do buildingsRead MoreProcter Gamble : Business1681 Words   |  7 Pagesto manufacture and market our products (vs. approximately $43.8 billion last year). In April 2010, we introduced an upgraded version of our Supplier Environmental Sustainability Scorecard. The Scorecard was developed with supplier and agency input and is designed to track and encourage improvement on key environmental sustainability measures in PG’s supply chain. The goals for the scorecard initiative include: †¢ Enhancing collaboration with our external business partners †¢ Improving key environmentalRead MoreSustainable Design Versus Aesthetic Design1213 Words   |  5 Pagesdue to human action. Then they set some laws in designing for the environment benefit only regardless of what the design look like, where this is not existed before. However, defining and judging a good design have become rising concern between designers. Some believe in design just for design’s sake and that a design should stand alone and be judged mainly on its aesthetic merits.   Others believe that a designer’s role is mainly one of social responsibility and that a good design should beRead MoreIndia Council For Youth Welfare Essay1318 Words   |  6 PagesBASIC INFORMATION ABOUT PROGRAM ïÆ'Ëœ NAME OF ORGANIZATION; India Council for Youth Welfare ïÆ'Ëœ NAME OF PROGRAM; Youth Leadership, Entrepreneurship and Economic Sustainability ïÆ'Ëœ LOCATION OF PROGRAM; Village Ayrakheda and Kosi in Mathura District, [UP] EXECUTIVE SUMMARY ORGANIZATION DETAILS ïÆ'Ëœ Organization Name : India Council for Youth Welfare ïÆ'Ëœ Organization Address : ICYW, 632, Lane no 3, Westend Marg, Mathura, Uttar Pradesh ïÆ'Ëœ Organization Contacts : Ms Sapna Gupta (General Secretary) ïÆ'Ëœ Contact PersonRead MoreSouthbank Essay813 Words   |  4 Pagessuch as Sunday sessions, sessions for kids, Musical events, free public, guided tours, etc†¦Categories of TLE activities in Southbank are in Appendix I. Role of the stakeholders toward the sustainability of TLE in Southbank Brisbane The contribution of stakeholders is essential for the long-term sustainability of tourism. Stakeholders are the group of people who have common objectives and interest regarding the resources and environment in question. According to Freeman (1984), stakeholders are theRead MoreCivil Engineering Case Study1295 Words   |  6 PagesIntroduction The paper is aimed at identifying the definition of sustainability and studying several general principles relevant to civil engineering. A case study of the regeneration of Mossley Mill in Northern Ireland which covers the rebuilding and reuse technology will be given below for detailed research. This kind of technology is not only a typical solution which meets the concept of sustainability, but also a classical paradigm in the civil engineering area. It is further suggested that theRead MorePhysical And Social Context Of The Building1137 Words   |  5 PagesExamine the physical and social context of the building The ‘Glass House’ is a building in which personal qualities are a vital component of the construction framework. The house is focusing on the correlation between an individual and buildings. There are architectural rules including conventions that establish a guide and maintain traditional approaches to building structures. However, Phillip Johnson operates against these standards of design rules and highlights the modernistic period due to

Cat Eye Syndrome Free Essays

Cat Eye syndrome Cat eye syndrome is a rare chromosomal disorder that may be plain to see at birth. The name â€Å"cat eye syndrome† comes from a distinctive abnormality in the eye that is shown in some affected people. This feature consists of partial absence of ocular tissue often affecting both eyes. We will write a custom essay sample on Cat Eye Syndrome or any similar topic only for you Order Now Affected ocular tissues may include the colored region, the middle layer, and/or the innermost membrane of the eye. Individuals with cat eye syndrome frequently have coloboma(s) (which is a structural defect of the eye), down slanting eyelid folds, widely spaced eyes and/or other ocular defects. Discovery and cause: This disorder was discovered in 1898. In individuals with cat eye syndrome, the short arm and a small region of the long arm of chromosome 22 are present three or four times rather than twice in cells of the body. Symptoms: * Partial absence of the tissue pertaining to the eye * Mild or moderate mental retardation * Cat-like, downward slanting opening * Malformations of the facial and the skull region * Eyes are widely spaced Inherited: As cat eye syndrome is an inherited genetic disorder, it occurs by birth. The defect can arise from either parent, as it can be transmitted through both sexes. The person is diagnosed considering the symptoms present in the body. Treatment: Treatment is given according to the severity of the symptoms. Patients with short stature are given  growth hormone therapy. Miscellaneous: A recent study suggests that cat eye syndrome affects 1 in about 74000 people, making this a pretty rare disorder. This chromosomal disorder can occur in both, males and females. In many cases, individuals are born with this syndrome because it is prevalent in their families. How to cite Cat Eye Syndrome, Papers

Principles of Palliative Care, Chronic and Complex Care free essay sample

Introduction Ageing and dying is a normal process and body goes through several changes in whole life. Palliative care is a kind of health care. It is offered to those whose illness cannot be cured. It helps people to live as well as possible while they manage their illness. This assignment discusses the principles of chronic, complex and palliative care. It will also looks at the assessment and management strategies in chronic, complex and palliative care. Furthermore, this will look at case study of 70 year old man diagnosed with adenocarcinoma of the right lung. The topics to be covered in this case study are nursing history of the client, nursing assessment, assessment tools and list of care priorities on key issues that associated with the nursing care of the client. Principles of Palliative Care, Chronic and Complex Care The Quality of life is most important principles of palliative care. According to The standards of Providing Quality Care for all Australians (2006) palliative care offers to all who have a chronic and life limiting disease, with slight or not vision of cure and for whom the main treatment option is to increase the quality of life. We will write a custom essay sample on Principles of Palliative Care, Chronic and Complex Care or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Alber et al ( 2010, p. 8) states that the symptom and pain management, spiritual care, psychological care and social support can be used to advance the quality of life of patients for whom there are no any other option of treatment.. If the client has a clear understanding of his diseases trajectory he will be able to make clearer choices. Parker Arandra (2009, p. 157) believes that most people with terminal illness will want to keep on living as long a quality of life is reasonable. Alber et al (2010, p. 19) also believes that to improve the quality of life in cancer patients, palliative care is one of the important treatment for them. Therefore, when measuring quality of life, diseases, and treatment related symptom physical functioning and psychological emotional wellbeing and social interaction are significant areas that need to be integrated. The provision of comfort care and symptom management is extremely important in palliative care. As previously mentioned they impact greatly on a person’s quality of life. Aranda (2007, P. 7) believes that alleviation of symptoms is closely tied to the palliative care goal of maximizing quality of life. Furthermore, Ferrell et al (2010, p. 06) states that the palliative care approach to the symptom management is based on through assessment o current symptom and planning a ahead for general problems. The study shows that a small but reliable optimistic impact of palliative care services on quality of life, symptom management and satisfaction at the end of life (Abernethy et al. , 2008, p. 586). Lewis and Kitchen ( 2010) states that effective communication skill plays significant role to the delivery of high quality palliative care to patients and their carers. In addition, education from the health workers to the patient, especially using easily understood terms is beneficial. It is important to use effective communication skills listen observe and instruct. A multidisciplinary approach is very important in palliative care. According to Hermsen and Henk (2005, p. 561) the care of person dying with chronic illnesses is not essay and needs a team of people who have special skills and expertise. It is a network that includes formal support from health care team members and informal support from family and friends. Moreover, holistic care is also one of the important principles of palliative care. It is not just a managing a client symptoms but it includes person as a whole. In palliative care to a certain extent holistic care will also incorporate the family. Street et al (2005, p. 44 ) states that nursing will be the key discipline in ensuring that emotional, social and spiritual dimensions are addressed but through consolations with and referral to colleagues in these dimensions of care. The end of life planning is also important key factor in palliative care. McDonald and Hobbs (2008, p. 1680) states that benefit of knowing in advance that death is imminent is that it provides an opportunity to accomplish preparation of death tasks. It gives the client and family time to communicate, discuss matters that are important to them. They are able to implement a plan of care and make choices as their care. Case study History of Present illness Mr. M. S 70 year old man diagnosed with metastatic lung cancer when he developed pain in his (R) shoulder and (R) hip and this was followed by investigation showing adenocarcinoma cells in bronchial washings. He underwent radiation treatment to the (R) shoulder. He has also been having chemotherapy. Over the last few weeks he has noticed lower limb oedma developing to the mid tibia. As a result, he had disturbed sleep decreased appetite and excessive weight loss in last few weeks and also experiencing increasing breathlessness and moist cough for past 3 weeks. He has pain in right shoulder radiating around in to scapular and in the hip area. He has constipation since starting opioids. Family History – His mother died age of 60 with lung cancer. Social History He belongs to Indengious family. Living with wife and two daughters are living in Sydney. He has no contact with daughters. Medical History – He has history of hypertension, high cholesterol epilepsy and hypothyroidism Present Medications He is on carbamezepine 200 mg, Fentanyl 100mcg, oxynorm 20mg, ibuprofen 400mg and simvastatin. His analgesic regime is ideal and he has noted improvement once Fentanyl dose has been commenced. Psycho emotional Consideration— He is anxious due to new diagnosis and fear of the unknown discussion. He has a current will no. POA pays into a funeral fund. However, has not decided on burial or cremation. Spiritual consideration – He has no spiritual considerations. Nursing diagnosis The first nursing diagnosis is ineffective airway related to secretion, pain, weakness and fatigue. Severe pain related to cancer and affecting daily activities. Furthermore, fear related to situational crises, change health status and perceived threat of death. The last one is deficient knowledge related to treatment, condition, prognosis, and self care. Nursing Assessment and Assessment Tools An accurate holistic nursing assessment is important to enhance the quality of life in palliative care patient. Yohannes (2007, p. 4) states that assessment of patient’s physical disability, psychological morbidity and impaired quality of life is the foremost step towards planning good end of life care. As Mr. M. S belongs to indigenous culture, it is the responsibility of nurse to provide culture competent care according to his culture, values and beliefs. Nurses are required to provide culturally safe practice because whenever they are interacting with a client they are entering bicultural relationships (Crisp Taylor 2008, p. 119). It is necessary to assess physical symptom of the patient related with cancer such as anorexia, pain, breathlessness, constipation and weight loss. All these symptoms affect his daily life activities. The main key issue for this patient is pain and nutritional status. The main concerns expressed by patients who are diagnosed with cancer are that they experiencing severe pain. Some patients are willing to follow the treatment would increase their quality of life. It is important that client and his families be confident that pain will be reassured successfully (Evan Higginson 2010, p. 425). The 70% to 90% patients who treated with pain medication properly they feel better. Nevertheless, studies also shows that around 30% to 60% of cancer patients fail to get satisfactory pain relief, with more than one-third experiencing moderate-to-severe pain (Ferral et al . , 2010, p. 06). Pain usually occurs due to the stage and location of the tumor. The Edmonton Staging system (ESS) pain assessment tool is used to measure the client pain. It is based on clinical staging of cancer pain. This tool is providing good understanding of pain type, frequency, description, aggravating factors, relieving factors and known prognostic factors response to treatment (Tere sa et al. , 2011, p. 10). In case of Mr. M. S he is experiencing constant stabbing pain in the right shoulder and right hip. His daily activities affected by the pain that are movements, traveling, walking and sleeping disturbances. The second issue is weight loss and anorexia due to chemotherapy. It is important to maintain good nutrition level to enhance quality of life. Chang Johnson (2008, p. 181) states that cancer patient has always poor appetite related to diseases, chemotherapy and pain, that results in excessive weight loss. The tool used for the assessment of nutritional status is Mini Nutrition Assessment (MNA). This tool provides proper screening of food intake, weightloss, mobility, psychological stress and body mass index. This has total 12 points that means if patient has 12 points. There is no risk of malnutrition, however, if patient has 11 points or less than that means malnourished and needs to be continue assessment (Morley 2011, p. 86). The main nursing care priorities for this patient is to maintain patent airway, pain related limitation in activities of daily living, risk of fall related to weakness, comfort measures to treat fatigue, well balanced diet, psychological and emotional support, transport, medications regime, counseling and education related to diseases prognosis, involvement of palliative care nurse, dietician, occupational therapist, general practitioner, family and relatives is necessary. Conclusion In conclusion, it is necessary in palliative, chronic and complex care that we recognize and manage emotional physical concerns early to achieve better outcomes for clients and family. 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