Category: Case study

Naturalistic observation method

This research method is used by most of the therapists and social scientists. The observational method focuses on studying the natural behavior of the participant in the everyday environment. This kind of research is usually carried out in such situations where the lab studies are sophisticated and non-beneficial. With the help of observational methods, psychologists can get much better assumptions of the ways and causes of why people react to certain situations. The observational process aims to represent the overall behavior of the subject. There are some strengths and limitations associated with this method.

Advantage: The most important recognized merit of this method is that it has higher ecological stability. Also, this helps researchers to establish brand-new concepts about natural settings.

Disadvantage: The major demerit of naturalistic observation is that this method does not help to find the exact cause of the behavior. If two researchers are examining the same situation, they may draw different conclusions from that moment of observation.

Case study

A case study is an in-depth investigation of a person, a group of people, or a phenomenon. In case studies, a variety of techniques are employed to collect the data such as one-on-one interviews, questionnaires, and psychometric tests. Earlier the research method was used in the clinical field but now psychologists use this method to inquire about a person, group, or community. This process involves research to observe the client’s behavior and provide detailed information about that behavior. The case study generally involves reconstructing a client’s case history, which is known as ‘idiographic research’. A case study is considered beneficial then only when it is able enough to convey the difference between the factual description and the opinion of the researcher, but the obtained information may not apply to every individual. The merits and demerits of the case study are listed below:

Advantage: The case studies have numerous advantages. The most prominent among all is that it can be done from a remote distance and it is not at all expensive. The investigators need not be present at the specific location to carry out the research. The interviews can be conducted over the phone. In addition to this, the cost associated with this process of obtaining data is almost negligible.

Disadvantage: The case studies are extremely time-consuming. As these studies are based on qualitative analysis, researchers need to be highly accurate in terms of collecting and presenting the data, which requires a lot of time.

Survey method

The survey method is a strategy for logical research where the researcher attempts to measure and assess the state of the community in comparison to one or more characteristics. The researchers do not interfere with the object of the exploration, he essentially records the circumstance as it is. The gathering of the information, the data building, and the data testing are the purposes of survey research. The information in surveys is required to be exploratory and descriptive, and the data must be explanatory and predictive. The pros and cons linked with the survey method are as follows:

Advantage: The most profound advantage of using surveys in psychological research is that they allow them to gather large amounts of data in relatively less period. They represent various attributes of a large number of populations which in turn helps to extract the most accurate results.

Disadvantage: The survey research can not be considered appropriate when it takes into consideration controversial issues. The controversial questions are not answered as accurately by the individuals as they face difficulty in recalling the information. The authenticity behind the issue is not revealed as effectively as the face-to-face interviews do.

References

1. McLeod, S. A. (2019, Aug 03). Case study method. Simply Psychology: https://www.simplypsychology.org/case-study.html
2. McLeod, S. A. (2015, June 06). Observation methods. Simply psychology: https://www.simplypsychology.org/observation.html
3. N., Pam M.S., ‘SURVEY RESEARCH,’ in PsychologyDictionary.org, April 13, 2013, https://psychologydictionary.org/survey-research/ (accessed February 3, 2020).
4. Sarah Mae Sincero (Mar 18, 2012). Advantages and Disadvantages of Surveys. Retrieved Feb 02, 2020 from Explorable.com: https://explorable.com/advantages-and-disadvantages-of-surveys

Cirrhosis is one of the leading causes of death in the United States, with the majority of cases being caused by excessive alcohol consumption. In Cirrhosis the liver undergoes structural changes and eventually fails to function due to the scarring. Because of these structural changes, pathophysiological changes begin to happen, with portal hypertension being the key change associated with Cirrhosis. Other changes associated with Cirrhosis include esophageal varices, Asterixis, steatorrhea, decreased absorption of fat-soluble vitamins, medication toxicity, bleeding and bruising, jaundice, and hepatic encephalopathy.

Cirrhosis of the liver is a chronic disease that causes cell destruction and fibrosis or scarring of hepatic tissue. Medical management for Cirrhosis is based on the presenting symptoms. The provider may order antacids to decrease the irritation of esophageal varices. Vitamins and nutritional supplements are sometimes given because of the nausea and vomiting, and because of the decrease in vitamins. Because of the ascites diuretics may be administered to decrease the fluid in the abdomen. You also need to teach the patient to avoid hepatotoxic medications such as Acetaminophen because the liver is not metabolizing like it is supposed to because of the scarring. A low sodium diet is usually enforced to help decrease fluid retention with ascites and a low protein diet to decrease the ammonia levels does decrease the risk of hepatic encephalopathy. Some nursing management for Cirrhosis is weighing the patient and the same time daily as similar as possible, monitoring intake and output, measuring abdominal girth at the same location, and sodium and fluid restriction to assess if the ascites are getting any better or getting worse. Monitor electrolytes because some may be lost with diuretics or with vomiting. Liver function tests such as ALT/AST, ammonia, and bilirubin should be obtained to assess liver damage. Examine for JVD and administer diuretics to help with fluid excess. Because of the risk of bleeding associated with decreased clotting factors you should monitor for signs of bleeding such as blood in urine, melena, and hematemesis. You should use the smallest needles possible and use soft toothbrushes. Protect the patient from falls and abrasions and after giving an injection apply direct pressure. Also, you might have to administer stool softeners, so they won’t have to strain with bowel movements. Because of the altered nutrition, you should prescribe a high-carb, high-protein diet as allowed. Educate the patient to avoid alcohol and watch for signs of withdrawal such as seizures, confusion, tremors, agitation, violence, and mood changes. Provide small frequent meals and elevate the HOB during meals. AST/ALT labs will be elevated because of the liver damage. Bilirubin will be elevated because the liver can’t conjugate it, this causes jaundice. Your albumin will be decreased because the liver can not synthesize this protein anymore. Ammonia will be elevated because the liver can not break down the proteins anymore. Prothrombin time will be prolonged because the liver cannot make clotting factors anymore.

Patients with Cirrhosis are prone to gastrointestinal bleeding because of the portal hypertension. Portal hypertension is caused by the portal venous system being blocked because of the scarring of the tissue causing blood to back up causing an increase in pressure and leading to enlargement of the veins making them susceptible to rupturing causing bleeding. Another complication is ascites which is the accumulation of protein-rich fluid in the abdomen that can cause abdominal pain and girth and can also cause shortness of breath due to the pressure on the diaphragm, it also can cause an increased risk for infection and some can develop pleural effusions. Hepatic encephalopathy is caused by high ammonia levels in the body because the liver is no longer able to breakdown the proteins into urea and excrete it out of the body, this can be recognized by neuro changes such as restlessness, confusion, seizures, and coma, this can be prevented by a low protein diet, management of encephalopathy is administration of lactulose to remove ammonia from the blood and neomycin which is a nonabsorbent antibiotic, asses neuro status and vital signs frequently, reduce ammonia by NG suctioning, and get daily ammonia levels. Coagulopathy can happen because the liver can no longer synthesize clotting factors and this causes prolonged PT and bleeding. Jaundice develops because the bilirubin can not be conjugated by the liver, so it remains in the body causing yellowing of the skin and sclera. Hepatorenal syndrome is a rapid deterioration of the kidney function because of altered blood flow to the kidneys, this causes elevated BUN and creatinine and sometimes oliguria, which has a high mortality rate. Spontaneous Bacterial Peritonitis is the development of peritonitis in the abdomen, this causes fever, abdominal pain, encephalopathy, and acute hemodynamic decompensation.

Enteral nutrition is given through a transnasal tube, gastroenteric tube, or PEG tube to give nutrition to patients who are unable to eat by mouth but have at least a partially functional GI tract. Can be given intermittently or continuously. You should check the placement of the tube by pulling back residual volume and this also checks for how you are tolerating the feedings, X-rays, or lung sounds. You should have the bed at least 30 degrees with feeding to prevent aspiration. You should not administer medications while the feed is running and never push the feed in a tube, use gravity. Some complications are tolerance, aspiration, D/N/V, tube displacement or obstruction, hyperglycemia, dehydration, and azotemia. Parental nutrition is given through am port-a-Cath or a PICC line only when enteral is inadequate or contraindicated. Should be given if oral intake has been inadequate for 7-10 days. Only give to those patients who have a nonfunctional GI tract. The line is infused with heparin to reduce fibrin buildup. Can cause infections and swelling of the veins and hyperglycemia. Medications should not be given down the same tube.

An endoscopy procedure looks at the upper GI tract and allows the doctor to visualize and biopsy. The patient should be NPO for 8 hours, Informed consent should be signed before sedation, and the patient will be placed in a left lateral position, sedation is required by midazolam, atropine, glucagon, anesthetic gargle, or spray, procedure: Monitor LOC, vital signs every 15 min for the first hour, O2 saturation, and pain. Monitor for signs of perforation such as pain, bleeding, fever, and difficulty swallowing. Evaluate gag reflexes to make sure they can have anything by mouth. The patient should be on bed rest until fully alert because of the risk of falls. Make sure they have transportation before the procedure begins because they will not be able to drive after.

Fecal diversion is indicated if the bowels need to rest or if the bowels cannot work properly. Preoperative care includes consulting with an enterostomal therapist, obtaining consent, administering bowel prep to ensure bowels are cleared, IV antibiotics before surgery, Possible NG tube placement, and instructing on cough and deep breath after surgery. Postoperative care includes stoma and wound care, Monitoring fecal drainage, early ambulation, pain medications, monitoring intake, and output, monitoring electrolytes, IV therapy, NGT placement, Skincare, and low residue diet.

Colostomy care includes ash warm water, dried thoroughly, Proper pouch fits snugly, Skin barrier, Change pouch q 5-10 days or PRN (leakage). Colostomy irrigation includes: Force should not be used with colostomy care, Position on the toilet,500 to 1000 ml warm water, 18 to 20 inches above stoma (shoulder height), Lubricate and dilate stoma, Irrigation sleeve, Instill over 5 to 10 min.

Nursing Diagnosis for Cirrhosis include Fluid Volume excess related to water and sodium retention secondary to decreased plasma protein, Fluid volume deficit related to third spacing of peritoneal fluid (ascites), coagulation abnormalities, variceal bleeding, and Risk for injury related to coagulopathy.

References:

1. Capriotti, & Frizzell. (2016). Pathophysiology Introductory Concepts and Clinical Perspectives. Philadelphia: F. A. Davis.
2. Hoffman, & Sullivan. (2017). Medical surgical nursing making connections to practice. Philadelphia: F. A. Davis.

The following case study is about an 18 year old white British male that shall be known as A for the purpose of this document. In our first session together, included in the contracting, was a discussion around case studies and verbal permission was given for our sessions together to be used. To date we have had ten sessions together with a view to end after two more. This case study looks at the initial presentation of the client, key movements in sessions and evaluation of where the client is currently at. The client presented as polite, confident and well-spoken and conveyed issues with low mood, difficulty sleeping, anxiety and low self esteem. The client talked of losing a Grandparent within the last year and his Father at age nine that he had seen every other weekend. The client did not come with any specific goals other that to alleviate the issues stated previously. He arrived for his first session accompanied with his mother, both were smartly presented and polite. A is of medium height and slight build and looks quite young for his age. The counselling sessions took place within an agency providing free counselling for young people aged between 12 and 25 and the client attended every session. This client has been taken to supervision on four occasions.

At our first meeting A struck me as a well brought up young man with good manners and respect for others and I immediately felt that I was given respect as his elder and as a female and that he was on his best behaviour at this point. The power dynamic was very evident in the room and there was a sense that this felt like a meeting with a teacher or a doctor etc. and nervousness around how this encounter may differ. There was a sense that there was a child sat opposite me despite the learnt polite behaviours demonstrated. A sat with an open relaxed pose but readjusted himself in the chair regularly. As I began the session with ‘what has bought you to counselling’ he began with a heavy sigh and muttered that he did not want to say too much too soon. There was a sense of holding everything together, not to lose control and become vulnerable and trust me too soon, it was as though this had been a thought process before the session and this was a reminder to himself. As A began to talk he demonstrated a deep thought process around the distress he felt and he was able to articulate and talk freely about his thoughts and experiences. I felt a tightness across my chest as he talked of the loss of his father and grandfather, there was a heaviness in what he was saying but not in his body language. There appeared to be a real disconnect between his experiences of loss and any emotion or the distress that he described, that they were irrelevant really.

At this point I experienced a lot of warmth for my client. I was aware of the desire to mother him and took this to supervision as I felt that A to wanted me to mother him. That if I had of offered advice he would have taken it but that this would lead quickly to a reliance I was unable to maintain and not offer any long term relief from the anxiety he was experiencing. At times I felt a frustration towards my client from a sense that some of what he was saying was forced and the motive behind what he was sharing was to hook me in or to maintain the connection or to appear how he perceived I was expecting him to. I wondered early on in our sessions whether his father had mental health issues and had past away due to suicide and considered whether A repeatedly labeling himself with depression and anxiety despite no diagnosis or contact with a doctor was an unconscious effort to connect with his father in some way. I considered whether this was an attempt to fill the gap in his identity left by an absent Father and many unanswered questions.

A described himself as being 18 now but not feeling or knowing how to feel like a man, as though something was missing. The word proud was repeated when he spoke of how he wished to be viewed by his significant others and the motivation behind his behaviours. He described his efforts as unseen and as relentless. A displayed emotion evident in his face and body language and verbalized his discomfort of sitting with the feelings saying he felt exposed and was desperate not to cry as he smiled and giggled nervously. When I challenged the issue with crying I was told that crying is a weakness.

Introduction

Lysergic acid diethylamide, also known as LSD, or “acid,” is considered the best-known and most researched psychedelic or hallucinogenic drug. [footnoteRef:1] It is made from a lysergic acid compound found in ergot, a fungus that grows on grains. [1: Passie,Torsten , John H. Halpern, Dirk O.Stichtenoth, Hinderk M. Emrich, and Annelie Hintzen. ‘The Pharmacology of Lysergic Acid Diethylamide: A Review.’ CNS Neuroscience & Therapeutics 14, no. 4 (2008): 295-314. doi:10.1111/j.1755-5949.2008.00059.x.]

Today’s recreational users of LSD often include people in their late teens and early twenties, who are involved in the psychedelic music scene. In the 1990’s, LSD was among the ranks of “club drugs” that, along with MDMA and ketamine, were found at dance clubs and large underground parties known as raves.[footnoteRef:2] [2: National Drug Intelligence Center. (April 2001). Information Bulletin: Raves]

In 2014, 0.3% of the 16,875 adolescent respondents (12 to 17year-olds) in the US were considered to be current users of LSD, 0.3% of the 11,643 young adult respondents (18 to 25), and 0.1% of 33,750 adult respondents aged 26 or older.[footnoteRef:3]

In 1938, Albert Hofmann, a Swiss chemist working at Sandoz Laboratories, discovered LSD. He later became the first person to experience the drug’s psychoactive effects „after he accidentally ingested a small amount in 1943. The effects Hofmann reported included, “restlessness, dizziness, a dreamlike state and an extremely stimulated imagination.” [footnoteRef:4] [3: Krebs, Teri S., and Pål-Ørjan Johansen. ‘Over 30 Million Psychedelic Users in the United States.’ F1000Research, 2013. doi:10.12688/f1000research.2-98.v1.] [4: Hofmann, Albert. LSD — My Problem Child. New York: McGraw-Hill, 1980]

In the 1950s, intellectuals, such as Aldous Huxley experimented with the drug for its alleged ability to induce a state of “cosmic consciousness.”[footnoteRef:5]

A lot of experiments with LSD led to a better understanding of how LSD affected consciousness by interacting with the brain’s serotonin neurotransmitter system. Nowadays, LSD is in Schedule I of the Controlled Substances Act of 1970[footnoteRef:6], the most heavily criminalized category for drugs. Schedule I drugs are considered to have a “high potential for abuse” and no currently accepted medical use – though when it comes to LSD there is significant evidence to the contrary on both counts. [5: Centre for Addiction and Mental Health https://www.camh.ca/-/media/files/guides-and-publications/dyk-lsd.pdf] [6: Controlled Substances Act https://legcounsel.house.gov/Comps/91-513.pdf]

LSD produces distortions of visual perceptions, that some people find awesome and fascinating but for another ones its effects can be frightening and terrifying. This is the drug, which is effective in extremely small doses, is a direct agonist for postsynaptic 5-HT2A receptors in the forebrain.[footnoteRef:7] [7: Neil R. Carlson; “Physiology of Behavior”’; 11th edition; pp. 120; 625]

General properties and physiology of behaviour

LSD is a highly potent synthetic hallucinogen. The hallucinogens are a chemically diverse class, but are characterized by their ability to produce distortions in sensations, and to markedly alter mood and thought processes. The hallucinations are most often visual, but can affect any of the senses, as well as the individual’s perception of time, the world, and the self.[footnoteRef:8]

Pure LSD is a white, crystalline powder that dissolves in water. It is odorless and has a slightly bitter taste. An effective dose of the pure drug is too small to see (20 to 80 micrograms). [8: World health organization Geneva. Neuroscience of psychoactive substance use and dependence. 2004. https://www.who.int/substance_abuse/publications/en/Neuroscience.pdf]

LSD is usually packaged in squares of LSD-soaked paper (“blotters”), miniature powder pellets (“microdots”) or gelatin chips (“window pane”). Blotters are sometimes printed with illustrations of cartoon characters. Users usually chew or swallow them, allowing the drug to be absorbed through the gastrointestinal tract. It also is inhaled or injected.

LSD has a high affinity for a range of different neurotransmitter receptors, but its characteristic psychological effects are thought to be mediated by serotonin 2A receptor (5-HT2AR) agonism. A neurophysiological research with LSD is limited to electroencephalography (EEG) studies in the 1950s and 1960s. These reported reductions in oscillatory power, predominantly in the lower-frequency bands and an increase in the frequency of alpha rhythms.[footnoteRef:9] LSD structurally resembles serotonin, which is an inhibitory neurotransmitter. Serotonin does not directly stimulate the brain but is essential for regulating mood and balancing excessive excitatory neurotransmitter firing in the brain. Serotonin has been found to be connected to many different types of behaviors in humans, including appetitive, emotional, motor, cognitive and autonomic behavior. It is involved in the control of perceptual, and regulatory systems, such as mood, hunger, body temperature, sexual behavior, and muscle control. LSD’s impact on serotonin also affects an area of the brain that detects external stimuli from all over the body, making it more responsive to input from the environment.[footnoteRef:10] [9: Neural correlates of the LSD experience revealed by multimodal neuroimaging. 2016 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855588/] [10: Carson-Dewitt, R., MD (editor). (2001). Encyclopaedia of Drugs, Alcohol, & Addictive Behaviour, 2nd edition]

LSD is known to combine with the serotonin pathway by binding and activating the 5-hydroxytryptamine sub-type 2A (5-HT2A) receptor. Activation of the 5-HT2A receptor is a common characteristic of serotonergic hallucinogens.[footnoteRef:11] [11: Halberstadt, A.L. (2015). Recent advances in the neuropsychopharmacology of serotonergic hallucinogens. Behavioural Brain Resources. 277: 99-120. http://www.ncbi.nlm.nih.gov/pubmed/25036425]

Slang terms for LSD: “Acid, boomers, doses, Yellow Sunshine, battery acid, blotter, microdots, dots, electric Kool-Aid, window pane, pane, purple haze, sugar cubes, cubes, Elvis, tabs, hits, blue cheer.’

After ingestion users feel the effects of LSD within 30 to 90 minutes, and these effects may last as long as 12 hours. The LSD experience, usually referred to as a “T R I P”, differs widely and is unpredictable. Individual reactions to the drug can range from ecstasy to terror, even within a single drug-taking experience. People who have used the drug before and had a positive experience, may have a negative experience, if they take it again.

Two factors that influence the way people feel when they take LSD are their “mindset”—their expectations, experience and mood at the time they take the drug— and the setting, or place where they are. For those who use the drug, the possibility of an adverse reaction, or “B A D T R I P,” may be reduced by taking the drug only when already in a positive state of mind, in a relaxed environment and with supportive friends. The ability of LSD to cause schizophrenic-like actions and perceptual disturbances may lead to a “bad trip,” which can potentially be dangerous to the mental and physical well-being of the user. Characteristics of Bad Trip are Intense anxiety; panic; delusions; the sense that one is losing his/her identity; paranoia; rapid mood swings; violent or hazardous behavior leading to accidental fatalities, homicides, self-mutilation, or suicide; some users may experience seizures.[footnoteRef:12] [12:]

LSD can have 2 kinds of effects: Short term and long-term effects. Short term effects[footnoteRef:13], itself is dividing in physical and psychedelic effects. Physical effects can be: Dilated pupils; raised body temperature; rapid heartbeat and elevated blood pressure; increased blood sugar; salivation; dry mouth; tingling fingers and toes; weakness; tremors; palpitations; facial flushing; chills and gooseflesh; sweating; nausea; loss of appetite; dizziness; blurred vision; sleeplessness. [13: Beck, F., & Bonnet, N. (2013). The substance experience, a history of LSD. http://www.ncbi.nlm.nih.gov/pubmed/23621940.]

Psychedelic effects are: [footnoteRef:14]Visual hallucinations, colors seem to become more intense, halos or rainbows may appear around objects, and shapes may become fluid in form. Besides this, according, to the Centre for Neuropsychopharmacology in London, the LSD modulates music-induced imagery via changes in Para hippocampal connectivity.[footnoteRef:15]

Rapidly changing, brightly colored geometric patterns and other images may be seen, whether the eyes are open or shut. These visual alterations are referred to as “pseudo-hallucinations”, because people know that what they are seeing is not real and is due to the effect of the drug. Strengthening of smells, sounds, and other sensations; Sense of heightened understanding; Distorted sense of time; Distorted perception of body and a sense of “depersonalization” in which the one feels one’s mind has left one’s body; [14: Darke, I. (1996). Postulated Mechanisms of LSD. Harry Mudd College. https://www.cs.hmc.edu/~ivl/writing/non_fiction/lsd/#1] [15: Effects of LSD and music on brain activity. 2016. https://www.researchgate.net/publication/309596938_Effects_of_LSD_and_music_on_brain_activity]

Synesthesia-a blending of sensory perception (i.e. “hear” colors or “see” sounds); It is the involuntary or automatic sensation of a sensory modality that occurs when another sensory modality is stimulated;[footnoteRef:16]The sense that one is undergoing a profound mystical or religious experience. [16: Alfra, P. (2015). Auditory Synesthesias. Handbook of Clinical Neurology. 129:389-407. https://www.ncbi.nlm.nih.gov/pubmed/25726281.]

Long-term effects of LSD use include Hallucinogen Persisting Perception Disorder (HPPD) and persistent psychosis. Drug-induced Psychosis: For some people, even those with no history or symptoms of psychological disorders, a distorted ability to recognize reality, think rationally, or communicate with others caused by LSD may last years after taking the drug. Hallucinogen Persisting Perception Disorder (HPPD): Known familiarly to LSD users as “FLASHBACKS” HPPD episodes are spontaneous, repeated recurrences of some of the sensory distortions originally produced by LSD. The flashback experience may contain visual disturbances, such as halos or trails attached to moving objects or seeing false motions in the peripheral vision.

More recently, the first case of Alice in Wonderland Syndrome (AIWS) associated with LSD use was reported. Alice in Wonderland Syndrome (AIWS), is same as Todd’s Syndrome, is an HPPD that is characterized by: macropia, micropsia, pelopsia and teleopsia, which are neurological conditions that affect human visual perception by creating the illusion that things are: bigger, smaller, closer than they actually are.[footnoteRef:17] [17: Lerner, A., & Lev-Ran, S. (2015). LSD-associated ‘Alice in Wonderland Syndrome’ (AWIS): A Hallucinogen Persisting Perception Disorder (HPPD) Case Report.” The Israel Journal of Psychiatry and Related Sciences. http://www.ncbi.nlm.nih.gov/pubmed/25841113.]

Additionally, some people who use LSD frequently feel compelled to take it. The drug takes on an exaggerated importance in their lives, leading to emotional and lifestyle problems. People who use LSD regularly do not experience physical withdrawal symptoms when they stop taking the drug. However, regular use of LSD will produce “tolerance” to the effects of the drug. This means that if LSD is taken repeatedly over a period of several days, it no longer has the same effect. After several days of not taking the drug, it becomes effective once again.[footnoteRef:18] [18: Centre for Addiction and Mental Health; LSD; 2010. https://www.camh.ca/-/media/files/guides-and-publications/dyk-lsd.pdf ]

Conclusion

According to above findings, we can say that hallucinogenic drugs referred-hallucinogens have the primary effect of altering the sensory perceptions of individuals who use them in a manner that significantly distorts objects in the real world or results in the individual having sensory experiences that produce perceptions of objects or events that are not exist in the real world (hallucinations). Unlike drugs classified as opioids, benzodiazepines, amphetamines, and others, LSD is not considered to have addictive properties.

Sometimes people who take the drug feel that the experience gets out of control. They may feel they are losing their identity; such a reaction can lead to a state of panic. They may try to escape from the situation, or become paranoid and frightful and shout at the people around them. People experiencing a dangerous reaction to LSD should be kept as calm as possible. Taking extremely high amounts of LSD alone can produce potentially fatal effects. Several research studies have documented mortalities as a result of overdoses of hallucinogenic drugs like LSD that were taken in combination with other potentially dangerous drugs (e.g., alcohol, prescription pain medications, stimulants, etc.). If their distress continues, they should receive treatment at a hospital emergency room.

The drug has made people feel that they could fly, or that they could walk through traffic, and this has resulted in accidental injuries and deaths. In some people, LSD may release underlying psychosis or aggravate anxiety or depression.

To sum up, the best way to avoid an overdose with LSD, its adverse/side effects is to never take the drug in the first place. It is unpredictable and dangerous—a person can use LSD many times without serious problems, and then suddenly experience aggression, self-harm, psychosis, or other adverse side effects.

Bibliography

1. Katzung, Bertrarm G., MD, PhD, 2018. “Drugs of Abuse” in Basic and Clinical Pharmacology 14th edition, edited by Michael Weitz & Peter Boyle. McGraw-Hill Companies, Inc.
2. Carlson, Neil R., 2013. “Drug Abuse” in Physiology of Behaviour 11th edition, edited by Craig Campanella & Jessica Mosher. Pearson education, Inc.
3. World health organization Geneva, 2004. Neuroscience of psychoactive substance use and dependence. WHO Library Cataloguing-in-Publication Data.
4. Passie ,Torsten , John H. Halpern, Dirk O.Stichtenoth, Hinderk M. Emrich, and Annelie Hintzen. ‘The Pharmacology of Lysergic Acid Diethylamide: A Review.’ CNS Neuroscience & Therapeutics 14, no. 4. 2008: 295-314. doi:10.1111/j.1755-5949.2008.00059. x.
5. Krebs, Teri S., and Pål-Ørjan Johansen. ‘Over 30 Million Psychedelic Users in the United States.’ F1000Research, 2013. doi:10.12688/f1000research.2-98. V 1
6. Lerner, A., & Lev-Ran, S. 2015. LSD-associated ‘Alice in Wonderland Syndrome’ (AWIS): A Hallucinogen Persisting Perception Disorder (HPPD) Case Report.” The Israel Journal of Psychiatry and Related Sciences.
7. Neural correlates of the LSD experience revealed by multimodal neuroimaging. 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855588/
8. Halberstadt, A.L. 2015. Recent advances in the neuropsychopharmacology of serotonergic hallucinogens. Behavioural Brain Resources. 277: 99-120. http://www.ncbi.nlm.nih.gov/pubmed/25036425
9. Effects of LSD and music on brain activity. 2016. https://www.researchgate.net/publication/309596938_Effects_of_LSD_and_music_on_brain_activity
10. Gasser, P., Holstein, D., Michel, Y., Doblin, R., Yazar-Klosinki, B., Passie, T., & Brenneisen, R. 2014. Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety with life-threatening diseases. The Journal of Nervous and Mental Diseases. https://www.ncbi.nlm.nih.gov/pubmed/24594678
11. Centre for Addiction and Mental Health; LSD; 2010. https://www.camh.ca/-/media/files/guides-and-publications/dyk-lsd.pdf
12. Beck, F., & Bonnet, N. .2013. The substance experience, a history of LSD. http://www.ncbi.nlm.nih.gov/pubmed/23621940.

Mr. Shoaib is a 62 year old male patient admitted to your ward. He has right ischemic CVA and resultant left site body paralysis. He has no sensation or movement in the left side of body. He has lost his gag reflux and is unable to swallow food. An N/G tube is placed for providing him nutrition. Mr. Shoaib is not able to change his position and is dependent on care givers for changing his position. He is also not able to carry out his routine daily life activities. His family is worried about whether he would be able to regain control of his life or not. They are also worried whether they would be able to provide him the care he needs when he is discharged from the hospital.

As a nurse I am well equipped to meet the various needs of patients demonstrating self-care deficits. According to scenario the methods nurses can follow to address certain issues. As nurses I can help patients maintain their own personal hygiene by providing reminders and motivation for self-care. This could include daily prompting for activities like bathing and washing up. For dressing/grooming I can help their patients by recommending clothing that is easy to put on and remove, giving them privacy, and providing frequent motivation. For feeding I can help enable patients to feed themselves as soon as possible. By creating a conducive environment to eating (positioning the patient, etc.), patients can stay independent throughout their meals. Toileting a nurse should work to simplify toileting for patients. This can include using bedpans, suppositories, stool softeners, or commodes. Nurses should also be nearby in case of any accidents or falls. In swallow assessment and speech deficit nurses should work closely with speech pathologists to ensure that any type of speech deficit will not interfere with communication about care.

Introduction

Self-care is defined as the activities initiated and performed by individuals to maintain a high quality of life, health, and wellbeing, and it is considered as a learned attitude acquired through personal interest, education and medical experiences (Orem 2001; Avdal Unsal and Kizilci 2010; Hartweg and Pickens 2016). The theory explains what self-care is and why it is necessary to sustain life (Ozturk and Karatas 2008; Pektekin 2013). According to self-care theory, human beings are capable of defining and covering their own needs (Avdal Unsal and Kizilci 2010). Nurses, then, are expected to develop skills to identify self-care skills of care receivers and to strive to understand those skills. When self-care power is not properly identified, nurses are unable to do the following:

• Make decisions about already present or potential self-care deficits and their causes.
• Produce a sound method to deliver valid and reliable assistance as well as pick up and practice useful nursing systems (Yesilbalkan Usta et al. 2005).

Self-care was introduced by Orem as one of the components of self-care nursing theory. Orem recognizes human and environment as a single unit and believes that human and environment, and also humans themselves, influence each other reciprocally in this unit. Beliefs, social and cultural background, personal characteristics, and relationship between health care providers and clients are some of the factors which influence self-care behaviors. In addition, ethnicity, socioeconomic background, educational level, employment status, environmental factors such as pollution, sociopolitical variables, and lack of knowledge are other factors affecting self-care behaviors.

Importance

The importance of self-care concept is related to human’s need for maintaining and promoting health and recovery. Lack of healthcare services and inadequate access to health services for the whole community can increase expenditure of healthcare services. Self-care activities relieves symptoms and complications of diseases, shorten recovery, and reduce hospital stay and re hospitalization rate. It has been reported that lack of self-care knowledge in patients with chronic disease, such as CVA, is the main reason for frequent referring to healthcare centers and re hospitalization.[2,7]

Self-care model: principles

The deliberate action of self-care is essential for health and well-being and when, due to health-related self-care limitations, individuals are unable to meet therapeutic self-care demands and experience self-care deficits, nurses are needed to assist persons to accomplish self-care. The nurse and patient meet in the helping situation where nurses design, manage, and maintain systems of care. These nursing systems include the social, interpersonal, and technological sub-systems and are designed to assist persons to meet self-care demands and thus to meet self-care requisites in living day-to-day. The self-care model guides the nurse to focus on the individual and his self-care behavior in living day-to-day rather than on any specific problem, symptom, or condition.

Analysis

The purpose of the nursing theories is to provide an interrelating framework focusing on the nursing practice. The defined nursing theories promote better patient care, improve the status of nursing profession, and improve the communication between the nurses, and provide guidance to the researches and education (Keefe, 2011). Orem’s Self-Care Deficit Theory is more recommended for the acute-care setting, where a patient receives active but short-term treatment for a severe injury or episode of illness. Orem focuses on finding the self-care deficit of the patient and providing the necessary care to promote his or her well-being.

Creating an increased awareness of the need for a nursing theory in the field of nursing is an initial step in enhancing the level of professionalism among nurses. Orem’s theory, being appropriate to clinicians at all levels, should be considered as a frame work for the delivery of nursing care to patients .Future training and orientation programs for nurses could specify this model as the basis for care, identifying and correlating its various components to the various levels of care implemented by the nurse. To demonstrate the application of theory to practice more specifically, one can correlate the level of care and type of injury to the systems identified by Orem. Nursing care for patients with CVA and resulting sequel requires total care and relies on input from other disciplines as well. The patient is unable to perform any aspects of self-care. This level of care correlates with the compensatory system. While this type of care is delivered each day in the environment, bed side nurses can be aware that they are functioning from within Orem’s framework. The patient is encouraged to take part in his or her own dressing changes, and even family members are encourage to take part, in some cases. This level of care correlates with the partially compensatory system, where the patient is encouraged to take part in self-care and the nurse facilitates. This application of theory to practice is easily seen in the CVA patient. The are totally dependent on other for daily activity. Those patients who are preparing for discharge, either to home or to a rehabilitation unit. Again, the activities that nurses perform that assist the patient in reaching that goal are performed within Orem’s framework. Once these patients have been discharged, nurses may follow their care and progress through rehabilitation centers and/or support groups, or maybe even survivor functions. As the nurse seeks appropriate resources such as case management, psychological consulting, or physical therapy consulting for the patient, the goal is to assist the survivor to integrate not only back into society, but into the work force, school, and home. Some nurses also provide education to community and industry as these patients return to their previous activities. This level of care directly correlates to the educative-development system and demonstrates a systematic and thorough approach to care from within Orem’s framework. Orem’s view of nursing as helping systems in which the helping is determined by the degree to which the patient is able to accomplish his or her self-care requirements further supports these correlations.26 As with nursing systems, methods of helping can also be classified in terms of extensiveness of help provided: A) doing for another; B) guiding and directing another; C) providing physical support; D) providing psychological support; E) providing a supportive environment; and F) teaching.26

These definitions and concepts can be directly correlated to goals in caring for CVA patients. Recent debate exists that the inclusion of courses teaching the theories of nursing may not be necessary. This debate is in opposition to the basic tenets of this discussion which is that theory serves as a guide to all disciplinary practice, research, and education. Most of what a nurse does to perform the tasks of caring for a patient is guided by a mental construct. Nursing conceptual models serve as guides for and sources of both middle-range theory and practice theory.(1)

Nursing theory, as defined by Melees, 9 is “an articulated and communicated conceptualization of invented or discovered reality (central phenomena and relationships) in or pertaining to nursing for the purpose of describing, explaining, predicting, or prescribing nursing care.” This definition illustrates the importance of communicating nursing theory and the purpose of prescription of nursing care.9 Another valid point, as stated by George,9 is the importance of understanding the cyclical impact that theory, research, and practice have on one another. For instance, middle-range theory can be tested in clinical practice. Clinical research is the testing process for theory. The research process may alter theory or even invalidate it. The more research that is conducted about a specific theory, the more useful the theory is to practice.9 Practice should be based on the theories of the discipline that are validated through research; research findings are published in the periodical literature as well as in books.9 All of these inputs to nursing practice are hallmarks of a profession. As a profession, burn nursing has a need to expand, develop, and grow professionally. The first step in reaching this goal and ensuring the delivery of theory based care lies in the process of assuring that nurses will develop a better overall view of the why they deliver specific tasks for specific patient needs. This can be accomplished by teaching and relating nursing theory during nurse training. As stated previously, this approach would illustrate the importance of communicating nursing theory and the purpose of prescription of nursing care.9

Orem asserted that nursing care and self-care procedures include both intellectual and practical dimensions. Self-care theory demonstrates that nursing care is meant to determine why the care receiver needs nursing, to organize and plan a nursing care, and to maintain the sustainability of nursing care (Ozturk and Karatas 2008; Velioglu 2012; Pektekin 2013).

Orem defined self-care as the practice of everyday life activities that individuals efficiently and intentionally perform on their own on a continuous basis. Self-care refers to a learned attitude developed with personal interest, education and medical experiences (Tomey and Alligood 1998; Ozturk and Karatas 2008; Velioglu 2012). Orem’s theory is an umbrella theory that is comprised of three nursing theories, which are subsequently discussed (Orem 1990; Baker and Denyes 2008; Altay and Cavusoglu 2008; Pektekin 2013

Conclusion

Nursing theories are instrumental in explaining the professional phenomena and their relations with each other to conceptualize nursing practices and to identify nursing care. Self-care is defined as daily life activities initiated and performed by individuals to sustain life, health, and wellbeing, and it is considered as one’s constant participation in their own health promotion. Self-care theory legitimizes the urgent need for self-care to maintain daily life activities, which requires the patient to participate in their own care. However, nurses can evaluate and compensate for the deficiencies of those unable to perceive and perform due to impairments in psychomotor functions.

Orem’s contribution to the field of nursing is substantial. Every day, nurses diagnose self-care deficits, and this allows them to craft solutions for their patients while staying mindful of their need to be independent and feel like they have control over their rehabilitation and treatment.

1. Department of Critical Care Nursing, Center for Nursing Care Research and Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
2. Department of Nursing, School of Nursing and Midwifery, Flinders University, Adelaide, Australia
3. Department of Medical surgical Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

1. Weis A. Model of Health Care Cooperative Care : An Application of Orem ’ s Self-Care Theory. 1988;11:141–6.

Nursing Problem (1st)

Assessment

Goals

Interventions with Rationales (I: Intervention; R: Rationale)

Evaluation

Controlling body temperature: Hyperthermia related to wound infection

Subjective:

• Matt had treated the wound himself by bathing it in vinegar and water
• His daughter discovered the left knee wound has been getting worse today

Objective:

• Abnormal vital sign: 38.9ºC in oral temperature
• Left knee wound back assessment: 2 x 2.5cm, wound bed is yellow, small amount of yellow-greenish discharge, swelling and redness on left leg

Goal:

After 3 days of effective nursing intervention, his body temperature will lower down to normal levels

Desired outcomes:

• His body temperature will be within a normal range which is below 38.0ºC and maintained stable during hospitalization
• His wound will decrease in size and have increased granulation tissue with absence of redness, swelling and purulent discharge
• He will demonstrate the understanding of measures to protect and heal the wound

For hyperthermia

• Assess and monitor his oral temperature every 4 hours. Utilize same methods of temperature reading with each measurement (R: Hyperthermia is a systemic manifestation of inflammation and may indicate the presence of infection; Helps to evaluate efficacy of treatment. Consistency in methods allows for accurate data collection and correlation.) https://nurseslabs.com/impaired-tissue-integrity/ Delmar’s Geriatric Nursing Care Plans, 第 1 卷 (Sheree Comer)
• Administer Panadol tablet 500mg every 4 hours if temperature is greater than 38.0C (R: This type of drugs affects the hypothalamic control center to reduce elevated temperature.) Delmar’s Geriatric Nursing Care Plans, 第 1 卷 (Sheree Comer)
• Encourage fluid intake up to 3-4L/ day, unless contraindicated (Increases in body temperature multiply insensible fluid losses by 10% for every 1ºC increase in body temperature, which result in dehydration which inhibits wound healing.) Delmar’s Geriatric Nursing Care Plans, 第 1 卷 (Sheree Comer)

For wound infection

• Examine and monitor the wound at least once daily; note and document changes in appearance, odor, or quantity of drainage (R: Identifies the presence of granulation tissue indicating healing.)

Nursing Care Plans

• Obtain routine cultures (R: Repeat periodically to evaluate for effectiveness of antimicrobial therapies)

Nursing Care Plans

• Give Augmentin tablet 375mg three times a day (R: It treats infections caused by bacteria by fighting bacteria in the body and helping to prevent certain bacteria from becoming resistant to amoxicillin.) https://www.drugs.com/augmentin.html
• 0.9% normal saline solution dressing to left knee wound daily (R: It can irrigate the wound by keeping viable granulation tissue, reducing the number of microorganisms and not triggering sensitive responses.)

Nursing intervention

• Instruct he and his daughter in the proper care of wound including hand washing, wound cleansing, dressing changes, and application of topical medications (R: Accurate information increases the patient’s ability to manage therapy independently and reduce the risk for infection.) https://nurseslabs.com/impaired-tissue-integrity/

After 3 days of nursing intervention,

• His body temperature is within normal range and maintained stable
• His wound has a decrease in size with minimized purulent discharge
• He is able to demonstrate the understanding of measures to protect and heal the wound

Nursing Problem (2nd)

Assessment

Goals

Interventions with Rationales (I: Intervention; R: Rationale)

Evaluation

Mobilizing: severe pain on back and left leg related low back pain and wound infection

Subjective:

• He complained of severe pain on back and left leg.

Objective:

• Pain score: 8/10
• Left knee wound back assessment: 2 x 2.5cm, wound bed is yellow, small amount of yellow-greenish discharge, swelling and redness on left leg

Goal:

His pain score will return to the normal range during hospitalization

Desired outcomes:

• His pain score will lower down to less than or equal to 3 out of 10 which indicates mild pain or even no pain.

Pain score

• He will report improvement of back pain and be able to get out of bed without assistance

For overall

• Assess and monitor the pain characteristics every 6 hours including quality and severity (R: It helps determine the effectiveness of pain control measures. If the patient demands pain medications more frequently, a higher dose may be needed.) https://nurseslabs.com/acute-pain/
• Assess for signs and symptoms relating to pain including BR and HR every 6 hours (R: Attention to associated signs may help the nurse in evaluating pain. An increase in BP, HR, and temperature may be present in a patient with pain.) https://nurseslabs.com/acute-pain/
• Give Tramadol tablet 50mg every 6 hours (R: Helps in moderate to moderately severe pain). Tramadol. For low back pain
• Apply an ice pack to area every 4 hours (R: Helps quiet painful inflammation or muscle spasms) https://health.clevelandclinic.org/back-pain-your-spine-and-father-time/
• Collaborate with physicians to do physical therapy (R: Helps patient to gain strength, and strengthening patient’s back and abdominal muscles) https://health.clevelandclinic.org/back-pain-your-spine-and-father-time/
• Assist him to maintain activity limitations, promote comfort, and educate the patient about the health problem and appropriate exercises (R: It is nurse’s responsibility to ensure that the patient understands the type and frequency of exercise prescribed, as well as the rationale for the program if there are muscle-strengthening and stretching exercises in the management plan.)

Clinical Companion to Medical-Surgical Nursing – E-Book

• Assess the patient’s use of body mechanics and offer instruction in sleeping that could produce back strain and a firm mattress is recommended (R: It produces excessive lumbar lordosis, placing excessive stress on the lower back in a prone position.)

Clinical Companion to Medical-Surgical Nursing – E-Book

For wound pain

• Refer to wound infection in 1st Nursing Problem
• His pain score has lowered down to 5 out of 10
• He reports improvement of back pain, but some assistance is still needed to get out of bed. Continue treatment is required

Nursing Problem (3rd)

Assessment

Goals

Interventions with Rationales (I: Intervention; R: Rationale)

Evaluation

Maintaining a safe environment: Risk for fall related to poor vision and limited mobility secondary to low back pain

Subjective:

• He complained of severe pain on back and left leg, some assistance was needed to get out of bed.

Objective:

• Recent fall episode: three days ago
• Morse Fall Scale: 50(high fall risk)
• His age: 65(high risk group)

Goal:

He will be free from any falls during hospitalization and after discharge

Desired outcomes:

• He will not fall during hospitalization
• The problem of low back pain will be alleviated with the pain score lowers down to normal range
• He will report improvement of back pain and be able to get out of back without assistance
• The vision will be improved by using adaptive devices.

He and his daughter will identify strategies to increase safety and prevent falls at home before discharge

For risk for fall

• Assess conditions that can increase the patient’s level of fall risk, such as changes in mental status, balance and medications every shift (R: Helps evaluate effectiveness of fall precautions) https://www.nursebuff.com/nursing-care-plan-for-elderly/
• Provide signs or secure a wristband identification to remind healthcare providers to implement fall precaution behaviors (R: Signs are vital for patients at risk for falls. Healthcare providers need to acknowledge who has the condition for they are responsible for implementing actions to promote patient safety and prevent falls) https://nurseslabs.com/risk-for-falls/
• Transfer the patient to a room near the nurses’ station (R: Nearby location provides more constant observation and quick response to call needs) https://nurseslabs.com/risk-for-falls/
• Respond to call light as soon as possible (R: This is to prevent the patient from going out of bed without any assistance) https://nurseslabs.com/risk-for-falls/
• Guarantee appropriate room lighting, especially during the night (R: Patients, especially older adults, has reduced visual capacity. Lighting an unfamiliar environment helps increase visibility if the patient must get up at night) https://nurseslabs.com/risk-for-falls/
• Bed and chair alarms must be secured when patient gets up without support or assistance (R: Audible alarms can remind the patient not to get up alone. The use of alarms can be a substitute for physical restraints) https://nurseslabs.com/risk-for-falls/
• Evaluate patient’s medications and how they can cause falling accidents (P: Identify drug interactions and side effects that can compromise the patient’s safety) https://www.nursebuff.com/nursing-care-plan-for-elderly/

For poor vision

• Assess the patient’s ability to see and perform activities once a shift for any more deterioration (R: Check for any changes affecting the patient’s visual acuity) https://nurseslabs.com/macular-degeneration-nursing-care-plans/
• Collaborate with ophthalmologist to have vision check (R: Determines the exact vision problem and Give proper treatment)
• Inform patient the advantage of wearing eyeglasses and to have these checked regularly (R: Hazard can be reduced if the patient uses appropriate aids to promote visual orientation to the environment. Visual impairment can greatly cause falls) https://nurseslabs.com/risk-for-falls/
• Encourage patient to see an ophthalmologist at least yearly (R: Can monitor progressive visual loss or complications. Decreases in visual acuity can increase confusion in elderly patient) https://nurseslabs.com/2-cataracts-nursing-care-plans/

For low back pain

• Refer to low back pain in 2nd Nursing Problem
• He does not fall during hospitalization
• The pain score has lowered down to 5 out of 10 and the problem of low back pain has been alleviated, but still requires continue treatment
• He reports improvement of back pain, but some assistance is still needed to get out of bed. Continue treatment is required
• The vision has been improved by wearing eyeglasses
• He and his daughter are able to identify strategies to increase safety and prevent falls at home before discharge

What are the characteristics of the individuals in this case study?

Carla was born in a small mining town and was raised by her aunt after the death of her parents when she was only little. Carla is a 54 year- old woman experiencing health inequity, thus resulting in her family’s lack of education, limited employment opportunities, low socioeconomic status and restricted access to healthcare resources. People living in rural and remote areas generally experience poorer health outcomes than people living in metropolitan areas for example; ‘54% of people living in rural and remote areas have one or more chronic diseases compared with 48% of those in major cities (AIHW, 2017). This can be seen through Carla’s daughter, Annie developing gestational diabetes during her pregnancy and Carla’s ex-husband John, later on, suffers from depression. Carla’s family is experiencing poor health due to a lack of sustainable income and being socially isolated from one another. It is clear within the case study that John and Annie are completely dependent upon Carla, causing an immense amount of stress for her to handle whilst providing money and food for her family. Carla does not own a car, so she has been eating toast for dinner to save up enough money for public transport to visit her daughter in the city. This would not only affect her physical health due to not getting enough of the proper nutrients she needs but is also taking a toll on her mental health. ‘54,000 fewer deaths would occur if all Australians had the same death rates as people living in the highest socioeconomic areas in 2009-11’ (AIHW,2018).

What are the social determinants of health that are evident in the case study?

The determinants of health are the social, economic and political conditions in which people grow, live, age and work. The social determinants of health are the ‘causes of ill health and emphasize social context, social stratification, the differential exposure people experience and their vulnerability to illness and injury’ (Baum, 2008, p.588). Economic and social determinants are clearly evident within this case study for example, Carla’s geographical location affects her education, leading to limited social and economic opportunities. Carla is experiencing chronic poverty with a constant lack of money for basic necessities, food and quality of housing. This has then been passed down to her children creating an intergenerational cycle of poverty with poor health outcomes (Understanding Health, p.26). Carla is unemployed impacting her psychologically with the amount of stress she is undergoing to try stay afloat. Another barrier to Carla’s health is the lack of affordable transport, meaning she is unable to access health services and go to stores with organic produce which then in turn creates social isolation. Carla and her family’s early childhood played a major role in their vulnerability to poverty and unemployment, portraying the vast amount of inequity experienced in the world. From her early childhood, Carla has been experiencing problems due to her financial and socio-economic status. Her ex-husband used to assist her financially but he later suffered from a head injury, stopping him from providing financial aid to the family. This lead to be a great burden upon Carla and found it even harder to find employment as needs of the family changed. Now that Carla’s daughter is pregnant, she is unable to provide her with medical assistance due to lack of financial capability. Food and nutrition are major contributors to health, this can be seen through Carla’s diet where she eats toast for dinner to save money to visit her daughter. This shows that Carla is food insecure impacting her physical, mental and social well-being and her ability to work. ‘People who are food insecure experience financial incapacity to purchase food and subsequently are at risk of a range of consequences including hunger, malnutrition and distress’ (Understanding Health, p.29).

Case I

This summary reflects the case study on Hotel New World Tragedy. This incident of collapse of the Hotel took place in the mid-month of March i.e. 15th March 1986 resulting in causalities of 33 deaths and 17 rescued during the rescue period. There were several assumptions made on the collapse such as internal blast, non-standard concrete mixtures, and poor site selection along with the weak foundation. After detail study of the collapse and investigation from many different aspects as on several assumptions were made, the guesswork came out to be wrong. But the detailed study of structural analysis gave an appropriate answer to the collapse. The negligence of an Engineer involved in the design missed the dead load consideration while designing Hotel which became the major cause for the failure. It’s very painful when carelessness of an Engineer involved found out to be true. The missing of dead load in the calculation gives the outcome of the small size of columns, beams, slabs and so on. The rescued team was initiated from the country and also the neighboring nation to save the lives of victims as soon as fast. This incident made several remarkable commendations of the Building Control Act 1989 and Building Control Regulations 1989 as a standard set to carry out the job by professional. Several reforms were made to Ethics and Code of Ethics and Code of Conduct. After the analysis and evaluation were done, duty and right ethics were significant for the fall of the Hotel NEW WORLD than to other ethical principles. So the remarkable commendation was taken as a mitigation factor on right and duty ethics to avoid future causalities.

Case II

This inscription refers to the incident that took place in Hyatt Regency at Kansas in U.S.A when two walkways collapsed at the hotel lobby. At that moment, the Tea dance party was being held in the lobby in which 100 people were killed along with more than 200 being injured. The hotel was just in its first anniversary when the incident took place. It was one of the most threatening catastrophes in structural construction in the engineering sector. After the incident detailed study was carried out to find the main root cause of the failure. The investigators found that during the construction the roof had fallen but the involved technical person didn’t give much attention and resume the construction. As per the engineer they had requested the client to recheck the design and the investigation on the work are done and remaining work to be done. There has been found fault in the calculation in the design and 60% of the load has only been considered according to Kansas Building Code. They have done so much negligence that they took the preliminary design into account and began the construction of the building and those drawing was forwarded to the manufacturer of steel company which was also one of the main reason for this fatal failure and the engineering firm wouldn’t have done their work as they weren’t assured of the work done. To avoid such manmade calamities, the American Society of Civil Engineers set a standard that the work is done building design plan from the initial to final phase should be under the responsibility of Engineer involved. A Municipal Engineer, State Level Engineer, the department responsible for building at their respective boundary should have a recheck on the drawing submitted by the client. As a penalty, the engineering firm lost the license and all the engineers, architects, land surveyors employed by Engineering firms also lost the license. Along with them, the owner of Hyatt Regency Hotel paid more than $140 million for the victims as he was equally responsible for this awful incident.

In this case study, my major concern would be the failure of Reinforced Cement Concrete (R.C.C) structure in two hotels in two different countries. One would be the failure in Hyatt Regency Hotel in Kansas City (U.S.A) and the other one which I am going to compare the failure with the code of ethics and code of conduct is Hotel New World” in Singapore (my city of dreams).

Introduction for case study I

Singapore is one of the fast-growing countries in South East Asia in case of Economy which directly promotes the living standard of the people. Singapore has a population more than 4 million with less area and high rise building known as skyscrapers has made the country renowned in the world. Unfortunately, the incident took place in ‘THE HOTEL NEW WORLD’ in Little India in Singapore which was built in 1971 which is only 6kms from the downtown of Singapore. The building was six stories and 24 meters high, which is considered as one of the tallest building in Little India, in spite of the fact that there are tall skyscrapers in the city area. The building consists of 36 concrete columns supporting six concrete floors with an average building weight of 6000 tons.

Introduction for case study II

The failure took place in Hyatt Regency at the city of Kansas (U.S.A). The incident took place on the second and fourth-floor walkways which were due to change in the design of the Hyatt Regency which took the life of 114 death-causing 200 injuries. The final design was forwarded by Jack D. Gillum and design his team who designed the building in such a way that pairs of rods should be running throughout starting from the second floor to the ceiling and the preliminary design was approached as [4]. The main attraction was the aesthetic view and design of hotel atrium which was spanned by 3 walkways starting from the second floor and ending on the fourth floor which is suspended by the roof. There was a bridge on the fourth floor which acts as an offset which was around 12 feet long and weighing around 64,000 pounds which were paired by hangars at uniform intervals. [6]

Investigation on the failure in case study I

There are several assumptions and thought made for the collapse of the building and are listed as follows.

• Internal Blast (Gas Leakage, Electricity shots, etc.) and Terrorist Attack
• Bad Engineering materials
• Poor Land Selection

The first assumption for the diminishing of the hotel building was suspected to be by a counterattack. To investigate these several steps were taken to evaluate and in addition, several actions were taken to find out the gas leakage and electricity cause but they were unsuccessful. The damage caused by these factors sets unique characteristics on shattered glass, on the debris of the building and several other leftovers. The next assumption was the poor building materials which made the building fall at once and flatten down vertically. All the technical person hand in hand together worked to find the concern of the vertical failure and made an assumption that should be due to a poor concrete mixture that decreased the strength or due to fracture of fallen which gave an outcome in the softness of concrete. Furthermore, the debris was taken to the laboratory to test and to find the exact reason for the tragedy but it didn’t meet the standard. The next theory taken into account was made by the Engineers about the construction of foundation and found out the type of soil where the foundation rested for years as there were no buildings as tall as The Hotel New World. They concluded that there was no failure in the foundation as only minor sway had been observed.[4]

Furthermore, to find out the actual evidence about the failure, Engineers, investigators went through the development plan to study more precisely about the failure. Several witnessed that they saw some sort of cracks in the building and pointed them out too. Studying the drawings, layout of the building they began their the investigation and surprisingly they reported crack and failure corresponded to different columns of the building and made a hypothesis that collapsed of column took place due to maximum limit stress of the building. After going through in depth of building calculation, the mistake was that structural engineer had missed out the dead load calculation which is the major cause of the collapse. Dead load is one of the major load that the buildings hold. On top of that, the heavy equipment was found in debris which wasn’t mentioned in the design plan. They even added three cooling towers at the roof of the building, placed a vault with 22 tons at the ground floor and the exterior floor was added with heavy ceramic for the aesthetic view which added about 50 tons in the span of 15 years of the building. Taking into account all the possible causes, the major cause was due to the negligence of a structural engineer who escaped the analysis of dead load to be taken into account. As the dead load was not considered then the design of structure couldn’t resist taking the live load. The failure took place is known as Progressive Collapse where failure in the area continued gradually to spread through connective structure causing an enormous loss when a building collapsed subsequently. More precisely we can say that Column number 26 referring to the design, overstressed occurred and then transfer a load of column 26 to column 32 which resulted in the crack in the building in the initial phase. As this process continued then the building couldn’t stand still and collapsed causing casualties. [10]

After the Hotel shattered to the ground level, many rescue team as firefighters, polices were directed to Little India to the place where the hotel is located. But the rescue team was not experienced and they didn’t have the rescue equipment either. Later the rescuers from the neighboring countries began to come with the equipment as life detector, cutting tool, etc.[8] As there were survivals in the debris the rescue team had to work intelligently in order to rescue them safely. It took around five days for a complete rescue operation where the team was successful to save the life of 17 people and 33 were found dead. [8]

After identifying the causes for the Hotel New World collapse tragedy, then some changes were made in the code and ethics in engineering. As we are clear that the Structural Engineer and draftsperson was the real culprit as the dead load was neglected during the design process, one of the reform made in code of ethics was that the document submitted by the professional Engineer needs to be rechecked by the other professional engineer so such mistakes could be avoided before some major/minor destruction would occur. Further, the design should be checked by the independent consultant with 10 years of experience before any design is approved. Next reform made was that the building authority has the rights to refuse any building plans that they felt was not meeting the standard requirement. The responsible person to this task should be registered with the Building Authority.

Investigation on the failure in case study II

The drawing forwarded by Jack and his team was considered and was used as a Construction drawing for the project. The drawing was just the preliminary drawings. The communication gap between the consultant, client and contractor made this incident happen. The client didn’t discuss the changes in the drawing approached by the contractor with his consultant and in a span of 10 days 42 shops drawings were submitted for approval and was stamped for construction. Before the failure of the atrium roof, more than 2700 square feet atrium roof was found to be collapsed during the construction. The main cause was due to connection failure at the roof. The contractor tried to defend themselves at court that they requested the client to review the drawings and inspection on the materials check but the client refused to take the action forwarded by the contractor which cause the client waste of money and time. The client only performed an inspection for the roof collapse and no inspection was carried for the work executed and the remaining work to be executed. [4]

The next reference to support the case failure is that the design of walkway only supported around 60 percent of the minimum load required as per Kansas City Building Codes. One of the main culprits is the owner who didn’t give much attention to the inspection of the work with the specialists which the engineering firm has proposed. There is no escape to the Engineering firm as well that they shouldn’t do the job as per client because they should also follow the norms of safety and their duty to handover safe project to the client. As 60 % of the minimum load was only considered during the design period, it shows that the engineer at engineering firms is not having adequate knowledge to prepare a report for such public buildings. As the pre-collapse have given the alarm that something was not going good. Then still if the engineering firms do the work in clients favor then the sole responsible is the Engineering firm and the Engineer involved in this project.[7]

As many people were the victim of the incident, the real affected were those who were inside the building and the friends family and relatives were still the victim as they lost their closed one in the incident. Two engineers were found guilty for the uncivilized negligence, misconduct and who showed an unprofessional behavior while performing his duties and responsibilities.

Duty, right, and virtual ethics

According to the Engineering Ethics, duty ethics are the duties that have some limit to perform and not to perform no matter the acts will guide to right or wrong path. Right ethics means that there are some rights it would be either positive or negative. As both of these ethics Duty and Right Ethics are interrelated with each other and works for the right of the individual. A person who does his/her work knowing his duties then he will certainly be performed in his moral action which is acceptable by the ethics.

One of the major steps to ethical action is that the performance of ours shouldn’t hamper any individual or society. We have no rights to work under such circumstances. Professionals like Engineers should perform their duty or action to provide the best design to their clients. We should always work in order to provide the best performance in any way we can which is the best way to serve our family, society, country, the world and last but not the least ‘Human ‘ comes to the top of the list. However, in this case, Engineers hasn’t worked with their professionalism. They have been so careless regarding the design of the structure and have missed the dead load calculations in the structural analysis report which is a shame to those technical person involved.

Virtual ethics deals with the character of an individual who has been guilty of the incident under the roof of their professional ethics. Relating these ethics to this case study there is no consideration of dead load in the design has been the main reason for the collapse. Now the question has arisen whom to blame. If the incident has taken place unknowingly but still the engineer can’t escape because the parameters cannot be neglected as they have knowledge of live load then they should have knowledge of the dead load. This was the commercial building so the design should be rechecked by the concerned authority at the national level of Singapore. For the next case study, according to ASCE that structural engineers are solely responsible for this unethical behavior adopted for the design process. The major ethical issue was that they were unaware of the public safety. If they have only thought of this then this day wouldn’t have come threatening so many people and taking away lives.[10]

Code of ethics and code of conduct for case I & II

Referring to the incident, based on the investigation by the authorized group and comparing the misdeed with the code of ethics from The Institution of Engineers, Singapore Rules for Code of Professional Conduct and Ethics and Board of Engineering code of professionalism and can be used to relate the incident.

• A Registered Engineer shall conduct himself honorably, responsibly, ethically and lawfully so as to enhance the honor, reputation, and usefulness of the profession. [1]
• A Registered Engineer shall check with due diligence the accuracy of facts and data before he signs any statement. [1]
• A professional Engineer shall not give professional advice which doesn’t fully reflect his best professional judgment. [9]
• A professional shall discharge his or her duties to his or her employer or client with complete fidelity. [9]

Referring to the NPSE code of conduct, Engineer in Engineering Firms performed against the “Rules of Practice”.

• Engineers shall not aid or abet the unlawful practice of engineering by a person or firm. [2]
• Engineers shall approve only those engineering documents that are in conformity with applicable standards. [2]
• Engineer shall only perform services in the areas of their competence. [2]
• Engineer shall avoid the use of statements containing a material misinterpretation of fact or omitting a material fact. [2]

Analysis and recommendation

In a general review of the tragic of the Hotel New World, we should study on several aspects in order to find out the exact reason for the incident and we can know several weakness and strength can be a lesson for the next project and a guideline to the newcomers as well as the professionals. Professionals should never work for their own benefit and always look forward to the willingness to work and consult seniors as per need but never work in an unknown parameter to ensure that the public respect our profession with due respect. In the next case study, Engineer has not performed in service of his/her competence. The engineer should never work under the pressure of anyone unless he feels that his doing is morally right and working under the code of ethics. As a technical person, I highly want to recommend several ideas based on my professional experience.

• Clients should also have the willingness to work according to the Site Engineer but they rather listen to their contractors and when an incident occurs then all the blame are to the technical person.
• The nation should make some policy in favor of us as well fairly judging than blaming all the construction issue to the technical personnel.
• In this study, if the dead load was considered but also if the tragic took place then also they used to blame Engineers involved than finding out the other reasons.
• The government should also have to take action before the construction and during the construction.
• The government should involve the technical person in decision making on the annual plan of budget so that the government can deliberate the best development plan to the people of the country and work efficiently on the utilization of budget.

However, it’s the responsibilities of an Engineer to deliberate the best design and propose the design according to the building bylaws of the respective area in order to save future causalities and government is also equally responsible for such type of tragic incident. On top of all, in all these planning and execution we should act as a human as no other can rise above HUMANITY.

Conclusion

This incident is one of the gloomiest catastrophes that took place in Singapore on 15th March 1986, in the HOTEL NEW WORLD “where 33 were killed and 17 of them were rescued. The incident was thrilling to the public and as well as Prime Minister of that period who took a further step to investigate the reason for the collapse. When the actual reason was flashed that it was due to a miscalculation by the technical person involved, then the commendation of the Building Control Act 1989 and Building Control Regulations 1989 with some added rules and changes in ethics wherever needed as a mitigating measure to avoid future tragedy such as the case. In conclusion for the second case study, to avoid such nostalgic failure the American Society of Civil Engineers has recommended that the work submitted by the private and public firm should be rechecked by the experienced professional working at municipal, state, and departments of building to avoid such causalities which took away 114 lives and 200 were injured.[7] A Municipal Engineer, State Level Engineer, the department responsible for building at their respective boundary should have a recheck on the drawing submitted by the client. An Engineer should never go against his morals, ethics, and code of conduct in order to get this profession respected and for the self-respect of the individual.

Introduction

A case study on the case of poliomyelitis is carried out. The main key about this case study is to find out all the possible information regarding to this poliomyelitis. The reason why I choose this disease because it make me more curious to know more about polio after I watched a television film named ‘Warm Springs’ that portrayed the U.S President Franklin D. Roosevelt was diagnosed with polio in 1921 and his fight to overcome the paralysis.

Background

Polio or poliomyelitis is an infectious disease that is caused by the poliovirus. This disease is also been considered as the disabling and life-threatening to human. It was been stated that 0.5 % of the cases people suffer muscle weakness and as a result caused them unable to move. This disease can exist over a few hours to a few days. The most fragile part is legs but the less common are muscles of the head, diaphragm and neck. The percentages polio that caused muscle weakness among all type of ages:

• 2 to 5 % are children,
• 15 to 30% are adults die
• 70% are infected with no symptoms
• 25% have minor symptoms
• 5% of people suffered headache, neck pain and pains in the legs and arms.

They normally back to normal in 1 or 2 weeks and also need years to recover. But, not for post-polio syndrome may existed but with slow evolution of muscle weakness that is almost similar to the person that had the initial infection.

To be exact, polio has existed for thousands of years. It was discovered by an Egyptian carving illustrate a young man with a leg abnormality similar to one caused by polio from 1400BCE. It has been circulated in human population at low levels and arise to be relatively uncommon disease in the 1800s. Polio outbreak spread in late 19th century in Europe and United States. In 1900s, polio outstretch epidemic proportions when at that time, other diseases such as tuberculosis, diphtheria and typhoid were decreasing. The infants were bare to polio through water supplies that have been polluted. The infants’ immune systems was supported by their maternal antibodies flowing in their blood that could conquer the poliovirus and build their lasting immunity. An English physician, Michael Underwood was the first person to recognize polio as a distinct condition. The Austrian immunologist, Karl Landsteiner was the one who discovered the virus in 1908. During the 20th century, this disease has been labelled as the most worrying disease among children. The first polio vaccine was developed in 1950s by Jonas Salk, then the oral vaccine was created by Albert Sabin that had been used until today. In 2013, World Health Organization (WHO) hope for vaccination struggle and early detection of cases until eradication of the disease by 2018.

So, how it can be spread? This virus can be spread from one person to another person through infected fecal matter that enters the mouth. Other than that, it’s also can be spread by food or water that contain human feces and less commonly from infected saliva. Those who infected are more likely to be concerned because they do not shown any symptoms of the disease even up to 6 weeks and probably spread the disease. To diagnose the disease by detecting the virus in blood by looking at the antibodies that fight up against the virus or finding the virus in the humans’ feces. If you have not been vaccinated, the chance of having poliomyelitis is high. You can be infected if you are:

• Travelling to places that had declared a recent polio outbreak,
• Pregnant women or people with weak immune systems,
• People with positive HIV and young children are at the mercy of getting poliovirus,
• Handling a laboratory specimen,
• Taking care of the infected person or live someone with polio.

Type of polio and symptoms

Up to 90 to 95% of people who affected by poliovirus are asymptomatic known as subclinical polio that does not have any symptoms, but still they are spreading the virus and cause infection to other people.

(i) Non-paralytic polio (abortive polio)

This type of polio symptoms can last from 1 to 10 days. The symptoms of this polio can be common one, flu-like or:

• Fever
• Sore throat
• Headache
• Vomiting
• Fatigue
• Meningitis

(ii) Paralytic polio

1% of the cases can be paralytic polio that can lead to paralysis in the spinal cord (spinal polio), brainstem (bulbar polio) or both (bulbospinal polio). The first symptoms are similar to non-paralytic polio. After 1 week, the symptoms will appear to be more serious:

• Loss of reflexes
• Severe spams and muscle pain
• Sloppy and loose limbs and sometimes just one side of the body
• Temporary, permanent or sudden paralysis
• Injured limbs especially the hips, ankles and feet.

It is very unusual cases for people who infected by polio to have a full paralysis. It is estimated that less than 1% will get permanent paralysis. 5-10% of the cases where the virus attacked the muscles that help you to live and can cause death.

(iii) Post-polio syndrome

There is a possibility for the recovered patient to be attack by polio that can happen in 15 to 40 years. It is also approximately that 20-25% of people who survived polio will get post-polio syndrome. The symptoms that may occur are:

• Continuation of muscle and joint weakness
• Muscle pain gets more worse
• Easy to get tired or drowsiness
• Muscle atrophy (muscle wasting)
• Struggle to breath and swallow
• Sleep-related problem or sleep apnea that have trouble to breath and others

Causes of polio

Polio is caused by the infection of Enterovirus known as poliovirus, PV. The RNA virus colonize the gastrointestinal tract oropharynx and intestine. The time ranges for the PV to incubate from three to thirty-five days or the common length of time can be from six to twenty days. After the time length, the PV infects and causes disease in humans. PV has a structure of a single RNA genome with enclosed protein shell, which is capsid. The function of capsid is to enable PV to damage certain cell. PV has 3 group of serotypes, Poliovirus type 1 (PV1), Poliovirus type 2 (PV2), and Poliovirus type 3 (PV3). The three serotypes have slightly non-identical capsid protein. All three of the PVs are extremely virulent and create the same disease symptoms.

PV1 has the most commonly to produce and most directly associated with paralysis. There are two possibility the virus can be transmitted. The first one is by fecal-oral route (intestinal source) and oral-oral route (oropharyngeal source). Fecal-oral route is caused by ingesting the contaminated food and water. In the endemic area, this wild PV can cause contaminate and entire human population. The PV occurs is seasonal in the temperate climates and the peak occur in summer and autumn. It is less seasonal in the tropical areas. The incubation time for the PV are from six to twenty days and a maximum length of three to thirty-five days of the first symptoms to show. The virus particle are excreted in the feces and takes about several weeks to get the initial infection. For the oral-oral route, it is frequently can be transmitted by the oral-oral route whereby it can visibly can be in an areas that have better disinfection and cleanliness. The spreading of the virus is possible as long as the virus stay around in the saliva or feces.

The risk of polio infection can increased by the immune deficiency, malnutrition, physical activity that have an immediate of the onset to paralysis, injuries involve skeletal muscles that caused by the injection of vaccines or therapeutic agents and pregnancy. For the pregnancy part, the fetus does not get to be infected by the virus as the maternal antibodies give the passive immunity that can save the infants from the infection of polio during the first few months of survivorship.

[image: C:UsersHPDesktopSEM 4 NOTESCSC134endemicpolio19882018_final02.png]STATISTIC / DATA Sources from: https://www.cdc.gov/polio/images/maps/endemicpolio19882018_final02.png

The data above shown the polio cases over the past 26-years.It is estimated the number of worldwide polio cases has fallen from 350,000 in 1988 to 407 in 2013, declining of more than 99% in the polio cases that have been reported. There are four regions that have been announced as polio-free, for example, the Western Pacific, the Americas, South East Asia and Europe. Afghanistan, Nigeria and Pakistan are considered to be the only three countries that still have polio endemic, whereas these three countries have never disturbed the spreading of the wild PV. 17 million or more than that, people are currently healthy would have been petrified by the virus. This could not be done by the efforts of people in fighting against the polio eradication.

As for the polio case in Malaysia, it is reported that in 2020, it is involved one case only, and in 2019, a total number of 3 cases were reported and still remain the same until now. The polio made its first comeback on 8 December 2019 after 27 years in Malaysia. The first case was involving a three-month old boy from Tuaran, Sabah was admitted to the intensive care unit.

Solution

There are two type of solution was created to fight back over the disease which are:

1. Passive immunization
2. Polio vaccine

1. Polio immunization

Polio immunization was created by William Hammon in 1950 at the University of Pittsburgh. He discovered that by purifying the gamma globulin component of polio survivors’ blood plasma. He also come up with the gamma globulin that carried the antibodies to poliovirus by helping to stop the spreading of the poliovirus, and contract the strength of the polio in other patients that had eased polio. Thus, during the large clinical trial, Henry’s polio immunization, the gamma globulin shown 80% of successfulness in reducing the evolution of paralytic poliomyelitis and preventing the less severe of the disease towards the patients that already have the polio. This solution cannot be used until now because the limitation of blood plasma gamma globulin supplies. This method was really unrealistic to use for worldwide. As a result, this solution is not used anymore and a group of medical helped each other to concentrate to find the suitable invention of polio vaccine.

2. Polio vaccine

A virologist named Hilary Koprowski was the first person to invent the 1st polio vaccine. It is based on a live weakened virus that can be identified as one of the serotype. In 27 February 1950, the very first polio vaccine was inspected to an 8 year old boy. The vaccine itself was fully function in Belgian Congo in the 1950s. Between 1958 and 1960, 7 million children that had PV1 and PV3 were given vaccination.

In 1952, Jonas Salk from University of Pittsburgh invented the second vaccine and use to the widespread in 12 April 1955. Salk vaccine was known as inactivated poliovirus vaccine that was based on the growth of the poliovirus in a type of monkey kidney tissue- tissue culture. Injection method was used to vaccine people. Hence, 90% and above of the individuals shown the development in their protective antibody to the three types of the serotypes poliovirus for 2 doses. Three doses can be used were as 99% are immune to the PV.

Another polio vaccine was developed, it was oral polio vaccine. This vaccine was created by Albert Sabin. It was created with the replicated passage of the virus that went into the non-human cell at sub-physiological temperature. The duplication was very lucid in the gut, where the primary site of wild PV infection and replication, but not able to photocopy structured with the nervous system tissue. About 50% of the receiver was given a single dose of Sabin’s oral polio vaccine made immunity to PV1, PV2 and PV3. 95% of the receiver were given three doses of oral vaccine – generate productive antibody to the three type of serotypes: PV1, PV2 and PV3. In 1957, the Sabin’s vaccine was tested to human and in 1958, the vaccine was chosen, as the vaccine itself was also in competition with other researchers’ live vaccine including Koprowski vaccine by the US National Institutes of Health. Sabin’s vaccine was licensed in 1962 and been considered the only oral polio vaccine used by the widespread.

The oral polio vaccine was chosen because it is inexpensive, easy to administrator and generate a superb immunity in the intestine by reducing the infection with wild virus in endemic areas. Sabin’s vaccine has been declared as vaccine of the choice as it authorise poliomyelitis in many countries.

Ways to improve

There is no cure for polio but can be prevented by vaccination. Moreover, some of the prevention step can be applied in order to fight against polio. A few common supportive treatments can be used:

• Bed rest,
• Painkillers,
• Antispasmodic drugs to relax muscle,
• Portable ventilators to help with breathing,
• Physical therapy – to treat pain in the affected muscles, to address breathing and pulmonary problems or corrective braces to help with walking,
• Pulmonary rehabilitation to increase lung endurance,
• Advanced cases of leg weakness – wheelchair or other mobility devices.

A lot of polio survivors with permanent respiratory paralysis used modern jacket-type negative ventilators that they wore over the chest and abdomen. Other historical treatment of polio also included surgical treatments such as tendon lengthening and nerve grafting, massage and passive motion exercises and so on.

Conclusion

In a nutshell, from this case study, we can conclude that polio is known as poliomyelitis is a life-threatening disease that can spread from a person to another person. Other than that, there is no cure for this disease, yet, we can prevent ourselves from getting this disease because prevention is better than cure.

A) Reason for conducting the study

The study that we chose was conducted because they wanted to find out if there was a possibility to contract the botulinum toxin that comes from Clostridium botulinum by eating clay cheese that he admitted to consuming. The patient went to the emergency room because of the signs and symptoms of botulism, which include dizziness, difficulty breathing, unable to swallow, dry throat, impaired reflex, lack of focal neurological signs, impaired vision, muscle and limb weakness, and respiratory failure (Farzinpoor, 2019). In order to find the cause, they had to run a series of tests to confirm their hypothesis.

B) Hypothesis

They hypothesized that the symptoms he had was related to food-borne botulism from the clay cheese that he consumed. Although there were other foods that he consumed, they were highly suspicious of it being the cheese. Food-borne botulism is the product of the botulinum toxin when Clostridium botulinum is grown in food. Since clay cheese in traditionally made in clay pots that are buried in the ground for months at a time (Gregory, 2018), it can be assumed that Clostridium botulinum is the root cause of his illness due to it being a bacterium that grows in conditions with low oxygen, also known as being an anaerobe (USDA, 2013).

C) Results and Techniques Used

The doctors ran a battery of tests from a complete blood workup, chest x-rays, monitoring of his heart rate, pulse, and respiratory rate, and even took samples of his gastric fluids to confirm the suspicion of Botulism Toxin. Gram-staining would have been used to identify the bacterium, Clostridium botulinum, and since it is a Gram-positive microbe its rod-shape would have shown purple under a microscope. The patient’s eaten food such as cabbage salad, vegetables, and the cheese were tested as well to confirm the diagnosis and to identify which of the four types of Botulism Toxin he had acquired. All these tests confirmed he was suffering from botulinum toxin and that it had come from his ingestion of clay cheese, and that goes to prove the hypothesis that you can get Botulism Toxin from eating Clay cheese. The tests proved that the clay cheese was the cause since it came back positive, while the other foods came back negative for the toxin. With the advancements of plastics and metals, some have moved away from the traditional clay pots and began to use the new plastic and metal containers (Farzinpoor, 2019).

In order to treat the patient, they had to give him three doses of antitoxin. The antitoxin, Botulism Antitoxin Heptavalent ABCDEFG Equine, is given through an IV by health professionals under instruction of the doctor (Mayo Clinic, 2020). He was also consulted by a neurologist, then transferred to the infectious diseases ward where he spent 11 days to recover until he was discharged and given medication. In addition to this patient, his wife and seven other people in his family also contracted the illness because of the same reason (Farzinpoor, 2019).

D) Significance of Results

This case study is important and significant because it will bring awareness to the potential hazards of using improper techniques of making this traditional food. People have been preparing clay cheese for centuries and are moving away from clay to more modern containers such as metal and plastic. Clostridium botulinum is an anaerobic microbe that thrives and produces spores the grow and flourish in low oxygen environments (Bauman, 2018, p. 605-606). Once you learn how this bacteria survives and thrives and you learn that clay cheese is made by sealing the cheese in a container and burying it underground for months at a time, you come to see how this could be a potential hazard to a countless number of people. Botulinum Toxin is rare with about 60 cases of food-borne botulism a year, which is the type this patient had, and only about 10% of those are fatal; but if we can educate the public on this newfound way of contracting the toxin maybe we can keep that number from growing.

E) Why did we choose this case study?

We chose this case study because of how interesting the case was. Here is someone who contracted Botulism Toxin in a complete and novel way from eating a food that has been around for centuries. Botulism Toxin is not new to the medical community and is not even new to the food industry, but we had never seen it present in a case such as this. Also, the fact that we are seeing a pandemic from a novel version of a well-known virus made this case more interesting. The information in the study was well presented in a way that was easy to digest and comprehend. There was also enough new information presented that peaked one’s curiosity to learn more about how this bacterium and how it was thriving in the making of this cheese.

References

1. Bauman, R. (2018). Microbiology With Diseases By Body System. (5th ed). Harlow: Pearson Education Limited.
2. Gregory, C. (2018, June 12). A Brief History Of Cheese In The Middle East. Culture Trip. Retrieved from https://theculturetrip.com/middle-east/jordan/articles/a-brief-history-of-cheese-in-the-middle-east/
3. Farzinpoor, Z. (2019, June 18). Food-borne Botulism Caused by Clay Cheese: A Case Report. Advanced Journal Of Emergency Medicine. Retrieved from
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6789077/pdf/AJEM-3-e44.pdf
5. Mayo Clinic. (2020, Feb 1). Botulism Antitoxin (Intravenous Route). Retrieved from https://www.mayoclinic.org/drugs-supplements/botulism-antitoxin-intravenous-route/proper-use/drg-20060934
6. USDA. (2013, August 7). Clostridium Botulinum. USDA. Retrieved from https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/foodborne-illness-and-disease/clostridium-botulinum/ct_index