Management Methodologies of Projects-Free-Samples for Students

Question: Discuss about the various Management Methodologies for making a Projects and Similarities and Dissimilarities between PRINCE2 and SDLC method. Answer: Introduction: Project management methodologies are a set of procedures that are required to be followed for the development of a new type of project, which first came in 1960. This process of developing projects in a skilled and efficient way came into action because business organizations or companies wanted their existing and targeted projects in a more structured method. The parameters needed for implementing this new decision of project development includes communicating, collaborating and getting advise from various departments of the organization or company involved. This report discusses about different types of management methodologies of projects. This report also discusses some project management methodologies namely SDLC and PRINCE2. Discussion: Since the time of invention, the traditional approaches have evolved and new phases and topics are added to facilitate effective project management (Burke, 2013). In the modern times, companies and organizations are implementing these methods to develop their intended projects with a beginning and end. Definition and role: The main definition of these methodologies are the implementation of processes which includes the initiation, planning, beginning work, controlling and closing the work to get the intended objectives. A project is a process, which is temporary and is initiated for the development of a product and service to meet the necessary outcomes (Burke, 2013). The methodologies has a primary requirement for completing the project successfully even under the presence of varied constraints which includes project scope, budget of the project, time required and quality of the product. Another constraint is the acquisition of raw materials intended for getting project outcome. The role of the methods is to control the processes in project management by making decisions and solving problems to ensure the achievements of the intended outcomes. These methods give a skeletal framework to the authorities of an organization or companies to accomplish them in an orderly process. Types: These methodologies are further divided into many types depending upon their process of operation. Though the adopted methodology is different, focus of it should be towards the achievements of required outcomes. PMBOK (Project Management Body of Knowledge) is a type of guide that describes the required work as a set of processes. It also includes three parameters, which must be included as input materials, tools and techniques, output materials (Ojeda Reusch, 2013). The various processes included in this guide are the initiation of work, planning, execution of them, monitor, control, and closure. Agile methods consist of the reaction to outcomes that are unpredictable through incrementing, iterating and providing feedback (Dingsyr et al., 2012). SDLC (systems development life cycle) is a management method that is used to address the concerns of an information system or software for its planning, developing, testing of the system. The main style of this method is initiation, development of concept, planning, design, development, test, execution, repair and disposal (Batra, Malik Dave, 2013). PRINCE2 (Projects in Controlled Environment) is a structured management method whose main effort is given on the division of the project into layered stages that are required to be controlled and managed (Lianying, Jing Xinxing, 2012). The different processes of these methods are the start, initiation, direction, control, management of products, managing boundary and end. Waterfall methodologies include a set of processes that is seen as a continuous flow of system (Newton, 2016). The main instances of this method consist of concept, initiation, analysis, construction, test, development and repair. This portion defines the similarities and dissimilarities between the PRINCE2 and SDLC methods. The basic similarity between these methods is that both of them are used for management of projects. In addition, they have the same processing structure. However, SDLC method is closed by evaluating the end products whereas the PRINCE2 method ends the process by termination. The SDLC methodology is also different in its application to small and less budget proposals. Project life cycle: The project outcome must achieve the goals intended. The project is supposed to include a beginning part, middle part and end part. The major parameters are start, planning, execution and closing. The start process involves the acquisition of the raw materials for the project. The planning part includes the focusing of detailed aspects in the project. The execution process involves the working with respect to the plan. The closing part involves getting the outcome (Burke, 2013). The PRINCE2 and SDLC methods mostly have the same structure when compared to the project life cycle. However, the methods discussed here are more elaborative in context when compared to the procedural structure of the life cycle of the project. Conclusion: Thus, it is concluded from the report that the different methodologies, which are adapted, provide the sole intent of management of projects. However, the methods have a different structure of execution, but the sole requirements are the achievement of outcomes. References: Batra, M., Malik, A., Dave, M. (2013). Formal methods: Benefits, challenges and future direction.Journal of Global Research in Computer Science,4(5), 21-25. Burke, R. (2013). Project management: planning and control techniques.New Jersey, USA. Dingsyr, T., Nerur, S., Balijepally, V., Moe, N. B. (2012). A decade of agile methodologies: Towards explaining agile software development. Lianying, Z., Jing, H., Xinxing, Z. (2012). The project management maturity model and application based on PRINCE2.Procedia Engineering,29, 3691-3697. Newton, R. (2016).Project management step by step: how to plan and manage a highly successful project. Pearson UK. Ojeda, O., Reusch, P. (2013, September). Sustainable procurement-Extending project procurement concepts and processes based on PMBOK. InIntelligent Data Acquisition and Advanced Computing Systems (IDAACS), 2013 IEEE 7th International Conference on(Vol. 2, pp. 530-536). IEEE.

Essay Topics - The Poets Society Essay

Essay Topics - The Poet's Society EssayDead poets society essays are used in schools to help students develop their writing skills. Since they are more difficult, the writers do not learn how to write in the normal way. The dead poets society essay should be read at a later stage in life and the writer will eventually improve his or her writing skills.Many of the people have assumed that the essay topics are dead poems because of the name of the topic. However, the dead poets did not write poetry for the purpose of selling poems in the market. It is known that their poems were very famous. These people wanted to keep their poems alive and popular so that their poems would be read by people. Thus, they decided to use these topics as subjects of the essay.People do not realize that poets are not interesting topics in the first place. Poetry is about the beauty of the soul, while the subjects of the essay are the beauty of the body. These subjects cannot be spoken about. It is better if people write them in the essay topics to make them fresh.The dead poets can be chosen from among the living poets because some of them wrote about the beauty of the soul while some wrote about the beauty of the body. Thus, it can be seen that these poets were writers that really went through the changes of life. There are a number of famous poets who will be the subjects of the essay.The dead poets are considered to be subjects of the essay topics because these poets were mostly poets. They were most famous at a specific time. Thus, these subjects are subjects that are only alive for a short period.Today, people are not interested in writing essay topics that have nothing in them. The topics are invented because they want to help students who do not know anything about this subject.The essay topics are suitable subjects because these subjects have real things to say about life. Thus, you can always come up with interesting topics that will improve your writing skills.

Steinbeck, John Parallels Essays - English-language Films

Steinbeck, John: Parallels Common Ground In many of John Steinbeck's works there are themes and elements that parallel his other works. Steinbeck often tackles the result of people's bad fortune and the realization that their dreams have been destroyed. We can see that in his Pulitzer Prize winning The Grapes of Wrath and his critically acclaimed novel Of mice and Men Steinbeck shows us the results of people having their dreams destroyed. Steinbeck shows us that in his work he gives different characters similar goals and aspirations and has them destroyed in similar ways. In both of the above mentioned books key characters have their dreams destroyed. "Steinbeck often created characters possessing lofty goals; lofty goals in a world of despair and corruption. His characters did not have a dream of tangible luxuries, but a dream of corporal well being and refuge with loved ones"(Thomas 238). In Of Mice and Men, Lennie and George travel to California in order to find work. Once they salvage up enough money, Lennie and George plan on being independent and not worrying about the outside world and its enigmas. George stated "Someday we're gonna get all the jack together and were gonna have a little house and a couple of acres an' a cow and some pigs." (Roberts, 187). George's dream ran deeper than a love for farming and independence. The motivation for this dream was not just a product of the poor state of the country and widespread unemployment, but it was a dream that could ensure a happy ending for Lennie. George is anxious to secure his own place so that Lennie can live the type of life where he can be happy and not be hurt by people who do not understand his simple ways. George would run the farm; Lennie would tend the rabbits. This was Lennies dream, to tend the rabbits. He could think of nothing else more enjoyable than tending the rabbits. "Lennies dram is to have all the rabbits that he can take care of, and his attempts to do the right thing are motivated by his fear that George won't let him take care of the rabbits." (Tedlock 243). In The Grapes of Wrath the Joad family also dreams of moving out west. They do this in hopes of escaping the direful situation in Oklahoma. "Gonna buy a car and shove out west where it's easy living." (Steinbeck 57). The Joads like Lennie and George plan on saving up enough money for their own plot of land. Once this task is accomplished they hope to live a self-sufficient life and rely on one another. They believe that once in California they will find life easier and find all they need in surplus. "Jus' let me get out to California where I can pick me an orange when I want it. Or grapes, there's a thing I ain't never had enough of. Gonna get me a whole bunch of grapes off a bush, or whatever, an' I'm gonna squash 'em on my face an' let 'em run off my chin".(Steinbeck 105). There is clearly a parallel between the themes of these two books. As both works have the same basis for the characters dreams. How the dream mwas destroyed George and Lennie never had their dreams come true. When they arrived at the homestead for work; George and Lennie at once felt hostility from the ranch owner's son Curley. Curley was a sinister short-tempered man possessing little physical stature. From Curleys first encounter with Lennie, Curley was looking for an excuse to fight the simple-minded Lennie. "Curley develops a hatred for the bigger man which will be expressed in his desire to mutilate Lennie in the final scene." (Magil 4296) Lennie ended up killing Curleys wife. This was not a malicious act however. It was an accident that had an unfortunate consequence. "Lennies greatest difficulty is remembering. While he never plans to do anything wrong, he simply cannot remember what is wrong and what is not." (Magil 89). That consequence being the death of Curley's wife, and that Curley ordered the men to kill Lennie. The workers assembled and took up arms. George knew that the men were not out to right a wrong, but out to seek vengeance. George decided that he must kill Lennie. George knew that this was the only solution that would spare Lennie the misery that would be inflicted on him by Curley and his men. Like George and Lennie the Joads never saw their dreams materialize. They to were

Old Spice Ad Analysis Essays

Old Spice Ad Analysis Essays Old Spice Ad Analysis Essay Old Spice Ad Analysis Essay December 11, 2012 Comp I Advertisement Analysis Advertisements come in various shapes, sizes, and mediums, and as humans, we are constantly surrounded by them. Whether they are on TV, radio, or in a magazine, there is no way that we can escape them. They all have their target audience for whom the advertisers have specifically designed the ad. When a company produces a commercial, their main objective is to get their product to sell. This is a multibillion-dollar industry and the advertisers study all the ways that they can attract their audience’s attention. The producers of advertisements have many tactics and strategies they use when producing an ad to get consumers to buy their product. These include things such as rhetorical appeals, logical fallacies, and â€Å"the male gaze. † The function of marketing is to either increase the number of customers or increase the rate of use among current customers. The number of customers can be increased by converting customers from competing brands, developing loyalty to the brand among current customers, or expanding the total market for the product class. The more ads they make, the more they in turn have to make in order to get our attention, it’s led to a vicious circle of clutter† (PBS Frontline: The Persuaders). Advertising is a battle of which company can fill up the most empty wall space. Consequently, cities turn into a mass chaos of posters and billboards. Subway tunnels have now been turned into moving pictures, to produce almost a â€Å"commercial† if you w ill. The buses themselves have been turned into moving billboards. Nowadays the thirty-minute block for a television show is about 15 minutes worth of advertisements and 15 minutes of the actual show. Along with that, many people are actually being paid to be an advertisement, whether it be standing out in front of a building with a sign, or putting a company decal on their car. Advertisements, likewise, cannot be escaped. However, often advertisers have to be sure and not â€Å"over do† their advertisements, or else the audience in which they are trying to appeal to will become annoyed. Old Spice, a major company for men’s hygienic products, has created a line of men’s body wash that has a very appealing and humorous advertising campaign. These ads are designed not only to get their product noticed in the marketplace, but also to eclipse other lines of men’s body wash. The Old Spice commercials imply that by using their product, a man will be or become more similar to the Old Spice man, or in other words, the ultimate man. The Old Spice advertisements capture men by reaching out to the needs of women, giving the ideal image of what a man should be and how he should smell, and by creating a sexual theme that attracts attention. The bottles used for all Old Spice products have red incorporated within the design. This is because red is the color of attraction. That is why red always surrounds Valentines day. Red can also signify power and strength. The Old Spice design tries to go with a classic, authentic look. It wants to appeal to a variety of ages. It has a very sophisticated look (Keitel). In our society, an extremely smart and effective way of selling a product designed for men is to appeal to women. Women have many opinions on commercials that deal with men’s products, and if they like the commercials, they will be more apt to either buy the product themselves or influence the men they know to buy it. Advertisers not only use sexual appeals to attract attention to their ads, but to position their brands as sexual and to suggest that sex-related benefits can ensue to the brand purchasers. In Old Spice’s current ad campaign, there are a series of commercials using different actors and sports stars that are very fit and good looking to highlight their body wash. In the ad they use ex-NFL wide receiver Isaiah Mustafa, promoting elements of masculinity, sex appeal, and humor. In the ad, Mustafa is coming out of a shower dressed only in a towel, saying in a deep voice, â€Å"Hello, ladies†, and then continuing to talk directly to women viewers, telling them to look alternately at him and then the man sitting next to them for the implied comparison in which no normal man would come out very well. The commercial then continues with rapidly shifting scenes that show Mustafa in romantic fantasy? like settings designed to appeal to women. He is shirtless on a sailboat at sunset, then holding tickets to â€Å"that thing you love†. The tickets then turn into diamonds, and finally then ad ends with Mustafa sitting shirtless on a white stallion on a tropical beach. The commercial’s appeal to women relies not only on the attractiveness of the actor and the settings, but to the humor that is based on the idea that such a perfect man can exist at all. Conversely, not only do these commercials reach out to women, but also there are men in the target audience and there is a message for them as well. These ads present an ideal image of how a man should be and what he should smell like. By using a good looking, fit, man for this advertisement, it gives the product an image that men want. The logical fallacy, ad populum, is present in this commercial. This ad almost shouts out the ideas that if you use the product you can look, smell, and be exactly like the man you see on your television. The Old Spice man, Mustafa, does everything better than you do and will give your woman more than you can give her. You can smell like the â€Å"ultimate man†, or as the slogan used in the ads says, â€Å"Smell like a man†. The ad makes a man react emotionally and appeal directly to his masculinity, vanity, and even his insecurity in being able to impress, attract, and keep women happy. This ad also portrays the idea of â€Å"scopophilia†. Scopophila is known as the pleasure in looking; by this, women want to have a pleasure in looking at their man, and the only way that will happen is if he uses Old Spice. In addition to appealing to women’s tastes and a man’s emotional need to smell like a manly man and attract a woman, this commercial uses the old reliable advertising strategy – sex sells. A sexually themed commercial can appeal to both men and women, and is sure to attract attention. Men and women are often portrayed in a sexual manner in ads of products that have absolutely nothing to do with sex itself. However, the sexiness of the advertisement causes people to remember the ad, and thus the product. This sexiness in advertising is enhanced and affected by the physical attributes of the models, their movement or actions, their interactions if there is more than one model, and the special effects provided by the camera. The desired result is achieved, because of the sexual nature of the ad, a fit and good-looking man talking directly to women in a seductive voice and in a romantic location. People, both men and women, stop what they are doing and watch. Sex can make the beholder feel young again. Sex may also reassure men of their masculinity and women of their femininity. The sexual content of the commercial also does more than grab people’s attention, it helps them remember the ads. The Old Spice ads are successful because they make an impression on people and lead to discussions with other people who have seen them. The advertisers do have to be careful with the use of sex appeal in these ads. If the sexual content is overdone, it might not work as intended. They need to make sure that people are not so distracted by the sexual appeal of the ad that they do not remember what the ad was for in the first place. It does not do any good to create a sensual or sexual message when all they can remember is the image and not the brand name. Therefore, advertisers need to make sure the sexual/sensual image being used is connected in some way to the product or service being promoted. This will create a link between the two and make the viewer much more likely to remember the product or service being advertised. When making a sexual ad, producers must tailor the message to the people they are targeting, which includes understanding the audience’s feelings and beliefs on public sexuality. Women have a different viewpoint on the subject of sexual appeal in advertisements. The objectification of women in advertising campaigns has significant psychological implications. It socializes women to think of them in the manner in which they are depicted, and causes them to engage in self-objectification. When women view advertisements featuring thin female models, it causes them to think that their own bodies should also be thin, creates anxieties relating to their weight, appearance, body satisfaction, and creates a negative mood. Thus, their body image causes them to suffer emotionally and psychologically. Bordo states in her essay, â€Å"Today, as many as one million men – and eight million women – have an eating disorder. † Perhaps, by buying the advertised items, the viewing audience of women believes they will instantly become taller, thinner, younger, and prettier. This is not the same psychological effect experienced by women who view ads with female models of average proportions, or with no female models at all. Objectification of women in advertisements and emphasis on the size of their breasts has created a society of cosmetically enhanced, large-breasted women. Their self-image is predicated on the medias portrayal of a desirable woman. In order to have high self-esteem, and see themselves as attractive and valued women, many females feel this enhancement is necessary. Most human consumption is a result of a drive to satisfy sensuous desires. Advertising uses sexual images to encourage this consumption. People become dissatisfied with their imperfect selves, and seek to become perfect by buying the sexually charged products. Sex is an easy way to get the attention of males and make a product seem desirable. Women are objectified, and men are swayed to purchase the product and as a reward, get the women. The women represented in these ads are all beautiful and physically well endowed. Men are stimulated by the immediate physical sexuality in the ads, whereas women seem to be more stimulated by the sexuality for the romantic aspect of it. Men want to get the women. Women want the sexuality for the promise of the future. There seems to be no question that the use of sexuality in advertising helps to sell a product. However, when sexuality is used, the concept is true that there is greater consumer interest in observing the ads. This increased consumer interest often leads to the purchase of the advertised product. Bordo, Susan. â€Å"Beauty (Re)discovers the Male Body†. Writing Analytically with Reading. 2nd ed. EDS. Rossenwasser, David and Jill Stephen. Boston: Wadsworth, 2012. 821-843. Print. Keitel, Victoria. â€Å"Old Spice Analysis. † Personal. PSU. n. d. Web. 11 Nov. 2012 Rushkoff, Douglas. â€Å"The Persuaders. † PBS Frontline. 9 Nov. 2004. Web. 11 Nov. 2012

Employee Incentive Plan Evaluation at XYZ Industries Essay

Employee Incentive Plan Evaluation at XYZ Industries - Essay Example The Company will implement a new incentive plan, the details of which are given in the following sections. The plan will be reviewed after a period of twelve months. Objective: To become the leading provider of blood bags in North America. Types of incentives proposed: Incentive plans are broadly classified into three groups, namely those for individuals, groups, and the enterprise (Bohlander & Snell, 2010, 455). Individual incentives: a. Hourly pay of $5 per hour with a maximum of $10 a day (five working days). Every employee is eligible. b. Sales incentive – 25 cents per bag, for exceeding targets for sales and marketing staff. There is no limit on the amount that can be earned. c. Bonuses – Thirty percent of basic pay for all employees twice a year (employees are at liberty to choose the time, but needs to provide one month’s advance notice. d. ... cturing and packing (Note – the company has excess production capacity and aims to achieve a 30 percent increase in sales this year) Enterprise incentives: a. The Company is planning to go public and is planning to introduce 100,000 shares in February 2011. It is expected the value of each share will be approximately $7. Of these, thirty percent will be held by the owners, fifteen percent will be given as employee ownership, and the rest be made public. Employees are not allowed to sell the shares to the public for a minimum period of five years. It is hoped that full cooperation from all employees and departments will be there for the successful implementation of the incentive plan. Review of the bonus plan: A review of the effectiveness of the plan was made after a period of fifteen months in June, 2011. The gap of an additional three months (plan introduced in January 2010). This was to assess the impact of the stock ownership plan which was planned in February 2011, as men tioned in the incentive plan. The review was conducted by the human resources manager, Mr A. as he had a good rapport with all employees. This was the first time that a relatively comprehensive incentive plan was introduced. Previously, only the group bonus plan was in operation. Hence the employees were willing to cooperate until the period of review was over. Moreover they were happy that they could obtain additional compensation when compared to previous years. But the following drawbacks were noted after discussions, which need to be looked into by the management and implemented as far as possible. The company did achieve it target of thirty percent increase in sales. With regard to the sales and marketing personnel had the following complaints especially from the top performers who

The Cold War Doctrines Essay Example | Topics and Well Written Essays - 1000 words

The Cold War Doctrines - Essay Example It was caused by political and economic differences between the United States and the USSR (Posen 98). President Harry S. Truman reigned in the United States during the cold war. He faced a lot of internal challenges during the cold war. The United States faced severe shortages in housing and consumer products, many strikes and widespread dissatisfaction with the level of inflation. Turman used certain tactics to dominate the United States during the cold war. He signed the National Security Act 1947 as part of the world war strategy. He also reorganized armed forces by merging the state of war and the department of the navy into the National Military Establishment. He also created the United States Air Force, CIA and the National Security Council (Bostdorff 28). He used administrative commands to stop ethnic prejudice in the military forces. He dismissed a bunch of communists’ supporters from office by the creation of loyalty checks. He bitterly fought the republican leaders on foreign policy. Through his belief against communism, he protected Turkey, Greece and Iran by making a peaceful solution, not sending United States troops to war, and prevention of soviet penetration. He came up with the Fair Deal program which involved anti-union Taft-Hartley Act and vigorous civil rights program (Bostdorff 14). He also made a commitment to recognize the institution of the state of Israel. This was made to sustain the formation of a motherland for the Jewish people. Turman’s presidency was extremely active in foreign policy, which was containment of Soviet expansion as the cold war unfolded. It is necessary to note that Turman authorized the Hiroshima and Nagasaki atomic bombs which killed thousands of people in Japan. He used nuclear weapons against Japan as the Japanese government refused the terms of Potsdam Declaration (Bostdorff 160). This made the Japanese surrender on the 14th of August; 1945. The atomic bomb scene was revisited in the cold war and was recognized to have rendered convectional forces largely irrelevant to the modern battlefield. Corruption was a key issue in Turman’s government which runs through individual members of the cabinet and the senior white house staff. He relied distinctly on his cabinet and popularized such phrases as ‘The buck stops here’. Turman initiated the Berlin Airlift. This was a strategy that delivered meals and other supplies using military airplanes to people. Turman also used the strategy of rapid demobilization, which involved sending the veterans home. This policy was primarily financial since it involved funding domestic spending requirements. President Eisenhower was the thirty fourth president of the United States. His presidency was dominated by the cold war which begun during Turman’s reign. He was popular for ending the Korean War and presiding over eight years of peace. He signed peace treaties with South Korea and the republic of China. He expanded t he National Security Council which was initiated by president Turman. He was the first president to conduct televised press conferences. Just like Turman he was an anti-communist, and through this, he developed a marketing and armed coalition with the Spain through the Pact of Madrid. Signing the Southeast Asia Treaty Organization alliance, was another strategy to prevent communism. He accepted the principle of containment which sought

Congestive Cardiac Failure With Digoxin Toxicity

Congestive Cardiac Failure With Digoxin Toxicity Contents (Jump to) Criterion-1 Causes, Incidences and Risk Factors of Congestive Cardiac Failure with Digoxin Toxicity: Comprehensive Understanding of the Disease on Patient and Family: Criterion-2 Signs Symptoms Pathophysiology Criterion-3 Drug Class Physiological Effect Criterion-4 Interventions-Rationales: Comprehensive Treatment of the Identified Condition: Supportive care Electrolyte abnormality management Bradycardia management Hemodynamic compromise management Ongoing monitoring and change of medicine CASE STUDY ON CONGESTIVE CARDIAC FAILURE WITH DIGOXIN TOXICITY Criterion-1 Causes, Incidences and Risk Factors of Congestive Cardiac Failure with Digoxin Toxicity: Digoxin toxicity caused by high levels of digitalis in the body. As in our case study Mrs. Sharon McKenzie, a 77 year old woman, used to take daily 250 mcg of digoxin, which is a very high dose for adult patients. Especially those, who are suffering from congestive cardiac failure, like our patient Mrs. Sharon McKenzie (Neo, et al, 2010). Body receives the therapeutic effect when it stores of 8 to 12 mcg/kg generally with minimum risk of toxicity in most patients with failure of heart and normal sinus or breathing rhythm (Mangoni, 2010). People withheart failurewho have this digoxin are commonly prescribed medications called diuretics that remove excess fluid from the part of body. This is also happens that many diuretics can cause potassium loss from the body (Johnson, Inder, Nagle Wiggers, 2010). Though ultimately it increases the risk of digitalis toxicity. Again, our patient, Mrs. Sharon McKenzie’s potassium level is low; 2.5 mmol/l. whereas a normal potassium level ranges from 3.5-5.0 mmol/l. You are more likely to fall into that condition if you take digoxin, digitoxin, or other digitalismedicinesalong with the higher effective drugs that interact withit such as flecainide, quinidine, amiodarone, verapamil, and others. Similarly, Mrs. Sharon McKenzie’s was also taking medication with digoxin like furosemide, warfarin, and enalapril (Siabani, Leeder Davidson, 2013). In recent years the incidence of digoxin toxicity has dropped among patients in hospitals. A study has been done on 183 outpatients, who are receiving on going treatment of digoxin toxicity at 10 urban and rural Department of Veterans Affairs Medical Centers in the Rocky Mountain region, to evaluate whether a similar decline of digoxin toxicity has occurred or not. The statistics over 1-year period, of that study is like that: Out of the 183 patients: 50 (27.3%) had one or more risk factors for digoxin toxicity. Serum digoxin levels were elevated in 13.6% of patients. Hypokalemia in 14.3%. Elevated creatinine levels in 17.9%. And possible drug interactions in 5.5% of patients. The most common risk factor of digoxin toxicity is the patient’s elderly age. Like in our case study, Mrs. Sharon McKenzie is also 77-year old woman. However there are other risk factors too, which render the elderly more vulnerable to digoxin toxicity. These contain an age-related decline in renal function and a decrease in volume of digoxin distribution. There is also an increase in the number of comorbid conditions, including cardiovascular and chronic obstructive pulmonary disease, which heightens vulnerability to digoxin toxicity. Comprehensive Understanding of the Disease on Patient and Family: Digoxin toxicity is a life-threatening condition, and when a serious disease like congestive cardiac failure caused by digoxin toxicity then it can impact severely in a bad way on a patient as well as his/her family (Betihavas, 2011). Due to which his/her family also suffer by seeing their loved one mentally disturbed. Often the patients with CHF who are depressed or who lack social support, the higher the support from the social side the higher the rate of healing as the family and the patient both in complex and double trouble. Criterion-2 Signs Symptoms Pathophysiology Severe ventricular arrhythmias: Sudden cardiac death and loss of consciousness are the basic signs and symptoms of the cardiac arrhythmias. Complaints such as dizziness, lightheadedness, fluttering, dizziness, and pounding, chest discomfort, quivering, shortness of breath, and forceful or painful fast beats are commonly reported with arrhythmias patients. Often, patients notice arrhythmias only after checking their peripheral pulses (Mudge, et al, 2010). The pathogenesis of the arrhythmias falls into one of two basic mechanisms: increased or covered up automaticity, triggered activity, or re-entry. Triggered activity occurs when early after depolarization and delayed after depolarization initiate spontaneous multiple depolarization, precipitating ventricular arrhythmias (Johnson, Inder, Nagle Wiggers, 2010). Arrhythmogenesis is probably the most common procedure and results from re-entry. It causes the change of state of mind and mood too. 2) Hyperkalemia: Higher potassium rate in your blood can affect how your heart works. Symptoms of hyperkalemia can include: Abnormal heart rhythm arrhythmia that can be life-threatening Slowheart rate Weakness (Neo, et al, 2010) Hyperkalemia may result from an increase in total body potassium secondary to imbalance of intake vs. excretion or from misdistribution between intra- and extracellular space (Nanda, 2009). 3) Hypokalemia: Usually symptoms of low potassium are mild Weakness, tiredness, or pain in arms or legs muscles, sometimes this might be so severe to cause inability and disability to move arms or legs due to weakness of muscles (much like a paralysis) (Hughes Crowe, 2010) Tingling or numbness Nausea or vomiting Abdominal cramping, bloating Constipation Palpitations (feeling your heart beat irregularly) Urine passing rate is too high simultaneously feeling thirsty mostly (Neo, et al, 2010). In the heart, low potassium levels make the myositis hypo-polarized or hyper excitable. Thus, arrhythmia occurs as a result of the atrium’s lowered membrane potential due to recovery from inactivation of the Na channel, which may trigger an action potential. In addition to this, reduced potassium in the extracellular space inhibits the IKr potassium current activity, and ventricular depolarization is delayed, which thereby promotes reentrant arrhythmias (Jeon, Kraus, Jowsey Glasgow, 2010). 4) Neurologic Symptoms: In the identified condition, the patient may also go through with neurologic symptoms which are: Visual disturbances, disorientation, and confusion.You might experience confusion. Although rare, you might also see bright spots, have blurry vision, or experience blind spots. In addition, you might urinate much more or less than usual (Betihavas, 2011). Your body could also become swollen. The physiologies of neurological symptoms are not easy to judge and too complex and our getting of them are incomplete mostly. From an evolutionary perspective it is easy to judge the neurological symptoms. Though it makes sense that the genuine physiologies of neurological symptoms are intricate and interrelated (Courtney, et al, 2009). 5) Sinus Node Dysfunction: Sinus node dysfunction refers to a number of conditions causing physiologically inappropriate atrial rates. Symptoms may be minimal or include weakness, effort intolerance, palpitations, and syncope. Diagnosis is by ECG. Symptomatic patients require a pacemaker. Sinus node dysfunction includes inappropriate and misbalancing the sinus bradycardia, alternating bradycardia and atrial tachyarrhythmia, sinus pause or arrest, and sinoatrial exit block (Jeon, Kraus, Jowsey Glasgow, 2010). SND also causes the abnormalities in SN impulse formation and propagation that also causes abnormalities in the atrium and in the conduction system of the heart (Higgins, et al, 2013). Slow ventricular rates and pauses at the time of stress is the general causes, furthermore, it includes following: Fatigue Angina Syncope Dizziness Fall Confusion Heart failure symptoms and palpitations Criterion-3 Drug Class Physiological Effect Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors cause blood vessels broadness, further descent the amount of work the heart has to do they may also have direct beneficial effects on the heart. These drugs are reducing the symptoms and the need for hospitalization moreover they are helpful to prolong life (Mudge, et al, 2010). Beta-blockers: Beta-blockers drugs lower down the heart rate and block excessive blockage in the heart. They also helpful in the heart disease. These drugs are usually used with ACE inhibitors and provide an added benefit. They may temporarily worsen symptoms but result in long-term improvement in heart function (Betihavas, 2011). Although ACE inhibitors improve outcome in patients with systolic dysfunction, many patients with hypertension experience congestive heart failure due to diastolic dysfunction related to left ventricular hypertrophy. ACE inhibitors have been shown to reverse left ventricular hypertrophy in patients with hypertension.A meta-analysis of the effects of several antihypertensive agents suggested that ACE inhibitors were the most effective agent in reducing left ventricular hypertrophy (Katz Konstam, 2012). Beta blocker is helpful in improving the function of the failing LV and need to prevent or reverse progressive LV dilation, sphericity, chamber and hypertrophy. Beta blockers also lower down the heart beating rate and LV wall stress. According to recent studies from laboratories have also proven that beta blockers can satisfy cardiomyocyte apoptosis in HF. These are the basic advantages and benefit of beta-blocker for the patient of heart at any higher stage (Katz Konstam, 2012). Criterion-4 As a registered nurse, my care plan for a patient suffering from Congestive Cardiac Failure with digoxin toxicity would be like, (Driscoll, et al, 2009) Interventions-Rationales: I realize that I would hold the medication Due to possibility of toxicity Wait for Electrolytes and digoxin test, as these tests were already ordered for our patient electrolytes can affect the action of dig and cause dysthymias and to find out the level of dig Monitor I O monitoring for renal function Monitor for edema and auscultator the lungs Monitor symptoms, VS S/E of dig toxicity Call the doctor. To get orders to carry out interventions and inform doctor Start an IV. For administration of medications (Mudge, et al, 2010). Comprehensive Treatment of the Identified Condition: The main goal of treatment is to correct cardiac toxicity.If the person has stopped breathing, as our patient Mrs.Sharon McKenzie confronting with shortness of breath, startCPRand get emergency medical help (Betihavas, 2011). Initial treatment includes: General supportive care Discontinuation of digoxin therapy and prevention of further exposure Administration of digoxin-specific antibody fragments (digoxin immune Fab) Treatment of specific complications: for example, dysrhythmias and electrolyte abnormalities (Jeon, Kraus, Jowsey Glasgow, 2010). Supportive care General supportive care includes attaching patients to a cardiac monitor, providing IV fluids in patients with hypotension or volume depletion (with caution for patients with CHF), supplemental oxygen, and/or repletion of electrolytes in patients with electrolyte abnormalities (Mudge, et al, 2010). Electrolyte abnormality management In case of Mrs. Sharon McKenzie, hyperkalemia is only corrected (e.g., with insulin/glucose) if it is considered life-threatening, because of the risk of producing hypokalemia, because her potassium level is low i.e. 2.5 mmol/l. One study showed that insulin interacts directly with Na(+)/K(+) ATPase pump and alters the effect of digoxin (Betihavas, 2011). This supports the finding that for patients with diabetes, insulin has been shown to have cardio protective effects after digoxin intoxication. Calcium is not used to treat hyperkalemia in patients with suspected digoxin toxicity as it may induce arrhythmia or cardiac arrest. Bradycardia management As Mrs. Sharon McKenzie’s ECG report showed sinus bradycardia, this will be treated with atropine. Atropine can be given every 3 to 5 minutes until there is a response or the 3 mg maximum dose is reached (San Miguel, et al, 2013). Hemodynamic compromise management As Mrs. Sharon McKenzie has signs of hemodynamic insufficiency and/or compromise (e.g., hypotension, altered consciousness or dizziness), digoxin immune Fab is given as primary management (Mudge, et al, 2010). Ongoing monitoring and change of medicine Ideally, digoxin is discontinued and a different medicine for rate control or a different inotrope prescribed (for AF, atrial flutter or CHF, respectively). If the patient has to remain on digoxin for some reason, then the dose of digoxin is adjusted for the patients medication profile (Edgley, Krum Kelly, 2012). Referencing: Jeon, Y. H., Kraus, S. G., Jowsey, T., Glasgow, N. J. (2010). The experience of living with chronic heart failure: a narrative review of qualitative studies. BMC health services research, 10(1), 77. Hughes, J., Crowe, A. (2010). Inhibition of P-glycoprotein-mediated efflux of digoxin and its metabolites by macrolide antibiotics. Journal of pharmacological sciences, 113(4), 315-324. 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