Dilation and Curettage Procedure Essay Example

Dilation and Curettage Procedure Paper A dilation and curettage procedure, also known as a DC, is a surgical procedure in which the cervix (lower, narrow part of the uterus) is dilated so that the uterine lining (endometrium) can be scraped with a curette instrument in order to remove abnormal tissues. During the dilation and curettage procedure, the patient is placed in supine position of the body with the legs separated, flexed, and supported in raised stirrups. The doctor inserts a speculum into the vagina, as during a pelvic exam, in order to see the cervix. Then, the cervix is slowly dilated by inserting a series of thicker and thicker rods into the cervix until its adequately opened, usually to between 6 and 9 millimeters in diameter. After dilation, a curette is inserted to begin removing tissue. Although the DC involves no stitches or cuts, the cervix is cleansed with an antiseptic solution. A dilation and curettage can be done as day-surgery or may require an overnight stay in the hospital. It is recommended that before the surgery, the patient take nothing by mouth (food, water, etc. ) for at least 6 hours before the scheduled operation. We will write a custom essay sample on Dilation and Curettage Procedure specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Dilation and Curettage Procedure specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Dilation and Curettage Procedure specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Before surgery or during the previous night, a bath maybe is advisable since it helps lower the bacterial count and lessen the chances of any infection from surgery. The genital area is shaved in order to begin skin preparation. Skin preparation begins at the pubic symphysis and extends downward over the labia. Next, each inner thigh is cleansed. After, the vaginal vault and cervix are cleansed using three spongesticks. Spongesticks must be discarded after wiping the anus. The patient’s bladder is drained with a straight catheter to prevent the bladder from compromising the field. Once the patient has been prepared, a drape sheet is tucked under the buttocks, followed by leggings and a drape sheet over the abdomen. For a dilation and curettage procedure, a scrub tech sets up the instruments on the back table, but he/she is not needed during the procedure. The surgeons take the instruments, such as Overstreet Endometrial Polyp Forceps, Skene Vulsellum Tenaculum, Schroeder Braun Tenaculum, directly off the back table themselves. Besides a Dilatation and curettage tray, a small basin, water-soluble lubricant, a Telfa (for specimen), perineal pad and sanitary napkin belt will also be needed on the back table for the dilation and curettage procedure. An antiembolism hose may be requested. A dilation and curettage may be used as a diagnostic or therapeutic procedure for abnormal bleeding. A dilation and curettage procedure can also be performed to determine the cause of abnormal or excessive uterine bleeding, to detect cancer, or as part of an infertility investigation. Causes of abnormal bleeding include the presence of abnormal tissues, such as fibroid tumors (benign tumors that develop in the uterus, also called myomas) polyps, or cancer of the endometrium or uterus. Abnormal uterine bleeding may also be due to a hormone imbalance or disorder when approaching menopause or after menopause. A dilation and curettage may also be performed following a miscarriage to remove the fetus and other tissues if they have not all been naturally passed. Infection or heavy bleeding can occur if these tissues are not completely removed. Occasionally following childbirth, small pieces of the placenta remain adhered to the endometrium and are not passed, which can cause bleeding or infection. A dilation and curettage is used to remove these fragments so that the endometrium can heal properly. For the dilation and curettage procedure, there is general anesthesia, regional anesthesia and local anesthesia. General anesthesia is given through either a breathing mask or an intravenous (IV) catheter. The IV may be placed in a vein in the patients hand, arm or neck. The patient may have a breathing tube inserted through their mouth and into their windpipe to make sure they’re breathing properly. General anesthesia relaxes the muscles, which makes it easier for the doctor to perform a pelvic exam. Regional anesthesia is injected into the area around the spinal cord, blocking any pain during the procedure. Local anesthesia, which is most common, is injected directly into and around the cervix to numb the area. The patient also receives a sedative from an IV. The dilation and curettage procedure has a low risk of serious complications. The most common complication that can occur is perforation of the uterus with either the dilators or the curette. When this happens, as long as no internal organs such as intestines, bladder, or rectum, or large blood vessels are damaged, the hole will almost always heal itself without further surgery. The risk for this problem is increased in patients with a narrowed opening to the cervix (cervical stenosis) or in patients with distorted internal uterine anatomy. This risk is also increased if the uterus is infected or has undergone previous surgeries such as cesarean sections or myomectomies. Injury to the cervix is another possible complication. Tears or cuts in the cervix can usually be treated by application of pressure and application of local medications to stop bleeding. In some cases, stitches in the cervix may be required, but this is not common. Other complications, as with any surgery, include bleeding and infection. Most bleeding is mild and resolves on its own. Infection is also rare and can normally be managed with oral antibiotics. On occasion, in patients with certain heart defects, the surgeon may give the patient antibiotics before and after the surgery to prevent bacteria from the vagina from infecting the heart valves. It is normal to experience vaginal bleeding and/or pelvic cramping for a few days after a dilation and curettage procedure.

The History of Japanese Ninjas

The History of Japanese Ninjas The ninja of movies and comic books- a stealthy assassin in black robes with magical abilities in the arts of concealment and murder- is very compelling, to be sure. But the historical reality of the ninja is somewhat different. In feudal Japan, ninjas were a lower class of warriors often recruited by samurai and governments to act as spies. Origins of the Ninja It is difficult to pin down the emergence of the first ninja, more properly called shinobi- after all, people around the world have always used spies and assassins. Japanese folklore states that the ninja descended from a demon that was half man and half crow. However, it seems more likely that the ninja slowly evolved as an opposing force to their upper-class contemporaries, the samurai, in early feudal Japan. Most sources indicate that the skills that became ninjutsu, the ninjas art of stealth, began to develop between 600 to 900. Prince Shotoku, who lived from 574 to 622, is said to have employed Otomono Sahito as a shinobi spy. By the year 907, the Tang Dynasty in China had fallen, plunging the country into 50 years of chaos and forcing Tang generals to escape over the sea to Japan where they brought new battle tactics and philosophies of war. Chinese monks also began to arrive in Japan in the 1020s, bringing new medicines and fighting philosophies of their own, with many of the ideas originating in India  and making their way across Tibet and China before turning up in Japan. The monks taught their methods to Japans warrior-monks, or yamabushi, as well as to members of the first ninja clans. The First Known Ninja School For a century or more, the blend of Chinese and native tactics that would become ninjutsu developed as a counter-culture, without rules. It was first formalized by Daisuke Togakure and Kain Doshi around the 12th century. Daisuke had been a samurai, but he was on the losing side in a regional battle and forced to forfeit his lands and his samurai title. Ordinarily, a samurai might commit seppuku under these circumstances, but Daisuke did not. Instead, in 1162, Daisuke wandered the mountains of southwest Honshu where he met Kain Doshi, a Chinese warrior-monk. Daisuke renounced his bushido code, and together the two developed a new theory of guerrilla warfare called ninjutsu. Daisukes descendants created the first ninja ryu, or school, the Togakureryu. Who Were the Ninja? Some of the ninja leaders, or jonin, were disgraced samurai like Daisuke Togakure that had lost in battle or had been renounced by their daimyo but fled rather than committing ritual suicide. However, most ordinary ninjas were not from the nobility. Instead, low-ranking ninjas were villagers and farmers who learned to fight by any means necessary for their own self-preservation, including the use of stealth and poison to carry out assassinations. As a result, the most famous ninja strongholds were the Iga and Koga Provinces, mostly known for their rural farmlands and quiet villages. Women also served in ninja combat. Female ninja, or kunoichi, infiltrated enemy castles in the guise of dancers, concubines, or servants who were highly successful spies and sometimes even acted as assassins as well. Samurai Use of the Ninja The samurai lords could not always prevail in open warfare, but they were constrained by bushido, so they often hired ninjas to do their dirty work. Secrets could be spied out, opponents assassinated, or misinformation planted, all without sullying a samurais honor. This system also transferred wealth to the lower classes, as the ninja were paid handsomely for their work. Of course, a samurais enemies could also hire ninja, and as a result, the samurai needed, despised, and feared the ninja- in equal measure. The ninja high man, or jonin, gave orders to the chunin  (middle man), who passed them on to the genin, or the ordinary ninja. This hierarchy was also, unfortunately, based on the class the ninja had come from before training, but it wasnt uncommon for a skilled ninja to ascend the ranks well beyond his or her social class. The Rise and Fall of the Ninja The ninja came into their own during the tumultuous era between 1336 and 1600. In an atmosphere of constant war, ninja skills were essential for all sides, and they played a key role in the Nanbukucho Wars (1336–1392), the Onin War (1460s), and the  Sengoku Jidai, or Warring States Period- where they aided samurai in their internal power struggles. The ninja were an important tool during the Sengoku Period (1467-1568), but also a destabilizing influence. When warlord Oda Nobunaga emerged as the strongest daimyo and began to reunite Japan in 1551–1582, he saw the ninja strongholds at Iga and Koga as a threat, but despite quickly defeating and co-opting the Koga ninja forces, Nobunaga had more trouble with Iga.​ In what would later be called the Iga Revolt or Iga No Run, Nobunaga attacked the ninja of Iga with an overwhelming force of more than 40,000 men. Nobunagas lightning-quick attack on Iga forced the ninja to fight open battles, and as a result, they were defeated and scattered to nearby provinces and the mountains of Kii. While their base was destroyed, the ninja did not vanish entirely. Some went into the service of Tokugawa Ieyasu, who became shogun in 1603, but the much-reduced ninja continued to serve on both sides in various struggles. In one famous incident from 1600, a ninja snuck through a group of Tokugawas defenders at Hataya castle and planted the flag of the besieging army high on the front gate. The Edo Period under the Tokugawa Shogunate  from 1603–1868 brought stability and peace to Japan, bringing the ninja story to a close. Ninja skills and legends survived, though, and were embellished to enliven the movies, games, and comic books of today.

Family Law Essay Example | Topics and Well Written Essays - 2500 words

Family Law - Essay Example n his judgment, Lord Nicholls was of the view that: â€Å"Often than not, tribunals and courts in interpreting the requirement threshold outline under section 31 0f the Act have constantly have to decide whether or not an alleged event actually took place. In his wise decision, Lord Nicholls further observed that as a general rule where there is a possibility that a past event might have taken place then that is proof enough to the requisite standard or threshold and the law regards such an incident as definitely having taken place† 2 The legal implication of such a decision by the court is that the determination should be made following the statutory, legal policy or otherwise. Consequently, determination of such an issue is susceptible to change since it is the judiciary and not the legislature that sets the policy and it is still in the hands of the court to reconsider the viability solution for the problem. In the case of Lancashire County Council and Another v. Barlow and Another and One Other Action Lord Nicholls of Birkenhead stated that the court is empowered under section 31(1) of the 1989 Children Act to make an order putting the child under the local authority supervision or placing him or her under the care of local authority, or even under the care of a probate officer. Nevertheless, certain minimum conditions must be met before the court making such an order this conditions are usually referred to as threshold conditions. These threshold conditions are outlined under section 31(2) the 1989 Children Act which reads: A care order or a supervision order may be made by a court if it satisfied ­_ a); that the child in question is suffering, or is likely to suffer, substantial harm; and b). that the harm, or possibility of harm, is actually attributable to the... Courts have held that they are empowered under section 31(1) of the 1989 Children Act to make an order putting the child under the local authority supervision or placing him or her under the care of local authority, or even under the care of a probate officer. Nevertheless, certain minimum conditions must be met before the court making such an order this conditions are usually referred to as threshold conditions. These conditions include: that the child in question is suffering, or is likely to suffer, substantial harm; and that the harm, or possibility of harm, is actually attributable to the care accorded to the child, or the care likely to be given to the child in the event the order was not made, and the care not being what it would be rational to suppose a parent to give the child; or where the child is beyond control of the parent . The court further noted that in the interpretation of section 31 of the Children Act of 1989, particular attention should be paid under section 1(3 ) of the Act which sets out the Childs' welfare checklist. The welfare checklist under the foregoing section includes consideration of any harm that the child is at risk of suffering or any harm that the child concerned has suffered and the capability of each of the child's parent to satisfy the needs of the child. Accordingly, the connection between the casual likelihood need not be that direct, sole, or dominant cause and effect and that a causal connection that is contributory meet the requirements.

Role of International Non-Government Organizations Essay

Role of International Non-Government Organizations - Essay Example Risk identification is basically a process that allows an organization or a company to identify any potential risks that the organization faces. Risk identification is the first and one of the main steps of the risk management process. Organizations usually carry out risk management to ensure that their assets and their operations are not damaged by a certain imminent threat. In case the company is unable to prevent any threat from occurring the organization implements certain measures that ensure that the damage is kept to a minimum (Karolak, 1995).In this paper, the author will evaluate how the tourism industry of Thailand recovered from the aftermath of Tsunami in 2004 and what role was played by government, NGOs and other stakeholders in helping the industry to return to its usual form. The tsunami of December 2004 affected six provinces along Thailand’s Andaman coast. It had an impact on 407 villages, completely destroying 47 of them, and killing more than 8,200 people. As of December 2005, 929 bodies remained unidentified, though by May 2006 this number had been reduced to around 500Í ¾ these bodies are at the Bang Maruan cemetery in Tsunami that disrupted the environment and created economic problems for the country required a coordinated relief effort supported by the government and international agencies to prevent further destruction, build back Thailand and its tourism sector. In this regard, it is essential to take into consideration the role of the non-profitable organizations like NGO’s who played their part in integrating all the activities related to crises management. There were many national and international operations carried out who had the purpose of delivering aid to the affected persons. However, there were many difficulties faced by these non-government organizations.

Why Play is Important for Children Essay Example for Free

Why Play is Important for Children Essay Children like to play, they need to run, chase, ride, skip and jump. The more they play, the more they want to play again. Play is important for Children because it practices their linguistic, cognitive and social skills and contributes to their general personality development. Children use their minds while playing, because they are thinking and acting as if they were another person. When they make such a transformation, they are taking a step forward abstract thinking in that they are freeing their thoughts from a focus on concrete objects. Play is also associated with creativity, especially the ability to be less literal and more flexible in ones thinking. Vygotskian who was a famous Russian psychologist wrote, In play a child always above his average age, above his daily behaviour; in play it is as though he were a head taller than himself. There are four types of play that reflect increasing levels of Childrens social interaction and sophistication. Solitary play is a play that takes place alone, often with toys, and is independent of what other children are doing. Parallel play involves children engaged in the same game or activity side by side but with very little interaction or common influence. Associative play is much like parallel play but with increased levels of interaction in terms of sharing, turn-taking and general interest in what others are doing. Cooperative play occurs when Children join and work together to achieve a common goal, such as building a large castle with each child building a part of the structure. Play have become quite indispensable to Childrens life, However, in order to motivate Children to learn from the games they are playing, Adults have responsibility to choose right playing method and age-appropriate games for the children. They are important elements to support the development of Childrens play. Types of Child’s Play Child’s play is seemingly limited only by imagination, but in general there are a few broad categories of child’s play that tend to cover the most common activities. Child’s play is often: * Quiet. These activities can often be conducted in one place, such as looking at books or working with blocks.  Children do not need great amounts of energy for quiet play and these activities are especially useful when a child is tired. * Creative. These activities allow a child to engage his/her imagination through painting, dancing, sculpting with clay and much more. Creative play allows children to come up with their own worlds, and many children enjoy being in charge of these activities. * Active. These activities require a good amount of energy and often help children develop their gross and fine motor skills. Playing with balls and climbing frames are examples of active child’s play. Cooperative. These activities involve more than one child. When children play with others and share their toys or take turns in an activity, they engage in cooperative play. * Dramatic/Role playing. Like creative play, children engage their imaginations during dramatic play or role playing and often take on the persona of a different character. Some dramatic play may take place with other children, though it might also include toys, dolls or even imaginary friends. Encouraging Child’s Play One of the most important things that a parent can do for their children is to be available for play. Activities that many parents enjoy doing with their children include: * Playing peek-a-boo with infants. * Singing silly songs and nursery rhymes with young children. * Reading to children of all ages. * Taking part in their children’s tea parties, school days or whatever other imaginary events they have dreamed up. * Dressing up in â€Å"costumes† and performing plays written and directed by their children. * Kicking or throwing a ball in the garden or park. * Playing â€Å"I spy† while out on walks or long drives. * Building towers of blocks or sand castles at the beach. For many parents, child’s play may seem lovely though relatively unimportant. If you find yourself wondering at the hours your child can spend engrossed in play, remember that (s)he is actually learning all about the world through these activities. Don’t wait for your child to invite you, join in and enjoy yourselves together! Learning through play Play helps young children to learn and develop their physical, social, emotional and intellectual skills through doing and talking, which research has shown to be the means by which young children learn to think. It is also how they learn to socialise as children engage in learning experiences with other children and adults. The Early Years Foundation Stage is a play based framework that childcare providers use as a tool to ensure that children from birth to five years are developing and learning to their full potential. Providers plan and provide a range of play activities, which help children to make progress in each of the key areas of learning and development identified by the framework: * Personal, social and emotional development. * Communication, language and literacy. Problem solving, reasoning and numeracy. * Knowledge and understanding of the world. * Physical development. * Creative development. There are lots of opportunities for you to help your child grow and learn. Parents can support their child’s development by choosing activities at home which gives them a chance to explore and use their imaginations. Visit our play activities page for ideas for fun activities for you and your child. The leaflet Learning Through Play contains further tips on how you can support your childs learning.

The Emphasis on Existentialisim in Lispector’s Work Due to The Traditio

The Emphasis on Existentialisim in Lispector’s Work Due to The Traditional Roles of Women The human mind often creates traumatized, twisted beliefs about the world after cataclysmic events have occurred. Picture 1920- the world has just been ravaged by bullets, bombs, and baleful butchers with malicious intent. The aftermath of World War II leaves the country of Ukraine encompassed in terror, anguish, and famine. Imagine being ravenous enough to consider devouring a decomposing relative, and then putting that consideration into action. Imagine a country where pogroms- violent attacks on ethnic groups, mainly Jews, that included the destruction of homes, businesses, and churches –are not only regular, but not surprising occurrences. Imagine suppression, repression, oppression, all the â€Å"-ions†Ã¢â‚¬ ¦Now insert a nine-year old girl struggling to live in this madness, add the rape and death of that girl’s mother, and there is the childhood of the renowned Brazilian author, Clarice Lispector. These experiences, which would alter anyone’s views on life, influenced and helped to develop Lispector’s existentialist ways of thinking. In these past occurrences, gender inequalities were very much prominent, which explains why Lispector focuses on the fate of women in her writing. Due to the oppressive government, women were confined to their traditional roles and in showing the lack of freedom, both mentally and physically, that this imposes on them, Clarice Lispector justifies her existentialist viewpoints through her writings; life is pain, misery, and inevitably death. These viewpoints are imminent when discussing the overall lack of freedom in Lispector’s stories â€Å"The Chicken†, â€Å"The Smallest Woman in the World†, and â€Å"Preciousness†. Within... ...for giving birth, her obedient stay after being caught, and her sudden yet unsurprising death describes, in Lispector’s viewpoints, the natural course of an average female’s life. Although Lispector wrote these stories in the 1940’s, reflecting on the then current gender inequalities and hardships of life during the aftermath of WWII, these themes are evident in all time periods, for as Lispector has shown, the innate traditional roles of women along with the pre-conceived notion of men being more significant than women are evident even in our time. These limits reflect Lispector’s existentialist viewpoints in showing that the life of a woman is restrained; women’s lives are filled with pressure, sadness, and ultimately death.

Summary of “Little Things” by Raymond Carver

Raymond Carver’s short story entitled â€Å"Little Things† is a representation of internal situation in a house when a husband and a wife could not retrieve the love that once felt before. The author did not state the names of the characters but only used the words â€Å"she† and â€Å"he† to refer the names of the characters as husband and wife. This story is a situation that most families usually get into because of the separation and the child is the most affected in the whole scenario for he or she could not able to determine whether to go with his or her mother or with his or her father. The story begins when the man paced his own things for he decided to leave his family. the woman was happy as according to her that the man will leave but it was felt from her emotions that it is hard for her to accept the situation. After packing all the things in his suitcase, the man went to the living room to get the baby but the woman did not want the man to take the baby so she grabbed the baby into the man’s hand. The baby started to cry but the two did not mend the tears and shout of the baby. They did not let each other to get the baby so they grabbed each other’s hands. Related article: †On Compassion† summary Because the woman is much weaker than the man, the man obtained the baby. The woman could not accept it so she tried again but the decision went on as the story ended. Carver’s story is a detailed short story as it represents the signification of elements and images that exists within the whole narrative. It shows that he is capable of acquiring consequences that emerged in the home where men and women could not recognize their weaknesses and incapability that made them quit from being together. Reference Carver, R. (1988). Little Things. Tess Gallagher From Where I'm Calling From: The Selected Stories Atlantic Monthly Press, 1988.