Review of Literature Essay Example for Free

Review of Literature Essay According to the World Health Organization, â€Å"Health promotion is the process of enabling people to increase control over, and to improve, their health† (2014). It is no surprise that a large cause of death in the United States is often a combination of genetic and environmental factors, as well as lifestyle choices (Chiverton, Votava, Tortoretti, 2003). Health promotion has always been apart of the nursing profession, but the push toward health promotion is larger now than ever before. In regards to health promotion, this essay will examine the purpose of health promotion in nursing, the evolving roles nurses will take on and how nurses can effectively implement teaching of health promotion in patients. Purpose of Health Promotion In light of the new health care reforms, preventative care is becoming the new gold standard of health care. Community-based care has much more emphasis than it ever has in the past. As patient acuity continues to rise, the need for better community-based care and health prevention education has never been clearer. Promotion of wellness is one of the main curriculum taught in nursing education and is also built into the job description of the nursing profession. Nurses are able to have more interactions with patients than any other health care discipline, which helps provide the opportunity of forming a trusting relationship with the individual. Creating this type of relationship gives nurses the opportunity to teach patients important health promotion strategies that are tailored to each individuals needs. The main goal of health promotion is to help promote a long healthy life free from preventable diseases. Read more:  Assess Individual in Health Care Essay Nursing Roles and Responsibilities Evolving in Health Promotion Due to many changes in health care over the years, nurses do their best to  keep up with the many demands of their job description. Unfortunately, a lot of the time this means health promotion education does not get the deserved attention it should. New care models must focus on keeping individuals healthy to avoid getting caught up in the vicious cycle of managing and treating illnesses, which leaves no time for health promotion (Chiverton et al., 2003). In the past, nurses have educated patients on how to manage illness once the illness has been diagnosed. The new goal of nursing is to assess patients for risk factors, identify and then educate patients on how to transform their lifestyle to lower their risk of being susceptible to identified illnesses. In order for nurses to become successful in health promotion, they must first become an effective educator. One part of becoming an effective educator is being able to evaluate the retention of information by the individual. If information is not being retained, the nurse then needs to reevaluate teaching methods and create a new plan centered on the patients needs. Making sure patients understand information is a vital part of a nurse’s job, this ensures patients have the knowledge needed to lead a healthy lifestyle and avoid illness. Implementation Methods for Health Promotion When implementing health promotion it is necessary to set objectives through clear communication. Using medical jargon when teaching someone with little health care background knowledge may lead to ineffective teaching and poor patient outcomes. Once the objectives of teaching are clear and information has been taught to the individual, the nurse should then assess if the individual was able to retain the information. Teach-back method is a positive way to evaluate if the individual was able to understand what the nurse has taught. Health promotion teaching should not end with the initial teaching. Follow-up conversations should be had between the nurse and patient to evaluate positive or negative outcomes since first teaching sessions. From there, the nurse can then provide feedback and reinforcement of initial teaching if necessary. Continual monitoring and encouragement may be needed from the nurse in order to reach set health promotion objectives. Levels of Health Promotion Prevention Within the realm of health promotion there are three levels of prevention; primary, secondary and tertiary prevention. Primary prevention is used before there is any disease present in individuals and focuses mainly on health promotion. Examples of primary prevention could be visiting a primary care physician regularly, receiving immunizations and becoming educated about physical activity. The main goal within this level of prevention is to create awareness within individuals and decrease vulnerability to illnesses (Edelman, Kudzma Mandle, 2014, p. 11). Primary prevention is most likely to produce positive outcomes if education is started at a young age (Doering, et al., 2014). Not all illnesses are preventable, and that is where secondary prevention plays a key role. A common example of secondary prevention includes regular health screenings to promote early detection and treatment of illnesses such as breast cancer. Secondary prevention can also be used for those with illnesses th at could have been prevented at the primary level like a heart attack. The goal of this level of prevention is early detection of illnesses to limit the amount of disability the illness may cause (Edelman, et al., 2014, p.15). Secondary prevention is pivotal in the adult population, and for this reason has become highly studied by nurse scientists (Tingen, Andrews, Stevenson, 2009). Finally there is a tertiary level of prevention, which is used when there is permanent disability or damage from an illness. An example of tertiary prevention could be regaining mobility to a livable level of functioning in an individual who has suffered from an amputation secondary to uncontrolled diabetes. The goal at this level of prevention is to rehabilitate a person to a â€Å"useful place in society† (Edelman, et al., 2014, p.15). Tertiary prevention usually includes a combination of self-help and professional help (Quick, Wright, Adkins, Nelson, Quick, 2013). Providing the disabled individual with resources and services is essential to help enable them to reach their highest level of recovery and functioning. Conclusion Health promotion will continue to be an important role in the nursing profession. Being able to effectively educate patients and create individualized plans will help each patient reach optimal outcomes. Finally,  understanding the different levels of health promotion, and starting education at a young age is ideal for positive patient outcomes. References Chiverton, P. A., Votava, K., Tortoretti, D. M. (2003). The future role of nursing in health promotion. American Journal Of Health Promotion, 18(2), 192-194. Doering, N., Hansson, L. M., Andersson, E., Bohman, B., Westin, M., Magnusson, M., Rasmussen, F. (2014). Primary prevention of childhood obesity through counseling sessions at Swedish child health centres: design, methods and baseline sample characteristics of the PRIMROSE cluster-randomised tri. BMC Public Health, 14(1), 1-24. doi:10.1186/1471-2458-14-335 Edelman, C., Kudzma, E., Mandle, C. (2014). Health Promotion Throughout the Life Span, 8th Edition [VitalSource Bookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/978-0-323-09141-1 Quick, J., Wright, T. A., Adkins, J. A., Nelson, D. L., Quick, J. D. (2013). Tertiary prevention for individuals: Healing the wounds. Preventive stress management in organizations (2nd ed.). Washington, DC US: American Psychological Association. doi:10.1037/13942-012 Tingen, M., Andrews, J., Stevenson, A. (2009). Primary and secondary tobacco prevention in youth. Annual Review Of Nursing Research, 27171-193. doi:10.1891/0739-6686.27.171 World Health Organization. (2014). Health promotion. Retrieved from http://www.who.int/topics/health_promotion/en/

Millennial Generation

Millennial Generation Chapter 1 Introduction 1.1 Overview The current world that we live now is being strongly influenced by the high technology waves. This kind of waves are altering our operations in business sectors like finance, economic, accounting and as well as insurance. Internet and its connectivity are increasingly important as the role of connecting people all over the world in the most cheapest and efficiency way. It is now become a necessary in all the peoples lives. According to the research, there are around 9.3 million people in Malaysia age 15 and above using internet at home or work locations, each of them consuming average of 1,066 pages of content and spending 14 hours online in June, 2009 (Comscore,2009). Internet is a new distribution channel for businesses to market and promote their products and services in order to increase their revenues, profitability and customers loyalty. For successfully enter and adapt in the new evolution of technology and electronic, businesses had change their operation structures into tec hnology-intensive based. Some businesses from shops to financial institutions even changed most of their products and services into E-based products or services. Generation Y also can be known as â€Å"Millennial Generation†. From its name, it obviously stated that this generation closely related to high technology and digital electronics. This generation mostly owned computer and have higher education. They frequently used high-technology products and services and they willing to be the innovator for using new E-product. Generation Y is an influential factor towards the future development in E-based services and products. Therefore, most businesses will focus their customer target on generation Y in the coming years. We are now entering into new phase of technology and electronics. With trimness of electronics technology many electronic tools and gadgets have become increasingly personal and portable. It makes people can surf net whenever and wherever they are. The conveniences of communication and networking have stimulated the growth of E-commerce. E-commerce can be translated as any form of businesses that using information technology for transaction. In order to stay ahead in millennium age, most of the companies used E-commerce regardless of business to business (B2B) or business to customer (B2C) or even customer to customer (C2C) (Ahonen, 2004). Services sector like banking also promote internet banking or online banking to facilitate their efficiency in the banking transaction. Online banking can reduce some unnecessarily procedures and provides convenience to customers. Yet insurance industry has been lagging behind others services industries in adapting new technology era. In addition, there are many researches done for investigating the factors that affect adoption of internet among different sectors in Malaysia (Stevens, 2002; Soliman, 2003; Wirtz, 2001; Coltman, 2001), but empirical data for e-insurance was limited due to insurance industry has been slow respond to e-commerce compared to other financial services (Esters, 1997). Insurance institutions have the direct competition with banking and financial institutions. It is the great time for insurance companies to utilize the convenience of communications and networking in establishing direct interface with customers. E-insurance is broadly defined as distribution of insurance services through information technology. The direct channel can eliminates the intermediaries, provides more efficiency, lower cost and more value added to the customers. Other than online purchases, E-insurance can offer varied types of services like online payments, register claims, review claims and renew insurance policy. Besides that, e-insurance also can reduce the level of management hierarchy and internal administration cost by automating all the business processes. There are some limitations of the regulatory for fully applied the e-commerce in certain countries. However, the insurance legislation world wide has been continuously updated and modified to fulfil e-insurance m etrics (Ahonen, 2007). This study examines the perception and expectation of generation Y towards E-insurance. It discusses about the existing e-commerce applied in insurance industry and the expectation of generation Y on the improvement in E-insurance in the future. The new high technology and electronic era started, it links the generation Y and the insurance industry together. It is important to examine the relationship between generation Y and E-insurance. Generation Y act as knowledgeable customers, they are pursuing simple, convenient, fast and efficiency services at lower prices. Therefore, it is the need for insurance companies to introduce E-insurance that satisfied the customers need. 1.2 Statement of problem E-commerce had widespread all over the various business from education to real estate sector. It will continue to grow up unabatedly because information is now the lifeblood of successful business. The importance of e-commerce can be seen from the Ninth Malaysian Plan (2006-2010); Malaysian Government has allocated RM 12.9 billion for developing e-commerce. According to the survey conducted by Nielsen Company (2007), there are 70% of internet users in Malaysia purchased online at some point in past. So there are many potential opportunities in e-commerce nowadays. Internet and electronic communication enables companies exchange or transfer their information to the other part of the worlds without boundaries. E-commerce also provides a new distribution channel for businesses to deliver their products or services to customers more efficiency and fast. Meanwhile, companies can connect their customers worldwide in real time. It can establish long term relationship with their customers. Since there are many advantages in adopting e-commerce, yet, not all businesses can successfully fully applied e-commerce especially insurance industry. Insurance industry has been lagging behind in the adoption of e-commerce. There are some barriers on adoption of e-commerce in insurance industry. All the business sectors included financial services sectors have been revolved to new e-commerce era because of the domino effect of globalization and liberalization around the world since 1990s (Piercy, 1999). New entrants of e-retailers of financial services sectors lead to intense competition among financial services providers. There is a need to improve service quality of their service in order to survive in the global market place. Yet, consumers are less likely to purchase online than expected in despite of the huge investments in online banking (Sarel Marmorstein, 2003; Wang, 2003). Better understanding of factors that affect customers acceptance on using internet banking is prerequisite of obtaining success in conducting e-commerce. However, lack of research on perception of consumers toward e-insurance in Malaysia. Another important issue is consumers feel unreliable towards security and privacy of e-commerce website (Jà ¤rvinen, 2001). Insurance policy requires exchanges of huge amounts information between the parties. Electronic exchange data or information that needed in insurance policy is an ideal way because Internet enables transfer data over worldwide. Yet the only concern is the private confidential of the data when it is being transfer through internet or any other electronic method. Because of the anonymous nature in internet, insured unable to ensure the data is transferred to the right person. In electronic environment, there is no guarantee of the data or information that being transferred is sealed and did not review by others. In addition, electronic exchange data can cause security problems like customer database may be hacked by someone who has negative intention. Furthermore, electronic documents without physical signatures are easily being pirated. According to Forrester r esearch 2001, the main reason (59%) of young consumers not purchase online is concern about the use of credit cards online and the second reason (47%) is concern about the privacy of the data they sent out to website. Besides, about 75% of US consumers of the Boston Consulting Groups survey are concerned about the degree of security and privacy provided in electronic environment (Goldman, 2001). There is a need for insurance companies to solve this problem by review other banks in gaining consumers trust towards online services (Mattila, 2003). In Malaysia, government had encouraged the development of E-insurance since January 2005. Persatuan Insurans Am Malaysia (PIAM) released the news of motorists will be the main beneficiary of the JPJs e-Insurance Project with effect from 1st January 2005. On 5th October 2004, Minister of Transport was launched an IT-based service with the full support of the JPJ, general insurers and takaful operators. The e-Insurance enables insurance companies to enter their policyholders motor insurance details and transmit them electronically to JPJs computer database for processing. With full implementation of e-Insurance, it minimizes the problems like long queues at the JPJ counters, shortening waiting times at the JPJ counters, reducing the need for repetitive capture of data will also ensure accuracy and consistency of data in JPJs database and eliminating physical motor cover notes will help resolve the problems of forged cover notes as well as reduce document inventory (PIAM, 2005). E-insur ance has brought to us many benefits but it still uncommon in Malaysia. E-commerce has brought a lot of questions. Is insurance industry suitable to apply e-commerce? How E-insurance ensured security and privacy of insureds information and data? What are the expectations of generation Y towards future E-insurance? How generation Y perceived adoption of E-insurance? Is adoption e-commerce an advantage or disadvantage for insurance industry? This study wants to lift up the veil of E-insurance. 1.3 Research objective The general objective of my study is to investigate the perception of generation Y towards E-insurance. The other objectives are: 1.) To study awareness and expectation of generation Y towards E-insurance. From this study, we want to know the high education generation Y perceived E-insurance. E-insurance is important for insurance industry in step out the first step of pursuing low cost customer services. Generation Y are their priority target of E-insurances product because generation Y have much of knowledge in computer. Generation Y treated as the future talented human capital of a country. They are high education and expertise in using computer. Therefore, their expectations and future requirements about E-insurance are important success factors of insurance industry. 2.) To examine the adoption of e-insurance in Malaysia E-insurance has not fully implemented in Malaysia. It is crucial to examine the current situation of adoption on e-insurance in Malaysia. 3.) To investigate the factors that can influence the perception of generation Y towards E-insurance and the adoption of e-insurance To establish long term relationship with customers, it is critical to investigate all the possible factors that may affect the views of the potential customers towards E-insurance. A good service is able to satisfy all the customers need. 1.4 Significance of study Insurance is essential for everyone. It provides a sense of security and peace of mind to us. It also provides financial stability to individual and businesses if insured risk occurs such as flooding, fires, accident or ill health. Insurance is a major component of financial sector. Nowadays, the adoption of e-commerce in financial sector has become obvious. Yet, the insurance sectors are lagging behind. This is mainly due to the complicated transaction involved in insurance industry. This study is aim to investigate the perception and expectation on generation Y on electronic insurance services as well as their willingness to accept E-insurance. Insurance industry in Malaysia have not fully implement e-insurance yet. Most of the consumers feel uncertainty towards this new e-commerce and some even do not aware about this. We are able to know the degree of awareness of generation Y towards e-insurance from the research. Generation Y are potential customers for e-insurance, their awareness of e-insurance is important to the development on insurance industry. According to previous research, it also showed that younger and high educated males with high level of income have higher probability to use internet banking services (Devlin Yeung, 2003). E-insurance also can be categorised as one kind of internet banking services, so perception of younger internet users towards e-insurance is important. The effect of liberalization and globalization around the world influenced the business sectors in Malaysia significantly. Liberalization allowed business transactions can be conducted cross over the boundaries of countries freely. E-commerce should be developed in Malaysia in order to gain the global competitiveness. Compared to other developing countries, Malaysia is lagging behind. In order to compete with other countries, Malaysia government need to support organization in adapting the changes in term of technological. E-commerce provides a new distribution channel for products and services which able to help companies deliver their products and services to customers efficiently all around the world. Although e-commerce provides many competitive advantages for business sector, however, insurance industry in Malaysia still have not implement the electronic insurance completely. It is necessary for government to generate effective strategy for establishing e-insurance in Malaysia. The antecedent of effective strategy is to obtain a clear understanding of perception of customer towards e-insurance. This study benefits government in term of more understand the customers need towards e-insurance, so government and business sector can complement with each other for establishing e-insurance in Malaysia successfully. Service itself is considered as interactive process whereby customers involved in the production process. Insurance is one kind of this service. Since insurance is an interactive process, customers viewpoint on the new electronic insurance must be paid with full attention. This study focuses on generation Ys response on the development of new electronic insurance because most internet users are generation Y now. With the generation Ys future wishes for electronic insurance, a user friendly and suitable E-insurance concept can be developed. This study also benefits insurance companies in developing the electronic insurance service which can satisfy customers need. A well-developed e-insurance service can meet customers requirement and increase their satisfaction. The speed of adoption on e-insurance in Malaysia will be improved. Society also benefited from the study because adoption in e-insurance enables them to access the insurance services through internet whenever and wherever they are. The success of establish e-insurance in Malaysia will bring many advantages to customers. E-insurance provides longer operation time, convenience, less transaction cost needed, and less processing time to customers. E-service has changed the way of people organize their lives. It enables people to make comparisons among the products or services through internet. The study also examines the customers concern towards security and privacy of e-insurance. Hence, after completed the study, the security and privacy of e-insurance systems can be enhanced according to the concern of society. This study investigate the relationship between generation Y and E-insurance and their expectation and perception on E-insurance in order to better establish a new era electronic insurance and to maintain long term relationship with customers. 1.5 Organization of study In chapter 1, the research begins with brief introduction to the topic â€Å"perception and expectation of generation Y towards E-insurance†. In the introduction, it briefly explained the term of e-insurance and generation Y and the relationship between them. After we have some basic ideas about the topic, problem statements of the study developed. The issues of e-insurance were addressed in the study. Objectives of the study are stated down and followed by explaining significant of study. Chapter 2: Literature review 2.1 Services and Goods Goods can be defined as physical products that being produced and sold to the market (Winsor, Sheth Manolis, 2004). In addition, goods also considered as something physical and tangible in nature that customers can feel, smell, taste or hear it prior purchase or make consumption (Rathmell, 1966; Shostack, 1977; Zeithaml, 1985). On the other hands, services are totally opposite to the characteristics of goods. Services normally are classified under intangible characteristics which cannot be touched, smelled, tasted, hear by customer before purchase and make consumption. Furthermore, services also can be classified as a product, a process involves of many activities and can be produced and consumed at the same time, and to some extent customers may participate in the service production process (Grà ¶nroos, 2000). One of the researchers defines service as something can be bought and sold but which you cannot drop on your feet, this definition points out intangible characteristics of service (Gummesson, 1987). Besides that, service also defines as an act that offered by other party (Lovelock and Wright, 2002). There are four main attributes that help in distinguishing between goods and services namely, tangible or intangible (the degree of physical feature), separability or inseparability (the degree of linkage between the product or service and providers and customers), variability or invariability (the degree consistency of the products or services attributes) and perishability (the degree of capacity for being stocked) (Berry, 1980; Fisk, 1993; Gronroos, 1998; Kotler, 1994; Shostack, 1977; Zeithaml, 1985). From the four main attributes, it clearly states that the things that classified as services only when it fulfilled the four main characteristics of intangibility, inseparability, variability and perishability. For example, hair cut service, it does not provide any tangible product to its customer but only intangible service, throughout the hair cut service, it need participation of customer, the hair cut services are inconsistency in quality and it cannot be stocked. Furthermore, among the four attributes of differentiating the goods and services, the intangible characteristic is the best definitive for services (Bateson, 1977; Bebko, 2000; Berry, 1980; Levitt, 1981; McDougall Snetsinger, 1990). Various definitions that used to define services stated above are prefers to include the intangibility features into the statements. Hence, intangibility characteristic of service is the most representative attribute for services in order to distinguish goods and services. However, the tangibility feature is becoming less useful and less definitive for distinguishing between goods and services in digital environment (Rust Oliver, 1999). This is due to digitized goods are consists of both tangible and intangible characteristics. For examples, online purchase DVD is intangible in nature because customers cannot touch or feel the product before the actual tangible product received. The development of electronic environment has blurred the clear distinctio n between goods and services by using intangibility attributes. In order to fill up the inadequacy of tangibility criterion, another framework which used four types of utilities to differentiate goods and services has been developed (Winsor, Sheth Manolis, 2004). The four types of utilities are time, place, form and possession. All retailers will provide time and place utilities to customers, the only differences can be make between goods and services is in term of form and possession (Rathmell, 1966; Hsieh Chu, 1992). Physical goods will only contributing little form utility for customers compared to service whereas the permanent of transfer of possession utility only completed when customers are purchased physical products rather than services (Clemes, 2000). According to this framework, insurance is classified as hybrid retailing or a mixture of goods and services because it provides a moderate degree of form and possession utilities. 2.2 E-service The new era of e-service has begun since the development of internet being introduced in 1994 (Ahonen, 2004). There are three phases of internet according to the previous research (Kalakota Robinson, 2001). The beginning phase (1994-1997) is home pages and website of every company available. The following phase (1997-2000) is taking part into e-commerce in business. The last phase (2000-) which means the current situation is to satisfy online consumers and try to take advantages of internet. However, the development of e-service of our country is lagging behind when compared to other foreign country. Although many researchers have defined e-service before, but there is no an exceptional definition for e-service. E-service can be known as a service that conducts through electronic method such as internet (Rust Kannan, 2002). There is a difference between technology based service and e-service concept, the latter concept need to be carried out through online method whereas technology based services can be an ATM service. Both of the concepts are benefited from development of information technology (Jà ¤rvinen Lehtinen, 2003). In an electronic environment, the service concept is important because the nature of the services is abstract and where the relationships between partners and customers are virtual (Grà ¶nroos, 2000). Since electronic insurance services are perceived as complex and difficult to use, therefore clear and well defined service concept should be emphasized (Jà ¤rvinen 2001; Ahonen Salonen 2005). There are four chosen characteristics, namely, intangibility, process nature, inseparability and interaction that used to test some selected e-services in previous research (Jà ¤rvinen Lehtinen, 2004). All e-services are intangibility in nature and remain intangibility if the consumers only search for information of particular product or service through online. There are only few services consists purely intangible characteristic. For example, previous studies stated that even financial services also aided tangible by their documents like loan agreement (Jà ¤rvinen Lehtinen, 2004). The characteristics of process nature also universal for all studied e-services which means that the customers need to be follow the specific procedures in order to get the services. Inseparability and interaction characteristics are deviated among different e-services (Jà ¤rvinen Lehtinen, 2004). Some characteristics of services in electronic environment have to be considered in order to shift the s ervice concept to (Ahonen, 2004). For e-service, it seldom needs personal interaction when compared to telephone based services (Lovelock, 2002). However, the argument is human factor plays an important role in service recovery when technical problems happened (Jà ¤rvinen Lehtinen, 2004). In addition, E-services can bring considerable profit for companies if they able to manage the e-service effectively. However, not all the products and services are suitable for online trading because internet as a marketing channel only able to realistically fulfill two out of five senses of customers which are sight and sound. Therefore, only products and services that fully utilize the two senses are suitable to sell online for example, CD (Stern, 1995). According to other researcher, Peterson (1997) suggested that the suitability of the products and services to be sold online based on three dimensions: (1) cost outlay and frequency of purchase; (2) value proposition; (3) degree of differentiation Based on the study, products and services that have low cost, high frequency in purchase, intangible value proposition and high degree of differentiation are more suitable to market through internet (Phau Poon, 2000). Is insurance suitable to sell online? Regarding to the three dimensions above, insurance has fulfilled two dimensions which are intangible value proposition and high degree of differentiation because insurance is considered as a customization service. Hence, insurance is considered suitable for marketing through internet. For successfully implement e-service, it not only depends of the suitability of the products and services but also depends on the customers perception towards e-service. Based on previous studies, the overall satisfaction of customer towards e-service can be improved through various factors which included convenience, saving time and money, ease of use, financial security and web site designed to be fun (Szymanski Hise, 2000; Meuter, 2000). Customers satisfaction is important determinant of successful e-service (Parasuraman Grewal, 2000). In order to successfully implement e-insurance in Malaysia, those factors also included in this study to determine adoption of e-insurance. 2.3 Insurance Insurance is defined as the evenhanded transfer of the risk of a potential loss, from one entity to another, in exchange for a premium and duty of care (Wikipedia, 2005). Insurer is the company that sells the insurance, and the insured is the party who buy the insurance. Insurance rate is the amount charged for a certain value of insurance. Insurance sold to consumers directly is known as direct insurance (Skipper, 1998). Meanwhile, direct insurance also can be defined as a service with particular terms and conditions agreed in an insurance policy. On the other hands, one of the researchers stated that part of the insurance service is to maintain a long term relationship between customers and insurance company rather than only holding legal responsibility with customers (Jà ¤rvinen, 1996). Intangibility, inseparability, perishability, heterogeneity and lack of ownership are characteristics of services (Cowell 1988; Zeithaml Bitner 1996). However, all these characteristics do not followed by insurance service. The tangibility of insurance services achieves through a physical paper of an insurance policy including a promise to pay compensation if a certain unforeseen event takes place. The insurance policy symbolizes the only evidence of that promise until losses occur (Majaro, 1982; 1985). In fact, no policyholder would prefer to have any losses, and thus we can conclude that consumers only purchase merely security or protection for their safety instead of compensation of losses. So, as a result it is in force to cause consumers consume insurance whole period that is a continuous consumption, but production is cross-sectional and dependent of the interaction of the consumer and the insurance company. Therefore, insurance service only partially fulfilled the characteris tic of inseparability. One of the unique natures of each service is heterogeneity on its part. There are various alternatives of insurance for consumers to choose which insurance policy is suitable for them but the terms and cover of most of the insurance is standardized (Jà ¤rvinen, 1998). In case of e-insurance, the heterogeneity part of the personal service forms the only unique part of insurance is eliminated. The back-office resources in insurance that used to balance the capacity can avoid perishability. As a result, large part of activities in E-insurance can be carried out without consumers existence and participation. Lastly, as regards to ownership, insurance holders actually own the partial ownership of the service because they reserve the right for claims settlements that will be paid from the reserves in the balance sheet of an insurance company by paying premium (Jà ¤rvinen, 2000). This means that insured consumers own their part of reserves, and that principle is based in Insurance Act. Co nsequently, we can conclude that the insurance service is quite specific from other services because it only fulfilled partially of the common service characteristics. One of the financial services is insurance, it seems to have different user frequency when compared to other bank services (Jà ¤rvinen, 2003). Specifically, consumers may have bank transactions weekly, but in case of insurance issues, such as risk analysis and insurance cover or claims applications, occur quite infrequently and with low frequency (Ahjos, 1999). Hence, there may be only one occurrence within few years, and that is premium payment. Thus, insurance deviates from bank services and in the case of Internet which means that consumers may never get used to e-insurance, because their actions are needed too rarely. Low frequency and infrequency may also be reasons that obstruct the consumers engagement, which may become the crucial point in developing e-insurance. Generally, insurance services is quite different from others banking services. Insurance companies have to take care of every step in implementing e-insurance successfully. This study is tries to unveil the mystery of insurance services in Malaysia. 2.4 Insurance in Malaysia The beginning of insurance launched in Malaysia can be traced to 18th and 19th centuries which transformed from the agency houses that acted as representative of insurance companies in United Kingdom. Hence, the insurance industry has been strongly influenced by the British insurance system and continued until today. At that time, almost all the insurance companies were established by foreign insurer. Domestic insurance companies were only being introduced in Malaysia after Independence Day. However, domestic insurance companies have faced failure and wound up due to inadequate technical and sound operation in the early 1960. To solve this problem, Malaysian government enacted insurance Act 1963 to regulate insurance industry which functioning under Ministry of Finance. The Insurance Act 1996 has replaced the Insurance Act 1963 on 1st January 1997 in order to supervise and regulate insurance industry more effectively (Ahmad Sungip, 2008). Basically, there are three types of insurance industry in Malaysia which included life insurance industry, general insurance industry and Takaful insurance industry (Aini Tee, 2003). Life insurance is insurance policy that covers variety of contingencies event occurred on human life whereas general insurance is all types of insurance policy except for life insurance. On the other hands, Takaful is insurance which based on Islamic principles (EconomicWatch, 2009). There are five main statutory insurance associations in Malaysia namely, Persatuan Insuran Am Malaysia (PIAM), Life Insurance Association of Malaysia (LIAM), Persatuan Insuran Kebangsaan Malaysia (NIAM), Insurance Brokers Association of Malaysia (IBAM) and Association of Malaysian Loss Adjuster (AMLA) (PIAM, 2009). Each statutory insurance association has different function. PIAM is an association of general (non-life) insurers, LIAM is an association of life insurers, NIAM is represents locally incorporated insurer with m ore than 51% Malaysian equity, IBAM is an association of insurance brokers, AMLA is an association of insurance brokers. Insurance companies in Malaysia were only started to conduct e-commerce in 1999 which was much slower when compared to other developed countries. During that period, Bank Negara Malaysia has allowed some of the insurance companies to establish Malaysia first interactive insurance website which enabled insured can make online payment and renewal of motor vehicles insurance policy. Till April 2000, Bank Negara Malaysia allowed a full range of life, general an

The Utopian Philosophy of Shangri-La in James Hiltons Lost Horizon Ess

The Utopian Philosophy of Shangri-La in James Hilton's Lost Horizon    For some people life may not be satisfactory. Life has many troubles including death, pain, and suffering. It leaves little hope. There are ways in which people can live to have a good life. This method of how a person should live is viewed differently thoughout the world. James Hilton represents this combination of ideas and cultures in the novel, Lost Horizon (1933). This novel tells the tale of four distinctively different people retreating from a war zone. In their retreat they are kidnapped and taken by plane deep into the Himalayan mountain wilderness. Little did they know that here in the confines of the mountains there is a paradise. This paradise is called Shangri-La and is a Tibetan Monastery and community in a place of splendid beauty. Surprisingly, the kidnapped group finds that they are considered guests in this elevated community. They are apprehensive of the cerebrated treatment that they receive, but soon accept and enjoy their "misfortune." Shangri-La is a paradise, but the guests become held prisoner to pleasure and happiness. In the time they spend at Shangri-La they learn that this is a Utopia where they do not age. Because of the people's long life, they find time to become educated and "achieve calmness and profundity, ripeness and wisdom, and the clear enchantment of memory" (155). Surprisingly, the paradise is rich in culture. It contained work of art that "museums and millionaire alike would have bargained for" (94). Along with the arts, Shangri-La's library contains "a multitude of books †¦ that the whole atmosphere was more of wisdom than of learning" (95). The distinct philosophical views of Shangri-La create the essence of th... ...bligation. Kant's theory to portray virtue is evident throughout the novel's setting to make sure that everyone will "find everything quite satisfactory" (68).    These four distinctively different philosophical theories create a complex web of mental environment, which is the most important aspect of the setting in this novel. These philosophies are so effectively blended into the spirit of Shangri-La, that they created a new philosophical fusion: a perfect society. The philosophical beliefs of the Shangri-Lain culture is what frames it into a Utopia. The philosophy is not only the setting, it is the deeper meaning of the story. This setting gives hope to the weary, and may be a link into the development, through philosophical understanding, of a perfect world. Works Cited Hilton, James. Lost Horizon. PocketBooks: Simon & Schuster Inc. New York, 1960.

Lost Dreams :: essays research papers

Lost Dreams   Ã‚  Ã‚  Ã‚  Ã‚  Remember as a little child, and all those dreams you had? You did anything to make those dreams come true, only to find out in two minutes everything could change. The dreams were gone, the struggle it took to get there seemed futile, and the life that was once organized was useless. Less than a year ago, I found out what exactly what that meant; all the hard work, the planning, and the dream were gone in two minutes.   Ã‚  Ã‚  Ã‚  Ã‚  The sun was bright and sunny that April morning, Florida seemed to always start spring right. It was my first time in Florida and Walt Disney World. I liked the weather and, most of all I was happy to be there to cheer. As a senior in high school, it was my last year to cheer with the girls I have cheered with since I was seven, and if that was not enough it was my last year on an all-girl team. I was going to attend Florida State University in the fall of 2004 and cheer on a co-ed team. The Florida State University coach and the high school coach were there to see me perform. By the morning of the competition, I was ready to prove myself to the coaches and my team. We crammed into an old school bus to ride us to the competition at Walt Disney World. When we got to the competition, I had to register in my individual event. After registration, the team got ready to perform.  Ã‚  Ã‚  Ã‚  Ã‚  The smell of hairspray overwhelmed us as the representative of the National Cheerleading Association said, â€Å"Maryland Twisters, you may take the floor.†   Ã‚  Ã‚  Ã‚  Ã‚  My body got cold for the first time in seven years. I was scared of a two-minute routine that I had practiced a thousand times. When I stepped onto the stage, I could feel my heart as it rapidly pumped. I was scared, as we set for the routine. The first task to complete was a standing tumbling. â€Å"Come on Michelle, jump!† I screamed inside my head. â€Å"You have to pull your legs around.† I landed. â€Å"Good, next was running tumbling.† As I moved to the next spot to start my running tumbling, everything seemed to move in slow motion. I was the last tumbler to go. â€Å"six†¦five†¦four†¦three†¦two†¦one† It was my turn. My legs started to run; my hands hit, then my feet. So far, I was okay.

Looking Backward by Edward Bellamy Essay -- essays research papers

Looking Backward   Ã‚  Ã‚  Ã‚  Ã‚  The book Looking Backward was written by Edward Bellamy and published in the year 1888. Bellamy started off his career as a journalist but then married and decided to devote his efforts to writing fiction novels. Looking Backward was published and Bellamy was famous. The book stirred around the country and had people imagining a world like the one Bellamy created in his book. The idea of a utopia as the one he describes is unbelievable. His book is what people, of even now in the twenty first century, wish the world could possible be like. However, Bellamy’s world of reasoning and judging of people based on the inner beliefs was not what people of then or now do. Bellamy’s book showed a world of rationality being applied to create a world of down right good and generous people. If rationality was every used to create a wholesome war-hearted society than the picture that Bellamy envisioned would be true today. Bellamy built his utopia upon the positio n that individuals did not compete with one another.   Ã‚  Ã‚  Ã‚  Ã‚  The story starts with a preface that explains the sum of the story. The story introduces the fact that Bellamy is writing as if it is already the twentieth century and the world is looked at through rationality. Bellamy uses the character Julian West to represent industrialization and how his utopia are used as the answers is used as the answers to industrialization problems, and Dr. Leete to represe...

Food Chains, Food Web, Ecological Pyramids Essay

In an ecosystem, plants capture the sun’s energy and use it to convert inorganic compounds into energy-rich organic compounds. This process of using the sun’s energy to convert minerals (such as magnesium or nitrogen) in the soil into green leaves, or carrots, or strawberries, is called photosynthesis. Photosynthesis is only the beginning of a chain of energy conversions. There are many types of animals that will eat the products of the photosynthesis process. Examples are deer eating shrub leaves, rabbits eating carrots, or worms eating grass. When these animals eat these plant products, food energy and organic compounds are transferred from the plants to the animals. These animals are in turn eaten by other animals, again transferring energy and organic compounds from one animal to another. Examples would be lions eating zebras, foxes eating rabbits, or birds eating worms. This chain of energy transferring from one species to another can continue several more times, but it eventually ends. It ends with the dead animals that are broken down and used as food or nutrition by bacteria and fungi. As these organisms, referred to as decomposers, feed from the dead animals, they break down the complex organic compounds into simple nutrients. Decomposers play a very important role in this world because they take care of breaking down (cleaning) many dead material. There are more than 100,000 different types of decomposer organisms! These simpler nutrients are returned to the soil and can be used again by plants. The energy transformation chain starts all over again. Producers: Organisms, such as plants, that produce their own food are called autotrophs. The autotrophs, as mentioned before, convert inorganic compounds into organic compounds. They are called producers because all of the species of the ecosystem depend on them. Consumers: All the organisms that can not make their own food (and need producers) are called heterotrophs. In an ecosystem heterotrophs are called consumers because they depend on others. They obtain food by eating other organisms. There are different levels of consumers. Those that feed directly from producers, i.e. organisms that eat plant or plant products are called primary consumers. In the figure above the grasshopper is a primary consumer. Organisms that feed on primary consumers are called secondary consumers. Those who feed on secondary consumers are tertiary consumers. In the figure above the snake acts as a secondary consumer and the hawk as a tertiary consumer. Some organisms, like the squirrel are at different levels. When the squirrel eats acorns or fruits (which are plant product), it is a primary consumer; however, when it eats insects or nestling birds, it is a tertiary consumer. Consumers are also classified depending on what they eat; they can be herbivores, carnivores, omnivores or scavengers. In looking at the previous picture, the concept of food chain looks very simple, but in reality it is more complex. Think about it. How many different animals eat grass? And from the Facts about Red-tailed Hawks page, how many different foods does the hawk eat? One doesn’t find simple independent food chains in an ecosystem, but many interdependent and complex food chains that look more like a web and are therefore called food webs. We described in the previous sections how energy and organic compounds are passed from one trophic level to the next. What was not mentioned is the efficiency of the transfer. In a highly efficient transfer almost all of the energy would be transferred — 80% or more. In a low efficiency transfer very little energy would be transferred — less than 20%. In a typical food chain, not all animals or plants are eaten by the next trophic level. In addition, there are portions or materials (such as beaks, shells, bones, etc.) that are also not eaten. That is why the transfer of matter and energy from one trophic level to the next is not an efficient one. One way to calculate the energy transfer is by measuring or sizing the energy at one trophic level and then at the next. Calorie is a unit of measure used for energy. The energy transfer from one trophic level to the next is about 10%. For example, if there are 10,000 calories at one level, only 1,000 are transferred to the next. This 10% energy and material transfer rule can be depicted with an ecological pyramid that looks like the one below. This pyramid helps one visualize the fact that in an ecological system there need to be many producing organisms at the bottom of the pyramid to be able to sustain just a couple of organisms at the top. In looking at the pyramid, can you guess how much larger the volume of each layer is as compared to the one just above it? Take a guess. It might not look like it but they are close to 10 times larger. A basic pyramid shape often represents a typical food chain or food web. The pyramid represents the decrease in the amount of energy, the number of organisms and the biomass from the producer to the high – order consumer levels. The decrease in the numbers and in the biomass represent the fact that, due to energy loss, fewer organisms can be supported at each successive trophic level. Pyramid of Energy Energy is lost between each link in a food chain. Much of the potential energy at each level never reaches the next level. Where does the energy go as it moves through a food chain? Some of the energy that enters a food chain is used as each organism carries out its life functions (i.e. foraging, metabolic processes, reproduction, predator/prey behavior, etc.). Producers manufacture their own food source directly from sunlight by the process of photosynthesis. In order to carry out life functions, consumers acquire energy through the ‘burning’ or breaking down of food molecules they consume (eat). Thermal energy (heat) is produced as a result of the burning of these food molecules. More than half of the energy from each food molecule is lost as heat. Only about 10% – 20% of energy at each trophic level is available to pass on to the next level. In other words, at each level there is only about 10% available energy to put on new biomass (growth). Pyramid of Numbers The loss of energy at each trophic level also explains why there are usually fewer organisms in each higher trophic level. The total number of plants in a particular area would generally be higher then the number of herbivores that the plants support and the number of herbivores would be higher than the number of higher order carnivores. Pyramid of Biomass Biomass is the total mass of dry organic matter per unit of area. Each higher trophic level contains less biomass than the previous trophic level. Therefore a drawing or graph that represents the amount of biomass at each trophic level would also produce the basic pyramid shape. Biomass is related to the abundance of organisms at each trophic level. Human Impact on Food Chains and Webs Humans have the ability to have a great impact on ecosystems. Living organisms are a significant portion of any ecosystem, therefore any activity that affects an ecosystem is also likely to affect the organisms within that ecosystem. If organisms are affected the food chains webs that the organisms are a part of will also feel the affects.

Asthma Case Study

University of Perpetual Help System – DALTA Alabang – Zapote Road, Pamplona, Las Pinas City College of Nursing A Case Study of Bronchial Asthma In Acute Exacerbation (BAIAE) Submitted by: Angela Marie Ferrer BSN 3B July 17, 2012 Definition A condition of the lungs characterized by widespread narrowing of the airways due to spasm of the smooth muscle, edema of the mucosa, and the presence of mucus in the lumen of the bronchi and bronchioles.Bronchial asthma is a chronic relapsing inflammatory disorder with increased responsiveness of tracheobroncheal tree to various stimuli, resulting in paroxysmal contraction of bronchial airways which changes in severity over short periods of time, either spontaneously or under treatment. Causes Allergy is the strongest predisposing factor for asthma. Chronic exposure to airway irritants or allergens can be seasonal such as grass, tree and weed pollens or perennial under this are the molds, dust and roaches.Common triggers of asthma sy mptoms and exacerbations include air way irritants like air pollutant, cold, heat, weather changes, strong odors and perfumes. Other contributing factor would include exercise, stress or emotional upset, sinusitis with post nasal drip, medications and viral respiratory tract infections. Most people who have asthma are sensitive to a variety of triggers.A person’s asthma changes depending on the environment activities, management practices and other factor. Factors that can contribute to asthma or airway hyperreactivity may include any of the following: * Environmental allergens: House dust mites, animal allergens (especially cat and dog), cockroach allergens, and fungi are most commonly reported. * Viral respiratory tract infections * Exercise; hyperventilation * Gastroesophageal reflux disease * Chronic sinusitis or rhinitis Aspirin or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity, sulfite sensitivity * Use of beta-adrenergic receptor blockers (including ophth almic preparations) * Obesity: Based on a prospective cohort study of 86,000 patients, those with an elevated body mass index are more likely to have asthma. * Environmental pollutants, tobacco smoke * Occupational exposure * Irritants (eg, household sprays, paint fumes) * Various high and low molecular weight compounds: A variety of high and low molecular weight compounds are associated with the development of occupational asthma, such as insects, plants, latex, gums, diisocyanates, anhydrides, wood dust * Emotional factors or stress * Perinatal factors: Prematurity and increased maternal age increase the risk for asthma * Breastfeeding has not been definitely shown to be protective. * Both maternal smoking and prenatal exposure to tobacco smoke also increase the risk of developing asthma Clinical ManifestationThe three most common symptoms of asthma are cough, dyspnea, and wheezing. In some instances cough may be the only symptoms. An asthma attack often occurs at night or early i n the morning, possibly because circadian variations that influence airway receptors thresholds. An asthma exacerbation may begin abruptly but most frequently is preceded by increasing symptoms over the previous few days. There is cough, with or without mucus production. At times the mucus is so tightly wedged in the narrow airway that the patient cannot cough it up.Prevention Patient with recurrent asthma should undergo test to identify the substance that participate the symptoms. Patients are instructed to avoid the causative agents whenever possible. Knowledge is the key to quality asthma care. Medical Management There are two general process of asthma medication: quick relief medication for immediate treatment of asthma symptoms and exacerbations and long acting medication to achieve and maintain control and persistent asthma.Because of underlying pathology of asthma is inflammation, control of persistent asthma is accomplish primarily with the regular use of anti inflammatory m edications. * Long-acting control Medication Corticosteroid are the most potent and effective anti inflammatory currently available. They are broadly effective in alleviating symptoms, improving air way functions, and decreasing peak flow variability. Cromolyn sodium and nedocromil are mild to be moderate anti-inflammatory agents that are use more commonly in children.They also are effective on a prophylactic basis to prevent exercise-induced asthma or unavoidable exposure to known triggers. These medications are contraindicated in acute asthma exacerbation. `Long acting beta-adrenergic agonist is use with anti-inflammatory medications to control asthma symptoms, particularly those that occur during the night these agents are also effective in the prevention of exercise-induced asthma. * Quick relief medication Short acting beta adrenergic agonists are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma.They have the rapid onset of acton. Anti-cholinergic may have an added benefit in severe exacerbations of asthma but they are use more frequently in COPD. Nursing Management The main focus of nursing management is to actively assess the air way and the patient response to treatment. The immediate nursing care of patient with asthma depends on the severity of the symptoms. A calm approach is an important aspect of care especially for anxious client and one’s family. This requires a partnership between the patient and the health care providers to determine the desire outcome and to formulate a plan which include; * the purpose and action of each medication * trigger to avoid and how to do so * when to seek assistance the nature of asthma as chronic inflammatory disease Anatomy and Physiology The upper respiratory tract consists of the nose, sinuses, pharynx, larynx, trachea, and epiglottis. The lower respiratory tract consist of the bronchi, bronchioles and the lungs.The major function of the respiratory system is to deliver oxygen to arterial blood and remove carbon dioxide from venous blood, a process known as gas exchange. The normal gas exchange depends on three process: * Ventilation – is movement of gases from the atmosphere into and out of the lungs. This is accomplished through the mechanical acts of inspiration and expiration. * Diffusion – is a movement of inhaled gases in the alveoli and across the alveolar capillary membrane * Perfusion – is movement of oxygenated blood from the lungs to the tissues.Control of gas exchange – involves neural and chemical process The neural system, composed of three parts located in the pons, medulla and spinal cord, coordinates respiratory rhythm and regulates the depth of respirations The chemical processes perform several vital functions such as: * regulating alveolar ventilation by maintaining normal blood gas tension * guarding against hypercapnia (excessive CO2 in the blood) as well as hypoxia (reduced tissue oxy genation caused by decreased arterial oxygen [PaO2]. An increase in arterial CO2 (PaCO2) stimulates ventilation; conversely, a decrease in PaCO2 inhibits ventilation. helping to maintain respirations (through peripheral chemoreceptors) when hypoxia occurs. The normal functions of respiration O2 and CO2 tension and chemoreceptors are similar in children and adults. however, children respond differently than adults to respiratory disturbances; major areas of difference include: * Poor tolerance of nasal congestion, especially in infants who are obligatory nose breathers up to 4 months of age * Increased susceptibility to ear infection due to shorter, broader, and more horizontally positioned eustachian tubes. Increased severity or respiratory symptoms due to smaller airway diameters * A total body response to respiratory infection, with such symptoms as fever, vomiting and diarrhea. Diagnostic procedures: * General Physical Examination * Skin: * Observe for the presence of atopic derm atitis, eczema, or other manifestations of allergic skin conditions * Evidence of respiratory distress manifests as * increased respiratory rate, * increased heart rate, * diaphoresis, and * use of accessory muscles of respiration. * Marked weight loss or severe wasting may indicate severe emphysema. * Pulsus paradoxus: * This is an exaggerated fall in systolic blood pressure during inspiration and may occur during an acute asthma exacerbation. * Depressed sensorium: * This finding suggests a more severe asthma exacerbation with impending respiratory failure. * Chest Examination * End-expiratory wheezing or a prolonged expiratory phase is found most commonly, although inspiratory wheezing can be heard. * Diminished breath sounds and chest hyperinflation (especially in children)  may be observed during acute asthma exacerbations. The presence of inspiratory wheezing or stridor may prompt an evaluation for an upper airway obstruction such as vocal cord dysfunction, vocal cord paraly sis, thyroid enlargement, or a soft tissue mass (eg, malignant tumor). * Differential Diagnoses * Airway Foreign Body Heart Failure Allergic and Environmental Asthma Pulmonary Embolism Alpha1-Antitrypsin Deficiency Pulmonary Eosinophilia Aspergillosis Sarcoidosis Bronchiectasis Sinusitis, Chronic * Bronchiolitis Tracheomalacia COPD URTI Churg-Strauss Syndrome Vocal Cord Dysfunction Cystic Fibrosis Foreign Body Aspiration Gastroesophageal Reflux Disease Laboratory Studies * Blood eosinophilia greater than 4% or 300-400/ µL * Eosinophil counts greater than 8% may be observed in patients with concomitant atopic dermatitis. * This finding should prompt an evaluation for allergic  bronchopulmonary aspergillosis,  Churg-Strauss syndrome, or  eosinophilic pneumonia * Total serum immunoglobulin E levels greater than 100 IU are frequently observed in patients experiencing allergic reactions, but this finding is not specific for asthma * British Thoracic Society recommends using sputu m eosinophilia determinations to guide therapy Imaging Studies In most patients with asthma, chest radiography findings are normal or may indicate hyperinflation. * Chest radiography should be considered in all patients being evaluated for asthma to exclude other diagnoses. * Sinus CT scanning may be useful to help exclude acute or chronic sinusitis as a contributing factor.. Pulmonary function testing (spirometry) * Spirometry assessments  should be obtained as the primary test to establish the asthma diagnosis. * Spirometry should be performed prior o initiating treatment in order to establish the presence and determine the severity of baseline airway obstruction. * The assessment and diagnosis of asthma cannot be based on spirometry findings alone because many other diseases are associated with obstructive spirometry indices. * Spirometry measures the forced vital capacity (FVC), the maximal amount of air expired from the point of maximal inhalation, and the FEV1. A reduced rat io of FEV1 to FVC, when compared with predicted values, demonstrates the presence of airway obstruction. Optimally, the initial spirometry should also include  measurements before and after inhalation of a short-acting bronchodilator in all patients in whom the diagnosis of asthma is considered. * Reversibility is demonstrated by an increase of 12%  and 200 mL after the administration of a short-acting bronchodilator Methacholine- or histamine-challenge testing * Bronchoprovocation testing with either methacholine or histamine is useful when spirometry findings are normal or near normal, especially in patients with intermittent or exercise-induced asthma symptoms. Bronchoprovocation testing helps determine if airway hyperreactivity is present, and a negative test result usually excludes the diagnosis of asthma. * Methacholine is administered in incremental doses up to a maximum dose of 16 mg/mL, and a 20% decrease in FEV1, up to the 4 mg/mL level, is considered a positive test r esult for the presence of bronchial hyperresponsiveness. Peak-flow monitoring * Peak-flow monitoring is designed for ongoing monitoring of patients with asthma because the test is simple to perform and the results are a quantitative and reproducible measure of airflow obstruction. It can be used for short-term monitoring, exacerbation management, and daily long-term monitoring. * Peak-flow monitoring should not be used as a substitute for spirometry to establish the initial diagnosis of asthma. * Results can be used to determine the severity of an exacerbation and to help guide therapeutic decisions as part of an asthma action plan. Exercise testing * Testing involves 6-10 minutes of strenuous exertion at 85-90% of predicted maximal heart rate and measurement of postexercise spirometry for 15-30 minutes. The defined cutoff for a positive test result is a 15% decrease in FEV1 after exercise. Eucapnic hyperventilation * Eucapnic hyperventilation with either cold or dry air is an alter nate method of bronchoprovocation testing. * It has been used to evaluate patients for exercise-induced asthma and has been shown to produce results similar to those of methacholine-challenge asthma testing. I. LABORATORY WORKS NAME OF TEST| NORMALVALUE| RESULTS| SIGNIFICANCE| Complete Blood CountPurpose: CBC is ordered to aid in the detection of anemias; hydration status; and as part of routine hospital admission test.The differential WBC is necessary for determining the type of infection. | RBC: 4-6 x 10/LHct: 0. 37- 0. 47Hgb: 110- 160 gm/LWBC: 5-10 x 10 /LLymphocytes:0. 25-0. 35Segmenters: 0. 50-0. 65Eosinophil: 0. 01-0. 06| 5. 480. 481598. 20. 250. 580. 07| Increased segmenters (mature neutrophils) reflect a bacterial infection since this are the body’s first line of defense against acute bacterial invasion. Lymphocytes are decreased during early acute bacterial infection and only increase late in bacterial infections but continue to function during the chronic phase. | I I. DRUG STUDYName of the drug | Classification | Dosage/ Frequency | Route | Mechanism of Action | Indication | Nursing Responsibilities | Generic name:Duavent ( ipratropium salbutamol) Brand name:DuaNeb | Salbutamol Sulfate| Nebule q 1 hour| Oral nebulization | The combination of ipratropium and albuterol is used to prevent wheezing, difficulty breathing, chest tightness, and coughing. | Management of reversible bronchospasms associated with obstructive airway diseases, bronchial asthma| Take care to ensure that the nebulizer mask fits the user's face properly and that nebulized solution does not escape into the eyes. * Evaluate therapeutic response. |