Business Law for Caparo Industries pIc v Dickman- myassignmenthelp

Question: Discuss about theBusiness Law for Caparo Industries pIc v Dickman. Answer: Introduction Tame v New South Wales (2002) 211 CLR 317 is amongst the leading cases of Australia when it comes to the obligation which one person owes to another based on negligence and the resultant contravention which lead to psychiatric injuries. This case saw the plaintiff making a claim of negligence against the law enforcement officer, in addition to the defamation as a result of the clerical mistake which the police undertook while the accident report was being filed. Upon the appeal being made against the police by the plaintiff based on the undertaken negligence of police in resulting in her psychiatric condition, the High Court rejected the appeal of the plaintiff. In this report, the police had wrongfully stated that blood alcohol level of Tame as .14 but this was actually the alcohol level of the other driver. And it was claimed by Tame that due to this, she felt that no one respected her and this is the reason why she developed the psychiatric state (Sappideen, 2009). Through the dis cussion being carried here, the case has been detailed where the issues and arguments presented by both the parties have been stated and the decision of the court has been critically analysed. Factual Background Tame in this case was involved in a collision of motor vehicles which took place on 11 Jan 1991 at Richmond, in Sydney. The accident occurred due to the fault of the other driver, Terence Lavender. After the accident, the law enforcement officers checked his blood alcohol level and it stood at .14, whereas the blood alcohol of Tame was 0 when the reading was taken (Federation Press, 2017). Constable Morgan was responsible for preparing the traffic collision report and he was a part of the Windsor Police Station. While preparing this report at the incident spot, he left the blood alcohol reading details of both Tame and the other driver as blank. In Feb 1991, the then acting traffic sergeant filled these blank segments and while filing, accidently switched the blood alcohol of both the drivers, where the other driver was stated to have 0 alcohol level and Tame to have .14 as the blood alcohol level. In around Mar 1991, the mistake was detected by the acting sergeant and he made corrections to the original report at this time (Health Law Central, 2017). Lavender was sued by Tame since he was driving a vehicle which was not insured as was required by the law and this claim was handled by NZI, which was the insurance company. Upon the settlement of the claim, Tame was awarded a significant value. However, come May 1992, the insurance company became hesitant when it came to payment of the physiotherapy treatment which was needed by Tame as a result of her injuries and this made Tame very anxious. The attorney of Tame, Wellers, was informed by Tame that she had no history of drinking and that she had no current drinking issues since the last 20 years. The attorney was also informed that the notion of being drunk was so wrong that she was horrified of it. This reaction of Tame was highlighted upon Weller informing her that the report showed that Tame had been drunk when the accident took place. And Tame was very apprehensive about her reputation which would be damaged as a result of the grave error. The police issued a formal apology to Tame for their mistake; and still Tame continued to blame the law enforcement for the NZI being reluctant in their payments for her treatment. After some time, Tame became obsessed with this issue and was clinically diagnosed with the psychotic depressive illness. As a result of this, a claim was initiated by Tame in the NSW District Court against the police (Federation Press, 2017). Issues and Arguments of the Parties Tame in this case, blamed her psychiatric injury as being resulted from the negligence of the police law enforcement officer where they failed in properly stating down her blood alcohol level in the accident report. This in turn, as per the plaintiff, led to the apprehensions on part of NZI in making the payment for her treatment. And it also resulted in her reputation being tarnished as she had been sober since last 20 years. She claimed that the police officer owed her a duty of care to properly state the right facts in the report and by not doing so, the duty of care owed towards her was breached as this breach of duty resulted in her psychiatric injury. The defendant highlighted that they had already issued a formal apology to Tame. They also stated that the claim of defamation being cited by the plaintiff was out-rightly wrong. This was due to the fact that for a claim of defamation to be upheld, it has to be shown that the careless misstatement of the defendant was relied upon by a third party. Here, it was very clear that no one had made reliance over this careless misstatement of the police officer. This can be proved from the fact that plaintiff had no evidence for this to have occurred. And also from the fact that the insurance company had considered the changed report which had been made by the police after the careless misstatement was noticed and corrected upon. So, even the insurance company had not made reliance on the police officers careless misstatement (HCA, 2017). The plaintiff also made an argument that the police officer had been negligent in the report which had been prepared by them and this was the reason why she developed a psychiatric condition. In this regard, the defendant highlighted that for making a successful case of negligence, one has to establish certain elements (Harvey and Marston, 2009). These include foreseeability, duty, its breach, resulting harm, direct causation and remoteness of losses (Gibson and Fraser, 2014). In this regard, the defendant cited Caparo Industries plc v Dickman [1990] 2 AC 605 for establishing that a duty of care was never owed by the defendant to Tame (E-Law Resources, 2017). This test requires proximity between parties, justness of penalties, along with the risk of harm to be reasonably foreseeable, for showing that a duty had been owed (Lunney and Oliphant, 2013). The defendant highlighted that this case did had proximity between the parties. Also, there was a clear lack of reasonable foreseeability in this matter. This was because no one could have predicted that if an accident report had been filled wrongly, the consequence of it would be a psychiatric injury and to state this as being reasonably foreseeable would be completely wrong. Hence, in case penalties are imposed over the defendant for these reasons, these would not be deemed as just or as being reasonable. So the threefold test given under Caparo could not be satisfied by the plaintiff, which means that no duty of care was owed by the defendant towards her (Australasian Legal Information Institute, 2017). The defendant also relied upon the famous English case when it came to the question of owed duty of care and foreseeability of losses and this was the case of Donoghue v Stevenson [1932] UKHL 100. In this case, the manufacturer was made liable towards the plaintiff for the breach of duty of care as a result of dead snail found in the manufactured ginger beer bottle (Latimer, 2012). However, the defendant stated that in the quoted case, the contaminated bottle was bound to injure the plaintiff, but here, the police officer could not have foreseen that wrongly stating the blood alcohol level would give someone a psychiatric injury (HCA, 2017). Reference also had to be made to Jaensch v Coffey [1984] HCA 52, where the requirement was to establish a relationship for duty to be present (Swarb, 2015). Even though there was a relationship, but it was not which resulted in the police officer being liable for psychiatric injury of the plaintiff. Another key point of this case was regarding the duty of care which was cited by Tame as being a general public member. In this regard, the defendant presented that it was very true that the police officers owe a duty of care towards the citizens; however, the duty which they owed towards Tame was to safeguard her from a possible criminal activity and this duty of care was not meant to protect Tame from a psychiatric injury since this was not their duty and also because the same was not related to the undertaken error (North, 2017). Yes, there had been an error as was accepted by the defendant but it was not related to the psychiatric injury of Tame since there was a sheer lack of correlation between the undertaken error and Tames psychiatric condition. Even though the injury was of substantial nature and damages would have been awarded, but that would have been the case only when the duty of care and foreseeability had been present, which was not the case (HCA, 2017). Court Judgment The appeal made by Tame in this case had been rejected by the High Court because they agreed with the points raised by the defendant where they could not predicted in a reasonable manner that by a wrong filing of form, a person could become mentally ill and this foreseeability was not only for the police, but for any prudent person (Vines, Roque and Rumber, 2010). In the view of the judges, the case of Donoghue v Stevenson helped in this regard, particularly when it came to the presence of duty of care and the reasonable foreseeability of the injury. The police officers, as per the High Court, did not have such an obligation of care which required them to prevent Tame from distress as a result of the wrongly filled report. The reason for this was given by the High Court as the case where the police officers if are made to check the emotional distress being caused to another person as a result of filing of report, then they would not be able to file an honest report as reports can off end even a rule breaker. Hence, the police could not be made liable for foreseeing the mental health of Tame when they were filing the alcohol report (HCA, 2017). The court also stated that the damages were to be awarded only in such cases where there had been a recognized psychiatric injury and one cannot be given these when there has been a distress caused to such person (Handford, 2017). For the Tames case, there was a lack of special relationship which could have made the law enforcement officer liable based on the case of Donoghue v Stevenson. The duty of care which is subjected to investigation would conflict with the duty of a police officer being in their position. And so, the police officers had to keep the duty as being a police officer before anything else (HCA, 2017). McHugh J viewed the obligation of care as something which would be owed only in cases of a nervous shock or psychiatric injury being foreseeable to a normal fortitude of an individual (Richardson, 2017). The injury, to be reasonably foreseeable, had to conform to the neighbour principle and reasonableness had to be given supremacy. This led to the court concluding that a duty of care was not owed by the police officers towards tame due to conflicting duties and the lack of foreseeability being reasonable. And so, a psychiatric injury could not be made successful (Webstroke Law, 2017). Critical Analysis The decision given in this case had been correct as the police officers could not be made liable for something which could not reasonably be foreseen. Also, the case made by defendant was very strong as they highlighted different cases to prove their point. The defendant had already apologized for wrongly filing a report and blaming them for a mistake, which has been corrected and which has shown to not have impacted the insurance companys payments. Hence, the court had rightly ruled in the favour of the defendant in this case. References Australasian Legal Information Institute. (2017) Tame v New South Wales [2002] HCA 35; 211 CLR 317; 191 ALR 449; 76 ALJR 1348 (5 September 2002). [Online] Australasian Legal Information Institute. Available from: https://www.austlii.edu.au/au/cases/cth/HCA/2002/35.html [Accessed on: 03/10/17] E-Law Resources. (2017) Caparo Industries pIc v Dickman [1990] 2 AC 605 House of Lords. [Online] E-Law Resources. Available from: https://www.healthlawcentral.com/cases/tame-v-new-south-wales/ [Accessed on: 03/10/17] Federation Press. (2017) Tame v New South Wales Annetts v Australian Stations Pty Ltd. [Online] Federation Press. Available from: https://www.federationpress.com.au/pdf/Tame%20v%20New%20South%20Wales.pdf [Accessed on: 03/10/17] Gibson, A., and Fraser, D. (2014) Business Law 2014. 8th ed. Melbourne: Pearson Education Australia. Handford, P. (2017) Psychiatric injury: the new era. [Online] The University of Western Australia. Available from: https://research-repository.uwa.edu.au/files/1003225/3609_PID3609.pdf [Accessed on: 03/10/17] Harvey, B., and Marston, J. (2009) Cases and Commentary on Tort. 6th ed. New York: Oxford University Press. HCA. (2017) Tame v New South Wales [2002] HCA 35. [Online] HCA. Available from: https://eresources.hcourt.gov.au/downloadPdf/2002/HCA/35 [Accessed on: 03/10/17] Health Law Central. (2017) Tame v New South Wales; Annetts v Australian Stations Pty Limited [2002] HCA 35. [Online] Health Law Central. Available from: https://www.healthlawcentral.com/cases/tame-v-new-south-wales/ [Accessed on: 03/10/17] Latimer, P. (2012) Australian Business Law 2012. 31st ed. Sydney, NSW: CCH Australia Limited. Lunney, M., and Oliphant, K. (2013) Tort Law: Text and Materials. 5th ed. Oxford: Oxford University Press. North, D.O.J. (2017) Personal Injury Claims Psychiatric Injury. [Online] Bar Web. Available from: https://portal.barweb.com.au/upload/fck/north%20sc%20-%20pi%20claims.pdf [Accessed on: 03/10/17] Richardson, B. (2017) Nervous shock in the High Court. [Online] Find Law. Available from: https://www.findlaw.com.au/articles/1364/nervous-shock-in-the-high-court.aspx [Accessed on: 03/10/17] Sappideen, C., at al. (2009) Torts, Commentary and Materials. 10th ed. Pyrmont: Lawbook Co, pp. 209-10. Swarb. (2015) Jaensch v Coffey; 20 Aug 1984. [Online] Swarb. Available from: https://swarb.co.uk/jaensch-v-coffey-20-aug-1984/ [Accessed on: 03/10/17] Vines, P., Roque, M.S., and Rumber, E. (2010) Is nervous shock still a feminist issue? The duty of care and psychiatric injury in Australia. [Online] Bar Web. Available from: https://sites.thomsonreuters.com.au/journals/files/2010/10/j19_v018_TORTLREV_pt01_vines_sanroque_rumble.pdf [Accessed on: 03/10/17] Webstroke Law. (2017) Tame v New South Wales [2003]. [Online] Webstroke Law. Available from: https://webstroke.co.uk/law/cases/tame-v-new-south-wales-2003 [Accessed on: 03/10/17]

Why The North Won The Civil War Essays - American Civil War

Why The North Won The Civil War You Are Bound to Fail. Union officer William Tecumseh Sherman to a Southern friend: In all history, no nation of mere agriculturists ever made successful war against a nation of mechanics. . . .You are bound to fail (Catton, Glory Road 241) The American antebellum South, though steeped in pride and raised in military tradition, was to be no match for the burgeoning superiority of the rapidly developing North in the coming Civil War. The lack of emphasis on manufacturing and commercial interest, stemming from the Southern desire to preserve their traditional agrarian society, surrendered to the North their ability to function independently, much less to wage war. It was neither Northern troops nor generals that won the Civil War, rather Northern guns and industry. From the onset of war, the Union had obvious advantages. Quite simply, the North had large amounts of just about everything that the South did not, boasting

Shakespeares Richard III essays

Shakespeares Richard III essays Richard III is considered one of Shakespeares most evil characters, one endowed with sharp wit and lacking in morals, who governs through fear and force. Richard III deals extensively with the themes of political corruption and dissimulation. Richard's reign is portrayed as a period in which nothing is sacred; neither on a political or social level, nor on a personal one. Richard will stop at nothing, not even at betraying his friends and murdering his kin, in order to become king. Although his traits of character are clearly illustrated through his deeds and words, Shakespeare provides the reader with an important contrast to the character of the king, namely the women of the play. These women are: the Duchess of York, Richard's mother; Anne who later becomes Richard's wife; Queen Margaret who was the former queen and Richard's arch enemy, and Queen Elizabeth, the current queen. Also, Queen Elizabeths daughter, Elizabeth, is present in the plot but the reader is never introduced to her. Richard appears one-dimensionally evil, a flat character, the embodiment of evil and moral decay. His evil ambitions are expressed at the outset of the play; his purpose is to deepen the chaos in the kingdom and ultimately become king. He is portrayed through the eyes of the characters, especially the women in the play. Anne, Elizabeth, the Duchess of York and Margaret are voices of protest and morality who condemn the actions of the king, and are able to see through his intrigues, and at times, even to foresee the consequences of his acts. In fact, the four women are used as voices of the Elizabethan age in the sense that they provide an extraordinary example of the world view belonging to that particular era in the history of England. Not only do these women point out moral truths, but they also ask for divine retribution and point to a higher moral authority which transcends the realm of human action. These women illustrate how moral ...

Analyse article Essay Example | Topics and Well Written Essays - 750 words - 1

Analyse article - Essay Example Schaper further argues that in a competitive market environment effective and efficient firms survive while the inefficient businesses collapse. Considering the remarks by the president of Toyota Company, the business may have faced serious competition from other vehicle manufacturers in Australia such as Elfin Sports Cars Pty Ltd, Ford Performance Vehicles, and GM Holden Ltd as well as competition in the export markets of other countries that offer favorable vehicle manufacturing conditions. Another factor that contributed to the decision by Toyota Company is high cost of production attributed to the high labor costs (BBC News Business 10 February 2014). Under normal circumstances, the cost of production in an organization is usually lower giving enough room for profit realization when products are sold. However, the Toyota Company based in Australia experienced reduction in profits and eventually loses in the production of vehicles due to the increased production cost. The company tried to solve the problem of increased labor costs through proposed changes in employee contracts that would have resulted in removal of additional allowances and changes in overtime (BBC News Business 10 February 2014) but the implementation was blocked in a Federal Court. The other critical factor that contributed to the decision by Toyota Company is lack of government support. According to Ch et al., government policies have both positive and negative impacts on businesses operating in the country in question (2011, p.941). In the case of Toyota Company, the impacts of policy changes by Australian government left the company with negative business effects. To begin with, a national commission recommended to the government that subsidies that were initially given to the car manufacturing industry should be stopped and that the companies should device ways of cutting down the production cost (BBC News Business 10 February 2014). Secondly, the proposed changes on employee

The purpose of higher education Essay Example | Topics and Well Written Essays - 500 words

The purpose of higher education - Essay Example So in order to secure a good position in a company, higher education is often a requisite. In relation to landing a dream job, higher education is also viewed as a magnet for good money. In an interview conducted, one student asserted that those with higher education are more likely to possess higher income potential. With more earnings, one is able to provide for his needs and even afford luxuries like expensive vacations, beautiful home or nice cars. In the interviewee's case, with more money pouring in he would be able to provide for his children's basic needs including better education. In addition, he would be able to financially aid his parents if need be. As a believer of education, I totally agree with the arguments given above. Pursuing higher education may be instrumental in being accepted to a prestigious firm. Although one may lack job related experience, a degree would certainly have a signaling effect to employers. A higher education would communicate to them that an applicant has learned vital skills needed to perform a particular job effectively. With this, everything else follows - higher salary, better life, brighter future. However, it is apparent that the said arguments revolve around the financial benefits derived from higher education.

Overview Of The Presenting Condition Nursing Essay

Overview Of The Presenting Condition Nursing Essay This case study is intended to explain pulmonary oedema through Mr. Toscanas case. It will discuss the pathophysiology of pulmonary oedema and how Mr. Toscanas chronic renal impairment is related to this specific condition. Also, Mr. Toscanas ECG, aerial blood gas results and blood tests result will be analysed and explained. Moreover, a nursing plan based on Mr. Toscanas condition will be made. Overview of the Presenting Condition Pulmonary oedema is a serious condition of the pulmonary system. In simple terms, it is actually excess fluid in the lungs (skinner Mckinner 2011). To be more specific, it is fluid that moves out from capillaries into the extravascular spaces and causes additional pressure to the lungs (Craft, J 2011). Pulmonary oedema is affecting about 1% of people over the age of 65 (Johnson 2009). It is a worldwide condition and the mortality rate is about 40% within a year of diagnosis (Parissis et al. 2010). The accumulation of the fluid can be in a slow process for patients with chronic renal failure. It can also occur fast for patients who suffer from myocardial infarction (McPhee Hammer 2010). There are two types of pulmonary oedema, one is cardiogenic pulmonary, and the other in non-cardiogenic pulmonary oedema (Craft, J 2011). Pulmonary oedema is defined as alveolar or interstitial oedema, and such a condition can be identified by chest X-ray (Johnson 2009). And often patients oxygen satur ation is less than 90% on room air (Johnson 2009). Also severe respiratory distress, with crackles over the lungs and orthopnoea, is often associated with acute pulmonary oedema (Parissis et al. 2010). The most common cause of pulmonary oedema is untreated heart failure (Johnson 2009). The acute respiratory distress syndrome and capillary vessel injury are other common causes of pulmonary oedema (Craft, J et al. 2011). Its signs and symptoms often include dyspnoea, hypoxaemia and increased work of breathing (Skinner Mckinney 2011). In severe cases of pulmonary oedema, patients often bring up pink frothy sputum when coughing and their carbon dioxide level increases while oxygen level decreases (Craft, J et al. 2011). Pathophysiology that Underpins the Presenting Condition As mentioned before, pulmonary oedema is excess fluid in the extravascular space and according to McPhee Hammer (2010) the extravascular space is constituted by the interstitial space and the airspace (alveoli and airways). The excess fluid can be found in one or both spaces in patients with pulmonary oedema (McPhee Hammer 2010). Moreover, both spaces have different barriers to stop fluid from entering into them (McPhee Hammer 2010). The intersitital space is protected by the pulmonary capillary endothelium, i.e. inside layer of capillary and airspaces are protected by alveolar epithelium, namely surface of alveoli (McPhee Hammer 2010). It is normal for blood vessel to leak and about 0.01% of pulmonary blood flow will leak into interstitial space every hour (McPhee Hammer 2010). There are several factors that may influence the amount of fluid leaking into interstitial space and the most important one is net pressure (transmural pressure) (McPhee Hammer 2010). The transmural pressure maintains the balance between the net hydrostatic pressure that moves fluid out of the capillaries, and the colloid osmotic pressure that keeps fluid inside the capillaries (McPhee Hammer 2010). Any imbalance of these pressures can lead to pulmonary oedema. Pulmonary oedema can be divided into two types: the cardiogenic and the noncardiogenic. The former is caused by increased transural pressure (hydrostatic or osmotic) while the latter is caused by increased permeability (damaged alveoli and/ or airways) (Copstead Banasik 2010). Increased pulmonary venous pressure, increased alveolar surface tension, or decreased capillary colloid osmotic pressure can all lead to cardiogenic pulmonary oedema (Copstead Banasik 2010). Non-cardiogenic pulmonary oedema is normally caused by an acute respiratory distress syndrome, which often results from injury, infection or inhaled toxins (Copstead Banasik). In this case study, there is no evidence of injury of the lungs nor inhaled toxins, nor infection of any kind. Thus, Mr. Mario Toscanas condition is more likely to be cardiogenic pulmonary oedema. Although the case study does not address any cardiac problem based on his age and/ or history of chronic renal impairment, Mr. Toscana is prone to cardiac d iseases. In patients with chronic renal diseases, there are damaged nephrons that cannot be regenerated (Craft, J et al. 2011). Due to slow losses of nephrons, the remaining nephrons have to take the burden and try to maintain the normal function of the kidneys (Craft, J et al. 2011). However, over time this compensation will increase the loss of nephrons and the kidney will lose its normal function (Craft, J et al. 2011). This loss of normal function can result in electrolyte imbalance, which leads to various conditions (Craft, J et al. 2011). Fluid over load, hyperkalemia, metabolic acidosis, congestive heart failure and pulmonary oedema are all the common conditions of chronic renal diseases (Craft, J et al. 2011). Cardiovascular diseases often presents in patients with chronic renal diseases and they have a very high morbidity and mortality rate (McPhee Hammer 2010). Hypertension can be caused by excess sodium and fluid, and vascular calcification by decreased glomerular filtration rate (Craft, J et al. 2011). Moreover, vascular diseases can lead or contribute to coronary heart disease, left ventricular hypertrophy, heart failure and stroke. Heart failure is defined as a complex syndrome, which comprises of several cardiac dysfunctions and causes inadequate cardiac output (McPhee Hammer 2010). The common type of heart failure is the left heart failure, also known as congestive heart failure (Craft, J et al. 2011). Additionally, congestive heart failure can result in both systolic and diastolic heart failures, and any of the two can cause pulmonary oedema (Craft, J et al. 2011). In systolic heart failure, the contractility of the heart decreases because of the disease and it can result in the i ncrease of preload (Craft, J et al. 2011). Eventually, the combination will lead to decreased cardiac output and result in increased afterload (Craft, J et al. 2011). Due to the reduced cardiac output, renal perfusion diminishes and plasma volume increases (Craft, J et al. 2011). Patients with systolic heart failure often present with decreased urine output, oedema and pulmonary oedema (Craft, J et al. 2011). And patients with diastolic heart failure can maintain a normal stroke volume and cardiac output (Craft, J et al. 2011). However, left ventricular end-diastolic pressure is still increased by the decreased compliance of the left ventricular, and the abnormal diastolic relaxation (Craft, J et al. 2011). The pressure pushes fluid to go back to the lungs and causes pulmonary oedema (Craft, J et al. 2011). ECG Examination An ECG can provide information on the electrical movement in the heart and ECG graphs give information such as heart rate, rhythm and any abnormality that may involve the heart (Jevon 2010). With the method proved by Jevon (2009), Mr Toscanas heart rate can be calculated, which is 120 beats per minute. According to Jevon (2009) heart rate over 90 beats per minute is defined as tachycardia. Based on his other presenting conditions, Mr. Toscanas tachycardia is most likely caused by hypoxia. Hypoxia is resulted from hypoxemia, which is the decreased level of oxygen in the blood (Craft, J et al. 2011). In order to meet the oxygen demand, the heart is trying to pump harder and faster to bring up cardiac output (Craft, J et al. 2011). On the one hand, hypoxemia can cause dilation of arterioles, capillaries and venules, in order to increase the blood flow through them (Copstead Banasik 2010). Therefore, peripheral blood flow is increased as well as venous return (Copstead Banasik 2010). Ven ous return is a major factor that influences preload and the increased venous return means increased preload (Copstead Banasik 2010). Preload is one of the factors that determines stroke volume, and when preload increases, stroke volume increases as well (Copstead Banasik 2010). On the other hand, the cardiovascular system is controlled by medulla oblongata of the brainstem and the neurons communicate with the heart via autonomic nervous system (Craft, J et al. 2011). The Bainbridge reflex causes increased heart rate with increased venous return at the same time (Craft, J et al. 2011). Mr. Toscanas ECG shows elevated ST segment and tale T wave as well. They are both signs of hyperkalaemia (Humphreys 2007). This condition can also be confirmed by his potassium level. The normal range of potassium is 3.5-5mEq/L, and his potassium is 5.8mEq/L (Humphreys 2007). Interpretation of Pathology Tests Mr. Toscanas Arterial Blood Gas Result shows that pH is 7.34 and the normal range is 7.35-7.45, which means his pH is lower than normal range. Hasan (2009) states that pH lower than normal range represents acidosis. According to Cowley, Owen Bion (2013) that high level of blood carbon dioxide means respiratory acidosis, and low level of bicarbonate means metabolic acidosis. The Arterial Blood Gas Result of Mr. Toscana shows blood carbon dioxide and bicarbonate is 51mmHg and 18mmol/L respectively. The normal range of blood carbon dioxide is 35-45mmHg and that for bicarbonate is 22-28mmol/L. Thus, his blood carbon dioxide level is higher and bicarbonate level is lower, which explains that Mr. Toscana is suffering both respiratory and metabolic acidosis (Hasan 2009). Besides, Mr. Toscanas blood oxygen level is 70mmHg and the acceptability range is 75-100mmHg. According to Hasan (2009) low blood oxygen level indicates hypoxia. SaO2 (saturation of haemoglobin by oxygen) is the most common way to monitor oxygen level in the body. For a healthy person, SaO2 below 95% shows lack of oxygen in the body and can lead to hypoxia (Humphreys 2007). There are many causes of metabolic acidosis, such as hyperlactataemia, ketoacidosis and renal tubular acidosis (Halperin, Kamel Goldstein 2010). In this case, based on his history of chronic renal impairment, the cause of his metabolic acidosis is more likely the renal tubular one (Halperin, Kamel Goldstein 2010). One of the functions of the kidneys is to clear the bodys acid load (Halperin, Kamel Goldstein 2010). However, for patients with chronic renal impairment, their kidneys are already damaged and they are losing normal renal function (Craft, J et al. 2011). Therefore, kidneys cannot remove acid out of body in an adequate rate. When the acid builds up in the body, it will neutralise with bicarbonate and generate carbon dioxide (Halperin, Kamel Goldstein 2010). Normally carbon dioxide will be exhaled. However, in this case, because Mr. Toscana suffers from an acute pulmonary oedema, he cannot exhale carbon dioxide effectively (Craft, J et al. 2011). One of the symptoms of pulmonary oedema is hypoxemia, which is low level of blood oxygen in the body (Craft, J et al. 2011). This occurs as the excess fluid builds up in the extravascular spaces, and impairs normal gas exchange in the lungs (McPhee Hammer 2010). Moreover, pulmonary oedema can cause dyspnoea, which is a difficulty of breathing and eventually it can damage alveoli (Craft, J et al. 2011). Both dyspnoea and the damaged alveoli can worsen the inadequate gas exchange (Craft, J et al. 2011). Based on Craft, J et al. (2011) when inadequate gas exchange occurs, oxygen in the alveoli cannot get into vessels and the carbon dioxide cannot go in to alveoli to be exhaled. While carbon dioxide accumulates in the body, pH decreases and respiratory acidosis occurs (Halperin, Kamel Goldstein 2010). In this case, besides the inadequate gas exchange, the chronic renal impairment also contributes to the increase of carbon dioxide in the body. The blood test results show both high level of serum creatinine and blood urea nitrogen. Based on Thomas Thomas (2009) creatinine results from muscular metabolism and will be cleaned out of the body by the kidneys. Urea nitrogen is resulted from protein metabolism and it will also be cleaned out of body by the kidneys (Thomas Thomas 2009). The reason for the increase in both creatinine and urea nitrogen levels is because of the decreased glomerular filtration rate, which is an indication of chronic renal disease (Craft, J et al. 2011). Holistic Plan of Nursing Care The first nursing care for Mr. Toscana is in fact to provide a reassurance to him as he is distressed by the tightness of CPAP mask and his difficulty in breathing. There is a very high chance that he will remove the CPAP mask. If CPAP is removed, it will make it even harder for him to breathe (Ducros et al. 2010). Nurses can educate Mr. Toscana on the use of CPAP and explain to him that by using CPAP, he can breathe more easily (Nehyba 2006). Nurses can also get his family involved to give reassurance to Mr. Toscana. Then, because Mr. Toscanas oxygen saturation is lower and he is presenting respiratory acidosis, nurses need to keep his oxygen saturation up (Lemone Burke 2011). Due to his acute pulmonary oedema, CPAP is a more effective way to deliver oxygen and open up more air ways, which in return improves his gas exchange in the lungs and reduces work of breathing (Ducros, L et al. 2010). Nurses need to remind themselves of a few things while looking after patients breathe with CPAP. First, CPAP mask needs to be sealed properly and tightened to provide a positive pressure air (Ducros, L et al. 2010). Second, nurses need to monitor the patients closely for any change in oxygen saturation and respiratory rate (Ducros, L et al. 2010). Third, they should allow breaks in between sections of the treatment so that patients can cough, drink or eat (Nehyba 2006). Also, breaks can release the pressure caused by CPAP mask and decrease the risk of pressure ulcer. Finally, like any other medical procedure, CPAP also has its adverse effects. When a full mask is used, CPAP therapy can lead to gastric distension (Nehyba 2006). In addition, some air can go into stomach and cause discomfort, splinting of the diaphragm and reduce lung expansion. Therefore, nasogastric tube may be required at some stage (Nehyba 2006) Monitoring Mr. Toscanas fluid intake and urine output is also important, as he has a history of chronic renal impairment and presenting pulmonary oedema (Lemone Burke 2011). A fluid balance chart can be used. If there is a negative balance, doctors need to be notified accordingly (Lemone Burke 2011). Nurses need to educate Mr. Toscana on adequate fluid intake. His vital signs also need to be monitored, especially his oxygen saturation and respiratory rate (Lemone Burke 2011). He is presenting signs of hypoxemia and respiratory acidosis, which can lead to respiratory failure (Craft, J et al. 2011). Therefore, closely monitoring his oxygen saturation and respiratory rate can identify any trend towards respiratory failure so as to intervene earlier to prevent it from happening. Cardiac monitoring is also required for Mr. Toscana because of the following reasons. First, his ECG shows heart rate of 120 which means tachycardia. Second, the most likely cause of his acute pulmonary oedema is heart failure. Third, abnormal potassium level can cause cardiac arrest (Humphreys 2007). Moreover, nurses need to check for any new arterial blood gas results and blood test results to be aware of any changing situation of the patient. Finally, as Mr. Toscana has a history of chronic renal impairment and both his arterial blood gas results and blood tests result show trend of renal failure, acute dialysis may be needed for him (Daugirdas, Blake, Ing 2012). For patients with chronic renal disease, their renal functions are impaired and some toxic wastes cannot be removed from their bodies (Craft, J et al. 2011). Dialysis is the only effective way to help them to remove these toxic wastes (Daugirdas, Blake, Ing 2012). Nurses cannot order dialysis. However, they can discuss patients conditions and tests result with doctors to arrange dialysis if necessary. Summary Pulmonary oedema is a crucial condition that can lead to respiratory failure. This condition can be caused by heart failure and worsen by chronic renal diseases. Procedures such as ECG, arterial blood gas test and blood tests can help nurses to understand patients conditions can identify any trend of deterioration. A detailed, holistic nursing care plan can help nurses to provide better care for patients.

Dnp Practice Model

Week 6 The DNP Project Describe a needs or change related to a practice environment, include your rationale for why this situation warrants attention Explain how your participation in a specific professional organization could be beneficial as you attempt to affect positive change in your identified practice environment through your DNP project I believe a significant practice problem is that many nurses do not see the need to advance their education after obtaining an R. N.By continuing to have the triple level entry into practice we do not have the control of the practice development that other professional practices may have. The other professional practices have entry degree requirements that are reflective of the expectation that each requires. It is difficult to persuade a nurse to incur debt and expense to obtain a DNP when they believe as an RN, the benefits do not outweigh the work required. They don’t see how the investment of further education can change the future of nurses.Nurses may not want to give up the opportunity to work at the bedside and do not want the politics of management. The DNP offers the opportunity to maintain the clinical expertise and further education. The AACN recommendations that the entry as a NP by the DNP will assist with this, as many nurses do want to obtain the NP licensure and level of practice. Another attractive measure of the DNP is the ability of the clinical nurse to stay at the bedside of the patient.Many nurses are not attracted to administration or education and have resisted advanced practice unless its clinical in nature. I am particularly interested in nursing education and have experience as a clinical education instructor at the undergraduate level. The national organization that I would join must have a strong educational component and outreach to encourage nurses to obtain advanced education. McEwin, M. , & Wills, E. M. (2011). Theoretical basis for nursing. Philadelphia, PA: Lippincott Williams & Wilkins