Man’s Nature is Evil †Hsun Tzuu Essay Essay Example

Man’s Nature is Evil – Hsun Tzuu Essay Essay Man’s footing demand is to last and boom. This is such because he loves himself. This love for himself is makes him selfish and selfishness makes him evil. There is no 1 in this universe that doesn’t love himself. This love for himself makes him set his demands over everything else. Puting one’s demands over other and non being considerate towards others and harming them for ain advantage is evil. There was 1000000s of ways to demo how work forces are evil. To get down with there are legion histories where work forces led wars against other states. destroyed belongings. In the name of suppressing their land they have taken guiltless lives all for their ain involvement. They try to warrant the wars by stating it’s to work out a certain issue but there’s no manner war is a solution to any job. Work forces have cheated and robbed others in the name of trade and commercialism. The biggest illustration is â€Å"Capitalism† which makes rich people richer and hapless people invariably poorer. Governments all around the universe have invented Torahs and ordinances to repress people. It is invented to protect the rich and powerful from the hapless and unfortunate people so that they can’t come back and repossess their stolen rights. The rich and powerful are ever traveling to look down upon the hapless people. If the hapless people are given a opportunity they’ll certainly rob the rich people of their assets and make precisely what the rich people did to them. There’s no clemency no forgiveness neither there is any love and spirit of brotherhood among work forces. All these unfairness. contending. wars. misrepresentation and lies everything proves that man’s basic nature is evil. We will write a custom essay sample on Man’s Nature is Evil – Hsun Tzuu Essay specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Man’s Nature is Evil – Hsun Tzuu Essay specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Man’s Nature is Evil – Hsun Tzuu Essay specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Hsun Tzu says man’s true nature is evil and goodness comes out as a consequence of his scruples activity. which is perfectly true. There are practical and true statements that he made in his essay where he depicts his man’s true signifier of evil. First of wholly if a adult male is non evil so he wouldn’t necessitate any instructor or counsel to be a good individual or to make good things yet he needs to be invariably guided by rules and instructions to go better. If a adult male is originally good in his true nature so there is no manner that he can acquire derailed from his true nature. But every bit shortly as his Born he is more goaded towards all the errors so his nature can be originally pure and good. Bing respectful towards their seniors and being careful towards their kids is what a adult male is supposed to make. They are non traveling to eat until the seniors have eaten or non traveling to rest until they will demand remainder until they have provided for their seniors and kids but all these travel against their true emotions. If they were originally good in nature so adult male would hold been of course respectful to others therefore his nature is what we call the antonym of good . A adult male is fond of beautiful sights. sound and gustatory sensation. Seeking the beauty to delight him is his true nature. He admires the outer beauty instead than the beauty concealed indoors. He loves the beautiful outside instead than looking deep inside person. He will neer like individual with an ugly face ; will neer take something with a bad gustatory sensation and smell even if it’s a medical specialty. This exemplifies his immorality and obscure nature. If a man’s nature was originally good so the sage male monarchs who invented ritual rules out of their scruples activity would hold neer had to do them. Man would make good things and do merely determinations without the sage king’s contriving the ritual rules. All the statements that Hsun Tzu makes here have supported my positions about man’s nature being evil. He has reassured my apprehensions about man’s true nature. If world is left free to indulge in his true passion this universe will shortly fall into pandemonium and convulsion. There will be no peace no Concord no harmoniousness no cordiality. We will decease of unfairness and our ain passion of evil. This is why we need the cherished ritual rules so that we can last and allow other unrecorded. With the above being discussed it is appropriate to state that man’s true nature is evil.

What to Expect When Getting Your Drug Test At Work

What to Expect When Getting Your Drug Test At Work Pre-employment drug screening is definitely a practice you should be aware of. Depending on the job you get, your sobriety can affect your job performance- even the safety and lives of other people. Employers are eager to make sure they can trust you and your judgment. Some employers are actually federally obligated to screen employees, such as the Federal Highway Administration, the Federal Aviation Administration, and the U.S. Coast Guard. Tests are much more likely in trucking industry, aviation, or mass transit, or for anyone hoping to work with NASA or the Department of Defense.Test TypesThere are two kinds of drug tests: the 5-panel test screen, and the 10-panel test. The 5-panel test screens for the following:CocaineAmphetamine/MethamphetamineOpiates (like heroin, codeine, and morphine)Phencyclidine or PCPTHC (marijuana)The 10-panel test screens for the following:CocaineAmphetamineMethamphetamineOpiates such as heroin, codeine and morphinePhencyclidine or PCPTHC (marijuana)Pro poxypheneMethadoneBarbituratesBenzodiazepinesSome marijuana use might go undetected, particularly if the THC has been removed, as in medical marijuana). Other drugs, like prescription pain medication, might show up. If you’re using any prescription drugs, you should disclose this information before the test- particularly pain medications, certain weight-loss supplements, and drugs like Xanax, Valium, Rohypnol, and Ativan. And if you live in a state where recreational pot use is legal, or you have a prescription for medical marijuana, you might want to consider chatting with an employment lawyer about your options if a drug test scenario comes up.Know the Rules and Your RightsA lot of employers reserve the right to test again once you’re employed. They can ask for a test regularly or randomly, and can demand a test on short notice, giving employees no time to try and cheat.There are limits to how much an employer is allowed to test, given the invasion of privacy. If you feel your rights have been violated, consult the employment laws of your state. Remember: you are also not required to take a test from a prospective employer. Just keep in mind, that might well cost you the job.Know  What You’re Getting IntoA few things to keep in mind to make sure you don’t lose a job to a failed drug test:Most tests are urine tests, though this is changing. Saliva tests (easier to pass as they only go back three days), and hair tests (which go back 90 days) are also possible. Employers could even ask to test your blood or nails.You can’t just drink an enormous quantity of water or exercise heavily to get a particular drug to clear your system- that’s mostly a myth.Certain drugs will stay in different people’s systems for different lengths of time. This depends on a number of factors, including individual metabolism, rate and quantity of use, the concentration, etc. The sensitivity of the test is also variable.

Economics of Taxation Essay Example | Topics and Well Written Essays - 1000 words - 1

Economics of Taxation - Essay Example Does the Family Credit alter the marriage penalty or bonus? Under the current 2006 tax system, the value of the personal exemption and standard deduction for household 1 (married couple) would be a consolidated amount of $16, 400. This is made up of the personal exemption of $3200 ($6400 for 2) and a joint standard deduction for the married couple of $10,000. The same value calculated for household 2 amounts to $8200 for personal exemption ($3200) and standard deduction ($5000). As per the Simplified Income Tax Plan proposed by the advisory panel on tax reform, Family Credit replaces the personal exemption and standard deduction. It is available to all taxpayers. For a married couple with no children, it amounts to $3300 whereas for an unmarried taxpayer it is $1650. Assuming that the current income tax brackets prevail, the following comparative analysis would justify whether the taxpayers prefer the old tax code or the new Simplified Tax Plan: 2. Which is more equitable: the current system with the personal exemption and the option to take either the standard or itemized deduction, or the Family Credit which everyone can take, even if they also itemize deductions? Discuss both horizontal and vertical equity and explain your answer. Solution: â€Å"Tax equity focuses on equal treatment of similarly situated taxpayers† (Sommerfeld, Anderson, & Brock 9). There are two tax principles, namely, horizontal equity and vertical equity. Horizontal equity is a basic yardstick used to measure whether tax burdens are fairly distributed. According to this principle, taxpayers with same income should pay the same amount in taxes. On the other hand, the principle of vertical equity is a proponent of the progressive structure of tax assigning high income earners greater responsibility to share the tax bill (Kaplow 1989). Under the current system, personal exemption is available to

Cost Benefit Analysis Essay Example | Topics and Well Written Essays - 9000 words

Cost Benefit Analysis - Essay Example [Refer to Appendix B] It was found, by the 1999 survey statistics in a table entitled "Extent of Flame Damage by Major Property Use, 1999, Structure Fire Reported to U.S. Fire Department" that in just the area of residential properties of only one and two family dwelling houses that: Table 6.2:Loss per Fire in One and Two-Family Dwellings, by Extent of Flame Damage Annual Average of 1989-1998 Structure Fire Reported to U.S. Fire Department [National estimates based on NFIRS and NFPA Survey] These are fires reported to the U S. municipal department and therefore exclude fire reported only to Federal or state agencies or industrial fire brigades. Fire in which the extent of flame damage was unknown or not reported have been allocated proportionately among fires with known extent of flame damage. Property damage figures have not been adjusted for inflation. Fires are rounded to the nearest ten and property damage is rounded to nearest hundred dollars. Sums may not equal total due rounding errors. There are defin There are definite cost benefits for properties that can be as a direct result of fire sprinkler installation, but, what is the cost benefit analysis with respect to saving lives The NFPA has kept statistics on large loss-of-life incidents for the last decade and has found that: NFPA has no record of a fire killing more than two people in a completely sprinklered building where the system was properly operating, except in an explosion or flash fire or where industrial fire brigade members or employees were killed during fire suppression operations. (NFPA, 2003) The following table shows that figure in a clearer scale: Table 6.1: Estimated Reduction in 1999 Civilian Death per Thousand Fires Due to Sprinklers, in Property Classes [National estimates based on 1999 NFIRS and NFPA Survey] Date reported in Version 4.1 as sprinkler status unknown was converted to no-sprinkler. It was necessary to use pre-1999 data to estimate what fraction of the 1999 fires coded as non-sprinkler really were no sprinkler. The conversion of data reported in Version 4 converted all fire where sprinklers operated to other/unclassified. It was necessary to use pre-1999 data to estimate what fraction of the 1999 fires coded as other operation were really sprinkler operated. These are fire .reported to U S. municipal fire department and so exclude fire reported only to Federal or state agencies or industrial fire brigades. Fire statistics do not include proportional shares of fires with sprinkler status unknown or unreported. Fires are estimated to the nearest hundred. Sums may not equal total due rounding errors. Total includes fires in properties without high occupancy, such manufacturing and storage properties. The NIST (National Institute of

Reflection On Experience Working In Accident And Emergency

Reflection On Experience Working In Accident And Emergency This fieldwork exercise was a visit to the Minors Department within Accident and Emergency (AE) for a large London National Health Service (NHS) hospital, to observe and interview an Emergency Nurse Practitioner (ENP) within the Department, and link their role in relation to primary health care (PHC). I had expected to learn further about the main connection between PHC and an acute care setting such as AE, assuming that it would be due to poor PHC management and issues with accessibility. These assumptions were based on some experience in AE as an Agency Nurse, along with colleagues, patients and media reports. 2.0 VISIT TO MINORS IN ACCIDENT EMERGENCY My fieldwork exercise began with covert observation in the AE waiting room, waiting for my fellow Nurse Practitioner (NP) student to arrive for a Saturday night shift. There were around 15 people and one child within the waiting room; a relatively calm environment, albeit for quiet restlessness, sighing, guarding and rocking, questioning companions as to when they would be seen, alongside comparing with others who had got in. Reception was a glass-shielded counter staffed by two personnel, informing patients registering, that there was a three hour wait. An electronic sign above reception welcomed patients, friends and relatives to the hospital, also informing them that we endeavour to see you in 4 hours; a reference to the Department of Healths (DoH) target, for patients to be discharged, admitted or transferred within four hours of presenting, in 98% of cases. The sign also requested for those with a minor illness, to attend the adjacent walk-in centre (WIC). Of note, aside from a clear focus on hygiene, was a sign notifying patients that treatment may not be free if not a United Kingdom (UK)/European Union citizen or resident. Such signage brings a principle of the Alma Ata declaration into question. The Alma Ata declaration arose following a joint World Health Organisation-UNICEF international conference, with a vision for healthcare for all people worldwide, with PHC at the heart (World Health Organisation, 2010). Although it can be argued that international guests are not paying into the NHS, and healthcare in the UK is not essentially free, given the National Insurance levy, the declaration views healthcare as a right for all, and not just those who are in a position to pay. On arrival, my fellow NP student showed me around AE. Within the adults section, the Department can be broken down to: Table 1: AE layout Department/Room Cubicles/Rooms Additional/Other Information Resuscitation 5 +1 paediatric cubicle Majors 16 Including 1 psychiatric cubicle Minors 12 Assessment/Triage 3 Clinical Decisions 10 Investigations and short term treatment (not more than 24-36 hours) Eye 1 Ear, Nose Throat 1 Plaster 1 X-Ray 1 Adjacent CT room being built next to Resuscitation The hospital is one of Londons major hospitals, opening in the 1700s in central London and developing into a main teaching hospital. With the increase in healthcare demands, more space was needed, and the hospital relocated to its present day location in the 1950s. In the 1970s, construction on the present hospital building began, and by the early 2000s, building and the final relocation of one of its hospitals was complete (Hospital website, 2009a). The AE Department is a 24 hour service, seeing around 100 000 patients per year, and of those, around 21% are admitted to hospital. Twenty two percent are children, to which a separate paediatric AE between the hours of 9am and 2am is available (Hospital website, 2009b). From April this year, the AE Department will become one of Londons four major trauma centres (MTC), and one of eight acute stroke centres (Healthcare for London, 2010). Preparations for this new designation were evident by the building of a computerised tomography scanner next door to Resuscitation, enabling suspected stroke patients to be scanned within two minutes of arriving. I spent most of my visit in Minors, a Department with 12 cubicles, which is staffed by two to three ENPs, one Senior House Officer, Registrar support, and a General Practitioner (GP) on Saturday and Sunday evenings. Despite having an adjacent WIC, this section of AE is dedicated to patients with minor injuries and illnesses. The most common presentations are due to infections (mostly ears, nose and throat, and urology), foreign bodies, wounds, fractures and head injuries. Numbers seen can vary, and around 150 patients had already been seen that day. There is a difference between days and nights, with days mostly seeing occupational injuries and GP referrals, with alcohol, drugs, domestic violence, assaults and foreign bodies featuring in the nights. In addition, weekends and evenings can see Minors taking on the role of an extended hours GP practice; supporting my hypothesis of poor PHC management and accessibility, as being a key cause of PHC in AE. The Department closes at 3am to reduce costs, but is sometimes too busy to do so. From next year, Minors will be a 24 hour service, with the aim for a Nurse-led service with Registrar support. This is to release medical staff for the new MTC, and in response to recommendations in Lord Darzis review on healthcare for London, discussed further in this assignment. The most surprising element of my visit, was to find out that ENPs are viewed and treated as junior doctors. This was mirrored by the consultation: history taking, examination, assessment, plan of care and documentation was that of seeing a medical doctor. While I was aware of the advanced and autonomous role of a NP, enabling diagnosing, prescribing and referring, I was taken back that NPs, certainly in this Department, have shifted from the nursing side of healthcare, and are now affiliated with medicine. The ENPs line management is a Registrar, who also supervises and signs off competencies. Any problems or concerns which need to be escalated, are dealt with by the Consultant. The AE Matron, and ultimately, the Director of Nursing are nowhere in the ENPs reporting line. The role of NP, reviews of urgent care, and PHC management are the topics I have chosen to base my discussion on. 3.0 DISCUSSION 3.1 Urgent care reviews The key review of urgent care in London is Lord Darzis Healthcare for London: A Framework for Action report. It was commissioned by NHS London in December 2006, in order to fulfil Londons healthcare needs over the next 5 to 10 years. The report acknowledged that many patients presenting to AE for minor illnesses and injuries would be better looked after in polyclinics or urgent care centres (UCC) with longer opening hours. Patients presenting to AE is not optimal due to the waiting period and being seen by junior doctors rather than GPs, who more suited to these complaints along with managing long-term health conditions (Healthcare for London, 2007a). The report proposes UCC with diagnostic equipment, where patients will have access to a Nurse or GP, recommending 24 hour access if based in AE (ie. Minors), or to be open on weekends and afterhours for those not hospital based (Healthcare for London, 2007a). A co-located UCC within AE can be important, in diverting urgent care away from attending AE/MTCs (Healthcare for London, 2007b). However, the ENP reported problems recruiting fellow ENPs with appropriate qualifications and experience, and was unsure whether Minors would be a Nurse-led 24 hour UCC, to coincide with the transformation of the main part of AE into a MTC in April. The Darzi report received criticism, largely directed at cost cuttings, cashing in on privatisation, the demotion of acute hospital services, the question of elderly care, and that future predictions on PHC and AE usage was an understatement. There is also criticism that recommendations have been made without practicalities, including polyclinic staffing, failings and costs of minor injuries units, and the future of healthcare staff (London Health Emergency, 2007). The ENP reported a poor skills mix at the adjacent WIC, such as not being able to read x-rays or suture, with patients being referred on to Minors. Alongside the question of resources being doubled up, such referring on leads to disjointed care and greater waiting lengths to be treated. It could also be confusing for patients to know where the best place to attend is, especially having been diverted from AE to the WIC on the advice of the Reception sign, only to end back up in AE. Clarity and streamlining of services is needed to improve patient experience. The Royal College of Nursing (RCN) survey found that Emergency Nurses were under huge strain to meet the DoHs four hour target, termed as unrealistic (RCN, 2010: website). The survey also reported that the majority of respondents felt that patients with various and complicated needs, have had their care rushed to meet targets, and 59% of respondents feeling the responsibility lying solely within Nurses (RCN, 2010). Yet the ENP I spoke to was happy with the target, which gave momentum if a patient needed to be seen by a Registrar and had been waiting over an hour, this would then be escalated to a Consultant. On questioning, the ENP felt that the target was realistic, practical and they had the resources. 3.2 Primary health care management and accessibility London has the most AE attendances and admissions than anywhere else in England, and many of the 83% of patients not admitted could be treated elsewhere, with 40% of complaints able to be resolved through PHC. However, access to PHC services in London after hours is inadequate; a main thought behind AE attendance. AE patients are more likely to be fulltime workers and may take reassurance in knowing that they will be seen in four hours, rather than a wait of up to (or longer than) 48 hours to see their GP (Healthcare for London, 2007b). According to the ENP, patients report issues making GP appointments and that AE is quicker than seeing their GP, as the main reasons for presenting with PHC matters. The Healthcare Commissions (HCC, now the Care Quality Commission) review on urgent care in England, found that more than 50% of patients have problems calling their GP surgery, and a quarter of patients found GP hours were not convenient, and avoided going (HCC, 2008). Incentives for GP surgeries to provide afterhours care was a recommendation by The Royal College of General Practitioner (RCGP) in their review on urgent care (RCGP, 2007). Yet, the HCCs review found that where GP services provide afterhours care, less than half had organised a phone diversion with local GPs, to divert afterhours calls to their services. The majority of patients attending afterhours GP services are seen within two hours after an initial telephone assessment (HCC, 2008). This is not only faster than attending AE, but a more appropriate use of resources. The review found that many people are not aware of healthcare services other than their own GP and AE, or they might be unsure of using them. There were also examples of patients being referred to services that were not accessible. Work needs to be done to increase both patients and healthcare professionals understanding of alternative healthcare services, and when to use them (HCC, 2008). This is a view shared by the RCGP, along with GP practices implementing systems to deal with urgent care and GP training (RCGP, 2007). The ENP expressed frustrations with GPs making inappropriate referrals to AE, rather than to Specialists, generally noting the practice of defensive medicine. Despite referring back to the GP on discharge, patients were bouncing back for simple things, such as to have their dressings attended to. The ENP rarely had time to speak with GPs, but when they did, it was mostly to phone to question why they had referred. In respect to patients, the ENP felt that they were either not taking responsibility for their health or there was poor self management, possibly due to poor or no patient education, such as not taking analgesia and attending AE to request. The RCGP also note the need for improved patient education and self management promotion in their review (RCGP, 2007). The ENP was also very critical of NHS Direct, Englands telephone advice line for healthcare. They felt that the service was inadequate, as it was not possible to make an assessment over the phone, and defensively referring to AE. Yet half of callers to NHS Direct were given advice on self management at home (NHS Direct, 2010). 3.3 The role of the Nurse Practitioner 4.0 SUMMARY This fieldwork exercise has been a valuable experience. It has demonstrated the impact PHC has on AE, an already stretched resource, exacerbated by poor PHC management and accessibility. For these reasons, I will bear in mind my present practice and on qualification as a NP, to make seamless and appropriate referrals.

Consciousness As Determined Th Essay examples -- essays research paper

Consciousness is understood in a variety of ways. In one belief, a person is conscious when awake, but unconscious when sleeping or comatose. Yet people also do things requiring perception and thought unconsciously even when they are awake. A person can be conscious of their physical surroundings, pain and even a wish or fantasy. In short a creature is conscious if it is aware of itself and that it is a physical and emotional being. Consciousness is a psychological condition defined by the English philosopher John Locke as "the perception of what passes in a man’s own mind".1 Consciousness is defined and perceived differently in many psychological view points. For instance the earlier views around the 19th century was diversely considered. Most perceived consciousness as a substance or "mental stuff" unlike an object from the physical world. Others deferred that the conscious mind was what separated man from lower forms of life. It is an attribute characterized by sensation and voluntary movement which described the difference between normal waking state of animals and men and their condition when asleep.2 Other descriptions included an analysis of consciousness as a form of relationship or act of the mind toward objects in nature, and a view that consciousness was a continuous field or stream of essentially mental "sense data." The method believed by most early writers in determining consciousness was introspection—looking within one’s own mind to discover the laws of it’s operation. This belief was limited when it was apparent when observationalists could not agree on observations. Obviously due to the differences in one’s own idea of introspection and the underlying views they possessed. The failure of introspection to reveal consistent laws led to the refection of all mental states as subjects of scientific study and thus psychology attached consciousness to its diversity. The term consciousness is most often used by philosophers and psychologists as meaning "attention to the contents or workings of one’s own mind." This notion had little significance for the ancients, but it was emphasized in the 17th century by John Locke and Rene Descartes. Contemporaries of ... ... physical framework of reality.6 Smythies presents that everyone has a private space in addition to the shared, public version. Each individual’s personal framework intersects with the familiar dimensions while remaining distinct from them, and it provides an arena for all conscious sensations that have spatial extension or location–objects discernible by sight or touch.7 To understand Smythies’ theory see Appendix A. In conclusion one can determine a variety of theories in the evolution of consciousness. As cited earlier, consciousness is viewed as being physical or material in some cases and yet in others it is viewed as a function of the inner mind or the minds eye. These theories have even been as radical as Smythies’ philosophy that the state of consciousness is a sort of physical plane. If we were to collaborate these theories to form a conclusive view point, individuals would possibly be able to understand consciousness and the workings of consciousness. Perhaps the mystery of consciousness is to remain a mystery. Possibly this mystery is the key to cognitive thinking. And perhaps the key to our personal evolution.

Critical Thinking Question Essay

1. Explain the differences between bacterial meningitis, aseptic meningitis, fungal meningitis, and tubercular meningitis. Bacterial meningitis is a primary infection of the pia mater, arachnoid and subarachnoid space, ventricular system and the CSF of the brain. The subarachnoid space is accessed either by a systemic, bloodstream or direct extension infection. Common causes of bacterial meningitis after the neonatal period are Meningococcus (Neisseria meningitidis) and pneumococcus (Streptococcus pneumonia). For neonates, pneumococcus and gram-negative enteric bacilli are common agents. Aseptic meningitis (viral meningitis, nonpurulent meningitis, lymphocytic meningitis) is an inflammation which is thought to be localized to the meninges. The population at risk depends of the virus. A variety of symptoms are caused by a plethora of viruses such as enteroviral (most common), mumps, herpes simplex types 1 and 2,, St. Lus encephalitis virus, West Nile virus, California encephalitis virus, Venezuelan equine encephalitis, Colorado tick fever, lymphocytic choriomeningitis virus, Epstein-Barr virus, and influenza virus types A and B. Fungal meningitis is a chronic, much less common condition than bacterial or viral meningitis. It most frequently occurs in persons with impaired immune systems or those with altered normal flora. Development is insidious and usually occurs over days to weeks. Also associated with chronic meningitis are syphilis, tuberculosis and Lyme disease. Tubercular meningitis is the most common and most serious form of CNS tuberculosis, and is found mostly in those with acquired immunodeficiency syndrome (AIDS). Miliary tubercules form in the brain and meninges, later eroding in the pia mater with mycobacteria entering in the CSF producing a hypersensitivity reaction which causes purulent exudate to the basal meninges, cerebrum and spinal nerves. Vasculitis occurs causing cerebral ischemia and infarction. Symptoms include headache, low-grade fever, stiff neck, nausea and vomiting, irritability, difficulty sleeping and fatigue. These signs and symptoms lead to increase to confusion, stiff neck, significant behavioral changes, and seizures. Additionally, hydrocephalus and cranial nerve palsies or cerebral infarcts may occur. Early diagnosis and treatment with proper antituberculosis may cause a 90% recovery rate. 2. A neonate has a harsh, loud, systolic murmur shortly after birth. This is best heard at the left lower sternal border. The neonate is acyanotic and has no other symptoms. What type of congenital heart disorder does this infant have? Explain why the neonate is not cyanotic. When could the infant become cyanotic? These symptoms describe a ventricular septal defect (VSD). This type of defect is a left to right shunt of blood flow through the septum of the heart and symptoms depend on the size of the shunt. Because of the increase in blood from the right ventricle (RV) into the pulmonary artery (PA), the PA, left atrium (LA) and left ventricle (LV) become enlarged. A large VSD causes a large amount of pulmonary volume. Over time, the smooth muscle layer of the arteriolar wall thickens and a decrease in diameter of the pulmonary vessels occurs which causes resistance to the new blood flow. An increase in pulmonary vascular resistance causes a reverse shunting through the VSD causing cyanosis from deoxygenated blood flowing through systemic circulation. This phenomenon is termed Eisenmenger syndrome. 3. How does defective gastric secretion of intrinsic factor (IF) cause anemia? What is this type of anemia called, and how does a person get it? Intrinsic factor (IF) is a mucoprotein that is produced by the parietal cells. It is responsible for absorption of vitamin B12 in the ileum. Decreased amounts of IF causes a lack of absorption of B12 resulting in pernicious anemia. IF deficiency may be congenital or from adult onset gastric mucosal atrophy and parietal cell destruction. In older adults, failure to absorb IF is the cause of almost all vitamin B12 deficiencies. Congenital IF disorder is caused by an autosomal recessive inheritance pattern which is a genetic disorder. Gastric atrophy may be autoimmune and occurs along with type A chronic gastritis. 4. Discuss the pathophysiologic relationship between cirrhosis and portal hypertension. Cirrhosis is an inflammatory disease of the liver that disrupts its structure and function. Fibrous bands are formed causing nodular regeneration giving the liver a bumpy appearance. The liver is smaller or larger than normal and is hard when palpated. Parenchyma of the liver becomes distorted and the biliary channels become obstructed causing jaundice. Shunting is formed in new vascular channels bypassing blood from the liver. Obstruction in the portal veins also causes abnormal high blood pressure in the system from resistance of the blood flow from the obstruction. This is termed portal hypertension. Cirrhosis of the liver is the most common cause of portal hypertension.