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resume white paper I’m Chanpory, and Waterhouse, this is eugenics theory my site on how to live and work better as a designer. You should follow me on Twitter here. For more, check out the William Waterhouse archives. The 7 deadly sins of of mice the american dream, resume design. So you’ve labored with sweat and John William, tears writing your resume, and now you’re all set to turn it into a magnificently designed creation.

Unfortunately, with the freedom of modern computers and Stop Puppy Mills! Adopt a Shelter, fancy software, comes huge opportunities for abuse. When it comes to resumes, both non-designers and professional designers commit some almost unforgivable sins. Here are the 7 deadly sins of John Waterhouse, resume design and how to repent: Take a tour of any office supply store and you’ll see shelves of extravagant “resume” papers featuring special “linen” and “parchment” finishes. Avoid these like dog poop on a New York summer sidewalk.

They’re too expensive and don’t make you look extra special. To repent: Save your money and get paper with a plain smooth finish. It can be slightly heavier than regular copy paper, but not stiff as a board. An ever so slight hint of cream is fine. It’ll make your resume easier on the eyes than the super-ultra-pure-snow-driven white paper many designers are fond of. Eugenics Theory! I prefer Neenah Classic Crest in Natural White with a Super Smooth finish. Never ever use pink paper with strawberry scent. The default typeface in Microsoft Word is William Waterhouse Times New Roman, and thus it’s the Mills! a Shelter Essay default for most resumes. It’s a tragedy, because Times’s letterspacing and wordspacing is wretched in Word. The result is an unharmonious mess.

To repent: Choose a different typeface. I won’t go into explaining x-heights or the difference between Humanist Sans and Geometric Sans. Waterhouse! If you’ve got money to spare, pick any of the typefaces in FontShop’s professional collection, and you’ll be a step above Times New Roman. If you’re cheap, use Matthew Carter’s Georgia. Four Communication! It’s free and John William Waterhouse Essay, already installed on your computer. Stop Mills! A Dog! If you send your resume electronically as a PDF, it also looks quite good on-screen. If you need more guidance, check out Before After’s tutorial on picking typefaces. Designers fresh out of William Waterhouse, school love teeny tiny type. The belief is that it looks elegant, refined, and allows for more white space on the resume. Grace And Mercy Story Of Noah And The! It’s a shame.

For all that elegance, no one can read it, because most people in William Waterhouse hiring positions won’t have fresh baby eyes with 20/20 vision. To repent: Set your resume no smaller than 9 points for sans-serifed type and 10 points for serifed type. Anything smaller, and your resume is at Grace in the and the risk of being shredded. Designers also love grey type. On an inkjet printer, grey text looks better because it reduces the appearance of noise. John William Waterhouse! If you go too light, though, it becomes illegible and Grace in the Ark Essay, unfaxable. William Waterhouse Essay! But wait, should you really be using inkjet to print your resume? To repent: Use a laser printer and print in 100% black for Puppy a Shelter Essay, ultimate clarity.

If you do go grey, don’t go lighter than 75% black. You may be tempted to add decoration like floral borders, rainbow colors, and William Waterhouse Essay, hearts. Perhaps, you want to use an illustration of a swan, tiger or unicorn to represent you. Different Types! This is great if you want to look like a box of crayons melted on William your resume. Otherwise, don’t try to Four Stages in Health Essay be cute.

To repent: Add some character by setting your name slightly larger, or in a different weight as the same typeface as the rest of your resume. Use color, but very sparingly, if at all. John Waterhouse Essay! No more than one color in addition to eugenics theory black. If you live in William Essay the United States, the standard paper size is 8.5 x 11in. In Europe, it’s 210 x 297mm. Anything else will fit awkwardly in a binder or file. When it doesn’t fit, it gets thrown out. To repent: Keep to the standard paper size of your geographic location. It’s easier to print and package. In an attempt to stand out, some designers format their resumes in a landscape format. This is of mice dream more annoying than innovative.

To repent: Keep to Waterhouse Essay a portrait format. The first person who sees your resume is usually a Human Resources person who sees hundreds of resumes daily. Too much variation from the norm makes it harder for them to Stop Adopt a Dog From a Shelter make a quick assessment of you. If you want to Waterhouse Essay stand out, write a good cover letter instead. So what does a good looking resume look like? Check out my follow-up post, Give your resume a face lift.

Great info but I think the resume format should match the and men the american job/industry you are applying to. It also comes down to the personal opinion of the Essay person doing the hiring. I had a resume designed and two people were interviewing me. One person really liked it and the other didn’t…But most importantly it got noticed and types, created conversation. I would say have common sense and keep it simple and not over done.

You will never please everybody so create a resume that reflects your personality and talent. Good Luck Cheers. All the John Essay comments are great. Mills! A Shelter Essay! However, I have to say I have always had interviewers ask me for William Essay, a hard copy of my resume at the beginning of the interview. Frankly, I have come to view that as a test of Four Essay, your organizational skills. I think if you suggested that they print it out themselves you would be ushered out the door very, very quickly. hello just asking, what should be the best paper size for resume/cv in philippines. is it short or long bond paper. waiting for reply..thanks^^ To a beginner this sounds intringuing, since simple groups are very natural objects to define, whereas vertex algebras seem more convoluted. , A very useful Design Refresher – Think I need to change some of my fonts around now !! More work … Don’t forget spraying it with perfume (unless your applying to be an escort)! HR people basically don’t give a damn what your resume looks like, as long as they can read it.

And most of John William Waterhouse, them just scan it to make sure you fit the job requirements. Of Mice The American Dream! So forget the nitpicky advice about William Waterhouse fonts. Four Stages In Health Communication! Most HR people wouldn’t know a font if it jumped out of the PC and bit them. … You’re probably going to be submitting your resume as a PDF anyway, in which case you ought to make sure the file will transmit OK and be clear enough to copy. Many companies just ask you to John William paste a text version of your resume into an online application, which is a dead give-away that they couldn’t care less how pretty it looks. Just make sure you leave out the silly dingbats. I have found in important novel my 10 years in the professional design world that HR are the John Waterhouse Essay non educated gate keepers of the employment world. Go get real employees opinions on said workers within HR…most cringe at the notion of different types, going through HR.

Really, what do people in HR do all day? There are some rules that can be broken and and broken well but not unless you’re an artist or graphic designer should you attempt them. Number one advice is just get your resume to the person that will be hiring and avoid HR like the plague. Wow, tough crowd. This is John William Waterhouse a perfect list of rules for design “begginers”. Of course designers and talented creative types may be able to in Health make an impact by John William Waterhouse, cleverly breaking some of these rules – but you’re probably going to have to use some software other than Word to pull that off. If you’re using Word this is your bible with one addition – NEVER USE WORDART. Nice work Chanpory. @James, I was thinking the exact same thing. Of Mice Dream! Tough crowd indeed! @Chanpory, great advice!

I’m in John a similar role as the important questions of mr.chips novel owner of a small agency and the resumes I have seen, whether for designers, developers, or even bookkeepers, are unbelieveable. My alltime favorite was one in Comic Sans (no joke!!). I think the key point is that design must always help achieve the goal. John Waterhouse Essay! The goal for eugenics theory, a resume is to get an interview. To that end, a resume’s design must help communicate the message/content of the resume effectively. Creatviity can have a place in your resume, but you ought to John William be conservative with it in my opinion: what’s clever, creative, and questions of mr.chips, “the best resume I’ve seen” to one person might just be tacky and Essay, overdone to another. OK…. this entire “7 deadly sins” is bullcrap. Any designer worth their salt knows that if you KNOW the rules, you can break the rules. There is nothing I like more than receiving a fantastically creative resume.

After all, they are coming to us to Stages in Health Communication be creative. It lets me see how well they understand how to sell themselves. I hate to say it, but your resume ideas only makes them look like the cream of the crap… not the cream of the crop. I think its just a matte of time until the John Waterhouse resume gets replaced. Sort of old fashion. I think you are all missing a very important piece—who is the eugenics theory audience? All of William Essay, these concerns are dependent on the type of and Mercy in the and the Ark Essay, job you are applying to (i.e. your audience). No matter what you are designing, this is the #1 variable to consider.

What is important when applying to a creative job, is very different than what is William Waterhouse Essay important in the financial world, for expample. Thanks for the tip on Georgia font – I had Garamond originally, and it looked terrible when converted to PDF. Just tried out Georgia and loved it! When we go to interviews, it’s nice to bring a copy of our resume along. That’s why it matters how it looks when printed. Just because HR has received it doesn’t mean the in the Story and the interviewer will necessarily have it on Essay hand. In addition, someone or someone’s just may pop in on the interview out of interest.

I was once take directly from the eugenics theory interview with HR straight to the manager to interview with her immediately because HR thought I’d be a good fit. I’m glad I had another copy of my resume on hand. It’s just good form to bring extra copies of a resume. PS Speaking of John Waterhouse, bad font; what’s up with the font on this page?! Its super bold and narrow… and and men dream, hard to read! Maybe try Georgia instead ;) I’m personally a huge fan of Waterhouse, Palatino Linotype. (or its cousin Book Antiqua) It’s a nice serif font that’s easy to read and eugenics theory, scan down through, it’s nicely formed and spaced and it’s ubiquitous but not always commonly used.

And even if you don’t have it you can download it free. Somebody up there also made the point of trying to mimic the style and branding of the William Waterhouse Essay company you are submitting to. If possible you should always do that. One idea is to important questions novel send the cv/resume in a nice folder the same colour as the company’s branding, to Waterhouse Essay use similar coloured paper or to use the same fonts. If you’re sending off internationally always look up the proper resume and cover letter format for the country you are sending to.

For example many countries in mainland Europe also expect you to embed a small, passport-sized photograph at of mr.chips novel the top of the Waterhouse Essay page. Be sure to different use the correct spelling also. True it’s best not to entrust your spelling and grammar to a machine, but, if you’re applying from one English-speaking country to another, be sure that you spellcheck it in John William Waterhouse Essay the appropriate language – e.g. British English v US English. I’ve found, actually, that many computers, for example Dell computers, were always pre-installed with US English as the default language regardless of where they were being sold to. Important Of Mr.chips Novel! So be sure and William, check that your computer and word processor are set to the right language for your country before you send your resume to anybody! This is so good to in the and the Ark Essay know and follow… I totally agree with kathy, but when you haven’t met the contact person the question would be: what should you present a graphically enhanced CV (Branding), a formal black white CV or a flash animated CV? Unless you are a branding fanatic,to the point that you go on and brand yourself and make your resume/letter stand out among others, there are definitely several ways to gain a remarkable first impression. It also dependent on the culture of the company you’re entering and the position you’re applying for… and how old are you and your experience… your CV is your spirit and John Waterhouse, vision, at Stop Mills! a Dog the end.. and if you get your CV to a company where they don’t like it, don’t worry… your CV has probably landed in the wrong place… and your spirit and vision doesn’t suite the company you’re applying for. I truly think design is essential, in order to stand out… but design alone doesn’t make the CV standout… it’s the content and experience and John Waterhouse Essay, the way you brand yourself.

Wow. According to your article, I’ve committed 3 sins: “gray text,” “weird paper size” and “horizontal format.” You probably should also add an 8th sin for kicks that I’ve also committed: “folding.” Now, taken that I’ve broken lots of your rules in resume design — why is Stop Adopt Essay it that I’ve been working for John Waterhouse, my company for different, 3 years and John, 10 months thanks to my “poorly designed resume”? There has to of mice the american dream be something wrong. A graphic designer’s resume should reflect his or her craft. It should have hints of their style and should totally have an experience to go along with it. Designing out William Waterhouse Essay, of the eugenics theory box is always favored and John, is always put on top of the pile if executed properly.

You should never confine yourself to designing freely. Your resume is another piece of your portfolio — one which your future employer will keep. I don’t believe filenames have been mentioned here. When sending a resume electronically, the filename resume.doc is the kiss of death. Be sure to change the filename to reflect your own name. In addition, use either PDF or DOC, never any other format – otherwise, you risk incompatibility. From Essay! Many H/R departments also use autoscan programs, and both multi-column and Essay, fancy fonts/paper will be puked out rather than scanned in. When sending electronically, the plainer, the better! Finally, whether or not sent electronically, be brief. These days, virtually no one is worth a two-pager. The point is to get IN the door for an interview… you can elaborate later, during the interview.

Hi, you guys would be surprised to know that most Turkish companies require your resume to have your photo!! (It mostly (read:always) works in my favour :P ) yeah, so my resume looks pretty messed up when I try to fit in my photo. It looks like a very detailed I-card! I think a photo within the resume screams prejudice. Im not Turkish(I worked and will work in Turkey again soon) but even when Turkish people apply to Turkish companies they add a photo. By the way, I know for and men the american, a fact that some American companies ask for Waterhouse, photos within a resume too (reference : my Turkish friends who’ve applied to American companies). I wish I could get some points on Story of Noah how to add your photo in your resume and not feel like a complete jackass. :P. As an engineer and John William, industrial designer who needs to walk a fine line between ‘logical’ and ‘artzy-fartzy’, I have found a san-serif font works far better than all the Mills! Adopt From a Shelter Essay suggestions above.

I have been using Tahoma for years and have gotten a call-back on every position I have applied for the last dozen years…I am 5 for John, 5. Tahoma kerns nice and tight and 10pt leave plenty of white space. If you know how, typesetting your documents in TeX can really improve the font appearance through proper use of ligatures and types of monopoly, a line-break algorithm that evaluates the appearance of the John William Waterhouse entire paragraph rather than that of the individual line. It can produce PostScript or PDF files for electronic usage. Failing that, it may be possible to use the Computer Modern fonts for which the program is configured in other programs like Word, and I expect these would still be a cut above Microsoft’s pet fonts.

I think everyone should come out eugenics theory, of the dark ages. We now have the John Waterhouse Essay facility of Stop Puppy a Dog From Essay, computers and John William Waterhouse, graphics……why not use them within reason. / Surely an employer with any intelligence would be absorbing the ease of reading and the content…….not crossing a prospect off because of the font used. Lets move into the 21st century people. As a recent “job seeker” I found this very useful. Grace In The Story Of Noah Ark Essay! though of William Essay, course we call them CVs in the Uk, the tips are all good. Questions Novel! Better equipped to avoid the John William Waterhouse Essay pitfalls now, although I don’t agree 100% with all the points it is none the less a useful read.

Thanks again. Pat. I think it would be best to send a virus to HR because all in all they never call anyone back. Most of HR have no clue about anything tech, nor do they have any creative brain at Stop Puppy Mills! Adopt a Dog a Shelter Essay all. I would rather just meet someone who works at the company itself than deal with a braindead HR zombie.

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Chronic Obstructive Pulmonary Disorder (COPD) Case Study. Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible. This newest definition COPD , provided by the Global Initiative for Chrnonic Obstructive Lung Disease (GOLD), is a broad description that better explains this disorder and its signs and symptoms (GOLD, World Health Organization [WHO] National Heart, Lung and Blood Institute [NHLBI], 2004). Although previous definitions have include emphysema and William Waterhouse Essay chronic bronchitis under the umbrella classification of COPD , this was often confusing because most patient with COPD present with over lapping signs and symptoms of these two distinct disease processes. COPD may include diseases that cause airflow obstruction (e.g., Emphysema, chronic bronchitis) or any combination of these disorders. Other diseases as cystic fibrosis, bronchiectasis, and asthma that were previously classified as types of chronic obstructive lung disease are now classified as chronic pulmonary disorders. However, asthma is now considered as a separate disorder and is classified as an of mice and men, abnormal airway condition characterized primarily by reversible inflammation. COPD can co-exist with asthma. Both of these diseases have the same major symptoms; however, symptoms are generally more variable in asthma than in COPD . Currently, COPD is the fourth leading cause of mortality and the 12 th leading cause of disability.

However, by the year 2020 it is estimated that COPD will be the third leading cause of death and the firth leading cause of William Waterhouse Essay disability (Sin, McAlister, Man. Et al., 2003). People with COPD commonly become symptomatic during the Adopt a Dog Essay middle adult years, and the incidence of the disease increases with age. The respiratory system consists of Waterhouse Essay all the organs involved in breathing. These include the nose, pharynx, larynx, trachea, bronchi and lungs. The respiratory system does two very important things: it brings oxygen into our bodies, which we need for and Mercy Story of Noah Ark Essay our cells to live and function properly; and it helps us get rid of carbon dioxide, which is a waste product of William Waterhouse Essay cellular function. The nose, pharynx, larynx, trachea and bronchi all work like a system of pipes through which the air is funneled down into our lungs.

There, in very small air sacs called alveoli, oxygen is brought into the bloodstream and carbon dioxide is pushed from the blood out into the air. When something goes wrong with part of the respiratory system, such as an infection like pneumonia, chronic obstructive pulmonary diseases, it makes it harder for us to get the oxygen we need and to get rid of the waste product carbon dioxide. Common respiratory symptoms include breathlessness, cough, and chest pain. When you breathe in, air enters your body through your nose or mouth. From there, it travels down your throat through the larynx (or voicebox) and into the trachea (or windpipe) before entering your lungs. All these structures act to funnel fresh air down from the important questions novel outside world into your body.

The upper airway is John Waterhouse, important because it must always stay open for you to be able to breathe. It also helps to in the Ark Essay, moisten and warm the air before it reaches your lungs. The lungs are paired, cone-shaped organs which take up most of the space in our chests, along with the heart. Their role is to take oxygen into the body, which we need for our cells to William Essay, live and function properly, and to help us get rid of carbon dioxide, which is a waste product. We each have two lungs, a left lung and a right lung. These are divided up into ‘lobes’, or big sections of tissue separated by different types of monopoly ‘fissures’ or dividers. The right lung has three lobes but the left lung has only William two, because the heart takes up some of the different of monopoly space in the left side of our chest. The lungs can also be divided up into even smaller portions, called ‘bronchopulmonary segments’.

These are pyramidal-shaped areas which are also separated from each other by membranes. There are about 10 of them in John William Waterhouse Essay each lung. Each segment receives its own blood supply and air supply. COPD VERSUS HEALTHY LUNG. Air enters your lungs through a system of pipes called the the american dream bronchi. These pipes start from the bottom of the trachea as the left and right bronchi and branch many times throughout the lungs, until they eventually form little thin-walled air sacs or bubbles, known as the alveoli.

The alveoli are where the important work of gas exchange takes place between the William Essay air and your blood. Covering each alveolus is a whole network of in the of Noah and the Ark Essay little blood vessel called capillaries, which are very small branches of the pulmonary arteries. William Essay? It is important that the air in the alveoli and the blood in the capillaries are very close together, so that oxygen and carbon dioxide can move (or diffuse) between them. So, when you breathe in, air comes down the trachea and through the bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of of mice and men the american dream this oxygen will travel across the walls of the alveoli into your bloodstream. Traveling in the opposite direction is Waterhouse Essay, carbon dioxide, which crosses from the important novel blood in the capillaries into John the air in different types the alveoli and is then breathed out. In this way, you bring in to your body the oxygen that you need to live, and get rid of the waste product carbon dioxide. The lungs are very vascular organs, meaning they receive a very large blood supply. This is because the pulmonary arteries, which supply the lungs, come directly from the right side of your heart. They carry blood which is low in oxygen and high in carbon dioxide into John Waterhouse Essay your lungs so that the carbon dioxide can be blown off, and of mice and men dream more oxygen can be absorbed into the bloodstream.

The newly oxygen-rich blood then travels back through the William Waterhouse Essay paired pulmonary veins into the left side of types of monopoly your heart. John Essay? From there, it is pumped all around your body to Stages, supply oxygen to cells and organs. The lungs are covered by smooth membranes that we call pleurae. The pleurae have two layers, a ‘visceral’ layer which sticks closely to the outside surface of your lungs, and a ‘parietal’ layer which lines the inside of your chest wall (ribcage). The pleurae are important because they help you breathe in John Waterhouse and out smoothly, without any friction. They also make sure that when your ribcage expands on Stop Mills! Adopt From Essay, breathing in, your lungs expand as well to fill the John Waterhouse extra space.

The Diaphragm and Intercostal Muscles. When you breathe in (inspiration), your muscles need to work to fill your lungs with air. The diaphragm, a large, sheet-like muscle which stretches across your chest under the ribcage, does much of this work. At rest, it is eugenics theory, shaped like a dome curving up into your chest. When you breathe in, the diaphragm contracts and William Waterhouse Essay flattens out, expanding the space in your chest and drawing air into your lungs.

Other muscles, including the muscles between your ribs (the intercostal muscles) also help by moving your ribcage in and out. Breathing out (expiration) does not normally require your muscles to work. Eugenics Theory? This is John William, because your lungs are very elastic, and when your muscles relax at the end of inspiration your lungs simply recoil back into their resting position, pushing the Grace and Mercy in the Ark Essay air out as they go. The Respiratory System and Ageing. The normal process of ageing is associated with a number of changes in both the structure and function of the respiratory system. These include: Enlargement of the alveoli.

The air spaces get bigger and lose their elasticity, meaning that there is less area for gases to be exchanged across. This change is sometimes referred to as ‘senile emphysema’. Waterhouse Essay? The compliance (or springiness) of the chest wall decreases, so that it takes more effort to breathe in and out. The strength of the respiratory muscles (the diaphragm and intercostal muscles) decreases. This change is different of monopoly, closely connected to the general health of the William Waterhouse Essay person. All of these changes mean that an older person might have more difficulty coping with increased stress on their respiratory system, such as with an infection like pneumonia, than a younger person would. Risk factors for COPD include environmental exposures and eugenics theory host factors. The most important risk factor for COPD is John, cigarette smoking.

Other risk factors are pipe, cigar, and other types of and Mercy in the Story of Noah Ark Essay tobacco smoking. In addition, passive smoking contributes to William, respiratory symptoms and COPD. Of Mr.chips? Smoking depresses the activity of scavenger cells and affects the John Waterhouse respiratory tract’s ciliary cleansing mechanism, which keeps breathing passages free of inhaled irritants, bacteria, and other foreign matter. When smoking damages this cleansing mechanism, airflow is obstructed and air becomes trapped behind the Communication obstruction. The alveoli greatly distend, diminished lung capacity. Smoking also irritates the goblet cells and mucus glands, causing an increased accumulation of mucus, which in turn produces more irritation, infection, and damage to William Essay, the lung. In addition, carbon monoxide (a by product of and Mercy in the Story smoking) combines with hemoglobin to form carboxyhemoglobin. Hemoglobin that is bound by carboxyhemoglobin cannot carry oxygen efficiently.

A host risk factor for COPD is a deficiency of alpha antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury. This deficiency predisposes young people to John William, rapid development of different of monopoly lobular emphysema, even if they do not smoke. John? Genetically susceptible people are sensitive to Four in Health Communication, environmental factors (eg. Smoking, air pollution, infectious agents, allergens) and Waterhouse eventually developed chronic obstructive symptoms. Carriers of this genetic defect must be identified so that they can modify environmental risk factors to delay or prevent overt symptoms of disease.

In COPD , the airflow limitation is both progressive and associated with an abnormal inflammatory response of the lungs to eugenics theory, noxious particles or gases. The inflammatory response occurs throughout the airways, parenchyma, and pulmonary vasculature. Because of the chronic inflammation and the body’s attempts to repair it, narrowing occurs in William Essay the small peripheral airways. Over time, this injury-and-repair process causes scar tissue formation and narrowing of the airway lumen. And Men The American? Airflow obstruction may also be caused by John William Waterhouse parenchymal destruction, as is seen with emphysema, a disease of the alveoli or gas exchange units. In addition to Four Stages in Health Communication Essay, inflammation, processes related to imbalances of proteinases and antiproteinases in the lung may be responsible for John Waterhouse Essay airflow limitation. Grace In The Of Noah Ark Essay? When activated by John chronic inflammation, proteiness and other substances may be released, damaging the parenchyma of the lung. Types? The parenchymal changes may occur as a consequence of inflammation or environmental or genetic factors (eg. Alpha1-antitrypsin deficiency). Early in the course of COPD , the inflammatory response causes pulmonary vasculature changes that are characterized by thickening of the vessel wall. These changes may result from exposure to cigarette smoke, use of tobacco products, and the release of inflammatory medicators.

Lung damage and inflammation in Essay the large airways results in chronic bronchitis. Chronic bronchitis is Mills! a Dog a Shelter Essay, defined in clinical terms as a cough with sputum production on most days for 3 months of John Waterhouse Essay a year, for Stop Adopt a Dog Essay 2 consecutive years. In the airways of the John William Waterhouse Essay lung, the hallmark of chronic bronchitris is an increased number (hyperplasia) and eugenics theory increased size (hypertrophy) of the goblet cells and mucous glands of the airway. As a result, there is more mucus than usual in the airways, contributing to William, narrowing of the of mr.chips airways and causing a cough with sputum. Microscopically there is infiltration of the Essay airway walls with inflammatory cells. Of Mice The American Dream? Inflammation is Waterhouse Essay, followed by scarring and remodeling that thickens the walls and also results in narrowing of the airways. As chronic bronchitis progresses, there is squamous metaplasia (an abnormal change in the tissue lining the inside of the different types airway) and John Waterhouse Essay fibrosis (further thickening and scarring of the airway wall).

The consequence of different of monopoly these changes is a limitation of William Waterhouse airflow. Patients with advanced COPD that have primarily chronic bronchitis rather than emphysema were commonly referred to as “blue bloaters” because of the bluish color of the and Mercy in the Story and the skin and lips (cyanosis) seen in them. The hypoxia and fluid retention leads to them being called “Blue Bloaters.” One of the most common symptoms of COPD is shortness of breath (dyspnea). Waterhouse Essay? People with COPD commonly describe this as: “My breathing requires effort”, “I feel out of breath”, or “I can not get enough air in”. People with COPD typically first notice dyspnea during vigorous exercise when the important of mr.chips novel demands on the lungs are greatest.

Over the years, dyspnea tends to Waterhouse, get gradually worse so that it can occur during milder, everyday activities such as housework. In the advanced stages of COPD , dyspnea can become so bad that it occurs during rest and is constantly present. Other symptoms of COPD are a persistent cough, sputum or mucus production, wheezing, chest tightness, and tiredness. Eugenics Theory? People with advanced (very severe) COPD sometimes develop respiratory failure. When this happens, cyanosis, a bluish discoloration of the lips caused by a lack of oxygen in the blood, can occur. An excess of carbon dioxide in the blood can cause headaches, drowsiness or twitching (asterixis).

A complication of Waterhouse Essay advanced COPD is cor pulmonale, a strain on the heart due to the extra work required by the heart to pump blood through the affected lungs. Symptoms of cor pulmonale are peripheral edema, seen as swelling of the ankles, and dyspnea. There are a few signs of COPD that a healthcare worker may detect although they can be seen in other diseases. Some people have COPD and have none of these signs. Common signs are: tachypnea, a rapid breathing rate wheezing sounds or crackles in the lungs heard through a stethoscope breathing out taking a longer time than breathing in enlargement of the chest, particularly the front-to-back distance (hyperinflation) active use of muscles in the neck to help with breathing breathing through pursed lips increased anteroposterior to lateral ratio of the chest (i.e. barrel chest). Emphysema is a chronic obstructive pulmonary disease (COPD, as it is otherwise known, formerly termed a chronic obstructive lung disease). It is often caused by exposure to Essay, toxic chemicals, including long-term exposure to tobacco smoke. Emphysema is characterized by loss of elasticity (increased pulmonary compliance) of the lung tissue caused by destruction of structures feeding the alveoli, owing to the action of alpha 1 antitrypsin deficiency. This causes the small airways to collapse during forced exhalation, as alveolar collapsibility has decreased. John Waterhouse Essay? As a result, airflow is impeded and air becomes trapped in the lungs, in the same way as other obstructive lung diseases.

Symptoms include shortness of breath on exertion, and an expanded chest. However, the constriction of air passages isn’t always immediately deadly, and treatment is available. Signs of Four Stages Communication Essay emphysema include pursed-lipped breathing, central cyanosis and finger clubbing. The chest has hyper resonant percussion notes, particularly just above the liver, and a difficult to palpate apex beat, both due to hyperinflation. There may be decreased breath sounds and John William Waterhouse audible expiratory wheeze. In advanced disease, there are signs of fluid overload such as pitting peripheral edema. The face has a ruddy complexion if there is a secondary polycythemia. Sufferers who retain carbon dioxide have asterixis (metabolic flap) at the wrist.

PFTs demonstrative airflow obstruction – reduced forced vital capacity (FVC), FEV1, FEV1 to FVC ration; increased residual volume to total lung capacity (TLC) ratio, possibly increased TLC. ABG levels- decreased PaO2, pH, and increased CO2. In Health? Chest X-ray – in late stages, hyperinflation, flattened diaphragm, increased rettrosternal space, decreased vascular markings, possible bullae. Alpa1-antitrypsin assay useful in identifying genetically determined deficiency in emphysema. The goals of John William Waterhouse COPD treatment are 1) to prevent further deterioration in lung function, 2) to alleviate symptoms, 3) to improve performance of daily activities and Grace Ark Essay quality of life. The treatment strategies include 1) quitting cigarette smoking, 2) taking medications to dilate airways (bronchodilators) and decrease airway inflammation, 3) vaccinating against John William Essay, flu influenza and pneumonia and Stop Adopt From 4) regular oxygen supplementation and 5) pulmonary rehabilitation. Quitting cigarette smoking. The most important treatment for COPD is quitting cigarette smoking. Patients who continue to Essay, smoke have a more rapid deterioration in lung function when compared to others who quit. Aging itself can cause a very slow decline in lung function.

In susceptible individuals, cigarette smoking can result in a much more dramatic loss of lung function. It is important to note that when one stops smoking the decline in lung function eventually reverts to that of a non-smoker. Nicotine in cigarettes is addictive, and, therefore, cessation of smoking can cause symptoms of Mills! a Dog a Shelter nicotine withdrawal including anxiety, irritability, anger, depression, fatigue, difficulty concentrating or sleeping, and intense craving for cigarettes. Patients likely to develop withdrawal symptoms typically smoke more than 20 cigarettes a day, need to smoke shortly after waking up in the morning, and John Waterhouse Essay have difficulty refraining from smoking in non-smoking areas. However, some 25% of smokers can stop smoking without developing these symptoms. Stop A Dog? Even in those smokers who develop symptoms of withdrawal, the symptoms will decrease after several weeks of abstinence. Treating airway obstruction in COPD with bronchodilators is similar but not identical to treating bronchospasm in William asthma. Bronchodilators are medications that relax the different types muscles surrounding the small airways thereby opening the airways. Bronchodilators can be inhaled, taken orally or administered intravenously.

Inhaled bronchodilators are popular because they go directly to the airways where they work. As compared with bronchodilators given orally, less medication reaches the rest of the body, and, therefore, there are fewer side effects. Metered dose inhalers (MDIs) are used to Waterhouse Essay, deliver bronchodilators. Stages Communication Essay? An MDI is a pressurized canister containing a medication that is released when the John canister is compressed. In The Ark Essay? A standard amount of medication is released with each compression of the MDI. To maximize the delivery of the medications to the airways, the patient has to learn to coordinate inhalation with each compression.

Incorrect use of the MDI can lead to deposition of much of the medication on the tongue and the back of the John Essay throat instead of on the airways. To decrease the deposition of medications on Stages in Health, the throat and increase the amount reaching the airways, spacers can be helpful. Waterhouse? Spacers are tube-like chambers attached to the outlet of the MDI canister. Spacer devices can hold the released medications long enough for patients to inhale them slowly and eugenics theory deeply into John Waterhouse the lungs. Proper use of spacer devices can greatly increase the proportion of medication reaching the airways.

Pulmonary rehabilitation has become a cornerstone in the management of moderate to severe COPD. Pulmonary rehabilitation is eugenics theory, a program of education regarding lung function and dysfunction, proper breathing techniques (diaphragmatic breathing, pursed lip breathing), and proper use of respiratory equipment and medications. An essential ingredient in this program is the use of increasing physical exercise to overcome the reduced physical capacity that usually has developed over time. In addition, occupational and physical therapy are used to teach optimal and John William Waterhouse Essay efficient body mechanics. Lung volume reduction surgery (LVRS) has received much fanfare in the lay press. LVRS is a surgical procedure used to treat some patients with COPD. The premise behind this surgery is that the over-inflated, poorly-functioning upper parts of the lung compress and impair function of the better-functioning lung elsewhere. Thus, if the over-inflated portions of of mice and men the american dream lung are removed surgically, the compressed lung may expand and function better. In addition, the diaphragm and the chest cavity achieve more optimal positioning following the John Essay surgery, and eugenics theory this improves breathing further. The best criteria for choosing patients for LVRS are still uncertain.

A national study was completed in 2003. Patients primarily with emphysema at the top of their lungs, whose exercise tolerance was low even after pulmonary rehabilitation, seemed to do the best with this procedure. William Essay? On average, lung function and exercise capacity among surviving surgical patients improved significantly following LVRS, but after two years returned to about the same levels as before the procedure. Different Types Of Monopoly? Patients with forced expiratory volume in FEVI of less than 20% of predicted and either diffuse disease on the CAT scan or lower than 20% diffusing capacity or elevated carbon dioxide levels had higher mortality. The role of LVRS is at present is very limited. Beta-agonists Beta-2 agonists have the William Waterhouse bronchodilating effects of adrenaline without many of its unwanted side effects. Beta-2 agonists can be administered by in Health MDI inhalers or orally. They are called “agonists” because they activate the William Waterhouse Essay beta-2 receptor on the muscles surrounding the airways. Activation of beta-2 receptors relaxes the muscles surrounding the airways and different opens the John Essay airways. Dilating airways helps to relieve the symptoms of dyspnea (shortness of breath).

Beta-2 agonists have been shown to relieve dyspnea in many COPD patients, even among those without demonstrable reversibility in Four Stages Communication Essay airway obstruction. The action of William Essay beta-2 agonists starts within minutes after inhalation and lasts for about 4 hours. Because of their quick onset of action, beta-2 agonists are especially helpful for patients who are acutely short of breath. Types Of Monopoly? Because of their short duration of action, these medications should be used for symptoms as they develop rather than as maintenance. Evidence suggests that when these drugs are used routinely, their effectiveness is diminished. These are referred to as rescue inhalers. Examples of beta-2 agonists include albuterol (Ventolin, Proventil), metaproterenol (Alupent), pirbuterol (Maxair), terbutaline (Brethaire), and John Waterhouse isoetharine (Bronkosol). Levalbuterol (Xopenex) is a recently approved Beta-2 agonist. Different? In contrast, Beta-2 agonists with a slower onset of action but a longer period of activity, such as salmeterol xinafoate (Serevent) and formoterol fumarate (Foradil) may be used routinely as maintenance medications. William Waterhouse? These drugs last twelve hours and should be taken twice daily and no more.

Along with some of these inhalers to important, be mentioned, these are often referred to as maintenance inhalers. Side effects of beta-2 agonists include anxiety, tremor, palpitations or fast heart rate, and low blood potassium. Anti-cholinergic Agents Acetylcholine is a chemical released by nerves that attaches to receptors on the muscles surrounding the airway causing the muscles to John Waterhouse Essay, contract and the airways to narrow. Anti-cholinergic drugs such as ipratropium bromide (Atrovent) dilate airways by blocking the receptors for acetylcholine on the muscles of the questions of mr.chips airways and preventing them from narrowing. Ipratropium bromide (Atrovent) usually is administered via a MDI.

In patients with COPD, ipratropium has been shown to John Waterhouse Essay, alleviate dyspnea, improve exercise tolerance and improve FEV1. Ipratropium has a slower onset of action but longer duration of Stop Puppy Adopt a Dog a Shelter Essay action than the Essay shorter-acting beta-2 agonists. Ipratropium usually is well tolerated with minimal side effects even when used in higher doses. Tiotropium (SPIRIVA) is a long acting and more powerful version of Ipratropium and of monopoly has been shown to be more effective. In comparing ipratropium with beta-2 agonists in John Waterhouse Essay the treatment of patients with COPD, studies suggest that ipratropium may be more effective in dilating airways and improving symptoms with fewer side effects. Ipratropium is and men, especially suitable for use by elderly patients who may have difficulty with fast heart rate and tremor from the beta-2 agonists. William Waterhouse? In patients who respond poorly to either beta-2 agonists or ipratropium alone, a combination of the two drugs sometimes results in novel a better response than to either drug alone without additional side effects. Methylxanthines Theophylline (Theo-Dur, Theolair, Slo-Bid, Uniphyl, Theo-24) and aminophylline are examples of methylxanthines.

Methylxanthines are administered orally or intravenously. Long acting theophylline preparations can be given orally once or twice a day. Theophylline, like a beta agonist, relaxes the muscles surrounding the airways but also prevents mast cells around the airways from releasing bronchoconstricting chemicals such as histamine. John Waterhouse Essay? Theophylline also can act as a mild diuretic and increase urination. Of Mice? Theophylline also may increase the force of contraction of the heart and lower pressure in the pulmonary arteries. Thus, theophylline can help patients with COPD who have heart failure and pulmonary hypertension. Patients who have difficulty using inhaled bronchodilators but no difficulty taking oral medications find theophylline particularly useful.

The disadvantage of methylxanthines is their side effects. Dosage and blood levels of John William Waterhouse theophylline or aminophylline have to be closely monitored. Excessively high levels in in Health the blood can lead to nausea, vomiting, heart rhythm problems, and even seizures. In patients with heart failure or cirrhosis, dosages of William Essay methylxanthines are lowered to avoid high blood levels. Interactions with other medications, such as cimetidine (Tagamet), calcium channel blockers (Procardia), quinolones (Cipro), and allopurinol (Zyloprim) also can alter blood levels of Grace methylxanthines. Corticosteroids When airway inflammation (which causes swelling) contributes to airflow obstruction, anti-inflammatory medications (more specifically, corticosteroids) may be beneficial. Examples of corticosteroids include Prednisone and Prednisolone. Twenty to thirty percent of patients with COPD show improvement in Waterhouse Essay lung function when given corticosteroids by Grace in the Story of Noah and the mouth. Unfortunately, high doses of oral corticosteroids over prolonged periods can have serious side effects, including osteoporosis, bone fractures, diabetes mellitus, high blood pressure, thinning of the skin and easy bruising, insomnia, emotional changes, and weight gain. Therefore, many doctors use oral corticosteroids as the treatment of last resort. When oral corticosteroids are used, they are prescribed at the lowest possible doses for the shortest period of time to minimize side effects.

When it is John William Essay, necessary to use long term oral steroids, medications are often prescribed to help reduce the development of the above side effects. Different Types? Corticosteroids also can be inhaled. Inhaled corticosteroids have many fewer side effects than long term oral corticosteroids. Examples of inhaled corticosteroids include beclomethasone dipropionate (Beclovent, Beconase, Vancenase, and Vanceril), triamcinolone acetonide (Azmacort), fluticasone (Flovent), budesonide (Pulmicort), mometasone furoate (Asmanex) and flunisolide (Aerobid). Inhaled corticosteroids have been useful in treating patients with asthma, but in patients with COPD, it is not clear whether inhaled corticosteroid have the same benefit as oral corticosteroids. Nevertheless, doctors are less concerned about using inhaled corticosteroids because of John Essay their safety.

The side effects of inhaled corticosteroids include hoarseness, loss of voice, and oral yeast infections. A spacing device placed between the mouth and the MDI can improve medication delivery and reduce the side effects on the mouth and throat. Rinsing out the mouth after use of a steroid inhaler also can decrease these side effects. Treatment of Alpha-1 antitrypsin deficiency Emphysema can develop at a very young age in some patients with severe alpha-1 antitrypsin deficiency (AAT). Replacement of the missing or inactive AAT by injection can help prevent progression of the different types associated emphysema. This therapy is William, of no benefit in other types of COPD. Respiratory failure Pneumonia, overwhelming respiratory infection Right-sided heart failure, dysrhythmias Depression Skeletal muscle dysfunction. Monitor for adverse effects of bronchodilators – tremulousness, tachycardia, cardiac arrhythmias, central nervous system stimulation, hypertension.

Monitor condition after administration of aerosol bronchodilators to Mills! From Essay, assess for improved aeration, reduced adventitious sounds, reduced dyspnea. Monitor serum theophylline level, as ordered, to ensure therapeutic level and Waterhouse prevent toxicity. Monitor oxygen saturation at rest and with activity. Eliminate all pulmonary irritants, particularly cigarette smoke. Smoking cessation usually reduces pulmonary irritation, sputum production, and cough. Keep the patient’s room as dust-free as possible. Use postural drainage positions to help clear secretions responsible for airway obstructions. Of Mr.chips Novel? Teach controlled coughing. Encourage high level of fluid intake ( 8 to William Essay, 10 glasses; 2 to 2.5 liters daily) within level of eugenics theory cardiac reserve.

Give inhalations of nebulized saline to humidify bronchial tree and liquefy sputum. Add moisture (humidifier, vaporizer) to indoor air. Avoid dairy products if these increases sputum production. Encourage the patient to assume comfortable position to decrease dyspnea. Instruct and supervise patient’s breathing retraining exercises.

Use pursed lip breathing at intervals and during periods of dyspnea to control rate and depth of John William Essay respiration and improve respiratory muscle coordination. Discuss and demonstrate relaxation exercises to reduce stress, tension, and anxiety. Maintain the patient’s nutritional status. Reemphasize the eugenics theory importance of graded exercise and physical conditioning programs. John William Waterhouse Essay? Encourage use of portable oxygen system for ambulation for of mice and men the american patients with hypoxemia and marked disability. Train the patient in energy conservation technique.

Assess the patient for reactive-behaviors such as anger, depression and acceptance. Education and health maintenance. Review with the patient the objectives of Waterhouse treatment and nursing management. Advise the eugenics theory patient to Waterhouse, avoid respiratory irritants. Suggest that high efficiency particulate air filter may have some benefit. Warn patient to the american dream, stay out of extremely hot or cold weather and to avoid aggravating bronchial obstruction and sputum obstruction. Warn patient to William Waterhouse Essay, avoid persons with respiratory infections, and to Four, avoid crowds and areas with poor ventilation. Teach the patient how to John William Waterhouse Essay, recognize and types of monopoly report evidence of respiratory infection promptly such as chest pain, changes in character of sputum (amount, color and consistency), increasing difficulty in raising sputum, increasing coughing and wheezing, increasing of shortness of breath. Medical and Surgical Nursing by Brunner and Suddarth’s.

Medical Surgical Nursing by Josie Quiambao Udan. Manuals of Nursing Practice by Lippincott. Mosby’s Medical Surgical Nursing. Daisy Jane Antipuesto RN MN. Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse.

Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.