Code of Professional Ethics and Conduct Essay Example | Topics and Well Written Essays - 2000 words

Code of Professional Ethics and Conduct - Essay manakinEach and every member of AICPA should be aware of the Interpretations, disciplinary runs and code of conduct thereby providing framework to work and provide desired results without affecting the ethical codes. This paper discusses in detail specific rules related to CPA Code of Ethics and Conduct focusing on prick 102 Integrity and Objectivity Section 201- Professional Competence Section 202 Compliance with Standards Section 501 Acts Discreditable Each section dscusses a separate cases on the expectation of code and its violation, the disciplinary action involved, prospects for AICPA to foresee breach in the above codes and personal viewpoints on disciplinary actions taken. 2. Case for Section 102 Integrity and Objectivity (James W. Kingery of Lubbock, Texas) ... Discussion The decision taken by AICPA is apt according to the disciplinary procedures as upon misrepresentation of facts and figures of a society, it is the welfare of the end consumer. i.e. the Investor which is being questioned. The investors take their major investment decisions based on the financial statements and other details provided by the company, and this being misrepresented can lead to negative results for the investor thereby leading to huge losses or even resolution of funds. Simultaneously, the same situation can arise for the company as it can lead to cooking up books and creating a bubble which can burst at any given point of time creating losses for end number of institutional and retail investors. Hence, a professional person CPA appointed by the company has to comply with the standards and norms and it is his responsibility to educate the management about the consequences of misrepresentation of facts, which unfortunately Mr.Kingery failed to implement. Hence, the decision taken by AICPA stands to be apt for the unethical behavior of the member. Prospects for AICPA to prevent misrepresentation of facts Create data base of companies who have hired CPAs and perform second line audit activities on a regular basis to go steady deviations by keeping the CPA framework . A post mortem review by Apex body would be advisable thereby limiting the indebtedness of CPA and minimize the chances of fraudulent practices to arise in the organization. (Mortimer, 2003) 3. Case for Section 201- Professional Competence (Bruno A Fedele, Jenkintown, Pennsylvania) Professional Competence is the ability to perform professional services that is based on professional standards through application of knowledge and skill with proper diligence (Mele, 2005). A CPA member is

Personal Nursing Philosophy Essay Example | Topics and Well Written Essays - 750 words

Personal Nursing Philosophy - Essay ExampleAs I registered nurse, I have formulated a nursing philosophy that will guide me in my role. First, I have recognized that nursing is a profession that has its own set of rewards. To achieve this rewards I should act in a professional way, this entails a commitment to achieve excellence in patient c be and ensuring that I upheld patients rights. I should also be ready to learn and accept corrections so that I can utilize the available resources to improve the patients health. As a nurse, I am committed in ensuring that the patients environment is conducive and will to lead to easy recovery. My philosophy also involves understand the meta paradigm concepts of the nursing profession. These are areas of concern to the profession and these calls for proper understanding of the following concepts. First, what does nursing entail? What is my personal understanding of health? How do I maintain a good environment? And lastly how do I treat patients ? As a nurse, I am determined to integrate the take practice components in my role. Nursing also involves scientific and philosophical approach in caring for individuals who seek medical care. Nursing also involves disease bar and management.... It is vital for patients to be consulted on various issues affecting them. Such issues include patient participation in their care, maintaining of dignity and self worth. I also regard that I have the authority to make independent decisions concerning patients care so long as it is with my scope of expertise (Daniels, 2006). This will enable me use creativity as well as knowledge to ensure that patients receive good health care. Understanding the anatomy and physiology of the human body is vital (Polifroni & Welch, 2007). Thirdly, there are two types of environments, the physical environment where health care is provided, and the internal environment, which refers to patients mental sentience (Fitzpatrick & Kazer, 2012). Both physical e nvironment and mental awareness considerations are necessary for thorough patient assessment and treatment. My philosophy as a nurse is that i should create a conducible environment to help in ensuring the patients quick recovery. I should show the patient that I care and entails connecting with the patient and forming a professional relationship. This helps in understanding the patient hence enabling me to make things that can positively affect the patient quick recovery (Barker, 2009). As a nurse, I should be concerned about the clients major power to handle the illness and the effect of diagnose on the clients family (Fitzpatrick& Kazer, 2012). This will enable me to advice the patient and the immediate family on how to manage the situation. This gives the patient a good state of mind and this accelerates the patients recovery. Understanding the patients religious and cultural beliefs and their attitudes

Strategic capabilities darden Essay Example for Free

Strategic capabilities darden EssayStrategic CapabilitiesIn this part of the report the opposite capabilities of Darden will be explained and which of these capabilities go across to competitive rivalry. But first the different alternatives and competences will be discussed which will lead to the capabilities. 1) ResourceA physical resource of Darden isThere different restaurants, with this is meant the different buildings that Darden owns with the different kind of restaurants. 1) CompetenceThe competence that Darden has isTo make different kind of dishes.1) aptitudeWhen the above mentioned resource ad competence atomic number 18 linked thusly the following mental ability emerges Flexible to make different dishes for different markets. Darden has 8 different brands. Each brand standing for its own kind of food standardized Italian of seafood. This means that Darden offers all kinds of food to the consumers. After applying the VRIN model to this capability the last is V- This capability is a value for the consumers due to the fact that Darden gives them the opportunity to pickax between different restaurants. This capability allows Darden to be profitable in the market. R- Different brands plus products are included in one chain. Unfortunately for Darden is capability is non Rare, different competitors have the same kind of capability. ( for example Laundrys, DineEquity) I- This capability is possible to imitate, hardly this will take some time and the right union of financial resources. N- This capability is possible to substitute by a nonher company. For example Yum Restaurants, they have also different dishes for different markets with their Taco bell, KFC and Pizza Hut. coating capableness 1)The above mentioned capability is not one that is unique and that is not difficult to imitate, but however it is still a effectualness for Darden due to the fact it gives Darden a great brand image, and it gives it an advantage compared to their smal ler competitors who do not have this capability as beardown(prenominal) as Darden.2) ResourceA Human resource that Darden has isWell trained and guided staff.2) CompetenceA competence that Darden has isSkill to buy the best products (for example Darden sources top tonus seafood from more than 100 varieties. 2) CapabilityWhen the above mentioned Resources and competence are combined then the following capability emerges Capable of making high-quality food.High quality is always something under discussion, what is high quality? In this case is meant food that has a very good quality versus cost proportion. And speaks to a lot of people. After applying the VRIN model to this capability the conclusion is V- This capability has a great value for the consumers because a good quality versus cost proportion is something that quest will remember and will tell to their friends and families. R- This capability is not rare, there are a lot of restaurants that poop make high quality food agai nst a good price for the consumers. I- Is this capability Imitational, yes when looking at the above mentioned point ( R) there it shows other restaurants are already doing this. N- This capability can be substitute, what has been explained earlier is that restaurants are already having the same kind of capability. Conclusion Capability 2)The capability of making high-quality food is very important for Darden because consumers expect a level of quality when they go to one of Dardens restaurants. For this case it is a strength of Darden. However it is not a very strong capability due to the fact that multiple competitors are doing the same and that it is very easy to imitate or substitute.3) ResourceA resource that Darden has isThere strong marketing.3) CompetenceA competence that Darden has isUsing all kinds of advertising.3) CapabilityWhen the above mentioned resource and competence are combined then the following capability emerges Dardens ability to market its restaurants. Darden is a leading advertiser in the full size dining segment of the hospitality industry. Darden uses different kind of methods to advertise their brands, like local and cable television, digital advertising, billboards, search engine marketing, radio and newspapers. After applying the VRIN model to this capability the following conclusion can be made V- This capability will generate more consumers which will bring more revenue, if the cost are low enough to be profitable in this part then this can be a huge Value to the company.For the consumers this will also be a Value because they bank check up to date with new actions, menu changes and promotions. R- This capability is not rare at all, almost every company has a marketing department and advertises itself. I- selling is very imitational due to the fact that everybody sees them so other companies can easily use the same kind of method, However due to the fact that Darden has multiple brands is can target and advertise to all these markets at the same time which gives them an advantage. N- This capability can be substituted by a different company, because there are already companies with multiple brands that target and advertise to different markets. (Laundrys) Conclusion Capability 3)Of the 3 capabilities mentioned in this part of the report, capability 3 is the weakest. It is still an important part of the company, but it is very difficult to stand out on marketing now a day compared to competitors. It is more a capability that is at least indispensable to be successful.Conclusion CapabilitiesWhen looking at the 3 different capabilities explained in this part the capabilities concerning the different dishes and the high quality of food are two strong and important capabilities that Darden has. The marketing capability is not as strong but it is still a plus point of the company. Without the marketing Darden would not be as successful as it is today.

John Taylor Gatto Against School Essay Example for Free

John Taylor Gatto Against tutor EssayWhen it comes to the traditional instruction, John Taylor Gattos Against School questions whether we re whollyy need the nine month, drawn out, traditional curriculum. Gatto goes on to name several roaring people through history that were non products of a contemporary school system. When I think of Gattos theory of forced schooling, a friend of mine named John Smith who goes by the alias of Viper comes to mind. Viper is in his latish 20s, lives in South Philadelphia, and has worked as a Roofer for the past 10 years. Viper went to a public school in South Philadelphia. Viper went to a school where said, It wasnt easy. I was scrawny and white and we were poorer than the jigs that went to school wit us, so we caught alota shit. Vipers school was extremely underfunded. Some days there would be trash rigid out by the trash cans cause nobody would change the trash bags, the food was shit, and the bathroomsforget it. He would walk twelve bloc ks back to his house conscionable to go to the bathroom. There were no extracurricular activities like book clubs and band and the school was rundown and decrepit.Eventually he started to miss classes regularly. He felt that the teachers did not care. Classes were extremely boring to him. He was actually approached by his biology teacher and told he could cut class everyday as long as he turned in his work and he would receive a D at the end of the year. He was not amused by the offer, he was not even interested in graduating anyto a greater extent. I expected to be a laborer for the rest of my life so I felt like education was unimportant. Vipers education started taking a back seat to work around his sophomore year of high school. He was the middle child in a family of four, all of whom have dropped out of high school and are laborers today. My parents made me get a job when I was thirteen, thats the way it was with all my brothers, says Viper. Eventually he started to make a dec ent amount of money and admits to being extremely nave, saying Why the fuck was I gonna go ta school for eight more years if I was makin 25-30 thousand dollars a year.Do the math, instead of spendin 100 thousand dollars in college and waste my duration in school I coulda made 200 thousand dollars by the meter I was 24. One day Viper decided to make an appointment with a school counselor. He was hardly going to class, working every day when he was supposed to be in school, and partying every night and having fun. School was more of a social event. He was just going to school to see his friends and make plans for the weekend. When he told the school counselor that he was planning on move out the counselor stood up, looked him in the eye, extended his hand and said, Good Luck The guy didnt even give a shit Viper said.By the time December came around of his sophomore year, he was a high school dropout. He was working everyday by that time already so he was not stagnant. He was still living with his parents. The fact that he dropped out was ok with them because he could contribute to the house, as his father put it. Viper eventually relieve enough money to get his own place and now lives with his wife of three years and their two children who are two and five years of age. He said, I always thought I learned more out of school than in high school, but its not what my kids are gonna do. He aspires to open his own roofing company one day. Although I do not agree with the path that Viper chose in life, he is happy and successful today. He is a great father and happily married. He does not drink anymore and devotes every second of his free time to his family. In a way he is almost a survivor to me. He is not well spoken or the brightest guy in the world, but he would do anything in his power to help any person in a bind.

Interactive Lecture Essay Example for Free

Interactive Lecture EssayWhat is interactional lecture?An interactive lecture is an easy way for teachers to intellectually contain and involve assimilators as active participants in a lecture-based class of any size. Interactive lectures ar classes in which the instructor breaks the lecture at least erst per class to have students participate in an employment that lets them work directly with the material. * The instructor might begin the interactive segment with an engagement trigger that captures and maintains student attention. * Then the instructor incorporates an activity that allows students to apply what they have learned or give them a context for upcoming lecture material. * As the instructor feels more(prenominal) comfortable using interactive techniques he or she might begin to call upon a blend of various interactive techniques all in mavin class period.Why use interactive lecture?Lecturing is a time-honored teaching technique that is an efficient method to present large amounts of field in classes of any size and it is efficient for sharing information with large numbers of students, but may result in students who listen passively. * Making lectures interactive by including techniques such as think-pair-share, demonstrations, and role playing, post foster active engagement and enhance the value of the lecture segments. * Using techniques that allow all of the students to participate, sort of of having individual students answer questions when called on, will promote student retention and learning of the material presented during lecture, give students practice in developing critical-thinking skills, and enable instructors to assess how salutary the class is learning that day. * Breaking up the lecture with these techniques not only yields format change to engage students, these activities allow students to immediately apply content and provides feedback to the instructor on studentActivity Based Teaching StrategiesThe education o n activity based teaching strategiesPromotes teaching and learning strategies for learning activities, students work and provide opportunities for real life so they can contribute to self-learning and this system can be used to investigate the family situation, or discover an argument and the depth the sharpness.Examples of activity based teaching strategies, as follows The excursion Games to make oral presentations Discussion of the training group innovative learning by projectsThe concept of learningThe activities are part of the President of the elements of the program strategy and education are also important for otherwise learning strategies and modern media The efforts of physical or mental drive students (and teachers) to achieve this result, the following defines as learning by students apply to intentional activity, and the deliberate and plannedHe knew the work and activities a student or students trustworthy for planning, the teachers request or desire of the classro om or outside resources, and in the form of movement or say or lay aside according to the source of the accident the conduct in the place of activity to stop.For us it is clear that the task of wages, and reached a low with a test product, and it is requirement that the timing of how success is possible to reach the exit, but the educational activity, whether the teacher did and learning activities is done with the students and the educational activity is a means of learning activities can be educational and various learning activities, but teaching and learning activities with learning activities based on strategic problems of combined measures.Components of practiceIt consists of activities in the proviso and planning of six elements1. Help2. Time3. Objective The production, which aims to4. Standard Admission5. Calendar6. Working (active substance)Benefits and advantages of activity based teaching strategies Learning by students through activity based teaching strategies on exp erience you get is of great importance because the education sector, with many goals and the advantages and benefits increasing the students attention and willingness to suffice to the educational settings Guide the development trend of students and their needs and develop their talents and the direction of education is correct. Provide real opportunities for students to self-study, where the benefits of the teaching learning situations in their future. lead to the change of the independence Work in cooperative learning encourage students to take responsibility for their own learning Move the student to reluctance to exercise and esteem for manual laborThe role of students in the development and use of learning activities based. The role of students to do different things, including1. Their personal interests2. Participate in educational objectives3. ontogeny good organizational skills to keep unions4. Involved in the program flow5. Demonstrate enthusiasm for seeking new knowledge6. In collaboration with otherThe teacher role in the development and use of activity based teaching strategies. Located in the role of the teacher in developing the strategy of education by learning and the most important things the teacher must first of a activity based teaching strategies, as follows1. The planning and facility for2. Identify outcomes3. Having noted the outcomes of learning using appropriate strategies such as the agenda report or wish to evaluate the stairs4. Choose the right on activities and stimulating for students5. Mechanisms within the group6. Promote cooperation in carrying out activitiesActivity based teaching strategies describes a range of pedagogical approaches to teaching. Its core premises entangle the requirement that learning should be based on doing some hands on experiments and activities. The idea of activity based teaching strategies is rooted in the familiar notion that children are active learners rather than passive recipients of information. If child is provided the opportunity to explore by their own and provided an optimum learning environment.

Amylase Activity In Germinating Barley

Amylase Activity In Germinating BarleyAmylase is a calcium low-level enzyme which hydrolyzes complex carbohydrates at alpha 1,4-linkages to form maltose and glucose. Amylase is an enzyme found in the germinating seeds. Imbibition process ca subroutines the release of growth plant hormone gibberelin which stimulates the synthesis of amylase. The operation of the amylase enzyme is affected by many factors such as temperature, pH, enzyme concentration, substrate concentration, and the presence of any inhibitors or activators. In germinating barleycorn, the food reserves are descentd in the endosperm. The cotyledons store food for the use of embryo in the form of starch. Amylase enzyme lose its down starch into maltose, a chain of two glucose molecules Maltose wherefore breaks down into glucose by the enzyme glucosidase. Glucose because enters the glycolytic pathway where it is used for the production of ATP and carbon molecules for biosynthesis. Glucose is used for the growth of p lumule and radicle. This process is also known as the germination process. The emergence of plumule and radicle indicate that the seeds corroborate germinated. In germinated seeds, the blue colour of the Benedicts solution change to brick-red precipitate indicating the presence of glucose while maintaining the yellowish-brown colour of the one solution indicating the absence of starch. However, in non-germinated seeds, the yellowish-brown colour of the iodine solution change to blue black indicating the presence of starch while maintaining the blue colour of the Benedicts solution indicating the absence of glucose. Most of the time, when all the starch realize been used up, the seedling capable of undergoing photosynthesis to produce energy and carbon.HypothesisThe higher the amylase activity, the higher the rate of seed germination. This is observed by a higher change in length of plumule and radicle. Hence, when performing the Benedicts test, the concentration of brick-red prec ipitate is higher seedlings and the solution remains blue for the dormant seed.AimThe aim of the experiment was to extract amylase from barley and to use it for the catalysis of a biochemical chemical reaction hence investigating the amylase activity during seed germination.Materials and methodsTen germinating seeds were taken and using a paper towel, the germinants were patted dry and the tip of the germinating seeds were recorded. Next, using a mortar and pestle, the 10 germinating seeds were crushed into a puree. Slowly adding 10 ml of buffer, the germinating seeds were march on crushed for two proceeding. This will allow the amylase to go into the solution. The crushed seeds was filtered into a 100 ml beaker and the amylase extract was poured into a measuring cylinder. The volume of amylase extract was recorded. A five-fold dilution of the latter was done by pipetting 5 ml of the amylase extract and adding 20 ml of buffer to make up a total volume of 25 ml. This mixture is cal led the diluted amylase extract. A control was then done by adding 5 ml of the diluted amylase extract in a test tube and placing it in a water bath at 80o C for 10 minutes. When the 10 minutes have elapsed the control was removed and allow to cool to room temperature.Next the activity of amylase per mass of germinating barley tissue is to be determined. For this, onto ceramic plates, one drop of iodine was placed into 21 wells. A reaction mixture was then prepared by adding 5 ml buffer and 1 ml of 0.5% starch solution in a test tube. Then using a pasteur pipette, one drop of the reaction mixture was removed and added to one drop of the iodine. The iodine turned blue black. This was done to ensure the presence of starch in the reaction mixture. The previously do diluted amylase extract is thoroughly remix and 1 ml of the latter was added to the reaction mixture. The mixture is called amylase reaction mixture. (As soon as the amylase reaction mixture was prepared, reaction started. Amylase started to break down starch into simple sugars). Immediately, starting with well 0 on the ceramic plate, one drop of amylase reaction mixture was added to the iodine using a pasteur pipette. At one minute interval, another drop of the amylase reaction mixture was added to another well. This was repeated until the achromic point was reached. When the achromic point had been reached, the time elapsed was recorded.Once the achromic point was reached, the amylase reaction mixture was kept for the determination of maltose. (Note Benedicts reagent gives a red-yellow precipitate of cuprous oxide when boiled with maltose. This reaction does not occur with starch.) In a test tube, 2 ml of the amylase reaction mixture and 2 ml of Benedicts reagent was added. A control reaction mixture was also prepared by adding 5 ml buffer and 1 ml of 0.5% starch solution but without the amylase extract. 2 ml of the control reaction mixture was then added in a test tube along with 2 ml of Benedicts reagent. Both the Benedicts reagent tubes were placed in a water bath at 80oC for 10 minutes and then examined for presence of cuprous oxide precipitate.All of the above steps were then repeated but with dormant seeds and seedlings. All data were then recorded for further investigation.

Palliative Care in End Stage Congestive Heart Failure

lenitive C are in End Stage congestive Heart FailureCongestive heart failure (CHF) is an inability of the heart to supply/pump blood to the body as it needs in normal. CHF is an acute illness and a continuing disease in which the passage of time whitethorn bewilder other physical and psychological diseases that poses a threat to the health of the long-suffering, and whitethorn be the cause of smell limiting (Ameri fucking Heart Association, 2010). This indicates the poor quality of life of the patient, exacerbating health problem. Hence, those patients need to attend alleviator business concern to improve the quality of life.Palliative care for CHF patient is very central to relive or prevent the pain which may be able to be cause physical problems such as (respiratory disorder and sleep disorder) or psychological problems such as ( picture and anxiety). Palliative care is backingive care which lets physical support, psychological support, spiritual support and complais ant support and that is to provide the best as much as possible to improve quality of life (Davidson, Macdonald Newton, 2010).How can you help and support Verner from the moderating care perspective?From the case Mr. Verner has complaining from several problems associate to his state of physical, psychological, social and spiritual. In the beginning I have to consider hold crop of care either in hospital or at home if there is sufficient support in all ways (Patient UK, 2010). Then unwell start with him a comprehensive assessment for his situation from perspective of alleviant care includes the physical and psychological, social, cultural and spiritual (existential). Mr. Verner has advanced heart failure or end stage heart failure where can be identified the stage according to Dunderdale, Thompson, Miles, Beer Furze (2005) by the New York Heart Association (NYHA). In addition NYHA can assess a variety of the physical symptoms and restrictions. An consequential aspect of Mr. Verner management is communication and listening, exploring his understanding and feelings close his illness. Exploring concerns about the future can provide opportunities to discuss death and preferences for end of life care (Jaarsma et al., 2009). There are physical and psychological complications caused by CHF. For example Mr. Verner case he does not sleep at night because he has trouble breathing, probably he has pulmonary congestion/pulmonary edema because according to (American Heart Association, 2010) pulmonary edema is one of the complications of CHF. So, medical intervention is needs in order to address the symptoms experienced by the patient, because medical care is very meaning(a) to pare patient stress and anxiety. Providing support through effective communication, skills may lift the moral of the patient. During communication I have to be honest and fidelity in addition in dealing with this patient must be show kindness, compassion and respect.In order to helping M r. Verner from the palliative care perspective I have to provide a good palliative symptom management, psychological, spiritual and social support will provide fancy and reassurance. worked up and social support is very important aspect for CHF patient. Where the presence of family, relatives and friends around of the patient would be a very strong supporter to improve the psychological status of the patient and reduce depression, anxiety, social isolation and loneliness (Jaarsma et al., 2009). Ill ask the provider of complaisant Work to communicate with family members to provide the counseling and patient needs from social services. similarly the family members should be encouraged in participating with palliative care aggroup to more improve in the physical care for the patient. Moreover, he may benefit from a referral to social services and district nursing. Liaison between his primary care team up and the local palliative care team is strongly recommended and Mr. Verner cou ld be wedded contact numbers for the palliative care services. Hospice care for further social support and respite may be beneficial.Providing spiritual support is one of the important aspect of palliative care whether from family or from clergy, to encourage and support the patient to let him look to the future with optimism and live with his society and daily activities in homy manner until he dies (Becker, 2010).Which problems and needs can you identify?From the case it shows to me Mr. Verner suffering from physical and psychological problems which includeHeart disease is the main cause of declension of his situation and increase physical problems that areAccording to Scherer et al., (2005) lack emotional and social in patients with CHF bring outs the psychological problems in evolution as experienced by Mr. VernerPhysical problemsNausea,VomitingVertigo all the day timeDecreased appetiteLack of energyTrouble breathingCough in night quiescency disorderPsychological problemsDep ressionAnxietySocial isolation/lonelinessHopelessnessFear of deathNursing diagnosisDecreased cardiac siding related to decreased myocardial contractility.Impaired gas exchange related to lung congestion resulting in trouble breathing and cough in night.Nutrition sick less than body requirements related to nausea and vomiting. grind related to lack of energy.Disturbed sleep pattern related to trouble breathing.Ineffective coping related to chronic illness (Berman, Snyder, Kozier Erb, 2008).Patients needsInformation about the disease process, treatment and general advice on what to do and what not to do.Physical support and managing symptoms to relieve/reduce suffering and improve general health for live comfortably.Emotional support to reduce the psychological symptoms, where the presence of family around him will be a particle accelerator for this support.Social services to provide equipment such as stair lifts, ramps, commodes and information about packages of care.Enhance the care, improve quality of life and provide end life care with respect culture (customs and traditions), dignity, beneficence, sympathy and empathy.Make a nursing care plan for Verner. Explain and motivate your suggested nursing interventions in accordance with the iv key areas listed in the introduction.Patient with end stage of heart failure may present with a variety of symptoms, which are similar to patients with advanced pubic louse (Matzo Sherman, 2010). A detailed history, physical examination, investigations and establishment of patient priorities will help in the management of their symptoms and improvement of quality of life. An accu judge drug history is important due to the nature of complex drug regimens. The difficulties of coping with unwanted drug side effects may cause patients to be afraid to report their non-concordance, which may precipitate hospital admission. Common physical symptoms are labour, pain, breathlessness, dizziness, cachexia, anorexia, nausea, ins omnia, difficulty in walking, constipation (Jaarsma et al., 2009).Communication skills are very important part in palliative care between palliative care team and patients and their families. There are elfin things, but significant that matter to the patient and family such as a clean, well-pressed uniform neat and tidy hair an upright posture a smile appropriate eye contact respecting gender, age, culture or disability a clear introduction of self and most important of all an attitude that reflect my positive interest in them as a person (Becker, 2010). Also during communicating with the patient must repeat the information. It is possible because poor cerebral blood may lead to confusion and memory problems (Patient UK, 2010).PHYSICAL SYMPTOMSSYMPTOM manipulateTrouble breathing, Cough in night and Sleeping disorderINTERVENTIONS (N) AND RATIONAL (R)Initial(N) Check vital signs, heart calculate, blood pressure and respiratory rate depth. Observe if any wheezes and crackles in lung bases or edema.(R) This assessment will be noting and presence of fluid in the lung with change in heart and respiratory rate (Lewis et al., 2007).(N) Administer O2 and put patient on semi follower position.(R) Over volume is increased in the heart failure patient so, it results in jugular vein vein distention and increased hepatojugular vein also (Morton, Fontaine, Hudak, Gallo, 2005).(N) Control pain if any, discomfort feeling.(R) Patients may experience chronic pain such as o dropsical limbs or osteoarthritis, or as a result of previous heart surgery (Morton et al, 2005).Ongoing Monitoring (N) Monitor vital signs, level of consciousness, oxygen saturation, cardiac rhythm, respiratory status and urinary output (Berman, 2008).Nausea, Vomiting, Decreased appetite and Lack of energy(N) Encourage the patient to eat the liquid food use a small amount of alcohol.(R) Could be good method to stimulate appetite and improving mood and general self esteem (Berman, 2008).(N) (Dehydration) O bserve skin or mucose membrane dryness and edema. ( Ongoing Monitoring ) Monitor urinary output.(R) Occurs most often with CHF patients. Hypovolemia fluid shifts and nutritional deficits contribute to poor skin and edematous tissue (Morton et al, 2005).Ongoing Monitoring (N) Help patient to do daily activities such as using a wheel chair.(R) Patient needs to to the full care of and need mostone to help him in accomplishing daily activities at least to feel satisfied (Lewis et al., 2007).The main symptoms related to the case that require item interventions of the palliative care teamCauses and effects on CHF patientsManaging symptomFatigueCHF patients feel constantly tired and lacking energy. The main factors contributing to fatigue are abnormalities in skeletal muscle due to reduced perfusion and neurohumoral changes the side effects of medications reduced activity anaemia lack of appetite and muscle wasting (Scherer et al, 2005). Fatigue causes reduced quality of life because i t severely restricts patients activities and creates difficulties in walking and getting out of the house. In the end stages of heart failure even managing personal hygiene and dressing can be difficult. Fatigue can also compound other physical symptoms such as constipation, oedema and pain (Davidson et al., 2010).Access to deterrent example programmes may be of benefit to reduce fatigue and can give patients greater sense of well being.Explanation to the patient and his family about the physiological causes of fatigue can help them understand what they are experiencing and referral to occupational therapy of physiotherapy for advice on energy conservation and exercise can be useful. Education about sanitary eating and correcting anaemia can also be beneficial (Jaarsma et al., 2009).BreathlessnessCommonly caused by pulmonary oedema due to failing left ventricular function or sometimes due to anaemia. Other causes such as chest infection should not be overlooked. Anxiety, depressi on and inactivity can also contribute to breathlessness (Davidson et al., 2010).Increasing diuretics is the first line treatment for breathlessness due to increasing congestion and providing by Respiratory Consultant. Home oxygen may be useful for patients with daytime low blood oxygen saturations. The use of breathing and relaxation exercises can help reduce the anxiety, which often accompanies breathlessness (Davidson et al., 2010).psychological (EMOTIONAL) SYMPTOMSCauses and effects on CHF patientsManaging symptom/ ManagementDiagnosis of heart failure may make emotional stress. Depression, anxiety, social isolation and loneliness are leafy vegetable symptoms experienced by patient with end stage heart failure. The lack emotional and social support is an important predictor of morbidity and when patient render isolated and lack the ability to cope with his disease this can also be a significant predictor of mortality (Jaarsma et al., 2009). A patients experience of depression is often compounded by their physical symptoms. Psychological symptoms are can reduce quality of life. Mr. Verner says I am not my disease, which can hinder hope for the future. From my experience when I give an opportunity to the patient as Mr. Verner condition, certainly will talk about dying. Fears of how he may die? How of pain?Emotional support is important for the patient. Effective communication with patient and his carer is needed from diagnosis and throughout the course of the illness. To maintain hope, patients can be offered good palliation of their symptoms and geographic expedition of their preferences for care. Information needs to be available about the disease process, common feelings experienced and local social support services. Referral to psychology services or counselors may be required and some patients may benefit from an antidepressant (Jaarsma et al., 2009). Tricyclic antidepressants are not usually advised due to their pro-arthymic side effects. Selective se rotonin reuptake inhibitor antidepressants (e.g. fluoxetine 20 mg once daily) are more commonly prescribed (Morton et al., 2005).SOCIAL AND FAMILY SUPPORTCauses and effects on CHF patientsManagementSocial and family support is very important element, which engaging social services are a high priority may affect adversely on some psychological problems such as social isolation, loneliness and sadness etc. Specifically the social aspect may be involved in the followers problems financial status, capacity to self care, adherence with lifestyle and carer burden (Davidson et al., 2010).Mr. Verner misses his children and grandchildren because he does not have energy to talk on telephone. And that make him in blighted condition.Social services to provide equipment such as stair lifts, ramps, commodes and information about packages of care District nurses for assessment of symptoms and support. District nurses are often not aware of patients reinforcement with CHF until they become hospi talized Community physiotherapy and occupational therapy for assessment and advice on exercise, energy conservation and home adaptations to aid in activities of daily living Benefits advice patients may be eligible for disability or attendance allowance (Dunderdale, Thompson, Miles, Beer, Furze, 2005).And assist in communicating with family and give advice to family in order to be cheeseparing Mr. Verner, even if the move to live with his children. The presence of family, relatives and friends around of the patient would be a very strong supporter to improve the psychological state of the patient and reduce depression, anxiety, social isolation and loneliness.SPIRITUAL (EXISTENTIAL) SUPPORTSpiritual support is an important aspect in palliative care. CHF reflected a gradual loss of personal identity and increased dependence and his illness make him incapacitate. Where it feels the burden on society and loses a sense of worth and meaning. Some patients have religious beliefs and fe el booming than other patients who blame the Lord and say, Where is all this time? Why the God made me like this case? (Christian medical fellowship, 2011).Spiritual support is provided by a clinically certified interfaith chaplain and a qualified by the palliative care team. And chaplain role in this is to restore hope and existential then make the patient to cope the reality (University of Iowa Hospitals and Clinics, 2011). And small things will make Mr. Thomas in happiness or make a huge difference, such as to bring his cat or a visit from a close friend or inspiration in art, poetry, music (Becker, 2010).CONCLUSIONPatients with CHF often experience a multitude of symptoms that affect adversely on their general health therefore it may happen to them to get sudden death. Participation with palliative care team is necessary to reduce the symptoms, provide the best as much as possible to improve quality of life and provide end life care with dignity. Nursing care plays an important role in the teamwork for patients with CHF, which can addressed with a variety of interventions, to relieve physical and psychological suffering, including treatment of pain, breathing difficulties and quiescency disorders. Communication is very important between palliative care team and patients and their families to adoption key work of care approach could improve patients access to appropriate palliative care. In addition, good communication between all those caring people for the patient in both primary and secondary care is essential. However, palliative care needs to be accessible early in the disease beginning because in the advanced stages patients may had worsened their health and then the team cannot provide the desired care. Finally I choose this case because I think the palliative care process as a practice in health part just for cancer patients but after dealing with Mr. Verner case I add to my nursing knowledge more specialized skills about the palliative care.