My Role in Preserving Natural Resources Essay Example

My Role in Preserving Natural Resources Essay Natural resources are materials and components (something that can be used) that can be found within the environment. Every man-made product is composed of natural resources (at its fundamental level). A natural resource may exist as a separate entity such as fresh water, and air, as well as a living organism such as a fish, or it may exist in an alternate form which must be processed to obtain the resource such as metal ores, oil, and most forms of energy. They   occur naturally within  environments  that exist relatively undisturbed by mankind, in a  natural  form.There is much debate worldwide over natural resource allocations, this is partly due to increasing scarcity (depletion of resources) but also because the exportation of natural resources is the basis for many economies (particularly for developed nations such as Australia). According to Theodore Roosevelt, The conservation of natural resources is the fundamental problem. Unless we solve that problem, it will ava il us little to solve all others’’. Resource depletion  is the exhaustion of raw materials within a region.In recent years, the depletion of natural resources has become a major focus of governments and organizations such as the United Nations (UN). This is evident in the UNs Agenda 21 Section Two, which outlines the necessary steps to be taken by countries to sustain their natural resources. Depletion of Natural Resources is associated with social inequity. Considering most biodiversity are located in developing countries, depletion of this resource could result in losses of ecosystem services for these countries. Some view this depletion as a major source of social unrest and conflicts in developing nations.The depletion of natural resources is caused by direct drivers of change  such as  Mining,  petroleum extraction,  fishing  and forestry as well as indirect drivers of change such as demography, economy, society, politics and technology. The current pr actice of Agriculture  is another factor causing depletion of natural resources. For example the depletion of nutrients in the soil due to excessive use of nitrogen  and desertification  The depletion of natural resources is a continuing concern for society. This is seen in the cited quote given by  Theodore Roosevelt, a well-known conservationist and formerUnited States president, was opposed to unregulated natural resource extraction. Air, water, soil, forests, animals, etc. , that are provided by nature or occur naturally are called natural resources. Some of these natural resources like sunlight and wind are renewable resources. This means that they can be used again and again without being exhausted. But some like forests, minerals, oil, etc. , are non-renewable. We need to conserve and preserve these resources or soon they will be exhausted. 1. Preservation of forests and wild animals: We need to stop destroying forests and cutting trees.Forests are the home to many di fferent animals, birds and insects. Many animals like the leopard, the Indian Wild Ass, the great Indian one-horned Rhinocerous, etc. have become endangered and are close to extinction because of the destruction of their natural habitat. Trees give us wood that helps in making so many things like furniture, paper, etc. Trees help in purifying the air and also hold the soil with their roots and stop soil erosion. We must protect our forests. This can be done in the following ways : * We must control the cutting of trees and plant more trees. We must prevent forest fires. 2. Converting forests to National  Parks  and Bird Sanctuaries: The government has now started protecting forests by converting them into national parks and wildlife or bird sanctuaries. Cutting of trees or killing of birds and animals is not allowed here and is punishable by the law. Grazing or cultivating of the land is also prohibited. Some national parks of India are marked on the map given alongside. The Kaz iranga National Park in Assam is famous for one-horned rhinoceros. Bird sanctuaries are areas where birds are protected and encouraged to breed.The Bharatpur Bird Sanctuary is one of the biggest bird sanctuaries in India. It houses more than 415 kinds of birds, out of which many birds like the Siberian crane, flycatchers, buntings, etc. , migrate from places as far away as Siberia and China. 3. Preservation of soil: Soil is a very important natural resource. Man and animals depend on plants for their food and plants get nourishment from the soil. So we can say that all living things depend on soil for their food. The process of wind, rain or rivers carrying away the top  fertile layer of soil is called soil erosion.Cutting of trees or deforestation, strong winds in places of less vegetation (deserts), running of water bodies over the soil and overgrazing are all causes of soil erosion. We can prevent it by the following methods : i) Forestation or planting trees as their roots hol d the soil together. Cultivating the soil also provides it cover and prevents wind from blowing it away, ii) Terrace or step farming done on slopes of hills slows the speed of water flowing down and reduces soil erosion. iii) Building embankments on river banks prevents soil erosion by the rivers. 4. Preservation of minerals:We must use minerals sensibly as they are non-renewable natural resources. There is only a limited amount of oil, limestone, iron, coal, etc. , found in the Earth. We should use renewable and non-polluting sources of energy like solar energy, wind energy, etc. , instead of coal and oil so that they can last longer. 5. Windmill is used to harness wind energy: Though some resources like air, water, soil, etc. , are renewable we should use them carefully as their pollution has affect on plants and animals too. Even a small change in environment or the quality of natural resources affects life around it.

A Project on Banana Fibre Extraction Essay Example

A Project on Banana Fibre Extraction Essay Example A Project on Banana Fibre Extraction Essay A Project on Banana Fibre Extraction Essay How to make pencils? Background One of the oldest and most widely used writing utensils, the pencil originated in pre-historic times when chalky rocks and charred sticks were used to draw on surfaces as varied as animal hides and cave walls. The Greeks and Romans used flat pieces of lead to draw faint lines on papyrus, but it was not until the late 1400s that the earliest direct ancestor of todays pencil was developed. About one hundred years later graphite, a common mineral occurring as soft, lustrous veins in rocks, was discovered near Borrowdale in northwestern England. The Borrowdale mine supplied Europe with graphite for several hundred years; however, because people could not then differentiate between graphite and lead, they referred to the former as black lead. Cut into rods or strips, graphite was heavily wrapped in twine to provide strength and a comfortable handle. The finished product, called a lead pencil, was quite popular. In the late sixteenth century, a method for gluing strips of wood around graphite was discovered in Germany, and the modern pencil began to take form. In 1779, scientists determined that the material they had previously thought was lead was actually a form of microcrystalline carbon that they named graphite (from the Greek graphein meaning to write). Graphite is one of the three natural forms of pure carbon- the others are coal and diamond. In the late eighteenth century the Borrowdale mine was depleted, and, as graphite was now less plentiful, other materials had to be mixed with it to create pencils. A Frenchman chemist, Nicolas Jacques Conte, discovered that when powdered graphite, powdered clay, and water were mixed, molded, and baked, the finished product wrote as smoothly as pure graphite. Conte also discovered that a harder or softer writing core could be produced by varying the proportion of clay and graphite- the more graphite, the blacker and softer the pencil. In 1839, Lothar von Faber of Germany developed a method of making graphite paste into rods of the same thickness. He later invented a machine to cut and groove the pencil wood. Following the depletion of the nce-abundant graphite source at Borrowdale, other graphite mines were gradually established around the world. A number of these mines were set up in the United States, and the first American pencils were manufactured in 1812, after the War of 1812 ended English imports. William Monroe, a cabinet maker in Concord, Massachusetts, invented a machine that cut and grooved wood slats precisely enough to make pencils. Around that time, American inventor Joseph Dixon developed a method of cutting single cedar cylinders in half, placing the graphite core in one of the halves, and then gluing the two halves back together. In 1861, Eberhard Faber built the United States first pencil-making factory in New York City. Today, the hardness of a pencil is designated by numbers or letters. Most manufacturers use the numbers 1 to 4, with 1 being the softest and making the darkest mark. Number 2 pencils (medium soft) are used for normal writing. Pencils are also sometimes graded by letters, from 6B, the softest, to 9H, the hardest. The idea of attaching an eraser to a pencil is traced to Hyman W. Lipman, an American whose 1858 U. S. atent was bought by Joseph Rechendorfer in 1872 for a reported $100,000. The first step in pencil manufacture involves making the graphite core. One method of doing this is extrusion, in which the graphite mixture is forced through a die opening of the proper size. In addition to the conventional wood pencil, a number of other pencils are widely used. In the early 1880s, the search for a pencil that didnt require sharpening led to the invention of what has variously been termed the automatic, propelling, or repeating pencil. These instruments have a metal or plastic case and use leads similar to those found in wood cased pencils. The lead, lodged in a metal spiral inside the case, is held in place by a rod with a metal stud fastened to it. When the cap is twisted, the rod and stud move downward in the spiral, forcing the lead toward the point. The early twentieth century saw the development of colored pencils in which the graphite core was replaced by a combination of pigments or dyes and a binder. Today, colored pencils are available in more than 70 colors, with 7 different yellows and 12 different blues. However, the cedar-casing lead pencil- manufactured at a pace of 6 billion per year in 40 different countries- continues to outsell all of its competitors, including the ballpoint pen. Raw Materials The most important ingredient in a pencil is the graphite, which most people continue to call lead. Contes method of combining graphite with clay is still used, and wax or other chemicals are sometimes added as well. Virtually all graphite used today is a manufactured mixture of natural graphite and chemicals. The wood used to manufacture pencils must be able to withstand repeated sharpening and cut easily without splintering. Most pencils are made from cedar (specifically, California cedar), the choice wood for many years. Cedar has a pleasant odor, does not warp or lose its shape, and is readily available. Some pencils have erasers, which are held on with a ferrule, a metal case that is either glued or held on with metal prongs. The erasers themselves consist of pumice and rubber. The Manufacturing Process Now that most commercially used graphite is made in factories rather than mined, manufacturers are able to easily control its density. The graphite is mixed with clay according to the type of pencil being made- the more graphite used, the softer the pencil, and the darker its line. For colored pencils, pigments are added to the clay, and virtually no graphite is used. Processing the graphite Two methods are used to form the graphite into its finished state. The first is an extrusion method in which the graphite and wax mixture is forced through a mold to create a spaghetti-like string, which is then cut to precise measurements and dried in ovens. In the second method, the graphite and clay mixture is poured into a machine called a billet press. A plug is placed over the top of the press, and a metal ram ascends from the bottom to squash the mixture into a hard, solid cylinder called a billet. The billet is then removed from the top of the machine and placed into an extrusion press that forces it through a mold, slicing off strips the To make the wood casings for the pencils, square slats are formed, and then grooves are cut into the slats. Next, graphite sticks are inserted into the grooves on one slat, and then a second slat with empty grooves is glued on top of the graphite-filled slot. Correctly sized pencils are cut out of the sandwich, and the eraser and metal ferrule are attached. size of the pencil core. After being cut to size, the cores pass along a conveyor belt and are collected in a trough to await insertion in the pencil wood. Making the wood casings 1. The cedar usually arrives at the factory already dried, stained, and waxed, to prevent warping. Logs are then sawed into narrow strips called slats; these are about 7. 25 inches (18. 4 centimeters) long, . 25 inch (. 635 centimeter) thick, and 2. 5 inches (6. 98 centimeters) wide. The slats are placed into a feeder and dropped, one-by-one, onto a conveyor belt which moves them along at a constant rate. 2. The slats are then planed to give them a flat surface. Next, they pass under a cutter head that makes parallel semicircular grooves- one half as deep as the graphite is thick- along the length of one side of each slat. Continuing along the conveyor belt, half of the slats are coated with a layer of glue, and the cut graphite is laid in the grooves of these slats. 3. The slats without glue- and without graphite in the grooves- are placed on another belt that carries them to a machine that picks them up and turns them over, so they are laying on the belt with the grooves facing down. The two conveyor belts then meet, and each unglued slat is placed over a slat with glue and graphite, forming a sandwich. After the sandwiches have been removed from the conveyor belt, they are placed into a metal clamp and squeezed by a hydraulic press and left clamped together until the glue is dried. When the pencils are dried, the ends are trimmed to remove excess glue. Shaping the pencils The next step is shaping, when the sandwiches actually become pencils. The sandwiches are placed on a conveyor belt and moved through two sets of cutters, one above and one below the belt. The cutters above the sandwiches cut around the top half, while the lower set cuts around the bottom half and separates the finished pencils. The majority of pencils are hexagonal, so designed to keep the pencils from rolling off surfaces; a single sandwich yields six to nine hexagonal pencils. Final steps 1. After the pencils have been cut, their surfaces are smoothed by sanders, and varnish is applied and dried. This is done with varnishing machines, in which the pencils are immersed in a vat of varnish and then passed through a felt disk, which removes the excess varnish. After drying, the pencils are put through the process again and again until the desired color is achieved. Finally, the pencils receive a finishing coat. 2. The pencils once again are sent on a conveyor belt through shaping machines, which remove any excess varnish that has accumulated on the ends of the pencils. This step also ensures that all of the pencils are the same length. 3. Erasers are then attached, held to the pencil by a round, metal case called a ferrule. The ferrule first attaches to the pencil either with glue or with small metal prongs, and then the eraser is inserted and the ferrule clamped around it. In the final step, a heated steel die presses the company logo onto each pencil. Colored pencils Colored pencils are produced in much the same way as black-writing pencils, except that their cores contain col oring materials such as dyes and pigments instead of graphite. First, clay and gum are added to pigment as bonding agents, and then the mixture is soaked in wax to give the pencils smoothness. When the pencils have been formed, the outsides are painted according to the color of the center mixture. Quaility Control Because they travel along a conveyor belt during the manufacturing process, pencils are thoroughly scrutinized before they are distributed to the public. Workers are trained to discard pencils that appear dysfunctional, and a select number are sharpened and tested when the process is complete. A common problem is that the glue of the sandwiches sometimes doesnt adhere, but this nuisance is usually caught when the sandwiches are being cut.

Expanded and Extended

Expanded and Extended Expanded and Extended Expanded and Extended By Maeve Maddox Tali asks, What is the difference between extended and expanded When do you use either? Although extend and expand can be used interchangeably in some contexts, extend applies to things that are being stretched out, while expand applies to things that are spread out. One implies length; the other area. If you extend your arm, for example, you stretch it out, making it longer. If your waist expands, its getting larger. As a business expands, or gets larger, it may extend its opening hours. Extend comes from a word meaning to stretch out, lengthen. (Latin extendere, stretch out, from ex out + tendere, to stretch.) Expand comes from a word meaning spread out, spread flat. (Latin ex out + pandere to spread, stretch. In this quotation that uses both words, extend conveys a lengthening of time, while expand indicates that more people will be covered by the credit: On Wednesday, the Senate voted to extend and expand the tax credit to include many buyers who already own homes. Here are some uses of both words: Laguna College of Art and Design officials hope to expand the library and build a new gallery. Availability of the iPad will expand to all of Best Buys U.S. stores Sessions Predicts Congress Will Extend Tax Cuts After Election Investigators are going to extend the probe until February 2011 A contract might be expanded to include additional specifications, or extended to last for a longer period: BP could expand the contract of a local disaster relief company, giving it the power to call in additional resources to defend Mobile Bay in the event its threatened by oil†¦ Last seasons UEFA Champions League runners-up, Bayern Munich, have decided to extend the contract of Coach Louis van Gaal. When expanded and extended are used as adjectives, context determines meaning: This article explains how to allocate memory and set up your system to run both expanded and extended memory. The Extended Mind refers to an emerging concept†¦that addresses the question as to the division point between the mind and the environment†¦ I have returned [from my travels] with an expanded mind and an open heart. Bottom line: Choose expand if what youre talking about is getting wider, becoming more inclusive, or taking up more space. Use extend if what youre talking about is increasing in duration, length, or reach. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:Spelling Test 1The Many Forms of the Verb TO BETreatment of Words That Include â€Å"Self†

Mediator's Opening Statement Essay Example | Topics and Well Written Essays - 750 words

Mediator's Opening Statement - Essay Example Throughout these proceedings any reference to the party against whom the claim is made will be identified as the respondent. My job as your mediator is to help you settle or resolve the dispute between you. I will not be deciding the outcome for you since my role as a mediator is to help you come to an agreement voluntarily. We will be convening based on an established schedule and when necessary to move this process along. With my help, you will identify your own interests and alternatives for the resolution of the dispute between you so that we can ultimately negotiate and execute an agreement that is acceptable to both sides and to which you will be bound once you agree to it. Therefore, unlike judges and arbitrators, I will not be deciding the outcome of this complaint. You as the parties to this process will decide the outcome. I will play a facilitative role in these proceedings. In my capacity as a facilitative mediator, my job is to understand and respect party autonomy. In t his regard, my role is to preside over these meetings and to allow you to discuss and air your differences in a meaningful and productive way. I will not make recommendations nor will I provide an opinion as to what I think the court might do in a similar situation or if it was seized of the matter. That is not my job as a facilitative mediator. My job is guide you via questions and comments that may help you to find common ground for arriving at a mutually agreeable conclusion on your own and without my input as to what would be a viable solution. It is also important to remind you, that throughout these proceedings, I will remain neutral in that I do not take one side over the other. I also want to assure you that this meeting is private and confidential and will remain so throughout these proceedings and after the matter is concluded. There are several reasons for ensuring privacy and confidentiality. First and most importantly, I do not want you to feel inhibited by the prospect of these discussions becoming a matter of public record. This might prevent full and frank disclosure which we need to ensure that this matter is resolved between you voluntarily. Secondly, privacy and confidentially ensures that my neutrality will not come into question if this matter is unresolved and you take it to court. If that happens, I might be called to testify for one party over the other and that would leave the appearance of bias. Thirdly, confidentially and privacy builds trust between you and me. Confidentiality and privacy however, can be waived, but only if the parties agree to it being waived. Another exception would be in rare circumstances where I might be compelled to testify in criminal proceedings or to give evidence in the investigation of criminal offences. The proceedings will be organized around joint and caucus sessions. Joint sessions are self-explanatory. Caucus sessions will be sessions in which I will meet with each of you separately to gain a prospec tive on your arguments, issues and interests. I am no way forming an opinion on your arguments, issues or interests, but merely seeking to identify them so that I can be more informed as to what and where you are going in joint discussions so that that I can guide you toward productive discussions that are aimed at guiding you toward a voluntary conclusion of the matter. Therefore, I do not want either or you to read

Integrated Marketing Communication and Information Technology Research Paper

Integrated Marketing Communication and Information Technology - Research Paper Example This research will begin with the statement that with the development of Internet technology consumer’s behavior, lifestyle and expectations have changed dramatically, thus making marketers and other professionals adjust to these changes. All these changes have been transformed into special subject known as Integrated Marketing Communication. Nowadays, in order to be successful, many companies have successfully adopted the principles of Integrated Marketing Communication (IMC). The American Association of Advertising Agencies defines IMC as a â€Å"concept of marketing communication, which sees the added value in an all-inclusive plan†, whereas the strategic importance of various communication tools (such as advertising, public relations, sales promotion, direct marketing) taken into account. This approach allows marketers â€Å"to ensure clarity, consistency and maximum communication impact†. One of the companies who has adopted IMC to its strategy is global com pany Samsung. In October 2011 Samsung rolled out Galaxy Note – the smartphone with a screen diagonal width of 5, 3-inches. These sizes of the smartphone were quite unusual and made it be perceived as a hybrid between the smartphone and tablet. There were many skeptics who were doubtful about the success of this particular product due to its unusual sizes. However, the company has achieved fabulous success having sold five million units of the Galaxy Note in the first five months. The launch of the second version of the Galaxy Note with 5,5-inches screen also has proved to be successful, as global sales have reached 10 million in the second half of 2012. The success formula of the Galaxy Note was comprised of three main factors, including the following: technological advancement, global operations and branding of Samsung, and unique marketing strategy.

The secret of Kentucky Fried Chicken (KFC) success

The secret of Kentucky Fried Chicken (KFC) success The secret of Kentucky Fried Chicken (KFC) success Kentucky Fried Chicken (KFC) is a very well known restaurant in the world. It is rated at number 60 as the world most well known brand by BusinessWeek (McDonalds at number 9 and Nescafe, 23). Its history spans almost 80 years when it started at Corbin (Kentucky-USA), in the 1930s. During this period the United States was under The Great Depression with almost 25% unemployment rate. The hard time was probably one of the biggest factor in forcing Harland Sanders (The Colonel) to start experimenting with various mix of spices and herbs, trying to get the best formula for his recipe. (If we still remember the Asian Economic Crash 1997-2002, one of the last remaining business that kept going during the recession was the food industry). By 1939, the recipe was already perfected and the Colonel had expanded his restaurant to accomodate 142 seats. This was a fairy large restaurant, the size is equivalent to several tennis courts. However there was one problem. The WAITING time! It took almost 30 minutes for the chicken to properly cooked. Turn the gas bigger and you risk of having the chicken cooked on the outside but still red with blood inside. Saved by the Pressure Cooker Thanks to technology, in 1939 pressure cooker was introduced. Pressure cooker allow liquid to boils at higher temperature. Water for example normally boils at 100 degree Celcius, but with a pressure cooker the sealed lid doesnt allow air or liquid to escape and enable water to boils higher at 125 celcius. This significantly shortened the time for cooking and as an added advantage, the nutrients (hence the taste) are retained making the food more delicious. Since the boiling point is much higher, this would also kill more germs and make the food last longer. It should be noted that The Colonel spotted the pressure cooking technique just weeks after it was introduced. This means he was always looking for ways to improve the taste and the time it takes to cook the famous kentucky fried chicken. Time means money Every minutes saved means less time waiting and more satisfaction to the customers. This would also encourage a first time buyer to become repeat customers. The Colonel is also a smart guy. He can read the writing on the wall. By early 1950s, he probably heard rumours that an Interstate Highway is going to be built BYPASSING his town. This could have a devastating effect on his business. He is now probably under serious dilemma. When the Interstate was finally opened in 1955, it caused a huge diversion of traffic away from his town. Owning a big percentage in a small town VS Owning a small percentage in a large country. Seeing an end to his business, the Colonel auctioned off his operations. Confident with the quality of his fried chicken, the Colonel started travelling from town to town franchising his recipe. He visited countless restaurants, promoting his recipe by cooking fried chickens for the owner and the workers. The first franchise was awarded to Pete Harman of Salt Lake City. A handshake agreement stipulates a payment of a nickel to the Colonel for each chicken sold. This is one of the real strength of the franchise system. It provides a stream of money albeit the sum is initially very small. Building a franchise network is like building a pipe for money to flow to you. In the beginning, the cost is huge because you have to set the infrastructure, digging the earth, linking pipes, bypassing obstacles etc. In the beginning the volume of water flow (money) in your pipe is also dismal. After a few years of hard work, the effort will start to bear fruits. A penny here, a penny there, ten pennies from this town, a hundred pennies from that city, a thousand pennies from this district, ten thousand pennies from that state and it happen EVERY DAY! Before long it started to make a huge impact on your income. The KFC secret recipe: Does it matter? It is an open secret that the KFC is made of a mix of 11 herbs spices. Using modern spectrometer, we can blast the Colonel spice with X-ray photoelectron or burn them with a specially designed gas and study the result. With a database of results made with similar technique using all spices herbs known to mankind, it would take just weeks before we could identified the exact names and percentage of those 11 spices. However, DOES IT MATTER Does it really matter to know the exact names and compositions of those spices? An average businessman would think the secret recipe is so valuable and willing to pay millions for a copy of it. A genius businessman would not pay even a penny!! It is the franchise system, not the spice recipe. Have you been to a night market (pasar malam) and tried the fried chickens sold by the hawkers? Have you ever been to a small restaurant or a foodstall and found out that the fried chicken was so crispy and delicious Then you were wondering why this small time businessman did not make a fortune out of his secret recipe! The next time you visited the restaurant again, did you notice that:- sometimes there was nobody to take orders sometimes it was closed without properly giving a notice in advance sometimes the table was in a mess and nobody to clean even after 5 minutes you were seated sometimes the sink was dirty and choke full with food residual. sometimes the fried chicken was overcooked, and at other times it was undercooked. sometimes the fried chicken was too hot and at other times it was not so spicy. What is the point? The secret recipe represent only a small percentage of the success of the KFC franchise. If I were to give a percent, it may not represent more than 20% of the total success. THE SUCCESS IS DUE TO THE FRANCHISE SYSTEM!! In a franchise system, everything is documented and there are strict rules for running the business. For example: The chicken must be cooked in a pressure cooker and left for 15 minutes The size of each of the chicken parts must at least 8 cm wide and weight 300 grams The chicken must be marinated overnight The age of the chicken when they were slaughtered must be between 60-70 days The minimum size of the restaurant must be 2460 feet The color of the logo, the chair and the table must be yellow and the floor is dark grey. The toilet must be cleaned every 3 hours. The sink must be cleaned every 30 minutes The windows must be cleaned every morning Food left unsold after 15 minutes must be discarded. The worker must wear company-shirt and trousers. No jeans, corduroy or leather. 5% of gross earning must be used for local advertisement 1% of gross earning must be used for national level advertisement 3% must be used for RD to develop new recipes local brand. The food must also be offered in discounted packages (e.g 2 chicken, 1 fries, 1 glass of pepsi) The food can be ordered seperately / ala carte but no discount applies. The restaurant must have air-condition. This long list of standard operating procedures is actually the key to the success of the franchise. The long list is actually an accumulated wisdom and know-how the franchise system have developed after a few decades of operation. Finally we found the holy grail!! THE SECRET RECIPE of KFC SUCCESS IS ACTUALLY THE WHOLE FRANCHISE SYSTEM!!

Pregnancy Induced Hypertension

[pic] OBSTETRICS POSTING CASE WRITE-UP PREGNANCY INDUCE HYPERTENSION Name: Muhammad Azraie B. Mat Ali Matrix Number: 1090265 Patient Identification Name: Nur Asilah Bt. Johari Age: 23 year old Race: Malay Sex: Female Address: Taman Raja Abdullah Occupation: Student D. O. A. : 13 March 2013 I/C: 900208035442 LMP: 27 June 2012 – sure of date – not on breast feeding – not on contraceptive – regular menses POA: 37/52 EDD: 4 April 2013 Chief Complaint(s) This is a referred case from Klinik Kesihatan Jalan Raja Abdullah for high blood pressure during regular ante-natal check-up for 1 day duration.History Of Presenting Illness Patient was apparently well until 1 day ago when she was diagnosed to have high blood pressure during her regular antenatal check-up at Klinik Kesihatan Jalan Raja Abdullah. She was normotensive throughout the antenatal check-up before until yesterday when the doctor noticed that her blood pressure was high which was 170/100 mmHg for three time consecutively. She denied of having an essential hypertension before and no positive family history of hypertension.On further questioning, she had headache, otherwise she not had any sign and symtoms of impending eclampsia such as blurring of vision, vomiting, epigastric pain and syncope prior to the admission. She claimed the first episode of headache was during last antenatal check up where she was diagnosed to have high blood pressure. History Of Presenting Pregnancy Pregnancy was suspected when she missed her menses for 4/52. It was confirmed by doing urine pregnancy test (UPT) at private clinic. At that time, no early ultrasound was done.She claimed that she experienced symptoms of early pregnancy such as nausea, vomiting and headache that last until 20/52 POA. Booking was done during 13/52 POA at Klinik Kesihatan Jalan Raja Abdullah. At that time, blood and urine investigation was done. Her blood pressure at that time was 112/70 mmHg. Blood group was O positive and VDRL was non-reactive. Urine investigations also normal. She attended all the ante-natal clinic regularly and all was uneventful. Symphyseal-fundal height was correspond to the date throughout the check-up.She was also normotensive throughout the visit until the last visit when her blood pressure was rise up. Quickening was felt at 20/52 POA and it was increasing in the frequency and intensity. Past Obstetric History She married in year 2011 at the age of 21 and this is her first pregnancy. Past Gynaecology History She attained menarche at the age of 13. She had a regular menses flow of 5 to 6 days duration with 28 to 30 days per cycle. It peaks on day 2 with no history of menorrhagia and dysmenorrhea. She denied of having any history of intermenstrual bleed and post-coital bleed.She not practicing any method of contraceptive and no pap smear was done before. Systemic Review Systemic review was unremarkable. She had no heart disease symptoms that can cause by hypertension, no headache, n o nausea and vomiting, and also no blurring of vision. Past Medical and Surgical History This is her first admission to the hospital. There was no history of asthma, essential hypertension, diabetes mellitus and heart disease in this patient. He denied of having any surgical intervention before. Family History All of her siblings were in good health.There was no history of twin or congenital abnormalities in her family. Both of her parents are still alive and in good health. Social And Personal History She live with her husband at Taman Jalan Abdullah. She is a student,and she denied smoking and consume alcohol. Her husband also a student, non smoker and not consume alcohol. Diet And Drug History There was no known drug and food allergies. Summary My patient, a 23 year old lady primigravida at 37/52 POA was admitted due to increased blood pressure during ante-natal check-up which was symptomatic. PHYSICAL EXAMINATION General Examination:The patient was lying supine comfortably suppo rted with one pillow. She was not in pain and not in respiratory distress. She is a medium built woman with clinically adequate nutritional and hydrational status. There was no gross deformity and skin colour changes in this patient. No attachment of iv branula on her limbs. Vital Signs: Blood pressure: 140/88 mmHg Pulse: 96 beats per minute. Regular rhythm and good volume. Temperature: 37oC Respiratory rate: 20 breaths per minute General Systemic Examination: Hand: The palm was warm and moist. The palmar creases was pink/not pale.No palmar erythema. No peripheral cyanosis and clubbing. Head and Neck: No jaundice and the conjunctiva was pink. Oral hygiene was good, no central cyanosis and the tonsil was not injected. Lower Limb: There was no ankle edema. Per Abdomen Examination: The abdomen was distended with gravid uterus as evidence of linea nigra and striae gravidarum. The umbilicus was centrally located and flat. No dilated veins and surgical scar. Abdomen was soft and non-tende r. Clinial fundus correspond to 38 weeks of gestation. Symphyseal-fundal height was 36 cm, which was corresponding to date.It was a singleton baby. Longitudinal lie with cephalic presentation and fetal back was at mother's left. The fetal head was not engaged. Liquor was clinically adequate. Fetal heart sound was heard. Examination Of Other System i. Cardiovascular System – apex beat was located at the left 4th intercostal space, lateral to the mid-clavicular line. – Both heart sound was present, and no additional sound. ii. Respiratory System – Air entry was normal and equal both sided. No additional sound was present. iii. Central Nervous System – All motor and sensory was grossly intact.Reflexes was normal. Summary: The patient, 23 year old primigravida at 37/52 POA, was examined and showed high blood pressure. All the reflexes were normal. Other system was normal. _____________________________________________________________________ Problem List: i. P rimigravida ii. High blood pressure INVESTIGATION 1. Urine Analysis ( 24 Hr Urine Protein ) To look any presence of protein in the urine to exclude pre-eclampsia and to assess the severity of the proteinuria quantitatively. Result : Negative finding. Interpretation : No proteinuria in this patient. 2. Full Blood CountTo assess haemoglobin and platelet count in this patient. Result : WBC9. 79Ãâ€"109/L Hb13. 2g/dL Plt270x109/L Interpretation : All parameters shows no abnormalities. 3. Renal Function Test To assess glomerular and tubular function of the kidney. Result : Sodium135 mmol/L Potassium4. 0 mmol/L Urea3. 0 mmol/L Interpretation : All parameters shows no abnormalities. 4. Liver Function Test To assess the level of aminotransferases and protein level especially albumin level Result : ALP134 ALT11 Bilirubin4 Total protein64 Albumin34 Interpretation : No abnormalities. 5. UltrasoundTo assess fetal condition, look for placenta pathology Result : BPD90. 6 mm36W5D FL64. 0mm37W6D HC 328 mm37W2D EBW2. 40 – 2. 60 kg Placenta : Fundal grade III Interpretation : Normal Amniotic Fluid Index : To assess the amniotic fluid volume ( poly-, normal, or oligohydramnios ) Result : 12. 0 PROVISIONAL DIAGNOSIS Gestational Hypertension Evidence: †¢ History – increased blood pressure more than 140/90 mmHg during last ANC – occur after gestational age more than 20 weeks – no proteinuria – no history of essential hypertension before †¢ Physical examination & investigation high blood pressure (170/100 mmHg) MANAGEMENT Aim of management : 1. Control the hypertension 2. Monitor the fetus condition by doing fetal kick chart and cardiotocography 3. Don’t allowed postdate 4. A tablet of Aldalat (Nifedipine) 10 mg 3 times daily 5. Daily monitoring of blood pressure for every 4 hours 6. Deliver the baby by induction of labour if more than 35 POA 7. Plenty of bed rest DISCUSSION PREGNANCY-INDUCED HYPERTENSION Definition :- Increase in b lood pressure after 20 weeks of gestation: †¢ BP ? 140/90 mmHg †¢ An ^ in systolic BP ? 30 mmHg over baseline An ^ in diastolic BP ? 15 mmHg over baseline BP measurement : Taken at least 6 hours apart with the patient at rest PIH can be divided into : †¢ Pre-eclampsia – mild, severe †¢ Gestational HPT †¢ Eclampsia As we received a pregnant woman with a high blood pressure during ante-natal check-up, we should bare in mind that one of the possible causes of it is Pregnancy Induced Pregnancy (PIH). In this case, full history of the patient should be taken including full obstetric history, signs and symptoms of heart disease, liver disease and renal disease to exclude any possibility of ssential hypertension and also signs and symptoms of impending eclampsia. As in this patient, there was no history of essential hypertension or family history of hypertension, and the high blood pressure was only discovered during ante-natal check-up at late pregnancy whi ch is at 37 weeks POA. She was diagnosed to have Pregnancy Induced Hypertension which are mild in severity because the blood pressure was maintained around 170/100 mmHg on subsequent ante-natal visit. She was not diagnosed to have pre-eclampsia because no proteinuria.Several investigation was done in this patient to look for any complication of pregnancy induced hypertension in the mother and the fetus. All parameters of the investigation show no abnormalities. It is because the hypertension is mild in severity and it occurs quite late in the pregnancy which make the complication difficult to arise. Complications of hypertension in pregnancy There are several complication that can occur in Pregnancy Induced Hypertension. Maternal :- †¢ Cerebral haemorrhage †¢ Heart failure †¢ Hepatic necrosis Acute tubular necrosis of the kidney Placental :- †¢ Placental insufficiency †¢ Abruptio placenta †¢ Oligohydramnios Fetus :- †¢ Intrauterine growth retardati on Drugs that can be used in pregnancy 1. Methyldopa (Aldomet) †¢ It is a central adrenergic inhibitor †¢ Action: v symphatetic activity, v total peripheral resistance †¢ Adverse effect : lethargy, drowsiness †¢ It is the safest drug in pregnancy 2. Labetolol (Trandet) †¢ ? /? adrenergic blocker †¢ Action : v total peripheral resistance, v cardiac output †¢ Adverse effect : fetal bradycardia, IUGR Contra-indication : 1st degree heart block, severe asthma 3. Nifedipine (Adalet) †¢ Calcium channel blocker †¢ Action : inhibit calcium influx in vascular smooth muscle †¢ Adverse effect : headache, reflux tachycardia, flushing 4. Hydralazine †¢ Peripheral vasodilator †¢ Action : direct action on vascular smooth muscle, v TPR †¢ Adverse effect : headache, sweating, nausea, palpitation †¢ Indication of use : in hypertension crisis In the ward, the blood pressure of the patient was controlled by given her good bed rest and daily monitoring of blood pressure.Other than that, the fetus condition monitored by doing cardiotocography (CTG). She also planned to have induction of labour. Indications for labour in this patient The indications for labour in this patient are :- i. She is at term ii. Delivery of the baby is the only treatment to bring down the blood pressure in pregnancy induced hypertension Risks of induction of labour 1. Failed induction – indicates that the attempt to induce labour has failed to result in full dilatation of the cervix. 2. Uterine hyperstimulation – which can cause fetal distress and uterine rupture