Sunday, January 26, 2020
Nursing Processes for Emesis Management
Nursing Processes for Emesis Management Nausea and vomiting are common complications of multiple conditions, procedures, therapies, and events such as motion sickness, pregnancy, anesthesia (general, regional, or local) or radio/chemotherapy. Symptoms can be debilitating for many patients, and in the case of post-operative nausea and vomiting (PONV) physical damage may result, such as rupture of sutures, stitches, and esophageal tissue, and metabolic problems, such as electrolyte imbalances and dehydration (Golembiewski et al, 2005; Gan 2006). In severe cases of PONV, although rare, aspiration of gastric contents may occur, resulting in pulmonary sequelae, such as pneumonia or pneumothorax (Scuderi and Conlay 2003; Bremner and Kumar 1993). Thus effective treatment of PONV, possibly through multimodal antiemetic prophylaxis, is an important are of research (Skledar et al. 2007). This essay will consider two commonly used, well-recognized antiemetic treatments namely cyclizine and prochlorperazine. Both represent very old drug therapies, with cyclizine having been launched as an antiemetic in 1953, and prochlorperazine as an antipsychotic in 1957 (Broccatelli, 2010), its use as an effective antiemetic emerging soon thereafter (Finn et al, 2005). These drugs are commonly used on most wards in my practice setting and therefore it is vital for nursing staff to understand their respective pharmacodynamic (PD) and pharmacokinetic (PK) profiles. Prior to prescribing it is also important that the nurse have relevant knowledge regarding how these drugs work, how their PD and PK properties are altered by disease processes such as kidney/liver failure and whether there are any relevant contraindications or precautions. Additionally, the potential for drug-drug interactions and the dose appropriate for the patients age and weight should be ascertained if beneficial pati ent orientated outcomes are to be achieved. These issues will be comprehensively discussed within this essay. Pharmacology of emesis There are a plethora of drugs on the market to treat emesis, however, deciding upon an appropriate and effective treatment for patients requires the cause of the underlying nausea and vomiting to be ascertained. This is because the symptoms can manifest as a result of a number of underlying pharmacological processes, as will now be described. Vomiting is a complex reflex action controlled by the vomiting centre (VC) in the medulla region of the brain, an important part of which is the chemotrigger zone (CTZ); stimulation of this in turn leads to VC stimulation which ultimately leads to vomiting (Goodman Gilman, 1996). Neurotransmitter mediated stimulation of the VC can arise from both peripheral and central impulses (Shanbhag, 2008). Thus gastrointestinal irritation, motion sickness and vestibular neuritis all manifest in nausea and vomiting as a result of neurotransmitter release. The three main neurotransmitters involved in the control of vomiting are acetylcholine (ACh; via muscarinic-receptors), dopamine (via dopaminergic receptors), histamine (via H-1 receptors), and serotonin (via 5-HT3 receptors) (Shanbhag, 2008). Inhibition or antagonism of these receptors achieves emetic control. The VC has neurons which are rich in muscarinic cholinergic and histamine containing synapses and is directly stimulated by the vestibular input (e.g. through motion sickness), whilst dopamine and serotonin release are involved in the visceral stimuli pathway (e.g. through chemotherapy treatment) and also in the CTZ stimulation pathway as shown in Figure 1. Thus drug classifications of anti-emetics arise on the basis of which of the three pathways that they target (Flake et al., 2004). Selective serotonin receptor antagonists and antidopaminergics target the visceral stimuli and the CTZ, whilst the antihistamines and anticholinergics target the vestibular input pathway (Hornby , 2001; Flake et al., 2004). Etiology of Nausea and Vomiting Cyclizines anti-emetic effects are not fully understood but it is thought that it works by blocking the transmission of information from the labyrinthine apparatus in the inner ear (i.e. the vestibular pathway) to the VC (Goodman and Gillman, 1996). Cyclizine may also target the CTZ and it thought to exhibit some ACh muscarinic receptor blockade which probably contribute to the antiemetic potential thus operating at several pathophysiological levels. However, a side effect of ACh blockade is sedation in some individuals along with the potential for certain deliriant and hallucinogenic effects, probably responsible for cyclizines abuse potential (Bailey and Davies, 2008). Cyclizine produces its antiemetic effect within two hours and it lasts approximately four hours (emc, n.d.). The exact mechanism of prochlorperazines antiemetic action is also unclear, but the drug is thought to inhibit apomorphine induced vomiting by blocking dopamine D2 receptors centrally in the CTZ and possibly peripherally through dopaminergic receptors in the intestine (Perwitasari, 2011).à However, it also has some potential to block anticholinergic and alpha-adrenergic receptors, and therefore can also result in sedation along with muscle relaxation, and orthostatic hypotension (Kelly, 2000). Following intramuscular administration prochlorperazine has an onset of action within ten to twenty minutes and a duration of action of three to four hours (globalrph, n.d.). Indications and dosage form Cyclizine is indicated for the control of postoperative and drug-induced vomiting and in motion sickness (BNF, 2012; emc, n.d.). It is given by mouth at a dose of 50mg tablets up to three times a day or parenterally as a 50mg in 1ml solution intramuscular (im) or intravenous (iv) injection again at a frequency of up to 3 times a day (Reynolds, 1993). The recommended dose in children aged 6-12 years is lower: 25 mg up to 3 times daily. For motion sickness, it is recommended that tablets be taken 1-2 hours before departure. Cyclizine can also be given for vertigo and, morning sickness in pregnancy, and to combatà opioid nausea. It is also prescribed for radiation sickness (medsafe, n.d.) and PONV (Cholwill et al., 1999), indeed it is given iv before the induction of general anaesthesia at half the recommended dose, to increase the lower oesophageal sphincter tone thus reducing the hazard of regurgitation and aspiration of gastric contents (medsafe, n.d.). Although prochlorperazine is classified as an antipsychotic, its principal use nowadays is in the treatment of severe nausea and vomiting of various causes including, PONV, vertigo and motion sickness (BNF, 2012). It has several dosage forms: tablet (5mg: one or two tablets 3-4 times daily), syrup (5mg in 5ml: 5-10 ml 3-4 times daily), suppositories (25mg twice daily), dissolvable tablet (buccal tablet 3mg: one or two tablets twice a day in adults and children aged 12 years and over), im injection (12.5mg in 1ml; 5-10mg repeated every 3-4 hours with a maximum daily dose of 40mg) and iv injection (2.5 -10 mg by slow IV injection or infusionà with a maximum daily dose of 40mg). The oral (and buccal) route is the only method of administration recommended for children, and it is not recommended in children younger thanà 12 years (BNF, 2012). The different dosage form of prochlorperazine provides the nurse with flexibility for example the elderly and children may prefer the syrup or b uccal tablet, or in dysphagia suppositories or intra-muscular injections could be more appropriate. Cyclizine and prochlorperazine are both considered first line treatments for nausea secondary to vertigo and motion sickness (Quigley, 2001) and are first line treatments in many hospitals in PONV (NHS, Salisbury; NHS Plymouth). A review by Matchar, et al. (2003) has suggested that oral prochloperazine may also be used as an adjunct in the treatment of nausea associated with migraine (Matchar et al, n.d.). No randomized controlled trial has been found which formally compares efficacy of cyclizine and prochlorperazine, however, two studies comparing cyclizine with perphenazine in ameliorating drug-induced emesis, have shown the former to have comparable antiemetic efficacy to this related phenothiazine drug (Dundee et al., 1975; Chestnutt and Dundee, 1986). These studies are featured in a Cochrane report (Stevenson, 2006) which investigates drugs for preventing PONV and highlights eight drugs which reduce PONV by a similar amount in this patient group, cyclizine being one. The report concluded, therefore, that the most important question to answer when treating emesis is What are the types and risks of side effects experienced by patients exposed to these antiemetics? Thus safe and effective prescribing requires the nurse to identify patient variables or comorbidities relevant to the drugs side effects, for example heart failure patients should not be prescribed cyclizine and individuals susceptible to visual disturbances should avoid prochlorperazine as per the drugs contraindications. It is noteworthy that both drugs may be prescribed in the later stages of pregnancy if considered appropriate by a doctor (Schaefer, 2007; CKS, n.d.).à [1]à The choice of antiemetic would depend upon the precise cause of the nausea in conjunction with the specific receptor affected. However, since several different neurotransmitters stimulate the CTZ, combining drugs with different mechanisms of action can often be more effective than increasing the dose of one individual drug (King and Brucker 2011). Indeed, combinations of antiemetics are often used in palliative care (NHS Scotland, n.d.). Notably, vomiting of unclear or mixed origin may respond to a phenothiazine such as prochlorperazine because, in addition to acting on dopamine and serotonin receptors in the CTZ, it also acts at the VC and vestibular area. Cyclizine and prochlorperazine are both commonly used anti-emetics in palliative care where nausea and vomiting are present in up to 70% of patients with advanced cancer (NHS Scotland, n.d.). Treating this patient population requires particular vigilance, since there may be a number of underlying reasons for and comorbidities contributing to the nausea and vomiting, and antiemetics may be inappropriate. Consideration for causes of the symptoms might include intestinal obstruction or constipation, anxiety, raised intracranial pressure (ICP), oesophageal candida, severe pain or hypercalcaemia all of which might warrant interventions other then antiemetics. Conversely, should the nausea and vomiting be identified as drug induced, then anti-emetics such as cyclyzine or prochlorperazine might be appropriate. Raised intracranial pressure stimulates vomiting centre via pressure receptors and can be problematic in patients with known or suspected brain metastases. Notable, cyclizine can be g iven to such patients, especially where corticosteroids are contraindicated (NHS Scotland, n.d.). Pharmacokinetics Cyclizine, like most antihistamines, is well absorbed from the GI tract. After oral doing the effects develop within 30 minutes, are maximal within 1-2 hours and lasts for 4-6 hours. A single oral dose of 50 mg cyclizine in healthy adult volunteers resulted in a peak plasma concentration of approximately 70 ng/mL, occurring at about two hours after drug administration. The plasma elimination half-life is approximately 20 hours.à [2]à Cyclizine is extensively metabolised in the liver via N-demethylation to the inactive metabolite norcyclizine (Figure 4), which is widely distributed throughout the tissues and has plasma half-life of approximately 20 hours. This metabolite has minor antihistaminic activity compared to parent drug. A single 50 mg dose of cyclizine when given to an adult male volunteer, results in less than 1% of the total dose administered being excreted as parent drug in the urine over a 24 h period. Thus urinary excretion of metabolite rather than parent drug is th e major route of elimination forà cyclizine. The metabolism is thought to be mediated through CYP 2D6 and therefore exhibit inter-subject variability dependent upon the CYP 2D6 genotype as demonstrated by Vella-Brincat et al. (2012) in their study of the PK of cyclizine (Appendix 1) and its major metabolite (Appendix 2) in palliative care patients receiving sub-cutaneous cyclizine. Results indicated that the metabolic ratio of parent drug to metabolite differed significantly according to CYP2D6 genetics.à [3]à Prochlorperazine is reasonably well absorbed from the GI tract and highly protein bound. It undergoes extensive metabolism both in the gastric mucosa and on first pass through the liver via the cytochrome P450 enzyme system (CYP 2D6 and CYP 3A4)à [4]à to inactive metabolites, which are subsequently excreted in the urine. Parent drug has a plasma half-life of between 4 and 8 hours, the precise half-life differing according to the mode of administration. An im injection produces its antiemetic effect in 5-10 minutes and it lasts for 3-4 hours. Onset of effects are related to the mode of administration hence the pharmacokinetic profile, thus an oral dose would have a slightly slower onset of action but would last longer compared with an im injection.à [5]à According to Finn et al (2005), although the drug has been accepted as a useful anti-emetic for over half a century, its therapeutic success has been limited by its low and variable absorption and high first-pass metabolism. H owever, the development of a new buccal formulation has improved the PK, since studies demonstrate that buccal administration of prochlorperazine produces plasma concentrations more than twice as high as an oral tablet, with less than half the variability (Finn et al., 2005)à [6]à (Figure 5). When placed in the buccal cavity between the upper lip and the gum the formulation forms a gel from which the prochlorperazine is released and absorbed. The plasma levels achieved at steady-state on a dosage regimen of one 3mg buccal tablet twice daily are similar to those observed with the standard oral dosage of one 5 mg tablet taken three times daily. The elimination half-life of prochlorperazine in this formulation is 9 hours. The safety and efficacy of this relatively new formulation has also been demonstrated by Bondà [7]à (1998) in a randomised, double-blind, double-dummy trial in patients with vestibular disorders. Side effects By virtue of their pharmacology, cyclizine and prochlorperazine are both central depressants and can cause impairment of performance (Benson, 2001). Consequently, the pharmaceutical data sheets for both drugs have warnings regarding their potential to interfere with the ability to drive or operate machinery safely due to their ability to cause drowsiness (BNF, 2012). Despite the fact that cyclizine is one of the older antihistamines it is considered less potent in this regard compared to others in its class (Broccatelli, 2010), however, there is considerable variability in response to this side effect which can range from slight drowsiness to deep sleep. For this reason in practice, when one drug is not effective or poorly tolerated then it is justifiable to give another drug or combination of drugs (Benson, 2001). This unwanted side-effect is also a feature of prochlorperazine especially in the elderly, and often diminishes with continued treatment of both drugs (emc, n.d.). Cyclizines other more common side-effects include headache and psychomotor impairment plus antimuscarinic effects, such as urinary retention, dry mouth, blurred vision, and gastrointestinal disturbances (BNF, 2012). Less common side effects are palpitations and arrhythmias, also dizziness, hypotension, muscular weakness and poor coordination (Goodman and Gilman, 1975). Prochlorperazine commonly causes CNS related side effect such as acute dystonia or dyskinesia, however these tend to be transitory (usually occur within the first 4à days of treatment) and are more common in children and young adults. Dopamine antagonists like prochlorperazine can also cause extrapyramidal effects, QT prolongation and even severe hypotension, especially in the elderly (emc, n.d.). Muscle spasms and restlessness are other reported side effects. Interactions Cyclizine exhibits pharmacological interactions with other drugs due to antagonism of its action (donepezil, galantamine, rivastigmine) or enhanced anticholinergic actions (tacrine, trimethobenzamine, triprolidine, trospium). Pharmacokinetic interactions may arise since cyclizine is an inhibitor of the hepatic CYP 2C9 isozyme system, which is involved in an NADPH-dependent electron transport pathway. This isozyme oxidizes a variety of structurally unrelated compounds, including steroids, fatty acids, and xenobiotics and contributes to the wide pharmacokinetics variability of the metabolism of drugs such as S-warfarin, diclofenac, phenytoin, tolbutamide and losartan. Pethidine and propanidid are also listed as having a potential to interact with cyclizine. Cyclizine also acts as an inhibitor of estrogen sulfotransferase, the enzyme responsible for estradiol metabolism. Prochloperazine has a plethora of interactions, both pharmacological and pharmacokinetic. The pharmacokinetic interactions are largely due to competitive metabolic interactions at the hepatic CYP 3A4 and CYP 2D6 enzymes. The CYP 3A4 isozymes are responsible for a variety of oxidation reactions e.g. caffeine 8-oxidation, omeprazole sulphoxidation, midazolam 1-hydroxylation and midazolam 4- hydroxylation, plus metabolism of structurally unrelated compounds, including steroids, fatty acids, and many other xenobiotics. Whilst the CYP 2D6 isozymes are responsible for the metabolism of many drugs and environmental chemicals, via oxidative transformation along with metabolism of drugs such as antiarrhythmics, adrenoceptor antagonists, and tricyclic antidepressants.à [9]à Consequently, the data sheet for prochlorperazine lists many drugs with interaction potential including adrenaline, amphetamine, carbamazepine, clonidine, desferrioxamine, guanethidine, levodopa, lithium, phenobarbital and propranolol. Managing Drug Therapy When managing the care of a patient, nursing staff must initially thoroughly assess the patient, then identify significant interactions between core drug knowledge (PD, PK, ADRs, interactions, contraindications) and the patients core variables (health status, age and gender, life-style and diet, environments, culture). Thereafter the nurse can plan and implement suitable interventions, which will maximise therapeutic effects whilst minimising adverse effects (Aschenbrenner and Venable, 2008). In order to achieve such objectives the nurse should ensure administration of the appropriate medication is given through a suitable route on a regular basis or as required, with ongoing patient evaluation and monitoring. Cyclizine and prochlorperazine are both considered first line treatments for nausea secondary to vertigo and motion sickness (Quigley, 2001) and are first line treatments in many hospitals in PONV (NHS, Salisbury; NHS Plymouth). A review by Matchar, et al. (2003) has suggested that oral prochloperazine may also be used as an adjunct in the treatment of nausea associated with migraine (Matchar et al, n.d.). No randomized controlled trial has been found which formally compares efficacy of cyclizine and prochlorperazine, however, two studies comparing cyclizine with perphenazine in ameliorating drug-induced emesis, have shown the former to have comparable antiemetic efficacy to this related phenothiazine drug (Dundee et al., 1975; Chestnutt and Dundee, 1986). These studies are featured in a Cochrane report (Stevenson, 2006) which investigates drugs for preventing PONV and highlights eight drugs which reduce PONV by a similar amount in this patient group, cyclizine being one. The report concluded, therefore, that the most important question to answer when treating emesis is What are the types and risks of side effects experienced by patients exposed to these antiemetics? Thus safe and effective prescribing requires the nurse to identify patient variables or comorbidities relevant to the drugs side effects, for example heart failure patients should not be prescribed cyclizine and individuals susceptible to visual disturbances should avoid prochlorperazine as per the drugs contraindications. It is noteworthy that both drugs may be prescribed in the later stages of pregnancy if considered appropriate by a doctor (Schaefer, 2007; CKS, n.d.).à [10]à The choice of antiemetic would depend upon the precise cause of the nausea in conjunction with the specific receptor affected. However, since several different neurotransmitters stimulate the CTZ, combining drugs with different mechanisms of action can often be more effective than increasing the dose of one individual drug (King and Brucker 2011). Indeed, combinations of antiemetics are often used in palliative care (NHS Scotland, n.d.). Notably, vomiting of unclear or mixed origin may respond to a phenothiazine such as prochlorperazine because, in addition to acting on dopamine and serotonin receptors in the CTZ, it also acts at the VC and vestibular area. Cyclizine and prochlorperazine are both commonly used anti-emetics in palliative care where nausea and vomiting are present in up to 70% of patients with advanced cancer (NHS Scotland, n.d.). Treating this patient population requires particular vigilance, since there may be a number of underlying reasons for and comorbidities contributing to the nausea and vomiting, and antiemetics may be inappropriate. Consideration for causes of the symptoms might include intestinal obstruction or constipation, anxiety, raised intracranial pressure (ICP), oesophageal candida, severe pain or hypercalcaemia all of which might warrant interventions other then antiemetics. Conversely, should the nausea and vomiting be identified as drug induced, then anti-emetics such as cyclyzine or prochlorperazine might be appropriate. Raised intracranial pressure stimulates vomiting centre via pressure receptors and can be problematic in patients with known or suspected brain metastases. Notable, cyclizine can be g iven to such patients, especially where corticosteroids are contraindicated (NHS Scotland, n.d.). Administration Precautions Due to its centrally acting effects, patients taking cyclizine should avoid alcohol and other depressants e.g. hypnotics or tranquillisers. Food may reduce irritation to cyclizine and since there is no interaction with food, this drug can be taken without regard to meals. The datasheet indicates it should be used with caution in hepatic disease, whilst in renal impairment there is a need for dose reduction (BNF, 2012). Cyclizine should also be used with caution in patients with severe heart failure. Other anticholinergic effects include visual disturbances, and sedation, which can make them dangerous for the elderly population or younger patients. Further, cardiovascular side effects e.g. hypotension, tachycardia, and palpitations have been reported, plus minor GI effect e.g. dry mouth and constipation. Cyclizine has a well-known abuse potential (Ruben et al. 2006). In opiate dependents receiving long-term methadone cyclizine is often taken in large doses intravenously to provide a m ore intense high. Thereafter the addict experiences depressive mood changes and a craving for cyclizine. Many individuals receiving long-term prescriptions of oral methadone have been identified as being habitual abusers of cyclizine.à [11]à Consequently, there is considerable reticence by pharmacists in prescribing the drug, and alternative treatments are generally sought. Obviously in the hospital setting there is little opportunity for such abuse, and the efficacy and cost-effectiveness of the drug would therefore take precedence over its abuse potential (Barber, 1995; Philips and Thompson, 1997). Although prochlorperazine being an antipsychotic phenothiazine drug can be employed in psychiatry, in lower doses it is usually prescribed for its anti-emetic properties. Patients taking the drug should take with a full glass of water, avoid excessive quantities of coffee or tea (containing caffeine) and also avoid alcohol. Prochlorperazine should be used with caution in patients with renal and hepatic impairment and cardiovascular disease; also in Parkinsons disease, epilepsy and in patients with a history of glaucoma. While the drug does not deliver the euphoria that is associated with many commonly abused drugs, it still has some abuse potential since it can alter mood and perception, but not to the extent of cyclizine. Moreover, dependence and tolerance can develop, which can drive the individual to continue to seek more of the drugà [12]à and result in overdose, characterised by symptoms of central nervous system depression to the point of somnolence or coma. Agitation and r estlessness may also occur in overdose. Other possible manifestations include convulsions, EKG changes and cardiac arrhythmias, fever and autonomic reactions such as hypotension, dry mouth and ileus. Managing Drug Therapy Nausea and Vertigo: In emetic patients, antiemetics should only be prescribed when the underlying cause is known, indeed antiemetic administration may be harmful when the cause can be treated, e.g. in diabetic ketoacidosis or digoxin/antiepileptic overdose. In addition to motion sickness cyclizine can be given to patients with nausea caused by mechanical bowel obstruction and raised intracranial pressure.à [13]à Once a decision has been made that antiemetic drug treatment is appropriate, the drug and the dosage form should be chosen according to the aetiology of vomiting along with core drug knowledge and patient variables. Thus prochloperazine is useful for episodes of more severe nausea and vomiting e.g. associated with diffuse neoplastic disease, radiation sickness, and the emesis caused by drugs such as opioids, general anaesthetics, and cytotoxics. Indeed, prophylactic use may be required if severe nausea is anticipated such as following chemotherapy treatment. (Aschenbrenne r and Venable, 2008). Prochorperazine may be a suitable choice because of its dosage forms, thus rectal suppositories can be useful in patients with persistent vomiting or with severe nausea and the buccal tablet dosage form is also useful in such instances. However, during use of phenothiazines it is important to monitor severe dystonic reactions, especially in children. It is recommended as a second-line treatment for vomiting in pregnancy after promethazine.à [14]à Whereas the efficacy of cyclizine in treating nausea and vomiting has already been unequivocally proven, it is only available in tablet and injectable form. Nevertheless, cyclizine may be the choice of drug over prochlorperazine in children since in this patient population the latter can only be administered orally (BNF, 2012), and therefore requires patient compliance for success. There is no evidence that either of the two drugs is superior to the other in terms of efficacy; also despite cyclizines longer plasma half-life compared with prochlorperazine, the duration of action is similar at around 4 hours. The adverse event profiles do however differ slightly, because of the differing underlying pharmacology of these two drugs. This is an important consideration in the choice of drug, alongside special precautions which, as described earlier, must be considered in conjunction with patients co-morbidities. It is also noteworthy that educating patients and their families regarding the drug of choice is important; for example warning patients against consuming alcohol with both prochlorperazine and cyclizine and warning patients against driving or operating machinery if susceptible to drowsiness with either drug. In summary, both cyclizine and prochloperazine have similar safety, tolerability and toxicity profiles despite their differing modes of action on a cellular level. Tolerability in terms of drowsiness is a potential problem for both drugs, but is generally dependent upon the individual patients susceptibility, warranting a trial and error type approach when determining which is the optimal drug of choice. Also, due to the drugs both being substrates of CYP 2D6 their phamacokinetic profiles may exhibit inter-subject variability by virtue of the different phenotypes of this enzyme which exist in the population. This differing pharmacokinetic profile would logically translate into a varied response in terms of therapeutic effects. Likewise, their potential to interact with other drugs is inextricably linked with their metabolism, namely metabolic competition at the cytochrome P450 enzyme receptor sites. Thus both drugs have the potential to interact with a wide range of other medications . Moreover, since both drugs are extensively metabolised in the liver, with excretion of metabolites in the urine, there is a need for caution in renal and hepatic disease. Cyclizine and prochlorperazine appear to be similarly efficacious with regard to their treatment of emesis caused by motion sickness. The literature is inconclusive regarding which drug would be more superior for PONV, or vertigo, and even though it has been suggested that prochlorperazine should be chosen over cyclizine when the nausea is severe, there does not seem to be any compelling evidence for this and many hospitals tend to choose cyclizine over prochlorperazine in their antiemetic protocols/guidelines. The most compelling evidence for choosing prochlorperazine over cyclizine in the primary care setting would be the high abuse potential with cyclizine. However, in the secondary care setting this is of minimal concern. Therefore a more compelling reason for choosing prochlorperazine over cyclizine in this setting might largely hinge on the greater flexibility in formulations available for prochlorperazine. Whereas both drugs can be given orally as a tablet, when patients are vomiting this may be inappropriate. The buccal tablet or rectal suppository, which is available for prochlorperazine, and is less invasive than an injection formulation may be more acceptable to many patients in such cases. To conclude, the present essay has demonstrated that the nursing process for effectively dealing with emesis is challenging and complex. Here we have witnessed the plethora of facts which the nurse must take into account prior to prescribing the antiemetic drugs cyclizine and prochlorperazine, and that even after attempting to optimise drug selection on the basis of such facts, success cannot be guaranteed. Ongoing monitoring of patient response/progress with the possibility of altering or augmenting the chosen drug therapy is necessary to improve outcomes, ensure patients receive optimal care, and that they enjoy maximal therapeutic success with minimal side effects. References Matchar DB, Young WB, Rosenberg JH, Michael P. Pietrzak, Stephen D. Silberstein, Richard B. Lipton and Nabih M. Ramadan. Evidence-based guidelines for migraine headache in the primary care setting: Pharmacological management of acute attacks. Available at: www.aan.com/public/practiceguidelines/03.pdf/. Accessed 28/10/12. CKS: Clinical Knowledge Summaries http://www.cks.nhs.uk/nausea_vomiting_in_pregnancy/management/prescribing_information/prochlorperazine/advice_about_prochlorperazine Goodman, L.S., and A. Gilman. (eds.) The Pharmacological Basis of Therapeutics. 5th ed. New York: Macmillan Publishing Co., Inc., 1975., p. 607). Benson A J, Medication for Motion S
Friday, January 17, 2020
Studies Related To Teaching Competency Education Essay
Aggarwal ( 1969 ) conducted a survey on measuring of competency of instructors of primary schools of M.P. the survey revealed ( I ) more than 53 % of instructors were non intelligent plenty to be instructors and intelligence was significantly and positively related to capable cognition ( r= 0.42 ) ( two ) out of entire primary instructors 52.6 % did non like learning profession and their attitude was significantly related to competences of schoolroom instruction and ( three ) 70 % of the instructors passed in the 3rd division and about 50 % instructors did non possess equal cognition of topic to be able to learn competent. George and Anand ( 1980 ) studied the consequence of microteaching on learning self- construct and learning competency of pupil instructors. The chief findings of the survey were ( I ) There was important difference between the pre- trial and post- trial mean learning self concept tonss of the control group of pupil instructors. ( two ) There was important difference between the pre- trial and post- trial mean learning self concept tonss of the experimental group of pupil instructors. ( three ) There was important difference between the average addition tonss in learning competency of the control group and experimental group of pupil instructors. ( four ) Micro- instruction facilitated the sweetening of the learning ego construct of pupil instructors. ( V ) Micro learning proved effectual in bettering the learning competency of pupil instructors. ( six ) Micro- instruction intervention followed by summated scheme of integrating of learning accomplishments was found superior to micro learning intervention based on independent learning accomplishments in bettering the learning competency of pupil instructors. Passi and Sharma ( 1982 ) studied learning competences of secondary school instructors in Indore. The findings of survey showed that ( I ) the competences identified were- giving assignments, loud reading, utilizing chalkboard, utilizing support, tempo, avoiding repeat, consolidating the lesson, covering with pupil responses, bettering students ââ¬Ë behaviour, audibleness, utilizing secondary support, acknowledging students ââ¬Ë go toing behaviour, showing verbal manner and switching centripetal channel. ( two ) male and female instructors did non differ in competence. There was a important negative correlativity between the self perceptual experience of linguistic communication instructors and learning competence. ( three ) there was a important positive relationship between instructors ââ¬Ë instruction competence and liking of their students of their instruction behavior. Patel ( 1984 ) found that interactions with co-workers could better learning competence. His survey involved eight scientific discipline instructors spread over a period of six months and noted that the treatments and counsel from co-workers resulted in 11 % addition in the capacity for presentation and capacity for co- ordination of different learning accomplishments, in ability and wont of utilizing audio- ocular AIDSs for effectual instruction and addition in involvement in practical and written work of the student, and a 10 % addition in cognition of content. Prakasham ( 1988 ) studied the instructor effectivity as a map of school organisational clime and instruction competence and found that ( I ) The unfastened school organisational clime positively affected both the instruction competence every bit good as instructor effectivity. ( two ) Teachers of urban schools significantly excelled over instructors employed either in semi- urban and rural schools or schools located in industrial countries on both learning competence and instructor effectivity. ( three ) Females scored constantly higher with and undistinguished difference in all types of schools ; categorizes in footings of district, direction type and organisational clime. ( four ) There existed a important relationship between learning competence and instructor effectivity. Rajguru ( 1988 ) conducted a survey of the function of schoolmasters of cardinal schools and primary corporation schools to propose redresss to better their competences. He found that ( I ) 64.5 % instructors were cognizant of their functions. ( two ) 28 schoolmasters said that they observed 90.3 % of lesson and arranged theoretical account lessons besides. ( three ) Central schools schoolmasters guided the primary school schoolmasters in their work and besides visited them on a regular basis. ( four ) They besides arranged seminars and workshops. However, they were non satisfied with the lesson observation work. This work was evaluated by the supervisor but there was no cooperation between them. ( V ) Each cardinal school schoolmasters had to work for 45 hours in a hebdomad. Teaching was for 12 hours, lesson observation for 18 hours and 25 hours for other activities. Choudhary ( 1990 ) investigated the relationship of the learning competences of 178 secondary school instructors with the student accomplishment. Teachers ââ¬Ë manner of structuring inquiries was of import in act uponing students ââ¬Ë wishing for instructors. Their instruction was observed on at least four separate occasions during 3 months of learning in schools. No important positive relationship was found between the positive attitude towards general pedagogical principals and any of the instruction competence. A hebdomad negative relationship was obtained between instructors ââ¬Ë attitude and relationship with kids. It was suggested that the fosterage of positive attitudes in pre- service instruction, pupil instructors towards general pedagogical rules, on the footing of patterns aimed at heightening students ââ¬Ë academic accomplishment might consequences in lower quality instruction because of its inauspicious consequence on pupil- instructors relationship. Bassi and Kaur ( 1991 ) conducted a survey of the learning competence of linguistic communication instructors in relation to their job- satisfaction, venue of control and professional burnout. He found that ( I ) Language instructors had a moderate sense of personal achievement and success, and so they did non see any professional burnout. ( two ) There was no difference between the instruction competence and occupation satisfaction of the instructors on the footing of venue of control. ( three ) Female instructors, urban school linguistic communication instructors were found more externally controlled and satisfied with their occupations than the rural and high school linguistic communication instructors. ( four ) There existed a positive correlativity between the step of occupation satisfaction and the standard steps of learning competence, professional burnout variables and standard steps of learning competence. Thiagarajan et. Al. ( 1995 ) studied the relationship between instructor competence as perceived by pupils and accomplishment in Economics as a map of sex. Findingss revealed a important correlativity between learning competence and accomplishment. The magnitude of correlativity was different in male childs and misss. Kaushal ( 2001 ) while analyzing the effectivity of schoolroom oppugning behavior preparation on a sample of 40 pupil instructors which every bit measured in footings of alteration in the schoolroom oppugning behaviour of pupil instructors and sweetening in learning competency reported that CQBT helps in heightening the learning competence of pupil instructors of experimental group as compared to command group of pupil instructors. Farah ( 2002 ) studied in his comparative survey of learning competences of the instructors trained through the formal system of instruction and those through the distance instruction system. The findings indicate that there is no important difference between the cognition and attitudes of instructors trained through distance manner and those trained through the formal system terminal there is a important relationship between the attitudes and accomplishments of instructors. Pushpam and Sourdarajan ( 2004 ) conducted a survey of learning competence of secondary school instructors and found that ( I ) instructors working in assisted and matriculation schools have better learning competence than instructors working in govt. and corporation schools. ( two ) The learning competence of more experient instructors is better than the teaching competence of less experient. ( three ) Aged and high income govt. instructors have better instruction competence. ( four ) Private unaided school instructors have better instruction competence and station alumnus have better learning competence than the alumnus instructors. ( V ) Permanent instructors show better learning competence than impermanent instructors. ( six ) Teachers with high income have better learning competence than instructors with low income. ( seven ) No difference was found between rural and urban school instructors sing their instruction competence. ( eight ) Positive attitude of instructors towards le arning profession, occupation satisfaction of instructors and intelligence of pupils increase the learning competences of secondary school instructors. Shokeen ( 2006 ) studied the consequence of schoolroom oppugning behavior preparation on learning competence of pupil instructors and their ego construct and found that the experimental group pupil instructors asked more inquiries in their schoolroom as compared to the control group. The CQBT was found to be a better scheme than the conventional programme, of pupil instruction as learning competence of pupil instructors was enhanced after CQBT. It was besides found that CQBT was non merely effectual in bettering the schoolroom oppugning behaviour of pupil instructors, but it besides helps in bettering their ego construct. The overall appraisal points towards the ultimate effectivity of CQBT and it provides a theoretical account for proof of instructor. Smriti ( 2008 ) conducted a survey of creativeness in relation to learning competence of B.Ed. pupils and found that ( I ) There is no important difference between the creativeness of B.Ed. pupils belonging to rural and urban background. Therefore it is concluded that creativeness is non being affected by country or part. ( two ) There is no important difference between the creativeness of male and female B.Ed. pupils. Hence creativeness is non being affected by gender. ( three ) There is no important difference between the creativeness of B.Ed. pupils belonging to scientific discipline and humanistic disciplines watercourse. Therefore it is concluded that creativeness is non being affected by topics studied by pupils. ( four ) There is positive correlativity between creativeness and learning competence of B.Ed. pupils. Augustine, J. ( 2010 ) studied the ââ¬ËTeaching Aptitude, Competency, Academic background and Achievement in Educational Psychology of Student- instructors in the college of instruction. ââ¬Ë A sample of 200 pupil instructors selected from 5 colleges of instruction in Kottayam Revenue territory of Kerala was used. The findings of the survey showed that ( I ) There is important positive relationship between learning competence and learning aptitude of pupil instructors. ( two ) There is no consistent positive relationship between academic background and learning aptitude of pupil instructors. ( three ) There is no important positive relationship between learning aptitude and accomplishment in educational psychological science. Khatoon, Azeem and Akhtar ( 2011 ) studied the impact of different factors on learning competences at secondary degree in Pakistan. The survey investigated in to a descriptive research to critically reexamine of the impact of different factors on learning competences at secondary degree. The survey has defined female school instructor ââ¬Ës socio cultural jobs and environmental jobs.The chief aims of the survey were to happen out the female school instructors, socio cultural jobs, and Environment jobs and to mensurate the instruction competence of instructors by relationship between instructors and pupils. The undermentioned consequences were drawn by the research worker in the visible radiation of the analysis of the information. The largely households are in favours of female instructor ââ¬Ës occupation. The consequence proves that the female save the clip for domestic work due to hold half twenty-four hours occupation. The consequence proves that professional green-eyed mons ter is everyplace and largely it effects on their instruction competence. Kavita ( 2011 ) studied the consequence of schoolroom oppugning behavior preparation on learning competence of pupil instructors, attitude towards learning and their ego construct. A close analysis of the consequences indicates that the CQBT was found to be better scheme, than the conventional programme, of pupil instruction as learning competency of pupil instructors was enhanced after CQBT. It was besides found that CQBT was non merely effectual in bettering the schoolroom inquiring of pupil instructors, but it besides helps in bettering their ego construct. The overall appraisal points towards the ultimate effectivity of CQBT and it provides a theoretical account for proof of instructor. Pawar, I.A. ( 2011 ) studied the ââ¬ËImpact of Teacher Training on Teacher Competencies ââ¬Ë . The findings of the survey showed that ( I ) There is no important difference between the average tonss on instructor competences graduated table of instructors who have trained through conventional and that of those instructors who have done instructor preparation through distance instruction manner in footings of their cognition and attitude. ( two ) There is no important difference between the average tonss on instructor competences graduated table of male and female instructors who have trained through conventional every bit good as distance manner.Surveies related to Psychological Capital:Luthans and Youssef ( 2004 ) found that Authentic leaders ââ¬Ë assurance, hope and optimism roots from their strong beliefs in themselves, in their positive psychological capital and in doing clear to associates precisely what they need from them in order to accomplish sustainable growing and public presentation at single, squad, and/or organisational degrees. Such leaders besides recognize that they have failings, which they work to suit by environing themselves with highly capable followings and constructing an inclusive and engaged positive organisational context. Such contexts support followings for being actively involved in executing their occupation functions and duties, every bit good as in lending to the leader ââ¬Ës ain development. Lifeng, Z. ( 2007 ) studied the ââ¬ËEffects of Psychological Capital on Emplyoees ââ¬Ë occupation public presentation, organizational committedness and organisational citizenship behaviour. ââ¬Ë The consequence of the survey showed that after commanding for the demographic variables ( gender and age ) , emplyoees ââ¬Ë hope, optimism and resilience individually had positive impacts on their occupation public presentation, organisational committedness and organisational behaviour. Employees ââ¬Ë psychological capital ( a combined concept of hope, optimism and resilience ) had positive impacts on their occupation public presentation, organisational committedness and organisational citizenship behaviour. To sum up, this survey through empirical observation tested the positive relationship between psychological capital employees ââ¬Ë results. The research consequences indicated psychological capital had positive impacts on employees ââ¬Ë public presentation. Luthans, Norman, Avolio, et.al. , ( 2008 ) conducted a survey on ââ¬Ë The mediating function of psychoogical capital in the supportive organisational climate- employee public presentation relationship. ââ¬Ë The survey investigates whether the late emerging nucleus concept of positive psychological capital ( dwelling os hope, resiliency, optimism and efficaciousness ) plays s function in interceding the effects of a supportive organisational clime with employee results. Using 3 diverse samples, consequences shows that employees ââ¬Ë psychological capital is positively related to their public presentation, satisfaction, committedness and a supportive clime is related to employees ââ¬Ë satisfaction and committedness. Avey, Luthans and Youssef ( 2008 ) studied ââ¬ËThe Additive Value of Positive Psychological Capital in Predicting Work Attitudes and Behaviors ââ¬Ë . This survey of a sample of employees ( N=336 ) from a wide cross subdivision of organisations and occupations found that their state-like psychological capital is positively related to desired extra-role organisational citizenship behaviours ( OCBs ) and negatively with unsought organisational cynicism, purposes to discontinue and counterproductive workplace behaviours. Except for single OCBs, their psychological capital besides predicted alone discrepancy in the same attitudinal and behavioural results beyond their demographics, nucleus self-evaluation, and personality traits, and person-organization tantrum and person-job tantrum. Avey, Luthans and Jensen ( 2009 ) studied the Psychological Capital: A Positive Resource for Combating Employees Stress and Turnover. The findings of the survey were ( I ) There was negative relationship between positive psychological capital and emphasis symptoms. ( two ) There was negative relationship between psychological capital and purposes to discontinue and occupation hunt behaviours severally. ( three ) Symptoms of emphasis would partly intercede the relationship between the psychological capital and both purposes to discontinue and occupation hunt behaviours. Mathur and Tiwari ( 2011 ) studied the Positive Psychology Capital, E.Q. , and S.Q. as determiner of subjective well-being in executive adult females and found that subjective well being is every bit and strongly influenced by several factors but the major 1s include positive psychological capital, E.Q. and S.Q. It is apprehensible that individuals who have properties of positive psychological capital, E.Q. and S.Q. can successfully get by with emphasiss of life and such emphasiss are perceived as chances instead than challenges. Based on these observations, it can be concluded that Psychological Capital, Emotional and Spiritual Intelligence play a important function in the care of Subjective Well Being in executive adult females. It can be indirectly assumed that these adult females must besides be really high on self- efficaciousness, resiliency, optimism and hope. Ravindranath ( 2011 ) explained the Life accomplishments as an attack in psychological capital in life and work scenes. He discussed that an intercession like life accomplishment s preparation are comprehensive including assorted countries like thought, behaviour and emotions. The concluding marks being self- consciousness, self- regard and accepting of others. In an person, life accomplishments develop over the old ages continuously in an active mode. There are many accomplishments, which are needed to successfully negociate each and every interaction. Expected learning results include a combination of cognition, values, attitudes and accomplishments with a peculiar accent on those accomplishments that are related to critical thought, and job resolution, self direction and communicating and inter- personal accomplishments. Further more life accomplishments evolved as a consequence of mental well being and wellness, so life accomplishments can be considered as an intercession scheme in positive psychological science and wellness. Kaur ( 2012 ) studied the occupation satisfaction of secondary school instructors in relation to psychological capital. She found that ( I ) there was negative negligible relationship between occupation satisfaction and psychological capital of secondary school instructors. ( two ) There was negative negligible relationship between occupation satisfaction and psychological capital of govt. secondary school instructors. ( three ) There was negative negligible relationship between occupation satisfaction and psychological capital of private secondary school instructors. ( four ) There was negative negligible relationship between occupation satisfaction and psychological capital of male secondary school instructors. ( V ) There was negative negligible relationship between occupation satisfaction and psychological capital of female secondary school instructors.Surveies Related to Religious Intelligence:Vaughan ( 2002 ) discussed that Spiritual intelligence is concerned with the interior life of head and spirit and its relationship with being in the universe. Religious intelligence implies a capacity for a deep apprehension of experiential inquiries and an penetration into multiple degrees of consciousness. Religious intelligence besides implies consciousness of spirit as the land of being or as the originative life force of development. If the development of life from stardust to mineral, veggie, animate being, and human being implies some signifier of intelligence instead than being a strictly random procedure, it might be called religious. Religious intelligence emerges as consciousness evolves into an ever-deepening consciousness of affair, life, organic structure, head, psyche, and spirit. Religious intelligence, so, is more than single mental ability. It appears to link the personal to the transpersonal and the ego to spirit. It goes beyond conventional psychological development. In add-on to self-awareness, it implies consciousness of our relationship to the transcendent, to each other, to the Earth and all existences. As a clinical psychologist, he farther explains that â⬠spiritual intelligence opens the bosom, illuminates the head, and inspires the psyche, linking the single human mind to the underlying land of being. Religious intelligence can be developed with pattern and can assist a individual distinguish world from semblance. It may be expressed in any civilization as love, wisdom, and service. â⬠Mahajan ( 2011 ) studied the Academic Achievement in relation to Emotional Intelligence and Spiritual Intelligence. A sample of 140 pupils analyzing in category Eleven from four schools of Hoshiarpur was taken for the aggregation of informations. The technique employed was multistage randomisation of bunchs at school and subdivision degree. B- Variate coefficients and t- ratios were used to analyze the information. The findings were- ( I ) There exists no important difference between the emotional intelligence of male childs and misss. ( two ) There exists no important difference between the religious intelligence of male childs and misss. ( three ) There exists positive and important relationship between academic accomplishment and emotional intelligence of male childs and misss. Besides the relationship was found positive and important for male childs and misss individually. ( four ) There exists positive and important relationship between academic accomplishment and Religious Inte lligence of male childs and misss. Besides the relationship was found positive and important for male childs and misss individually. ( V ) There exists positive and important relationship between Emotional Intelligence and Spiritual Intelligence of male childs and misss. Jeloudar and Goodarzi ( 2012 ) examined the relationship between instructors religious intelligent and their occupation satisfaction index at senior secondary schools degree. Participants were 177 pedagogues who completed the religious Intelligence Scale ( ECI ) , and a version of the Job Descriptive Index is a graduated table used to mensurate six major factors associated with occupation satisfaction based on a selected demographic variable. The findings of the survey showed that there were important relationship between instructors ââ¬Ë religious intelligence and their occupation satisfaction. The survey besides revealed that there was important difference found between instructors ââ¬Ë religious intelligence and their academic degrees. Further there were important relationship was found between instructors ââ¬Ë religious intelligence and five factors of occupation satisfaction: ( nature of the work itself, attitudes towards supervisors, dealingss with colleagues, chances for publicity, work status in the present environment ) , but no important relationship with one factor ( salary and benefit ) of occupation satisfaction. Rastgar, Davoudi and Oraji ( 2012 ) conducted a survey in Mazandaran, a state in North of Iran, and aimed to analyse the function of emplyoees ââ¬Ë religious intelligence in perceptual experience of organisational justness. There were 1100 forces in Mellat bank. A sum of 366 questionnaire were distributed among the bank forces and 288 filled questionnaires were returned. The factor analysis and findings show that emplyoees ââ¬Ë religious intelligence has a important positive influence on perceptual experience of organisational justness. This determination implied that the higher the degree of emplyoees ââ¬Ë religious intelligence, tended to increase the degree of employees ; perceptual experience of organisational justness.
Thursday, January 9, 2020
A Rose For Emily By William Faulkner - 1079 Words
Emily was walking down the very long sketchy alley in Paris; she had nowhere to go and was very homeless. She no longer has any family they all passed away. So she just walks down the street and does not really do anything but walks down the alley and tryââ¬â¢s to find food through the trash. Emily is very short. She has very dark brown hair with dark brown freckles you might mistake them for chocolate chips. She has very long caramel brown hair with a bunch of split ends. Emily and has only one goal in her life but is to scared to try it. ââ¬Å"Iââ¬â¢m going to lay down right between these garbage cans.â⬠Emily says. As Emily opened her humungous brown eyes she saw a tall strange man standing there. The strange man had short bleach blonde hair andâ⬠¦show more contentâ⬠¦Ã¢â¬Å"Sure but you may not tell anybody and do not touch the picture.â⬠ââ¬Å"Oh wow it sure is beautiful.â⬠ââ¬Å"Yes I no it is. Will you help me find it?â⬠ââ¬Å"Yes sure but what do I get if I help you?â⬠ââ¬Å"Hmmmmmâ⬠¦Ã¢â¬ ¦. Well I will let you have this little blanket on my lap?â⬠ââ¬Å"I guess.â⬠ââ¬Å"Okay great. My grandmother put on the note one clue and once I find the place where the clue is and then there will be a little piece paper showing were the next clue is on a little sticky note.â⬠ââ¬Å"Oh wow that sure is going to keep us busy.â⬠ââ¬Å"Yes so the first clue is many good smells and many different colors. What does that mean?â⬠ââ¬Å"Maybe the zoo.â⬠ââ¬Å"Umm no way the zoo does not smell good at all.â⬠ââ¬Å"Oh I no my grandmothers old garden. When I lived with her I would always see her in the garden all day. She absolutely loved her garden. â⬠ââ¬Å"Okay were is your grandmothers old garden?â⬠ââ¬Å"It is about one mile away. Not to far away.â⬠ââ¬Å"Ok lets start walking.â⬠Tyler and Emily walked for about one hour until Emilyââ¬â¢s eyes got huge. ââ¬Å"Oh my gosh. This is were my grandmothers house was and now its nothing but dirt.â⬠ââ¬Å"Will we should start digging through this dirt.â⬠ââ¬Å"Yes. There was this huge pile of dirt and Emily just sat down and something was poking her hand. She looked over and it was white sticking out of the dirt. She picked the paper and the paper said. High tower almost tall as the sky.â⬠ââ¬Å"Your grandmother must meanShow MoreRelatedA Rose For Emily By William Faulkner923 Words à |à 4 PagesA Rose for Emily; A Tale of The Old South William Faulkner was born in New Albany, Mississippi in 1897 but lived most of his life in Oxford, a small town nearby. After dropping out of high school then briefly joining the Canadian Air Force, he returned home and completed three terms at the University of Mississippi (Fulton 27). During his early twenties Faulkner spent time in New Orleans and Europe before returning to Oxford and publishing his first book of poems. In 1929 he married Estelle FranklinRead MoreA Rose For Emily By William Faulkner1729 Words à |à 7 PagesJune 24, 2015 ââ¬Å"A Rose for Emilyâ⬠In every neighborhood there is always that one house that is a mystery to everyone. A house that everyone wants to know about, but nobody can seem to be able to dig up any answers. Itââ¬â¢s the type of place that you would take any opportunity or excuse to get to explore. The littler that is known, the more the curiosity increases about this mysterious place or person. In the short story ââ¬Å"A Rose for Emilyâ⬠by William Faulkner, this mysterious person is Emily Grierson, andRead MoreA Rose For Emily By William Faulkner949 Words à |à 4 PagesIn William Faulknerââ¬â¢s ââ¬Å"A Rose for Emilyâ⬠it is clear how Emilyââ¬â¢s gender affects how the individuals in the town perceive her. Emilyââ¬â¢s gender particularly affects how men understand her. Throughout the whole piece Emily is seen as a helpless individual who is lonely and has suffered losses throughout her life. When the reader reaches the end of the story the actions that Emily has taken is unexpected because of the way she is perceived by the narrator. In the beginning of the story, when the wholeRead MoreA Rose For Emily By William Faulkner1577 Words à |à 7 Pagesââ¬Å"A Sarah Markins Dr. Bibby ENG 107 February 11, 2015 ââ¬Å"A Rose for Emilyâ⬠by William Faulkner ââ¬Å"A Rose for Emilyâ⬠, written by William Faulkner in 1931, follows a series of peculiar events in Miss Emily Griersons life. Written in third person limited, Faulkner utilizes flashbacks to tell of the period between the death of Emilyââ¬â¢s father and her own passing. Split into five short sections, the story starts out with the townspeople of Jefferson remembering Emilyââ¬â¢s legacy and how each new generation ofRead MoreA Rose For Emily By William Faulkner1552 Words à |à 7 PagesRyan Dunn Mrs. Williams English 11 March 11, 2016 In the short story ââ¬Å"A Rose for Emilyâ⬠by William Faulkner, the reader is given a glimpse of the internal conflict of the main character, living in the past, and the involvement of an over involved society causing the reader to look into the consciousness of an individual haunted by a past and lack of a future. The story is set in a post-Civil War town in the South. He is able to give the reader a glimpse of the practices and attitudes that had unitedRead MoreA Rose For Emily By William Faulkner1507 Words à |à 7 Pages1897, William Cuthbert Faulkner was born in New Albany, Mississippi. He stands as one of the most preeminent American writers of the twentieth century. His literary reputation included poetry, novels, short stories, and screenplays. Faulkner won two Pulitzer Prizes for Fiction and the Nobel Prize in Literature. ââ¬Å"A Rose for Emilyâ⬠is a short fascinating story written by William Faulkner and it was his first short story published in a national m agazine. The story involved an old woman named Emily GriersonRead MoreA Rose For Emily By William Faulkner883 Words à |à 4 PagesIn the timeless classic, ââ¬Å"A rose for Emilyâ⬠by William Faulkner we are introduced to Emily Grierson, a matured sheltered southern woman; born to a proud, aristocratic family presumably during the American Civil War. Through out the short story William Faulkner uses many literary devices such as symbolism, metaphors and allegory to play with ââ¬Å"timeâ⬠and how time reflects upon his main character Emily Grierson. Emily being one who denies the ability to see time for what it is linear and unchangeableRead MoreA Rose For Emily By William Faulkner1270 Words à |à 6 PagesWilliam Faulknerââ¬â¢s short story ââ¬Å"A Rose for Emilyâ⬠thoroughly examines the life of a strange woman name Emily Grierson who lives in the town of Jefferson. If we examine ââ¬Å"A Rose for Emilyâ⬠in terms of formalist criticism, we see that the story dramatizes through setting, plot, characterization, and symbolism on how Miss Emilyââ¬â¢s life is controlled by a possessive love she had for her father and lover. William Faulkner uses Emilyââ¬â¢s life as the protagonist to examine from a formalist aspect. In orderRead MoreA Rose For Emily By William Faulkner1780 Words à |à 8 PagesIn 1930, William Faulkner wrote a five-part story entitled ââ¬Å"A Rose for Emilyâ⬠that follows the life of a young woman named Miss Emily Grierson. Faulkner sets his story in the Old South, soon after the ending of Americaââ¬â¢s Civil War, and represents the decaying values of the Confederacy (Kirszner Mandell, 2013a, p. 244). One of these values which the text portrays quite often in ââ¬Å"A Rose for Emilyâ⬠, is the patriarchal custom of society viewing men as having more importance than their female counterpartsRead MoreA Rose For Emily By William Faulkner1277 Words à |à 6 PagesMiss Emily Grierson, the main character in the strange short story ââ¬Å"A Rose for Emilyâ⬠written by William Faulkner. It would be best to examine her in a mental capacity as well as the circumstances that may affect her. Throughout the story, Miss Emilyââ¬â¢s unpredictable and eccentric behavior becomes unusual, and the reader, like the townspeople in the story, is left to speculate how Miss Emily has spent years living and sleeping with the body of Homer Barron. An important quote from the story was that
Wednesday, January 1, 2020
Essay J.R.R. Tolkien - 1127 Words
John Ronald Reuel Tolkien, creator of a world. When someone who knows Tolkien is asked about his works, one thought comes to mind, Middle Earth. This was the playground in his mind that such vivid descriptions of fantasylands came from. It is the base of his most well known stories, where dreams are just the norm. br brJ.R.R. may owe much of his success to his diverse beginnings. On April 16, 1891, Mabel Suffield and Arthur Reuel Tolkien were married in Bloemfontein, South Africa. They soon gave birth to John Ronald Reuel Tolkien on January 3, 1892, who was christened later that month. br brIn April of 1895 Mabel took J.R.R. and his younger brother to Birmingham England. Arthur, their father, was supposed to follow them in a fewâ⬠¦show more contentâ⬠¦To console and distract him J. R. R. improvised a story, the story of Rover, a real dog magically transformed into a toy. After many fantastic adventures in search of the wizard who wronged him, at last he wins back his doggy life. This charming tale, inhabited by a terrible dragon and a wise old whale, by the king of the sea, and the Man-in-the-Moon, was a Tolkien family favorite. Before Tolkiens death, it went through several drafts over the years, but was not published until after his death. br brIn 1919, J.R.R. went to work for the Oxford English Dictionary for 2 years, which expanded his horizons even further, as he developed a rich use of the English language. In 1921, he began teaching at the University of Leeds, and by 1924, became Professor of English Language. In 1925 Tolkien moved to Oxford, where he served as Rawlingson Professor of Anglo-Saxon and Fellow of Pembroke College for the next 24 years. During this time he specialized in old and middle English. br brIn 1936 the Hobbit is completed and published the following year. Originally this masterpiece was intended to be a childrens book, but it is now celebrated throughout the fantasy genre as a classic. This is by far, my own personally favorite book I have ever read. It has all the elements of a wonderfully written fantasy. br brBilbo Baggins, the hobbit, is in a peaceful sort of cozy hole in the Shire, a place where adventures are uncommon and rather unwanted.Show MoreRelated J.R.R. Tolkien Essay895 Words à |à 4 PagesJ.R.R. Tolkien J.R.R. Tolkien (1892-1973) gained a reputation during the 1960ââ¬â¢s and 1970ââ¬â¢s as a cult figure among youths disillusioned with war and the technological age. His continuing popularity evidences his ability to evoke the oppressive realities of modern life while drawing audiences into a fantasy world. John Ronald Reuel was born on the third of January, 1892, at Bloemfontein, South Africa, where his father, Arthur, had taken a position with the Bank of Africa. In 1895 Tolkienââ¬â¢sRead MoreEssay on The Hobbit by J.R.R. Tolkien530 Words à |à 3 PagesThe Hobbit by J.R.R. Tolkien Dont judge a book by its cover. This famous phrase can very well be applied to the hobbit a small human like creature that goes along with 13 dwarves and a wizard. The wizard, Gandalf, has total faith in the little hobbit knowing full well that when the time comes he will serve the dwarves quite well. He does this with the help of a ring that makes him invisible. He saves the dwarves from evil spiders that wish to eat them. Uses it to help themRead More J.R.R. Tolkien Essay example1443 Words à |à 6 PagesJ.R.R. Tolkien Merely mentioning the name J.R.R. Tolkien conjures up fantasies. Though his trilogy The Lord of the Rings is well known, not much else is known about the man who was a scholar before anything else. It is, in fact, the cult scale popularity of the trilogy that obscures the many accomplishments that marked his life. He won an exhibition, or a middle class merit scholarship, to Oxford University in 1911. By the time he attained his bachelorââ¬â¢s degree, he was conversant in seven languagesRead MoreThe Lord of the Rings by J.R.R. Tolkien Essay1019 Words à |à 5 Pagesthe Rings. The Lord of the Rings written by J.R.R. Tolkien has been read and loved by many and will be enjoyed by many more in the years to come. Tolkien was an amazing linguist and author. He will be remembered for his great imagination and intriguing stories. His interest in language was the spark that led to the creation of The Lord of the Rings (Hodges 33-35). Tolkien led an interesting life that influenced his bo oks greatly. John Ronald Reuel Tolkien was born on January 3, 1892, in South AfricaRead MoreEssay on Reader Response to The Silmarillion by J.R.R. Tolkien801 Words à |à 4 Pagesnbsp;nbsp;nbsp;nbsp;nbsp;I read a book the other day. It was a wonderful book called The Silmarillion by J.R.R. Tolkien. I really enjoyed it; it gives the background information on the creation of Middle Earth. In it, Tolkien tells us of Illà ºvatar, Eà ¤, the Valar and the birth of Elves, Dwarves and Men. But, you know, I donââ¬â¢t think it has anything at all to do with Elves, Dwarves, Men and some god named Illà ºvatar. I think Tolkien really wanted to write a Biblical allegory and a critique on ridiculous human nature reallyRead More J.R.R. Tolkien Biography Essay examples1521 Words à |à 7 Pages J.R.R. Tolkien was born in South Africa, although he considered himself a British man throughout his adulthood. He experienced World War I firsthand in the trenches. He was a professor of Old English and other a rchaic languages and had a strong love for such languages. Tolkien also felt a strong tie for his homeland, England, and desired to create mythology for England. Tolkien was able to write the first modern fantasy novel through his life experiences and his love for archaic languages andRead MoreTreatment of Race in the Hobbit by J.R.R. Tolkien1151 Words à |à 5 PagesIn The Hobbit, there are character groups that could be compared to specific groups within society. J.R.R Tolkien, the author of the novel, said (during an interview-type session) that the dwarves seemed similar to Jewish people. He may have thought/said this because of the dwarvesââ¬â¢ greed for riches or because, throughout the book, the dwarves are disliked by many of the character groups. Tolkien also describes Goblins (or Orcs) as having wide mouths, sallow skin, flat noses, and slanted eyes. HeRead MoreQuenya: A Non-real Language Invented by J.R.R. Tolkien936 Words à |à 4 Pagesmade by J.R.R Tolkien. He be gan devising the language around the year 1910 and changed around a lot of the structure until it reached the final stage. The vocabulary was mostly not changed that much but the name has been changed quite a bit of times before it was called Quenya. It was changed from Elfin to Qenya to it finally being called Quenya by J.R.R Tolkien. A lot of words in Quenya came from The Finnish language but also familiar with Latin, Greek and ancient Germanic languages. Tolkien madeRead MoreJ.R.R Tolkien Tolkien was born in South Africa and after both his parents died when Tolkien was at600 Words à |à 3 Pages J.R.R Tolkien Tolkien was born in South Africa and after both his parents died when Tolkien was at a young age he moved in with relatives to England. This is where all his writing started. He went to college and studied Anglo Saxon and classic literature. He even enlisted in the army, which was very common for this time, and all this time at war he never stopped writing. He finally got released from the army because of an illness. All these events in his life have majorly influenced his writingRead MoreThe Hobbit by J.R.R. Tolkien589 Words à |à 2 PagesPlot: The Hobbit is about a hobbit named Bilbo Baggins whos living in the Shire Hobbiton. A wizard named Gandalf shows up with 13 military dwarfs and asks Bilbo to help reclaim the dwarfââ¬â¢s treasure. On the way they thought run into issues and obstacles. Wondering through tunnels in the Misty Mountains after being left behind, Bilbo find a strange Golden ring that when worn turns you invisible and pockets it. After that he meets back up with Gandalf and the 13 dwarves only to later be abandoned
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