Write a letter advocating for ARNPs in Florida to have or not to have Essay

Write a letter advocating for ARNPs in Florida to have or not to have the right to prescribe controlled substances - Essay Example To clarify further the website of Florida Board of Nursing clearly mentions under section FAQ that a nurse practitioner cannot prescribe controlled substance. The ARNP’s here illegally prescribing controlled substance by forgery of signature of physicians and by using their DEA number. This kind of irresponsible behaviour of issuing controlled substance even to the teenagers in our locality by few ARNP’s can lead to irreparable loss to society by affecting the health of its members. Excess and uncontrolled dosage of substance abuse negatively impacts physical and psychological health of an individual and even result to death. This kind of substance abuse has its impact on society also as the individual under substance use often encourage others to take up the same. I will appreciate if you consider the issue reported in the letter. I would like to be sent information on the investigation done if it does not violate any rules or regulation. For any further information please contact me on (111) 111-1111 or

Operation management and decision making Essay Example | Topics and Well Written Essays - 2500 words

Operation management and decision making - Essay Example This is an area of some uncertainty in the capacity planning process. Hitachi Ltd is one of the companies used capacity management as the main tool to plan and control its production processes and improve performance. Hitachi Ltd. is a global leader on the electronic market specialized in Electronic Devices, Power & Industrial Systems, Digital Media & Consumer Products, High Functional Materials & Components, Logistics and Financial Services. The paper and analysis will concentrate only on one sphere of its activity: Electronic Devices. These are represented by the following types of products: power tools, measurements tools, electronic devices, semiconductors, etc. A special attention will be given to one product, semiconductors. In this segment, the efforts of executives to improve the management process have resulted in an influx of technological advances. Semiconductors are manufactured in Japan and Asia (Hitachi semiconductors 2008). For Hitachi Ltd, capacity planning is not visionary or futuristic thinking, but an example of process versus substance. Capacity management for semiconductors is the process that creates a balance between what is desired and what is possible. Capacity management enables managers to distinguish truly important decisions from less important ones and to build a strategic agenda. It is a process that deals with interdepartmental issues and allows the organization to develop synergy among functional components. It is a process that helps managers deal with turbulent, complex, and influential environments. It helps to identify critical success factors or key result areas, to avoid incremental thinking, and to effectively deal with change. The main products for semiconductors are Interlayer Dielectric Materials, High Heat resistance Photopolymers, die bonding paste, different types of bonding films, Epoxy Molding Compounds, liquid encapsulants, a high heat resistant coating. The product pu rity is strongly affected by many upstream variations (Hitachi semiconductors 2008). Local engineering systems help stabilize the columns to insure that the product meets minimum market specifications. These variations result in higher energy consumption and lower production capacity. At times, large variations disrupt the column operation to such an extent that it is necessary to shut down and restart. The fundamental source of such variation is easily traced to variations in the rates and concentrations of the many feeds that are pumped to the tank farm. In this case, as a recycle facility, it is not practical to negotiate with the suppliers for more consistency in the raw materials. There is little choice but to take the recycled acid as it comes, variation and all. There is a possibility, however, of reducing the magnitude of the problem by modifying the process and control system designs to be less sensitive to such unavoidable upstream variations. The plumbing of the tank is c hanged to make better use of the capacity of the inventory to reduce the magnitude and the frequency of the variations seen by the columns (Chase & Jacobs 2003). The main outputs are power semiconductors (high voltage, diodes), semiconductors for communication systems, and SDRAM for electronic technology (Hitachi semiconductors 2008).. "Improvements in production and inventory control translate

Changing Care Needs through the Life Stages

Changing Care Needs through the Life Stages Shane Quigley Introduction In this essay, I will be discussing the changing care needs through the life stage of my case study Margret whose name has been changed to protect the confidentiality of the person. I will be taking you through the development of late adulthood, the development of Margret, factors affecting Margret and my recommendations on helping Margret’s personal needs. The information provided will be mostly personal life experience from my module book and some internet pages. Development during Late Adulthood Aging affects people differently from person to person, but generally in late adulthood people experience both gains and losses. People lose their instant energy a younger person may have, but the ability to conserve energy is gained for future activities when needed. Age also brings a better sense of patience, experience, wisdom and understanding one may not have had before as a person has seen and experienced changes in their life before, this wisdom improves the quality of life regardless of the physical changes that may occur. Physical changes in the body in late adulthood are inevitable no matter how healthy a life you live but maintaining a healthy balanced lifestyle coupled with daily exercise can help you live a better quality of life and may keep the body and mind fresh into late adulthood too. Primary aging in late adulthood has an effect on appearance, sensation and motor abilities. A person in late adulthood may have more wrinkles as less collagen is produced in skin, skin becomes less elastic it also becomes thinner. Warts and skin tags and liver spots may form around the body as well as noticeable blood vessels. The hair may thin and turn grey as melanin is not produced as frequently in the body as before and height is decreased as bone density decreases. Intellectually in late adulthood the senses begin to decrease or dull in this stage of life the lenses of the eye discolour and are rigid, making the perception of colour harder to interpret, reading may also become difficult without the proper corrective glasses. Hearing also decreases in this stage , especially being able to hear high-pitched sounds, as a result of this paranoia may develop and could develop a level of unfound distrustfulness in response to not being able to hear well, as they could not interpret if the person was talking about them or not, this can be corrected with proper diagnosed hearing aids which are widely available. Also cognitive changes in late adulthood are not rare, memory fades as we age, however some people defy the general trends and can maintain their mental sharpness into their late stage of life through keeping their mind active and alert as much as possible. The theorist Jean-Piaget believed this is the formal-operative thinking stage in late adulthood, hypothetical problem solving skills decline, but decision making is faster and more logical and focused. Research has shown that keeping the body physically fit can attribute to staving off mental illnesses and other cognitive diseases such as Alzheimer’s and dementia. Eriksson’s theory of Identity vs. Despair best described the social and emotional development of late adulthood. As the theory involves coming to terms with the decisions you made in life. Those who view they have achieved a sense of integrity view their life in a larger context and are more at ease with themselves and accept their life course. People in late adulthood have experienced a lifetime of knowledge, which can make them feel more secure with themselves which they may not have had when they were younger. Adjusting to retirement is vital and a big step in this stage, adjusting can be easy and have no adverse affects on their life. On the other hand some people may find it hard adjusting depending on their emotional state, income and social network. Friends and family play a significant role in late adulthood in maintaining good life satisfaction by providing companionship and doing social activities. Staying in contact with people promotes successful aging and people d o better if they continue to engage with life and maintain close friendships and relationships. Margret Development and Personal Prejudices, Fears and Anxieties Physically Margret has no major illnesses thankfully for her age, she just has the characteristics of primary aging such as wrinkles and sagging skin but her hearing and sight is quite sound for her age. She does not need the use of hearing aids and only uses reading glasses to read, mobility is fine as she does not need the use of a walking stick or wheelchair and frequently walks every day up the town and to the library. Intellectually Margret keeps her mind active and has no mental-illnesses or diseases, she does this through her hobbies such as reading, playing Sudoku and other mind puzzles and crosswords in her favourite newspaper The DailyMail. Also her frequent trips to the library to read up on fiction and the World Wars during the week helps keep her mind active and fresh, as-well as walking which has been proven to keep the mind mentally stable. She also attends the local bingo with friends, bingo keeps the mind fresh as you constantly have to be aware your numbers are being called and have to keep the brain focused as you pay attention. Emotionally and Socially Margret has a close knit of friends she keeps in touch with regularly from childhood and the group she goes to bingo with. Family is very important to Margret. She has just one daughter and two grandchildren which she sees twice a week. This means the world to Margret especially after losing her spouse two years ago to cancer. Margret says she is blessed with her daughter and grandchildren and is grateful of the group of friends she has to make her happy especially when her husband died. She also attends mass every Sunday in her local church. Spirituality is very important for change in late adulthood and religion plays a big role in Margret’s life and accompanied with church, she also goes to Lourdes once a year. These social activities help keep Margret in touch with other likeminded people and promote a healthy social lifestyle. My own personal prejudices, fears and anxieties regarding late adulthood would probably be the youth of today as I think they do not have the same respect as the past generation had. I would be fearful when I grow older into this stage travelling on public transport as I think the youths on public transport can be quite loud, intimidating and sometimes aggressive, and can be quite the stressful and terrifying experience especially at night time. When you reach a certain age, you are forced to use public transport as your license is taken away from you. You lose that freedom you once had, that sense of independence is gone and in my opinion you feel like you are being treated like a child not a valued member of society. Fear and anxieties would that be finically, the economy the way it is at the moment may reduce or take away the pension. I also fear I wouldn’t be able to afford the necessities I need to live, that I would a burden to my loved ones if I got ill. Also a big fear /anxiety is that I could develop a cognitive illness such as Alzheimer’s disease or dementia, that if this happened who would look after me, that I would be too much of a burden on family and might end up in a nursing home. Another fear is that may not be able to leave enough money for my children and the cost of the funeral would be left for them to fund. Variations/Factors affecting Individual at this stage of life Mobility in later life can be a concern as primary aging causes a decrease in bone density and organs in general but with Margret’s frequent walking into town and the library every day, she is delaying this decline of the bones as much as possible. Another factor is you memory fading and potentially getting a cognitive illness in this stage of life. Finically at this moment in time since she is on a widowers pension and is surviving comfortably at the moment. Socially and emotionally she is afraid of the well-being of her friends at this moment as some of them have fallen ill as she is close to them and relies in them for support after her husband’s passing. Recommendations to respond confidently to the needs of the person Conclusion I would recommend in conclusion that Margret should go to the doctors at least once a month to make sure she is fit and healthy, also to get her eyes checked in the opticians to see if she needs other glasses to see with. And to get her ears checked to see if hearing aids are needed. I would recommend more regularly exercise on top of her walking like joining her local gym. In some places the over sixty-fives can join for free and most places do a discounted offer for O.A.P’s, there is also a social benefit to going to the gym too as you are out of the house, meeting similar aged people too and aids cardiovascular and respiratory functions, slows the loss of muscle and helps with the decline of bone density and promotes sound sleep and fights depression. I would make sure she has a healthy diet which includes a balanced diet, less sugar and plenty of water as-well as multi-vitamins supplements with plenty of fresh fruit and fresh food to provide optimal organ function. Also to avoid smoking which she has not done throughout her life anyway. Also to cut out excessive alcohol consumption, Margret may have two glasses of wine a day. I would recommend cutting back to one to reduce risk of liver damage. I would recommend trying to reduce as much stress in her life and keeping up as much social activities as possible to promote healthy well-being mentally and physically to aid cognitive functioning and prevent depression. I would also recommend trying new skills and try new activities to aid mental activity and promote healthy mental functioning. Bibliography Web Pages 1 5M4339 Shane Quigley

Drinking And Driving Essay -- Alcohol, Drunk Driving, DUI

What possesses a person to get behind the drivers’ seat of a car and drive intoxicated? This question is always asked whenever a drunk driver is involved in a drinking and driving incident. Many people drink and drive without thinking about the consequences. The majority of fatal car crashes are caused by alcohol related incidents. Of all traffic fatalities in the United States in 2005, 39% of traffic related accidents were alcohol related (Alcohol Alert, 2006). Driving while intoxicated puts drivers and others lives at risk. Drinking and driving do not mix and the consequences can be prevented. A simple solution can be by simply having designated drivers to help keep drunk drivers off the road. All 50 states have a designated blood alcohol concentration level. This blood alcohol concentration level is determined when a person is legally drunk. A person is not permitted to operate a vehicle when this limit is reached. The limit for all 50 states for the blood alcohol concentration level is .08. 43 states and the District of Columbia have strict laws that prohibit the driver and the passengers from possessing an open container of alcohol in the passenger compartment of a vehicle (DUI and DWI Laws, 2007). Drinking alcohol can have many side effects on a person. Every person’s body will react differently to alcohol absorption. Alcohol begins to be absorbed into a person’s bloodstream within one to two minutes after an alcoholic beverage is consumed. After consuming alcohol it accumulates in the bloodstream. Intoxication usually occurs when an individual drinks alcohol faster than the liver can oxidize it. While the percentage of alcohol in the blood increases, the more a person becomes intoxicated (Hanson, 2007). Remember th... ...or his or her actions, there would be fewer accidents in the world. The next time someone gets behind the wheel of a car he or she should reevaluate their actions and think of the consequences. References Alcohol Alert. (2006). Alcohol alert. Retrieved June 8, 2007, from http://www.alcoholalert.com/drunk-driving-statistics.html Drinking and Driving Data. (2007). Nhtsa. Retrieved June 8, 2007, from http://www.nhtsa.dot.gov/kids/research/drinking/index.cfm DUI and DWI Laws. (2007). Iihs. Retrieved June 8, 2007, from http://www.iihs.org/laws/state_laws/dui.html Hanson J.D., (2007). Alcohol Problems and Solutions. Potsdam. Retrieved June 8, 2007, from http://www2.potsdam.edu./hansondj/DrinkingAndDriving.html Jourard, R. (2007). Drinking and Driving. Retrieved June 13, 2007, from defencelaw Web site: from http://www.defencelaw.com/drinking-driving-1.html

Privatized Public Beaches in Lebanon

Privatized public beaches in Lebanon OutlineI. IntroductionII. Causes of privatising public beachesA. Political groundsB. Economic groundsIII. Effectss of privatising public beachesA. Addition in monetary valuesB. Private beaches considered publicDecision IV Beachs in Lebanon have been used through old ages for several grounds. The Lebanese jurisprudence provinces, like any other state in the universe, that entree to the beach should be free and unfastened to everyone ( †¦ .. ) . This fact did non censor some of the powerful Lebanese people to privatise these public beaches. † Over 10 1000000s of metres of lands historically classified as Mashaa’ ( repossessing public belongingss ) , in add-on to public belongingss which some are State-owned, such as sea and rivers, were conquered over the last coevalss † ( Safadi, 2012 ) claimed the Lebanese curate of finance. This support took topographic point in order to build an model for economic system that would to boot downgrade the construct of public countries and the public good, stressing much more on private involvements. This type of devastation erased landscaped countries, beaches, agricultural lands and to the full eliminated celebrated markets and popular histori cal edifices. Not merely this, but it besides changed many topographic points that were full of memories, which must be preserved. Privatizing beaches have been turning improbably fast with clip. New epicurean beach resorts are turning like mushrooms all along the seashore, with all types of swimming pools and fancy Jacuzzis right at the seafront whereas barmans functioning cocktails in the center of bars inside the pools to sounds of loud music. This state of affairs has ne'er been inexistent, on the contrary nowadays through most of the clip really soundless and in different fortunes. Political intercessions were one of the chief causes of feeding this job. The beach has been â€Å"privatized † from all waies, from north to south. This denationalization does non profit the national exchequer nevertheless, it increases unusually the income of politicians who took over these beaches. A broad figure of these shores in Jounieh, Gieh, Jbeil and many other parts in Lebanon are transformed into Luxury resorts barely accessible by a few figure of the population. Even though this denationalization has several negative facets, it is still present in our state since political figures and parties are endorsing this type of work, even more, they are the proprietors of such undertakings. Despite the bad effects they can hold on the environment, they still prefer to up lift their ain benefit on top of any other topic. Their chief intent is to raise the biggest sum of money possible. Other than the political grounds that contribute in enlarging this subject, economical gro unds besides play an of import function. The proprietors of these topographic points hide behind touristry while supporting their work, as if taking over the populace had become an of import portion in enlarging the tourers activities. They claim that tourers are attracted to epicurean edifices and resorts therefore the topographic points are being built under the rubric of leisure and comfort. They try to do it as epicurean and every bit large as possible and in parallel raise the monetary values. In this instance, merely the rich category benefit. In contrary to what is thought to be done, these topographic points have more to veto than positive on touristry. The monetary values are increasing with the old ages making unaffordable rates that alternatively of pulling tourers forcing them off. Not merely these causes have erased the public beaches in Lebanon, but besides it created several economical effects and beaches that are considered populace could still be private. Thousands of Lebanese delay for summer season so they can get away the concrete metropolis to pass the twenty-four hours at the beach. However, in Lebanon there are now merely a few metres of seashore designated as public beaches. A big subdivision of Lebanese can no longer dunk their pess into the sea along their huge coastline. This fact is due to the improbably high monetary values imposed by the private sector, which even increases from weekdays to weekends. There are really few picks now: 250 beach nines are the lone manner the Lebanese can entree the sea. Not merely this, but every twelvemonth, the monetary values of entry rise and every twelvemonth. For illustration, for a Lebanese household to pass a twenty-four hours at the beach today, the cost scope would be from 100 000 L.L. to 200 000 L.L. Th is is the instance of a five members household merely. This is of class without factoring in the monetary value of H2O, nutrient, and drinks, because most beach nines employ people to seek bags upon entry, so that non even a bag of french friess enters the nine. Everything has to be bought indoors. Normally in resorts outside the capital, the monetary values are lower since the clients are largely locals but still sometimes unaffordable to many of the population. Harmonizing to the alleged nine proprietors, this addition in monetary value is explained and necessary. It is mentioned that the cost of Diesel, the addition in the rewards and conveyance costs of the employees, the rise in supplying electricity under the current terrible rationing agenda, and the rise in monetary values of stuffs to clean the pools have been factors to set these high monetary values. One specific illustration is about electricity being indispensable, â€Å"from air conditioning, pool filters, to the kitc hen and lighting. With the rise in the monetary value of Diesel, the cost of runing the generator has risen to $ 15,000 a month.† In add-on to the cited antecedently, the effects of privatising beaches have lead us back to many old ages earlier. During the war period, while some of the Lebanese people were excessively busy killing each other, others were clearly caught by something else. Stealing sand from the populace was at that place chief concern. They siphoned off 1000s of dozenss of sand, 10s of 1000s of trucks, possibly more, were sold off. Al-Akhbar estimations that one truckload of sand is deserving 400USD today. Let’s assume it was merely 300 or 200USD back so, that’s 1000000s if non one million millions of dollars stolen from the people. It is really likely presents to see a private belongings a public 1. Even while purchasing a land at the sea, it might be uncomplete whereas portion of it is really the sea due to the enlargement of lands. On the other manus, due to the immense sum of sand stolen in the yesteryear, the shore bound back so was manner more advanced in the sea. In this peculiar instance, the sea lawfully begins at the border of that unnaturally reclaimed piece of land. So much sand has disappeared, that the sea moved inland and is technically portion of the land being rented or bought. In decision, privatized beaches are present all around the universe. However, in other states than Lebanon, there is a replacing for the private topographic points. In Lebanon, the private is taking over the public illicitly due to political grounds and economical intents. The effects of the subject are enlarging, monetary values are increasing and private lands are considered private. Mentions:Mashaa’ collective, 2013,Reclaiming the parks in Beirut,retrieved from hypertext transfer protocol: //www.arteeast.org/2013/10/20/reclaiming-the-seashore-through-art-and-activism/Lahoud C. , 2012,A call to weaponries to assist Lebanon’s seashore,the day-to-day star, retrieved from hypertext transfer protocol: //www.dailystar.com.lb/Culture/Books/2012/Feb-08/162529-a-call-to-arms-to-help-lebanons-coast.ashx # axzz32C6fD5wtGino, 2012,Why Some Beach Resorts in Lebanon Are Completely Legal,retrieved from hypertext transfer protocol: //thelaw.com/2012/07/03/why-some-beach-resorts-in-lebanon-are-completely-legal/Beach blockers,2011, retrieved from hypertext transfer protocol: //now.mmedia.me/lb/en/reportsfeatures/beach_blockersAbouzaki R. , 2012,Lebanon’s Beachs: Sand Castles for the Richretrieved from hypertext transfer protocol: //english.al-akhbar.com/node/85131

Community Health in the Event of a Sars Outbreak Essay

SARS (Severe Acute Respiratory Syndrome) is a respiratory illness caused by a coronavirus, originally reported in Asia in February 2003 and spread to over two dozen countries before being contained (Centers for Disease Control and Prevention [CDC], 2005). Once infected, individuals with SARS initially develop a high fever and other flu-like symptoms including headache, body aches and â€Å"overall feeling of discomfort† before, in most cases, progressing to pneumonia (CDC, 2005). The disease was first diagnosed in a middle-aged man who had flown from China to Hong Kong. A few days after the announcement of the disease, rumors and panic began to spread, causing people to buy out food and supplies, as the Chinese government insisted the disease was under control and insisted on calm (â€Å"Timeline,† 2003). As the disease killed the man and the physician diagnosing the disease, it continued to spread through multiple countries, infecting thousands of people and killing hundreds (â€Å"SARS,† 2011). By the end of the month, Hong Kong and Vietnam were reporting cases of severe and â€Å"atypical† pneumonia (â€Å"Timeline,† 2003). In March 2003, the WHO issued a global health alert and an emergency travel advisory, and United States officials encouraged all citizens to suspend non-essential travel to the affected countries and Singapore, Ontario and Hong Kong initiated home quarantine (â€Å"Timeline,† 2003). Schools in Southeast Asia closed and there were significant economic effects as well as air travel stalled and business worldwide was affected. In April, countries threatened to quarantine entire planeloads of people if anyone on board showed symptoms, and others threatened jail time for those who obstruct the attempts to control the disease (â€Å"Timeline,† 2003). On April 3, 2003, SARS became a communicable disease for which a healthy person suspected of being infected in the United States could be quarantined against their will (â€Å"Executive Order,† 2003). By June 2003, the number of new cases had slowed down enough to end the daily WHO updates and travel advisories were slowly being lifted (â€Å"SARS,† 2011). On July 5, the WHO declared SARS had been contained (â€Å"WHO,† 2003). As of 2005, no new cases of person-to-person transmission have been reported (â€Å"Surveillance,† 2005). Indicators and Data The main epidemiological indicators for SARS identified by leading healthcare organizations such as the WHO and EpiNorth are the incubation period, infectious period, and case-fatality ratios (World Health Organization: Department of Communicable Disease Surveillance and Response [WHO/DCDSR], 2003; Kutsar, 2004). According to the WHO, the median incubation period reported was 4-5 days, with a minimum reported incubation period of 1 day in 4 cases and a maximum of 14 days reported in China. After further analysis of 1425 cases it was determined that 95% of patients would begin to experience symptoms within 14. 22 days on infection (WHO/DCDSR, 2003). The infectious period, or the period of communicability, was determined to be within the second week of illness, when patients are more severely ill and experiencing rapid deterioration (Kutsar, 2004). During the SARS outbreak of 2003, 8,093 people were infected and 774 of these people died as a result of their infection, with a case-fatality rate of 9. 6% (CDC, 2005; â€Å"Revised U. S. Surveillance,† 2003). The cases were reported from 29 countries on 4 continents, with 29 cases from the United States (â€Å"Revised U. S. Surveillance,† 2003). Other epidemiologic factors affecting the spread of SARS were found, as well. Twenty-one percent of all cases were healthcare workers involved in procedures that generated aerosols, with 3% of the United States cases and 43% of the Canadian cases being people in this group (Kutsar, 2004). Other risk factors found included â€Å"household contact with a probable case of SARS, increasing age, male sex and the presence of co-morbidities† and, in China the slaughter of wildlife for human consumption (WHO/DCDSR, 2003, p. 14). Routes of Transmission In the laboratory setting, the virus was found in respiratory droplets, feces, saliva, tears and urine (WHO/DCDSR, 2003). SARS is primarily spread through close, personal contact, such as kissing, hugging, eating or drinking, as well as being within 3 feet of a person who coughs or sneezes while infected and shedding the virus. These activities allow the respiratory droplets shed during these activities to come in contact with mucous membranes found in the eyes, nose and mouth (Kutsar, 2004). Other modes of transmission include aerosolizing procedures in hospital settings and contamination of surfaces in â€Å"healthcare facilities, households and other closed environments† (Kutsar, 2004, para. 12). There has been no confirmation of fecal-oral transmission or of transmission via water or food; however, over one-third of the earliest cases in China were among food handlers (Kutsar, 2004). Finally, there is a possibility of animal vector transmission, as discussed in regards to the Hong Kong’s Amoy Gardens (WHO/DCDSR, 2003). Effect of Outbreak on Community The SARS outbreak caused major effects on the communities affected. Based on the 2003 outbreak, one can assume similar issues would develop should the disease recur. The biggest impact to communities affected would be the strain on the healthcare system. Since SARS is a largely respiratory disease, it can cause very serious problems in the patients infected, requiring hospitalization in many cases. In the 2003 outbreak, population most likely to develop SARS was healthcare workers. As such, an increase in hospitalizations within a community with a decreased amount of healthcare workers worsens the strain on the community’s healthcare system. Further effects on the community in the event of a SARS outbreak would be seen in the closing of public buildings, such as schools. If the schools closed, as they did in Southeast Asia during the 2003 outbreak, families with two working parents would have to find alternatives for their children. With employment rates in the United States being low at this time, many people may be hesitant to ask for time off work, fearing that someone else would easily replace them in their position. These concerns could also increase the possibility of mass transmission, as many people may try to continue working while sick, not realizing they were carrying the deadly disease. Additionally, many people may procrastinate seeking medical advice on their symptoms, fearing they would be instructed to stay home from work, hospitalized or even quarantined. As evidenced in laboratory studies of the virus, virus secretion increases as the disease lingers (Kutsar, 2004). Simply, the longer a person is infected, the more easily they transmit the infection to others. As more and more of the community becomes infected, and possibly quarantined, other services in the community will suffer. Grocery store shelves may remain empty longer, as healthy staff struggle to keep up with the demand. Mail delivery may lengthen due to more postal carriers becoming ill and staying home. Businesses in general may be forced to shorten their hours due to an inability to schedule staff, resulting in problems with banking, supplies, and even medication disbursement. Further, the community health system would be greatly stressed, as the number of people needing care would grow, potentially covering a larger area than normally served and straining the resources of the public health system. This strain would impact all of the programs served out of the local offices, impacting even more people. Protocol In the State of Illinois, SARS is listed with the Class I(a) conditions that have been declared to be â€Å"contagious, infectious, or communicable and may be dangerous to the public health,† and, needs to be reported to the local health department within three hours of initial clinical suspicion (Control of Communicable Diseases Code, 2008). This can be done electronically through mail, phone, fax or the web-based system, I-NEDSS (Illinois National Electronic Disease Surveillance System) and will include case name and contact information as well that of the physician. After the local public health office has been notified, they will contact the Illinois Department of Public Health, also within three hours using the same techniques. This report shall include race, gender, and ethnicity as well (Control of Communicable Diseases Code, 2008). These reports are sent via the National Notifiable Disease Surveillance System (NNDSS), which is operated by the Centers for Disease Control (CDC) in collaboration with the Council of State and Territorial Epidemiologists (CSTE) and allows the CDC to monitor new cases and disease trends as well as evaluate the efficiency of prevention and control activities, program planning and evaluation, and policy development (Centers for Disease Control and Prevention [CDC], 2011). Modification of Care As a community health nurse, one must be constantly aware of changes in the environment served. If a report of poor air quality is issued while the community health nurse is caring for patients suffering from asthma and other respiratory disorders, immediate action must be taken as the poor air quality can cause exacerbations. First, the nurse will need to prioritize the patient load—which patient is the most susceptible to this change in air quality and should be seen first? Then, the nurse will begin calling or, if time allows, visiting the patients to check in and provide further direction. Some of the interventions the nurse may suggest are to stay indoors closing all windows and doors to prevent the poor air from entering the home and interfering with the patient’s breathing. Additional suggestions would be to limit activity which would increase the oxygen demand in the patient’s body, resulting in faster, less efficient respirations. Patients should be reminded to keep their rescue inhalers with them at all times, as well as to be sure and take all their preventative medications as prescribed. If the nurse is making home visits, s/he will be checking the medication bottles to see if the patient has been compliant. While in the home, she will auscultate the patient’s lungs to assess for worsened wheezing from baseline and recommend a visit to the patient’s physician if necessary. As the air quality reports improve in the next few days, the nurse will continue to monitor those patients most susceptible to ensure they have no residual effects from the previous days.