Research paper Example | Topics and Well Written Essays - 2500 words - 2

Research Paper Example However, as the industry grew the early manufacturers could not keep pace with the technology that advanced in so many directions all at the same time. Vertical integration in the industry became difficult as there were too many technologies and manufacturing intricacies. As a result specialist companies emerged that mass-produced specialized components and supply it to several computer manufacturers. This form of outsourcing worked cheaper for computer manufacturers and many such as IBM, Sony, HP and Compaq abandoned the vertical integration model. They preferred to concentrate on efficient assembly and marketing their own brand computers instead of developing and R&D base and investing in it. Dell, however, preferred to continue with the shorter-value chain model by selling directly to customers, avoiding the intermediary commissions and costs associated with distribution through independent retailers. Gradually, companies such as HP even started outsourcing the assembly to contrac tors, while focusing on product design and marketing. All the vendors tried to minimize the amount of finished goods in dealer inventories and shorten the time it took to replenish dealer stocks. Dell stuck to its own business model of Built-to-Order (BOT). Dell’s supply chain efficiency had eroded between 2003 and 2006 when it peaked at five days on inventory supply. They found it difficult to get cooperation from other organizations and bureaucracy started prevailing within the organization. There was misalignment between its procurement and supply chain activities, and with its assembly line. Dell wanted to partner only with reputed suppliers rather than have 20 suppliers all supplying to all computers manufactures. They stuck to one or two suppliers and maintained long-term partnership with them. They however, brought down their inventory turn cycle from 32 days in 1995 to 7 days in 1998, and to four

Gharar in Islamic Law Assignment Example | Topics and Well Written Essays - 2500 words

Gharar in Islamic Law - Assignment Example Finally, even if the relevant agreements amounted to agreements to pay Riba, the principal sums advanced could validly be claimed (Usmani, 2001). Hence, Murabaha Agreements should be in accordance with Islamic law, all that is required is certification by Islamic Bank’s Religious Supervisory Board and the principal amounts are dispensed in accordance with the terms of Murabaha Agreements (Usmani, 2001). The Gharar contains uncertainty in a contract or sale where the goods may or may not be available (the bird in the air or the fish in the water). It shows ambiguity in the consideration or terms of a contract. As such the contract would not be void. An example tainted with Gharar is an agreement to sell goods which have already been sold (Vogel and Samuel, 1998). This paper finds Gharar in depth in three contracts. The three contracts that I have analyzed in this paper are about car, property and stocks. The Bank has followed the methods of Islamic banking while still Gharar ca n be found in them. Elements of Riba and Gharar are present in the contractual documents. The transactions if carried out under the mentioned products (cars, stocks and property) require Murabaha Financing. The important ingredients of the Murabaha Financing Agreement are The Preamble: it is an integral part of the agreement; Definitions: incorporation of the terms: a) Account b) Agency Agreement c) Agreement d) Client Financials e) Declaration f) Due dates g) Goods h) Murabaha Account i) Purchase Price j) Security k) Security Deposits; Purchase and Sale Agreement; Mode of Payment; Representation of the Client; Representation of the Institution; General Covenants of the Client; General Covenants of the Institution; Warranties of the Institution; Security; Risk of Loss; Takafol; Damages; Governing Law and Jurisdiction; Set off; Acceleration; General; Execution of document by the Counterparts ( The Institution and The Client); Dated; Witnesses; Schedule of Documents: a) Agency Agreeme nt b) Declaration c) Promissory Note d) Description of Security (Ghafoor, 1995). Murabaha Finance Agreement for Car The first contract is about Murabaha Finance Agreement for car. The contract is about a client bank agreement on buying a car in instalments but there are several conditions for the client, which he has to adhere in order to get the car. A down payment is given after which, monthly instalments are fixed for the customer. As this is a Murabaha contract, therefore it is essential to know about Murabaha. Murabaha is a term in Islamic Fiqh and it refers to a particular kind of sale having nothing to do with financing in its original sense. If a seller agrees with his purchaser to provide him specific commodity on a certain profit added to his cost it is considered Murabaha transaction. The basic ingredient of Murabaha is that the seller discloses the actual cost he or she has incurred in acquiring the commodity and then adds some profit thereon. This profit may be lump sum or may be in fraction (Al-Qardawi, 2001). In conventional financing, the financier lends money to the client on interest. After giving the interest bearing loan, the financier has nothing to do with its usage. In the case of Murabahah no money is advanced by the financier. Instead the

The Selling Process and Selling Tools Essay Example | Topics and Well Written Essays - 1750 words

The Selling Process and Selling Tools - Essay Example Determining and estimating the competition strength is also important in sales and marketing. What qualifies a service or a product to particular market segmentation and what hinders maximum profits should be determined. Knowledge of the segment that will need a company’s product or services will save time and resources, and this can be done by determining dimensions of sales. The demand for a product should be well estimated for accurate production. Demand estimation will reduce wastages of resources or loss of customers because the products were not enough. Trade area analysis is very important in sales, as a company will know which part of the country needs their goods or services. Trade areas differ with geography, political stability, and economic advantage and a company that has all these details will have a competitive advantage. Market potential and sales forecast should also be checked before a company engages are sales in an area. The product that a company is sellin g is the most important aspect is sales and marketing. What the product entails is something that matters to the customers and should be what a company takes it into account before manufacturing it. Why the product, who will it benefit more, where will it be sold, how much will it go for, and what profits margin is expected to bring. A good product should not stay on the shelf for long instead every production should be increased because demand has also increased. Pricing for personal selling has been considered the strongest promotion tool as it personalizes the message to the customer. The sales tend to be higher when personal selling is conducted, ensuring that all the profits go to the company instead of having to divide them among the sales agents. Personal selling also uses various technologies and helps overcome geographic limitations because the companies are able to draw budgets for the sales. This kind of selling also promotes good relationships between the customers, mana gement, and employees. This creates loyalty in the company a very important aspect of a business. Promotion strategy is an element very important in the marketing mix that involves advertising of a product for customers to be familiar with it before purchasing. Advertising to be done before the product is in the market to get people responses and ensure that the customers do not forget its value. Personal selling is the other component of promotion strategy where the producer promotes their product personally. This creates brand loyalty from the customers ensuring that they do not stop using the product.

Emotional and Behavioral disorders Essay Example | Topics and Well Written Essays - 250 words

Emotional and Behavioral disorders - Essay Example me of the common EBD conditions include affective disorders, anxiety disorders, schizophrenia, conduct and attention disorder, and adjustment disorders (Lehr, 2005). In general for the management of students with EBD in a classroom setting may not really be effective (Keller, 2002). The approaches that are chosen should be evidence-based and proven through empirical literature. The level of support provided to the students should be classified into 3 levels, namely, primary, secondary and tertiary prevention. At the primary level, problems are prevented from developing, and in general all the students are targeted through teaching appropriate behavior. Secondary prevention includes decreasing the severity of the problems and lowering the risks that may be present to the students. At the tertiary level, established problems are reviewed and appropriate interventions are implemented. Besides, the severity and duration of the negative outcomes are reduced using various measures (Lehr, 2005). Children with EBD may need placement for at least some duration of time in special classrooms that provide a structured environment for development. The outcomes in such an environment are more controlled and predictable. Students in such a program would be rewarded for appropriate behavior (Hewett, 2002). The teacher would constantly assess the needs of the classroom and demonstrate systematic teaching through several modes including discussion, presentation, modeling, etc. Behavior modifications may be required though behavior therapies such as positive reinforcement, contracting, etc. Supportive therapies in the form of music, art and exercise therapies may be needed to increase a self-understanding and self-esteem of the child (Council for Exceptional Children, 2011). One of the key elements in managing stress that may be required by teachers teaching children with EBD is self-awareness. Through self-awareness, the teacher is better able to understand the

Starbucks Essay Example for Free

Starbucks Essay Starbucks uses HR to help to budget and manage costs. They do this by having a set of people for specific tasks. If someone is more skilled they will move that person to another place because they have better skills and the quality of their work is much better which shows that they have better qualifications. Human resources make the business a work place and at Starbucks the employees have certain characteristics like their behaviour and age, which helps to improve the businesses expectation from customers. Cut wastage Starbucks are bringing in new ways to cut waste, like recently they have introduced a reusable plastic cup, which looks like a normal Starbucks cup. They are selling these for an extra $1 and also the customer receives a discount from Starbucks so this is persuading the consumer to get this because it will help them to get a discount and also they are saving money. This will help to improve the business and also it helps to budget costs because they are reusing their products. Starbucks have electrical products which can be repaired or recycled also the distributors of the electronic equipment have a part to play in the reducing the amount of WEEE going into landfill sites. The building waste the landlord is in charge to manage the waste there. Reduce amount of stock held Starbucks have to make sure that they maintain the amount of stock they order because they might not have enough space in there warehouse to store it. So they only order items that they know are going to sell well and they use on a regular basis like Starbucks cups, milk and sugar products like that. They want to maintain the amount of stock because they are trying to control budget costs and by maintaining stock they are helping to reduce costs at the same time. So they are improving the company’s performance by doing this. ICT computers and technology Starbuck stores have Free Wi-Fi in there stores which allow customers to buy beverages and use there Wi-Fi to do work. Because Starbucks have a lot of seating for the customers which allows customers to come in and enjoy a drink while doing some work. Other reasons are that Starbucks needs to have technology because they think like Starbucks rewards card and they need technology to use these items, which will help them. Also having these items helps to reduce waste and it helps to control budgets because the cards are reusable and the free Wi-Fi will persuade customers to buy a drink or food from there. Less mistakes in production When the staffs is making the customers food or beverage they need to ensure that items are made to a good standard so they aren’t making mistakes which will cause a problem also it will help to save money for the business. This will help to control their budgets which are important when it comes to ordering stock so they don’t have less stock during a certain order. Everything is produced efficiently so when the customer orders a double cream hot chocolate they receive a double cream so the customer is happy and the staffs is listening to the customers’ requirements. Fewer loans Starbucks need to ensure that they don’t have a problem with taking loans out and also they need to make sure they aren’t taking loans out for no apparent reason so they don’t make a loss. Starbucks won’t effect as much if they take a loan out because they are a multimillion business so they don’t really need to worry about taking loans out. Controlling budgets may help businesses stay in profit. Controlling budgets will help Starbucks stay in profit because it will help them to understand which areas of the business needs more progress and help. Like Starbucks will need to determine which sectors of the business need more of a bigger control like the rent will always be the same each month but during Christmas and winter Starbucks tends to bring out new products like gingerbread latte so they will need more stock around this time of the year. So controlling the budget will vary depending on the time of the year. Cut down on maintenance Starbucks need to cut down on maintenance but they need to maintain their machinery so they can produce the products for the consumers otherwise there will be problem. They need to ensure that items can be reused like I said before they introduced a reusable cup for customers to use. The other things they need to consider are that they need to ensure there are several different aspects of things.

Ethical and Legal Issues on the Internet Essay Example for Free

Ethical and Legal Issues on the Internet Essay Plagiarism is probably the main concern when it comes to blogging and academic assignments. Should it be our responsibility to minimize plagiarism, yes it is. Academic Integrity helps keep higher learnings foundation strong. That is why it is very important to minimize or even try to eliminate plagiarism. Academic integrity surely includes issues like cheating and plagiarism, copyrights, patents, intellectual property. But it concerns the way in which we present ourselves to the community of which we are a part of. Its the obligation of students, administrators, faculty, and staff, to come together to educate students for personal and social responsibility. Schools offer to the learning community information about academic and research integrity, the responsible conduct of research, and about the ways in which our individual actions have an effect on our participation with, a vibrant and creative academic and social community. Plagiarism, the use of anothers words, ideas, data, or product without  appropriate acknowledgment, such as copying anothers work, presenting someone elses opinions and theories as ones own, or working jointly on a project and then submitting it as ones own. Cheating, the use or attempted use of unauthorized materials such as annotated or instructor editions of the course textbook, information, or study aids; or an act of deceit by which a student attempts to misrepresent academic skills or knowledge. Fabrication is the intentional misrepresentation or invention of any information, such as falsifying research, inventing or exaggerating data, or listing incorrect or fictitious references. There are ways for responsible blogging; as long as people can be ethical and follow them blogging may become more credible. First Bloggers should check their facts before blogging. It is so simple to produce and share content why not make sure it is 100% facts before sharing. Bloggers should respect all copyright laws, people associate online content with public domain content which can get the blogger in hot water. Bloggers should include links to a more detail source of the material that is being written. Giving credit where credit is due is very important in responsible blogging. The blogger should always reference their sources, this practice is important under an ethical point of view, but also give the reader a place to get the main source of facts.

Sickle cell disease, an disease of red blood cells

Sickle cell disease, an disease of red blood cells Introduction This paper presents a detailed overview of sickle cell disease, an inherited disease of the red blood cells. The paper begins with a brief discussion of the aetiology, prevalence of sickle cell disease. Next the paper investigates the pathophysiological aspects of the disease and the physical manifestation of symptoms the patient presented with. The paper then discusses how sickle cell disease affects suffer. Finally the paper presents and evaluates treatment and management of care. The conclusion will provide a summary of the points discussed. Sickle cell disease (SCD) encompasses a group of haemo ­globinopathies. There is currently no cure for adults with this hereditary disease, which mainly affects people of Afro-Caribbean origin and, to a lesser extent, Mediterra ­nean, Middle Eastern and Asian groups. There are large numbers of people around the world who suffer from acute or chronic pain, or indeed both, as a result of sickle cell disease. Sickle Cell Society (2008) estimates that sickle cell disease affects approximately 10 000-12 500 people in the UK. Sickle cell disease comprises of a group of inherited blood disorders that alter a persons haemoglobin, causing chronic haemolytic anaemia and producing acute and chronic pain as a result of reoccurring episodes of vascular occlusion (Lal. and Vichinsky, 2005). Adult haemoglobin consists of two alpha globin and two beta globin chains wrapped around a haem (iron containing) molecule. Haemoglobin is the main substance of the red blood cell. It helps red blood cells carry oxygen from the air in the lungs to all parts of the body. Normal red blood cells contain haemoglobin A. Haemoglobin S and haemoglobin C are abnormal types of haemoglobin. Normal red blood cells are soft and round and can squeeze through tiny blood tubes (vessels). Normally, red blood cells live for about 120 days before new ones replace them. People with sickle cell conditions make a different form of haemoglobin A called haemoglobin S (S stands for sickle). This is caused by mutation in the beta chain which means the haemoglobin has a lower affinity for oxygen that causes sickle cell anaemia is the most common (Serjeant Serjeant, 2001). The mutation causing sickle cell anaemia is a single nucleotide substitution (A to T) in the codon for amino acid 6. The change converts a glutamic acid codon (GAG) to a valine codon (GTG). The form of haemoglobin in persons with sickle cell anaemia is referred to as HbS (Bain, 2002). The nomenclature for normal adult haemoglobin protein is Hb. Red blood cells containing mostly haemoglobin S do not live as long as normal red blood cells (normally about 16 days) (De, 2005). They also become stiff, distorted in shape and have difficulty passing through the bodys small blood vessels. De (2008) explains when sickle-shaped cells block small blood vessels, less blood can reach that part of the body. Tissue that does not receive a normal blood flow eventually becomes damaged (Serjeant Serjeant, 2001). This is what causes the complications of sickle cell disease. People who inherit the mutation from both parents or the mutation from one and thalassaemia (lack of a beta chain) from the other will suffer sickling. Those who inherit the mutation from only one parent will be sickle cell disease carriers and rarely display symptoms (Information Centre for Sickle Cell and Thalassaemic Disorders, 2008). Patient X presented in accident and emergency (AE) in sickle cell pain crisis. Vaso-occlusive pain is caused by the tendency of sickle haemoglobin molecules to crystallise, distorting the red cells into crescent shapes on deoxy ­genation, occluding small blood vessels. Disrup ­tion of normal circulation leads to acute tissue ischaemia and secondary inflammation and, when prolonged, infarction of bone, joints and vital organs (Elander et al, 2004). According to Information Centre for Sickle Cell and Thalassaemic Disorders (2008) vaso-occlusive pain episodes experienced by patients with sickle cell disease vary tremendously in frequency and severity. Some patients rarely have painful crises, while others spend the greater part of a given year in the hospital receiving analgesics (Anglin, 2007). The cooperative study of the natural history of sickle cell disease showed that about 5% of patients accounted for one-third of hospital days devoted to pain control (cited in Johnson, 2004) . To complicate matters further, the pattern of pain varies over time, so that a patient who has a particularly severe year may later have a prolonged period characterized by only minor pain. According to Sickle Cell Society (2008) the frequency and severity of vaso-occlusive pain episodes often change as a person moves from childhood to being an adult. The breakpoint often occurs during the late teens or early 20s. Changes in hormonal status that occur during these years could contribute to the changes in severity of sickle cell disease (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). However, no causal relationship has been established, so the association remains only temporal. The mode of onset of sickle cell pain crises likewise varies. Roberts de Montalembert (2007) states patients can develop agonisingly severe pain in as little as 15 minutes. In other instances, the pain gradually escalates over hours or even days. Acute tissue ischaemia is associated with extreme pain, which may last from hours to weeks. The average duration is 5-7 days (Johnson, 2004) and the episodes are usually self-limiting. Streetly (2005) stresses prolonged infarction can lead to a multitude of compli ­cations, such as organ damage, degeneration of the spine and joints, and ischaemic leg ulcers. These compli ­cations are associated with chronic pain and disability. The sites affected in acute painful crises vary for each patient. Pain occurs commonly in the extremities, thorax, abdomen, and back (Oni, 2009). Pain tends to recur at the same site for a particular person. For each person, the quality of the crisis pain is usually similar from one crisis to another. Patient X had been managing the pain at home with paracetamol, heat rubs and 50mg of diclofenac a non-steroidal anti-inflammatory drug (NSAID). Sickle Cell Society (2008) states most patients manage episodes of pain at home. Oral analgesics, combined with rest and fluids often allows a person to ride out the pain episode. Some patients report that warm baths or warm compresses applied to aching joints ameliorates the severity of the pain (Roberts de Montalembert, 2007). Patient Xs pain became progressive worse so presented in AE for stronger opioid medication. According to the Trust policy a comprehensive, multidisciplinary team strategy is essential, particularly for managing patients with fre ­quent acute or chronic pain. Therefore, on admission patient X was assessed by the doctor and a pain assessment was undertaken by the nurse. According to Wright Adeosun (2009) patients presenting in accident and emergency departments with a painful episode should be immediately triaged and administered analgesia within 15 minutes of arrival and a prompt, accurate pain assessment is the cornerstone of effective pain management. It should include pain site, duration, score, character, exacerbating and relieving factors, associated symptoms, previous analgesia and physical examination. Ideally, the assessment tool would be locally recognised and used and therefore be familiar to patients. Moreover assessment should be prompt to expedite pain relief and allow life-threatening syndromes, such as acute sickle chest syndrome, to be treated urgently (Johnson, 2004). During the assessment patients will benefit from reassurance that they are believed when they report pain and that med ­ication will be delivered swiftly. De (2005) however reports incidences where healthcare professionals have not believed the patient report of pain which resulted in the patient displaying pseudo-addictive behaviour in an attempt to manage their pain and receive appropriate analgesia. This behaviour is an iatrogenic syndrome resulting from poorly treated pain (Serjeant Serjeant, 2001). According to Stuart Nagel (2004) without adequate knowledge of prompt assessment and management and how this can manifest, pseudo-addictive behaviour, such as groaning or other physical behaviour where the patient is trying to demonstrate that they are in pain, can be misconstrued as behaviour associated with substance addiction. Such behaviour could be, for example, aggression, conflict and arguments about analgesia. Wright Adeosun (2009) contends it is important to remember tha t this behaviour, although similar to behaviour found in substance dependence, is actually a result of poor pain management and is an indicator that this person needs their pain management approach reviewed urgently. In line with the Trust policy patient X was triaged within 15 minutes and during the evaluation, the doctor asked patient X whether the pain feels like typical sickle cell pain. Most patients can distinguish back pain due to pyelonephritis or abdominal pain due to cholecystitis, for instance, from their typical sickle cell pain (Anglin, 2007). De (2005) contends if the quality of the pain is not typical of their sickle cell disease, other causes should be investigated before ascribing it to vaso-occlusion. As this was typical of patient Xs sickle cell disease the doctor prescribed morphine 10mg titrated against the level of pain. Opioid-agonist drugs like Morphine are the mainstay of treatment for acute sickle cell disease pain and can be given orally. The dose must be titrated appropriately to reflect the drugs thera ­peutic duration of action and the intensity of the pain. Johnson (2004) contends patients whose pain is severe enough to warrant hospitalisation usually require opio ids. Morphine an agonists, opioid and it works by attaching to opioid receptors. There are four types of receptor: mu (ÃŽÂ ¼); delta (ÃŽÂ ´); kappa (ÃŽÂ º); and opioidreceptor- like (ORL). The ÃŽÂ ¼ receptors are thought to be responsible for most of the analgesic effects of the opioids and for some of the main unwanted morphine derivatives which include respiratory depression, hypotension, sedation, nausea, pruritis, constipation and dependence (Hall, 2009). Drugs may then need to be given to relieve and prevent analgesic side-effects (Hall, 2009). The morphine was administered intramuscularly (IM) however Johnson (2004) argues that pain relief occurs more slowly with intramuscular injections, and the injections themselves can produce substantial discomfort. Consequently, intravenous administration of analgesics is usually preferable. Maxolon 10mg was prescribed intravenously (IV) because of the undesirable side effects commonly associated with opioids. Opioids may induce nausea and vomiting by stimulating the chemoreceptor trigger zone, reducing gastrointestinal motility or increasing vestibular sensitivity (Hall, 2009). Evidence shows that nausea and vomiting can negatively affect the quality of life of patients in term of functional outcomes, patient-perceived care by hospital staff and patient satisfaction with regard to overall hospital stay (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). Identifying the incidence of nausea and vomiting and characterizing the prescribing of antiemetics are necessary in an effort to improve tolerability of opioids. Maxolon injection contains the active ingredient metoclopramide hydrochloride, which is a type of medicine called a dopamine antagonist (British National Formulary, 2010). Metoclopramide works primarily by blocking dopamine receptors found in an area of the brain known as the chemoreceptor trigger zone (CTZ). The CTZ is activated by nerve messages from the stomach when an irritant is present (Hall, 2009). Once activated, it sends messages to the vomiting centre in the brain which in turn sends messages to the gut, causing the vomiting reflex. Blocking the dopamine receptors in the CTZ prevents nausea messages from being sent to the vomiting centre. This reduces the sensation of sickness and prevents vomiting (Finlay, 2004). Once both drugs had been administered the role of the nurse was to monitor effectiveness and to reassess the pain score. Patient X was encouraged to report any further pain accordingly. According to Johnson (2004) as pain control improves, the analgesia should be maintained to prevent the patient from slipping back into a painful cycle. Patient X was then nursed in the observation unit and after 2 hours reported increasing. After being reviewed by the pain team a patient controlled analgesia (PCA) was offered. The popularity of PCA has generally risen since a report published by the Royal College of Surgeons of England and the College of Anaesthetists (1990), and PCA is now regarded as a routine, safe modality associated with high levels of satisfaction among postoperative patients (Ballantyne et al, 1993). While much has been written about PCA in connection with postoperative pain, comparatively little has been reported in connection with sickle cell disease pain. Of the few studies focusing on PCA use by sickle cell disease patients, Gonzalez et al (1991) has attempted to measure patients acceptance of PCA, and then only as the secondary goal of a clinical trial. In a much early pilot study of three adolescents with sickle cell disease Schechter et al (19880 suggested that drug usage may dramatically reduce as pain subsides, but the intended trial was never conducted because doctors feared it might fuel patients propensity for addiction. The Society Cell Society (2008) however report that some sickle cell patients actually disliked receiving morphine because of its association with drug abuse and addiction and Johnson (2003) findings indicate that some sickle cell disease patients prefer to receive PCA to promote fast and predictable pain relief and give themselves a degree of control over their pain. Moreover, continuous subcutaneous infusions have been used to counteract any delays between intramuscular and intravascular injections (Hall, 2009). This also takes away the reliance on the next dose having to be delivered by health professionals and thus promotes patient autonomy. The role of the nurse was to teach patient X and his family about the medication: description, action, effects, and possible side effects. Johnson (2003) stresses the importance of reinforcing that analgesics make pain manageable and it may not take the pain away completely. The subcutaneous route was used for the PCA. Diamorphine was prescribed because it has the advantage of being more water and lipid-soluble, making it more rapid acting, easier to inject in smaller volumes such as 5-10mg per ml subcutaneously (Hall, 2009) and avoids absorption problems (Rees et al, 2002). Typically, bolus doses of diamorphine need to be higher than in postoperative PCA regimens, for example 5-30mg, and lockout times longer, which can be 20-60 minutes. To increase safe practice around the use of PCAs, a double check of pump settings and medication orders is required when a new syringe is loaded into the PCA system and with subsequent dosage changes. This double check was performed by the nurses and documented on the PCA chart on an hourly basis. Hall (2009) points out that patient can become drowsy as their pain is controlled. Often, this reflects the fatigue that comes with one or more sleepless nights with pain crisis at home. Johnson (2004) reinforced by Oni (2009) argue that the analgesics should not be discontinued automatically for somnolence as long as the patient is easily aroused. A common misconception is that if a patient with sickle cell disease is sleeping, the analgesics are controlling the pain. Rees (2003) contends sickle cell disease patients often sleep despite severe pain. Therefore, when a PCA has been commenced the nurse should evaluate the patient for respiratory status (rate and depth), sedation level, side effects, and pain severity 2 hours x 12 hours, then 4 hours thereafter (De, 2005). A pulse oximetry was used to monitor saturations levels and patient X was commenced on 2 litres of oxygen as it is in their deoxygenated state that red blood cells containing Hb S take on their abnormal, rigid half-moon-like state (Information Center for Sickle Cell and Thalassaemic Disorders (2008). Research suggests that sickled cells can actually regain their normal disc shape when exposed to a higher oxygen concentration (Zipursky et al, 1992 cited by Sickle Cell Society, 2008). When oxygen therapy is being administered De (2008) advocates an upright position as this position optimises and maintains ventilation and perfusion. Patient X needed assistance due to the pain to sit upright and a mouth care tray was provided due to the side effect of oxygen therapy causing dryness of the nasal and oral mucosa (Sheppard and Davis, 2000). A jug of water was also made available at the bedside and the call buzzer was left in easy reach. Effective management of an episode of painful sickle crisis according to Lal and Vichinsky (2005) requires intravenous fluids as this will help to decrease blood viscosity, improve blood flow and reduce risk of renal compromise. Providing adequate hydration is a component of almost every treatment protocol for vasoocclusive crises (De, 2005). Dehydration is one of the principal precipitating factors for pain crises. However, overcorrection of fluid balance can have a negative effect, including possibly increasing the risk of acute chest syndrome. This syndrome, characterized by cough, chest pain, dyspnoea, fever, and radiographic changes, is the most common cause of death for patients with sickle cell disease (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). Stuart and Nagel (2004) suggest hydration should be provided to correct deficits, replace any ongoing losses, and maintain normal body fluid volume (euvolemia). In addition, to this the patients pain may improve with oral hydration. Patient X was prescribed 1 litre of intravenous (IV) normal saline over 8 hours and oral hydration was encouraged by the nursing staff. This was monitored on the fluid balance chart. Patient Xs vital signs temperature, pulse, blood pressure were continuously monitored to detect any changes. Patients with sickle cell disease are susceptible to overwhelming infection (Wright Adeosun, 2009; Stuart Nagel, 2004). The most significant factor is splenic autoinfarction during childhood (Sickle Cell Society, 2008). Functional asplenia leaves patients vulnerable to infections with encapsulated organisms such as Streptococcus pneumoniae and Hemophilus influenzae. Further, some studies suggest that neutrophils do not function properly in patients with sickle cell disease (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). How the mutation in sickle cell disease might lead to a defect in neutrophil function is unclear. Patients with SCD and unexplained fever should be cultured thoroughly. If the clinical condition suggests septicaemia, the best action is to start broad spectrum antibiotics after complete culturing. Signs of systemic infection include fever, shaking chills, lethargy, malaise, and hypotension (Oni, 2009). Patient remained apyrexial and 2 days after admission the quantity of analgesia was slowly reduced as patient Xs symptoms improve. While the tapering of intravenous analgesics can require only two or three days, control of a full blown crisis often requires 10 to 14 days. Less commonly, bouts of sickle vaso-occlusive pain require several weeks to control. In conclusion this paper has presented a detailed overview of the management of pain in sickle cell disease, an inherited disease of the red blood cells. Sickle cell disorder can have a profound effect on a persons life. Acute painful episodes among patients with sickle cell disease may occur in any body part or several sites simultaneously. A thorough pain assessment will indicate the type of pain management approaches that are most likely to be effective. Patients should always be encouraged to engage in activities that will help them manage their own pain and boost their confidence rather than make them dependent on health care professionals. This case profile has highlighted the importance of optimal care for a patient with sickle cell disease which should be a comprehensive, multidisciplinary team approach with prompt, accurate pain assessment as this is the cornerstone of effective pain management.