A 12-year-old boy began to complain of frequent headaches 4 months before his hospital admission. On the day of his admission, he had a major motor seizure, which his parents observed. During the seizure he lost bladder and bowel control. On physical examination he appeared to be in deep postictal sleep. He had no focal neurologic signs. On examination of the optic fundi, no evidence of papilledema was found. Studies Results Routine laboratory work Within normal limits (WNL) Skull X-ray study, p. 1062 No evidence of skull fracture Lumbar puncture, p. 651 Opening pressure 250 cm H2O (normal: <200 cm H2O) Closing pressure 220 cm H2O (normal: <200 cm H2O) Cerebrospinal fluid (CSF) examination, p. 651 Blood Negative Color Clear Cells Lymphocytes 0-2/mm3 (normal: <5/mm3) Polymorphonuclear leukocytes None (normal: none) Protein 120 mg/dL (normal: 15-45 mg/dL) Glucose 50 mg/dL (normal: 50-75 mg/dL)
Questionably malignant cells Serologic test for venereal disease Negative (normal: negative) Electroencephalography (EEG), p. 549 Focal slowing of wave pattern in posterior aspect of the cerebrum (normal: regular, rhythmic. electrical waves) Brain scan, p. 785 Increase in radioactivity in the posterior aspect of the brain (normal: homogenous and minimal uptake of radioactive material) Cerebral angiography, p. 988 Neovascularity (tumor vessels) in the posterior aspect of the brain, involving the cerebellum and the occipital lobe of the cerebrum (normal: normal carotid vessels and terminal branches) Magnetic resonance imaging (MRI) of the brain, p. 1106 Tumor of the cerebellum extending into the posterior cerebrum Computed tomography (CT) scan of the brain, p. 1026 A soft tissue mass arising out of the cerebellum and invading the occipital lobe of the cerebrum
Diagnostic Analysis The skull X-ray study ruled out the possibility of a skull fracture as the cause of the boy’s problem. Lumbar puncture excluded the possibility of meningitis or subarachnoid hemorrhage: however, the high protein count and questionable positive cytology indicated a possible neoplasm. An EEG located an area of nonspecific abnormality in the posterior aspect of the brain. Brain scanning, cerebral angiography, and CT scanning indicated a posterior fossa tumor. These tests are mentioned in this case study mostly for historical interest. Under most circumstances, this young boy would have a MRI of the brain early in the diagnostic period. Because of these findings, the patient underwent a craniotomy. In many centers, this young boy would have a nonoperative stereotactic brain biopsy instead of a craniotomy. An invasive medulloblastoma was found to be arising from the patient’s cerebellum and involving the occipital lobe of the cerebrum. The tumor was unresectable. Postoperatively. the patient was given phenytoin (Dilantin) and radiation therapy to the involved area. A chemotherapy regimen was administered. The patient’s tumor did not respond to the therapy, and he died 4 months after the onset of disease. Critical Thinking Questions 1. What are the major assessments that the nurse should make during seizure activity? 2. Why is the EEG a priority study for patients with seizure disorders?
The unshakable British faith in the monarchy was as firm as ever, not diluting or eroding even slightly on account of these changes. (Park, 1950, pp. 3-5) In essence, the 19th century, during whose most part Britain was under the rule of one of its longest-reigning monarchs, Queen Victoria, saw the emergence of a peculiarly hybridised, yet often contradictory system of governance. Quintessential democratic institutions, such as the parliament, the judiciary, the cabinet and the local government were alive and well, but functioned under a monarchy. On the one hand, fair and free elections, the ultimate identifier of a democracy, were being held with amazing regularity; on the other, it could not be denied that participation in these elections was limited to the handful of rich and powerful. It was to correct this set of imbalances and to draw more people into the electorate that the Reform Acts were passed. The basic intent of these sets of legislation was the promotion of greater democracy, by drawing the excluded and marginalised sections of society into the electorate. (Pugh, 1999, p. 20) The nation went through three Reform Acts, passed in 1832, 1867 and 1884, whose central aim was increasing the numbers of the electorate. (Hammond & Foot, 1952, pp. 212-214) At about the time these Acts were passed, a parallel social and political reform movement, Chartism, was very active. The basic demand of this radical, unionised movement was greater political participation for the working classes, so that the fruits of the Industrial Revolution percolated down to the labour class, too. (Maccoby, 1935, p. 33) However, in the light of the needs of the day, and the priority these Acts had, they met with little success in actually bringing in democracy to the country. What has been said about the Reform Act of 1832, perhaps holds good for the other Acts, too –that they were “…an excellent example of the British skill of muddling through. An aristocracy muddled through to a democracy, taking many of the aristocratic virtues with them; and they muddled through from an age of privilege to an age of numbers. The democratic implications of the act(s) were not in fact revealed for more than a generation…” (Smellie, 1962, p. 164) As a result, through most of the Victorian Era, although efforts were made haltingly towards bringing in more democracy, there was no more than a sprinkling of democracy; even this happened at the grassroots level, being restricted to the municipal level, as a series of Acts were passed at the local government level. (Harrison, 1996, p. 20) Part VII: Conclusion: A study of the thesis question throws up a mixed picture. Overall, democracy, so essential a feature of these countries today, had had to make a bumpy and potholed journey. In all these countries, democracy was nebulous and uncertain in the 19th century, albeit in varying degrees. In Britain, a parliamentary democracy was very much in full bloom, but the inherent love and pride of the British people for their monarchy pre-empted a switch to a full-fledged democratic form of government. As a result, these democratic institutions functioned under a monarchy that controlled the largest empire of the day. In France, the scene was different. In the absence of democratic institutions of the kind Britain had nurtured, the governance the French Revolution brought about vacillated between various kinds, with the result that democracy took a backseat. In Germany, the struggles inherent in a newly unified nation, coupled with its naivety in running its newly developing imperialism resulted in too many squabbles and bottlenecks for democracy. The nation that Bismarck had welded together had the ingenuity to only work under a newly consolidated empire, not having been inculcated the necessary mindset for a democracy. It was never going to be easy for these fissiparous peoples to be administered a sudden dose of democracy, as by definition they had been inured to centuries of localism. By the end of that century, democracy was nowhere registered in the average German psyche. Of all these nations taken up for this study, it can be said that Britain had the highest form of democracy by the end of the 19th century; yet, here too, despite the Reform Acts, which could not be termed a great harbinger of democracy, it was nowhere near what may be termed a pure democracy, something that came so naturally to some of its colonies, principally America.>