Persuasive Speech On Smoking - 1591 Words

Abstract Smoking is the most preventable leading cause of death in the United States and causes many health risk such as lung cancer, and heart and blood vessel complication. My main purpose of this persuasive speech is to convince people that smoking is harmful for themselves, the people around them and their wallets. In 2015 and estimated of 36.5 million people were current smoker (Jamal, A., King, B. A., Neff, L. J., Whitmill, J., Babb, S. D., Graffunder, C. M., 2016). In addition smoking doesn’t not only harm the direct smokers, but also the people around them from secondhand smoking. According to the national cancer institute tobacco has 7000 chemical, of those 250 are known to be harmful, including hydrogen cyanide, carbon†¦show more content†¦Also, smoking causes more death combined than Human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, and firearm-related incidents (CDC, 2017). According to the national cancer institute tobacc o has 7000 chemical, and 250 which are known to be harmful, including hydrogen cyanide, carbon monoxide, and ammonia (2017). Among the 250 known harmful chemicals in tobacco smoke, at least 69 can cause cancer. These cancer-causing chemicals include the following; arsenic was commonly used in rate poison and benzene is found in gasoline (Martin, T., Jelic, S. 2017). Smoking doesn’t only harm the people that are directly smoking, but also the people around them. It’s important that smoker’s realize that by smoking they are putting themselves and people around them at harm, like their children, wife, husbands, and other people. I have a best friend that smokes cigarette, and he has been smoking since he was 18 years old. He knows that smoking is bad and that it causes cancer, but doesn’t know all of the other health risks that are associated with smoking. Smoking has short term and long term effect on our health. The purpose of my speech today is to convi nce you that smoking is harmful to your body, and people around you also known as second hand smoking and your wallet. There are many health risk that are associated with smoking, cancer being one of the result of smoking. According to the American Cancer SocietyShow MoreRelatedSmoking Persuasive Speech780 Words   |  4 Pageshealth wasn’t getting better. e. Thesis: Through my speech, I want to persuade you to not smoke. It is important as it could harm our body and our world f. Preview of Main Points: First I will talk about what the problem with smoking, next, the causes of smoking and lastly the solution and what we can do. Transition to 1st Main Point: Now, I will be talking the problem with smoking II. Main Point 1: The problem with smoking is that it harms people’s health a. Sub-point A: CDCRead MoreSmoking Persuasive Speech811 Words   |  4 Pagessmoke? Well I have. In the world there are fifteen billion cigarettes sold a day. That is ten million sold every minute! In this, I will be telling you about how smoking is bad for you, bad for the environment, and ways smoking in public can be stopped. Smoking should be banned! First of all, as almost everyone knows, smoking is bad for people. When people smoke their chances of having a heart attack go up immediately. Also the chances of getting cancer go up as well. This is because theRead MorePersuasive Speech Smoking859 Words   |  4 PagesSmoking Kills General Purpose: To persuade Specific Purpose: To persuade my audience to write their senator and urge him/her to increase anti-smoking campaign funds. Central Idea: Smoking is injurious to human health, hence, stricter/inclusive clean indoor air policy should be adequately enforced. Introduction: How many of you have seen your parent’s or grandparent’s lifespan getting cut short because of bad choices as a result of addiction to smoking? You are not alone.I hadRead MorePersuasive Speech: Dangers of Smoking Essay629 Words   |  3 Pages      Persuasive Speech Dangers of Smoking Specific Purpose: To inform the audience of the dangers of smoking and persuade them not to.   Ã‚   Introduction: 1. Did you know that smoking is the number one preventable cause of death in the United States? 2. According to cancer.org there is 440,000 deaths a year caused by tobacco. 3. On average every smoker costs their employer almost 2,000 dollars a year in lost labor.    By the end of the speech, the audience will be informedRead MorePersuasive Speech to Stop Smoking734 Words   |  3 PagesHello my name is ---------and here to persuade you to stop smoking. Smoking is not only bad for health it is also as bad for the people around you. Breathing other peoples smoke is called passive, involuntary or secondhand smoking. The non-smoker breathes side stream smoke from the burning tip of the cigarette and mainstream smoke that has been inhaled and then exhaled by the smoker. Secondhand smoke is a major source of indoor air pollution. How does this affect the passiveRead MorePersuasive Speech About Smoking1065 Words   |  5 PagesYou’ve probably heard that the American Heart Association has declared sitting as the new smoking. Chances are, your first thought when you heard this was something like â€Å"whatever†¦just one more thing that’s bad for me†. But, If sitting is the new smoking, then I could be in trouble and I bet most of you could be too. Many of us have jobs where we sit all day. The only moving around we do is to walk to the bathroom, walk to our car, or walk to someone’s office. And when we get to those destinationsRead MorePersuasive Speech About Global Warming922 Words   |  4 PagesPERSUASIVE SPEECH OUTLINE General Purpose: To persuade Specific purpose: After listening to my speech, my audience will know how they can change their lives for a bigger challenge – to save the world. Thesis: Knowing what a problem nowadays is global warming, how CO2 gas affects it and how can we change it. Title: Lifestyle to make some changes INTRODUCTION I. Attention Material: Question â€Å"DoRead MorePersuasive Speech Outline1028 Words   |  5 PagesPERSUASIVE SPEECH OUTLINE TOPIC: WHY YOU SHOULD GIVE UP SMOKING PROPOSITION: Give up smoking and you will save yourself and the others around you and live in a healthy environment. SPECIFIC OBJECTIVES/PURPOSES: I want to persuade my audience on how harmful smoking does to the body and giving up the habit is the right way to do because it will literally save their lives and the people around them and the environment as well. SPEECH PLAN ATTENTION STEP: Opening statement: Smoking†¦Read MoreRhetorical Analysis Of The Speech Why We Need End The War On Drugs 1433 Words   |  6 PagesRhetorical Analysis of TEDTalk In the speech â€Å"Why We Need to End the War on Drugs† given by Ethan Nadelmann, a drug policy reformist, Nadelmann gives a compelling and persuasive argument on how and why we should end the war on drugs. Nadelmann describes himself as the oldest son of a rabbi and a human rights activist who works to end the drug war. He urges that the drug war is very dynamic and what the United States is doing in relation to stop it is not effective. This helps launch into what heRead MoreRoutes to Persuasion Essay1374 Words   |  6 Pagesthat areidentical to the audience she/he will be perceived as smart. Also, to project animage of expertise it is necessary to speak confidently and withouthesitating. Trustworthiness of the communicator is assumed if direct eye contact is used and speech is rapid. If the speaker is seen as not trying toinfluence or is arguing a position that is against their personal interest theywill be considered trustworthy. An attractive communicator has certain qualities, like physical appeal and similarity

Theodore Roosevelt And Woodrow Wilson The Progressive Era

During the Progressive Era from 1890-1920, America saw three new presidents: Theodore Roosevelt, William Howard Taft, and Woodrow Wilson. This period of time is known as the Progressive Era due to the political and social changes made to move away from a laissez-faire government to a more active government by the administrations of these presidents. Prior to this period, Americans had to suffer through poor working conditions, low wages, social and class inequality and become victims to large corporations that took advantage of the people. In particular, the administrations of Theodore Roosevelt and Woodrow Wilson established the key principles and ideas of economic reform and social reform, which would end up returning the power from the manipulative corporations back to the government, establishing a model for a more active role for the federal government, and improve the lives of Americans. However, even though Roosevelt and Wilson had similar intentions of reforming America, they both had different means of achieving it. At the start of the twentieth century, America was still facing racial inequality post-Civil War and segregation of whites and blacks after the Reconstruction Era. With the blacks being fed up with their current conditions, they participated in the Great Migration, in which they moved from the South to the North for a better life filled with more opportunities; blacks were ready for real reform of American society. Realizing the seriousness of thisShow MoreRelatedCompare And Contrast Theodore Roosevelt And The Progressive Era755 Words   |  4 PagesDuring the Progressive Era, two presidents, Theodore Roosevelt and Woodrow Wilson, were very essential and celebrated during their time. Roosevelt became president in 1901 and was probably one of the most influential Republicans ever to have power over the American people (â€Å"Theodore Roosevelt.†). Being a democrat, Woodrow Wilson ran his campaign in a very different way than Presiden t Roosevelt. He became president in 1913 and was easily one of the best presidents the United States ever had, leadingRead MoreTheodore Roosevelt s The Progressive Era Essay1543 Words   |  7 PagesTheodore Roosevelt’s presidency marked the beginning of a very liberal period in American history. This new ‘Progressive Era’ was mobilized largely by the middle class as an attempt to put an end to the problems created by the period of excess that was the Gilded Age. Believing that big business was ruining democracy, and assuming a moral obligation to shield the poor and downtrodden from corrupt capitalists, the Progressives commenced an era of sweeping reforms. From the outset, the ProgressiveRead MoreWilsonian Progressivism vs. Roosevelt Progressivism901 Words   |  4 Pagesas the Progressive Era. This is when reformers strived for better welfare policies and more rights for the people. Although three presidents reigned during this movement, only two are known f or their policies. Theodore Roosevelt, the arrogant and egomaniacal president spoke out of ambition, whereas Woodrow Wilson, the more morally inclined leader spoke out of actual desire. Both had similar ideas, but their means of displaying them, and actually carrying through were different. Roosevelt was militaristicRead MoreThe Age Of Uncertainty Between 1890 And 1920 s A New Movement Essay1423 Words   |  6 Pagesemergence of Populists, Progressives and Radicals came a vast difference between what was thought as American. All groups claimed to be trying to make the US a better place however each differed vastly in their ideas of going about it. During the age of uncertainty between 1890 and the 1920’s a new movement called the Progressives emerged in parts of the Unites States. They emerged as part of a long tradition of reform aimed at correcting the issues of the country. Progressives ranged across the socialRead Morecompare and contrast of Theodore Roosevelt and Woodrow Wilson808 Words   |  4 PagesPresidency of Woodrow Wilson and Theodore Roosevelt By HIS 204 American History since 1865 Instructor: Kathleen Scarpena November 25, 2013 Theodore Roosevelt and Woodrow Wilson are two of America’s most celebrated presidents during the 20th century. Theodore Roosevelt who was a Republican had a military background and created the American conservation movement. Theodore Roosevelt was also once shot by an would be assassin and still managed to give his speech. Roosevelt was famous by hisRead MoreDbq 2003 Form B Apush Essay658 Words   |  3 PagesThe Progressive Era was a thirty year period in which the United States was completely reformed. Actions were taken to improve working conditions for laborers, create a sexually unbiased work system and regulate the economy. President Theodore Roosevelt and Woodrow Wilson both helped create a more direct democracy in which the people would have a voice. During those thirty years, amendments 16 to 19 were ratified to regulate and reform the country. Muckrakers were writers who worked for the printingRead MoreRoosevelt, Taft, and Wilson: Progressive Presidents1675 Words à ‚  |  7 Pagescountry and the Progressive Era, more than a decade. The presidents of this time, Roosevelt, Taft, and Wilson, were like chefs developing a recipe for the betterment of the United States. Every act that was passed, each decision that was made, was a trial or taste-test of the constantly changing recipe for the country. If something angered citizens or drew criticism, the president went back to his office, his kitchen, and was ready to make more changes. Where he left off in the progressive recipe, theRead MoreThe Liberal Era Of The Progressive Era1220 Words   |  5 PagesA great democracy has got to be progressive or it will soon cease to be great or a democracy. ( ). The Progressive Era consisted of reformers demanding the government to clean up society. Entering office in 1904, Theodore Roosevelt was an individual in the republican Party, but as the country began to spin out of control Roosevelt joined the new Progressive Party and saved the country from a disa strous ending (685). Reformers set out to cleanse the country go its wrong doings. The progressivismRead MoreFranklin D. Roosevelt s President Of The United States1546 Words   |  7 PagesChapter 31-33 Test: Individual Question When Franklin D. Roosevelt was elected to his first term as president of the United States in 1932, America was in a severe depression. When Franklin Roosevelt took office in March of 1933, President Hoover handed the problems of the Great Depression over to Roosevelt. Upon taking office, Franklin Roosevelt issued a bank holiday which forced all banks to close from March 6 to March 10 while he met with Congress to pass the Emergency Banking Act to allow banksRead More The Progressive Era Essay798 Words   |  4 Pagesall power rested with the politicians and businessmen. Reformers known as Progressives attempted to undo the problems caused by industrialization. The Progressive movement sought to end the influence of large corporations, provide more rights and benefits to workers, and end the control possessed by party leaders. At the national level, Progressivism centered on defeating the power of large businesses. The Progressive Era was a period in American history in which impro ving working conditions, exposing

Literary Criticism for John Updike AP free essay sample

His father was a school teacher and his mother was an aspiring writer. He excelled in school, and worked for his local newspaper. Updike was granted a scholarship to Harvard, and went on to study at Oxford in England. He was first published in 1958, and released a book of poetry. He continued to be published, and in 1963 he received the National Book Award for his book entitled The Centaur. The next year he became the youngest person ever elected to the National Institute of Arts and Letters. Updike consistently wrote throughout the 60s and 70s. He won the Pulitzer Prize in 1981 for his novel Rabbit is Rich, and again in 1991 for Rabbit at Rest. He continued to write into his later years. John Updike died in Massachusetts at the age of 76 due to lung cancer (http://www. achievement. org/autodoc/page/updobio-l). The following series of published literary criticisms focus on John Updikes short story AP. It is one of his more famous short stories. The selected critiques analyze the story in terms of its style, theme, or literary devices. Subsequent to the article responses is a literary criticism based on a personal reflection to the story and its ties to modern society using evidence from the original text. Title of Source: The art of John Updikes AP Author: Toni Saldivar Search Engine: ProQuest Literature Module Website: ProQuest Web Address: http://search. proquest. com. ezproxy. barry. edu Abstract: Toni Saldivars essay entitled, The art of John Updikes AP, is a literary criticism allusions to art in order to increase the romanticism of the story, and that dramatic irony is significant to the construction of the meaning of plot for a reader. The introduction emphasizes the importance of this short story in terms of American literature. The piece was first published in The New Yorker, and therefore assumes that the reader has a certain amount of knowledge that is required to fully appreciate the writing. The next section gives a synopsis of the story and an explanation of the main character, Sammy, a nineteen year old boy. According to Saldivar, the overall focus of the essay is to show how Sammy is not only starting to come to terms with the reality of modern society, but also his own cultural role, including his sexuality. In relation to this assertion, the article argues that the reader can only understand Sammy, and truly enjoy the story if they are able to sense the dramatic irony and romanticism of the plot. The story is full of metaphors, but the most important one is not explicitly written in the original text. The reader is supposed to make the connection between Sammys description of the young girl and Botticellis Venus. The dramatic irony comes from how Sammy is able to allude to things that are beyond his scope of knowledge. He knows there is a world beyond his suburban bubble, but he knows nothing about it. Evaluation of Criticism: This literary criticism is very abstract in nature, but provides strong textual evidence to support its claims. Once it is understood that Updike wrote the story for an intended audience, it makes sense that the plot contains elements that connect to classic art and also relies on subtle dramatic irony. However, the article is long- winded in its explanation of the connection. It provides numerous examples from the original text, and also uses art criticism of the Venus for further evidence. It also repeats its thesis statement in various places and in numerous ways. The driving point is that understanding the allusion to Botticelli, and grasping the elements of Sammy that can only be read between the lines is essential to appreciating the story for all that it is worth. This literary criticism is useful because it illustrates how the arts are connected, in this case, writing and painting. The arts are fluid and can translate between different mediums. The story is considered modern, but the painting is a classic. The character of Sammy is also meant to be relatable, even to future generations. The essay is well researched and soundly written; it is a good example of what a published literary criticism should look like. Title of Source: Irony and Innocence in John Updikes AP Author: Lawrence Jay Dessner Search Engine: Literature Resource Center Website: Gale Web Address: http://go. galegroup. com The critical essay by Lawrence Jay Dessner explains the importance of the themes f irony and innocence in John Updikes short story AP. The essay begins with a short summary of the story, and introduces the character of Sammy. Dessner argues that the story depends on irony. The reader expects a certain action and reaction from Sammy, but instead he does the opposite. This irony provides an innocent air of humor due to Sammys lack of world knowledge and youthful outlook on life. The remainder of this literary criticism analyzes Sammys interactions with the other characters in the book, including the difficult customer, the girls, and the grumpy manager. This particular literary criticism is short, but also very clear. It does not waste time explaining every detail of the plot because it assumes the reader is already familiar with it. The purpose of the essay is to provide a meaning to the story that goes beyond the original text. The argument is that the story relies on the irony and innocence of Sammys character. The author makes his assertions, and provides textual evidence to back up each claim. Although the story itself has a tone of vagueness in terms of its characters, the author of this essay gets very specific when analyzing the meaning behind the characters actions. The arguments in this criticism are concrete, and provide good insight to John Updikes influential story. Title of Source: Sammys Erotic Experience: Subjectivity and Sexual Difference in John Updikes A P Author: Greg W. Bentley The essay begins with an introduction of the story, and a short summary of the plot. This literary criticism reveals its argument right away, and that is that the storys popularity stems from its sexual nature, and that it portrays a feminist message through the perspective of a male. The argument also goes on to say that this message creates a distinct type of irony. The main character of the story, Sammy, has an erotic experience, but it is not inappropriate, simply a rite of passage. Citing an expert in feminism, the author argues that men and women are not very physically different in terms of sexuality, but are biologically different. Textual evidence is also used to prove this claim. The essay points out that Sammys struggle comes from the reactions of the other men in the story. The other men provide an example of conventional masculinity, but Sammy has his own feelings and opinions of women that differ from the other men. The article focuses on the sexuality and eroticism of he story, but makes sure to present these themes in an intellectual and healthy way. Greg W. Bentleys critical essay takes a controversial theme of Updikes short story, introduce and explain the feminist theories that are essential to essays argument. Citing a credible expert and using evidence from the original text make the essay easy to follow and understand. At first glance the essay may seem abstract, but to the contrary, it is very realistic. This literary criticism points out that America responds to sex. The setting of this short story is a microcosm in the macrocosm that is American ulture, and sex plays a large role in that culture. This piece also explains the difference between girls and women by using the girls in the story as an example. Updike wrote this story during a time of great change in American culture; things were loosening up. Sex was something that was once never spoken about, but now is accepted as a rite of passage. The author is right in saying that sex appeals to Americans, that is what makes this story so relevant to even the modern reader. Works Cited Bentley, Greg W.. Sammys Erotic Experience: Subjectivity and Sexual Difference in John Updikes A P. Journal of the Short Story In English 43 (2004): 121-141. Gale Group.

Tiotropium Versus Salmeterol For Prevention -Myassignmenthelp.Com

Question: Discuss About The Tiotropium Versus Salmeterol For Prevention? Answer: Introducation Bronchitis on the other hand is developed due to the inflammation of the bronchial tubes accompanied by the over secretion of mucus. The over secretion of mucus eventually leads to blocking of the airways and contribute to difficult air passage during the process of respiration. It has to be understood that smoking is a very important contributing factor that has a profound role in the pathophysiologic development of this respiratory disorder. For the case study, Robert, the patient under consideration had been a chain-smoker for 40 years, smoking can be considered as the origin of the disease he had developed. According to the case study, Robert had been diagnosed with COPD 18 months ago and had been feeling unwell for months befire that as well. Hence, it can be concluded that the onset of manifestations brnchitics and emphysema had begun since a long time. The added burden of smoking excessively had contributed effectively to further deteriorating the disease, along with the age f actor of the patient in the case study. COPD pathway (Vogelmeier et al., 2011) impact of age on COPD (Erb-Downward et al., 2011) Exacerbation of the COPD: An exacerbation can be defined as the sudden worsening or deterioration of the conditions that the patient is going through. In case of COPD, exacerbation can be due to many factors; however the most common contributor is bacterial infection. It generally comprises of sudden acute shortness of breath and altered quantity and consistency of the phlegm. In case of COPD, an exacerbation event can last up-to several days and can effectively complicate the health condition of the patient. In case of an exacerbation of COPD, the airways of the patient go through enhanced inflammation, and coupled with increased mucous production, the gas exchange is impaired effectively (Vogelmeier et al., 2011). There can be many contributing factors that lead to an exacerbation event, along with bacterial, infection, environmental pollution is also another reason for the sudden worsening. With respect to the case study, for Robert, the most important risk factor that might have had a profound role in the development of the exacerbation of the disease is infection. Infection by Streptococcus pneumoniae often leads to further blockage of the airways which contributes to impaired gas exchange and leads to dyspnea. According to the case study, Robert had been a smoker for 40 years and continues to smoke in the present. Hence, the second risk factor for Robert that might have led to exacerbation is smoking (Erb-Downward et al., 2011). It has to be understood that allergens, especially smoke, can irritate the inflamed airways and air sacs resulting in further inflammation. Hence these are the two risk factors behind the exacerbation of COPD experienced by Robert in the case study. Pathophysiology of pneumonia: Pneumonia can be described as the infectious disease facilitates the inflammation of the air sacs and results in overproduction of phlegm. The infection can have either bacterial or viral Origin. During aspiration process the bacterial pathogen enters the body through the airways and colonize the lung parenchyma. On a more elaborative note, it has to be mentioned that the infection mechanism is facilitated by the invasion of the lung parenchyma. The overgrowth of the bacteria in the lung parenchyma provokes the overproduction of intra-alveolar exudates like mucous. It has to be mentioned in this context that the pneumonia infection manifests further as soon as the pathogen reaches the alveoli, the host defences at this point are usually overwhelmed by either the virulence or the inoculum size of the pathogen, and the infection spreads (Musher Thorner, 2014). The community acquired pneumonia (CAP) can be considered as the most commonly reported type and the mechanism of the infection in case of the community acquired pneumonia differs from the other types significantly. The community acquired pneumonia is fundamentally unique from any other type of pneumonia by the fact that it is not associated with the health care facility at all. In case of CAP, the causing organism can be over 100 different types. The most common types of infectious agents in case of the community acquired pneumonia, are bacteria, virus, fungi and even allergens. However, in case of hospital acquired pneumonia is often more severe as it is acquired by the patient during hospice stay, and the causing agent is often antibiotic resistant strains. The patients on ventilators and intensive care units are at the most risk of this type of pneumonia. In case of the health care associated pneumonia the point of acquiring the infection is due to a long term stay in any communit y care setting or any outpatient clinics (Johansson, Kalin, Tiveljung-Lindell, Giske Hedlund, 2010). Pharmacology of the medications administered: It is a selective Beta 2 adrenergic receptor stimulating drug, and the most important function of this medication in case of COPD is of bronchodilation. It has to be mentioned that the stimulation by salbutamol activates the adenyl cyclase which is then transformed into cyclic AMP. The increased concentration of cyclic AMP then in turn relaxes the bronchial smooth muscles and reduces the airway resistance by relaxing the bronchial tubes from trachea to terminal bronchioles (Albert et al., 2011). The contraindications for salbutamol include any patient with a history of hypersensitivity reaction along with any patient with fast history of cardiac tachyarrhythmias. Hence if Robert has had any history of hypersensitivity, Salbutamol will be contraindicated for him. Also salbutamol is a well tolerated drug. yet side effects may occur due to any dosage or administration route error. With respect to this case study, the nursing professional should also be careful if Robert exhibits any signs of tremors special in the hands or any preparation of tachycardia, which is the most frequently reported side effects of salbutamol (Bischoff et al., 2011). Budesonide/efomoterol fumarate dehydrate (symbicort): This medication is a combination of a long acting Beta 2 adrenergic receptor agonist and an inhaled corticosteroid. This medication is considered to be a maintenance therapy for the COPD patients. The inhaled corticosteroid or budesonide, has anti-inflammatory properties which help to reduce the inflammation of the bronchial airways and facilities better air passage. And formoterol is the long acting beta agonist bronchodilator which relaxes the muscles and prevents any bronchospasm, hence it will help relaxing respiratory muscles of Robert and wil evade any chances of him going through bronchospasm (Agusti, 2014). There are two major contraindications of this medication, with any acute episodes of COPD where intensive measures are required this medication cannot be administered. In case of Robert, any hypersensitivity reaction to the components of this medication will be harmful as well if taking this medication. Adverse reactions to this medication include allergic reaction, adrenal insufficiency and even an increased risk of infection such as pneumonia. There are 2 nursing considerations for this medication when administering to Robert, risk for infection and hypersensitivity. Patient education includes explaining to Robert to never use budesonide or formoterol in case of acute bronchospasm. In case of exceeding wheezing, Robert should be instructed to seek out immediate medical attention due to the possibility of acute asthmatic attack (Agusti, 2014). Tiotropium: Tiotropium is another bronchial muscle relaxant which is used to prevent any wheezing or shortness of breath. This medication is an anticholinergic and it relaxes the muscles around the bronchi and will facilitate smoother air passage in case of Robert. The contraindication for this medication includes any hypersensitivity to anticholinergics. Along with that renal diseases in glaucoma also contraindicated against the administration of this medication (Wise et al., 2013). The adverse effects of this medication are constipation, nausea, muscular pain, and nosebleed. Robert will need to be educated about the possible side effects of this medication all diseases are the most plausible adverse reaction to this medicine. The nursing considerations include the fact that this medicine should only be taken to prevent bronchospasm for an ongoing broncos ransom attack this medication should not be taken (Wise et al., 2013). The main contributing factor behind the doctor changing Roberts medicine chart by replacing the symbicort with tritopium can be the fact that symbicort can only be used in regular cases of COPD, it has no noticeable effect on exception of subdivision patient had been going through. Along with that, the major side effects of symbicort is pneumonia, and as the patient has already been suffering with community-acquired pneumonia continuing symbicort can be very harmful for the patient. Hence, the doctor replaced Symbicort with Tiotropium, which is a more targeted and fast action relieving medicine mainly used for treating bronchospasm attacks and exacerbations that Robert has been having (Wise et al., 2013). Amoxicillin: Amoxicillin is a penicillin type antibiotic that is used to treat many bacterial infections including pneumonia by Streptococcus pneumonia, and it can be used to treat Robert. It is usually administered orally every 8 to 12 hours and dosage is dependent on the severity of the infection. The contraindications include any allergies to penicillin type antibiotics and any renal disease which can be aggravated due to administration of this medicine. As Robert had no past history of renal diseases mentioned, this antibiotic can be easily used for Robert. Adverse effects that Robert might encounter include nausea,vomiting, and diarrhea. Nursing considerations include patients with mononucleosis not been given this medication along with patients with any hepatic impairment. Care should also be taken to ensure that phenylalanine is present in the oral chewable tablets and suspensions given to Robert. Patient education includes teaching Robert to chew or crush the chewable tablets rather than swallowing it and to notify the carer in case of any aggravation or bloody urine (Torres et al., 2015). Ceftriaxone: This is another cephalosporone type medication that is used to treat this infection, and is a very common treatment option for pneumococcal infections for elderly patients like Robert. The contraindications include hypersensitivity and the risk of calcium ceftriaxone interaction, which is needed to be assessed before administering to Robert. The adverse effects that Robert can have include bronchospasm, diarrhea, and nausea. Nursing considerations include checking for any allergies reaction of shortness of breath that Robert might experience. In terms of patient education, Robert should be instructed to notify and seek attention in case of hypersensitive reaction (Martin-Loeches et al., 2010). Levoflaxone: It s a quilonone used to treat pneumococcal infections in case of penicillin resistant strains. The contraindications include hypersensitivity, diabetes, and renal disorders. The adverse effects that Robert may have include nausea, insomnia, diarrhea and headache. The nursing consideration for this are ensuring Robert not being allergic to quilonone compounds and should be run slowly to avoid stinging. The patient teaching must include informing Robert to refrain from taking vitamins and supplements long with the possible side effects (Postma et al., 2015). Psychosocial interventions for COPD: According to the case study, Robert has been suffering from Exacerbation of COPD and severe community acquired pneumonia which has is associated with suffering and restrictions which can eventually have a significant psychological burden on the patient. Psychosocial burden associated with co-mosbidities have been reported to have a huge impact on the recovery statistics and wellbeing of the patient, and can even alter the response of the patient to the treatment pathways. Administering psychotherapic intervention can help the patient overcome the issues effectively. The most common intervention is cognitive behavioral therapy which will help Robert deal with the stress. However another psycho social intervention is mindfulness based therapy, which is gaining popularity in case of such disorders as well according to Agusti (2014). Moreover, relaxing therapies like yoga and meditation sessions can also help Robert find strength to cope with the stress and regain control of his recovery with respect to the case study (Wong et al., 2014). The next results can be yielded by an integrative psychotherapic plan incorporating cognitive behavioral therapy, mindfulness based intervention and relaxation technoques; which can address the differential psychotherapic need of a critical patient like Robert. References: Agusti, A. (2014). The path to personalised medicine in COPD.Thorax,vol 69(9), pp 857-864. DOi: 10.1136/thoraxjnl-2014-205507 Agust, A., Edwards, L. D., Rennard, S. I., MacNee, W., Tal-Singer, R., Miller, B. E., ... Crim, C. (2012). Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype.PloS one,vol 7(5), e37483. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0037483 Albert, R. K., Connett, J., Bailey, W. C., Casaburi, R., Cooper Jr, J. A. D., Criner, G. J., ... Make, B. (2011). Azithromycin for prevention of exacerbations of COPD.New England Journal of Medicine,365(8), pp 689-698. DOI: 10.1056/NEJMoa1104623. Almagro, P., Cabrera, F. 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