Project Basic Patient Care graduate paper help

In the third year of my nurse training, I was placed in a local hospice. Following undertaking in house training; which included infection control, it was highlighted that there had be an increased infection rate within the hospice. I noticed how the presentation incorporated the importance of hand hygiene however it did not demonstrate the correct hand washing procedure. For the purpose of the assignment, I was explore my personal and professional development through explaining how carrying out a practice placement project has impacted on my learning and development. Hamill (1999) recommends writing in first person when referring to your own experiences, I feel this highlights personal and professional qualities and allows us to reflect and analyse on our own development.Project Basic Patient Care graduate paper help

The flexible learning module includes attending university one day a week to plan and discuss learning needs and assessments. Race (1998) describes flexible learning as “Putting the student at the centre of the learning process, enabling some control around how and when you will study, undertaking activities as an individual or with contact with a lecturer, and continuing to facilitate your own learning. Therefore, once a week, we were allocated time to attend action learning sets in the university.Communication, in healthcare, is a multidimensional concept that involves patients, family members, and a health care team. There is a direct correlation with communication, improving a patient’s well being, and quality of care. Adequate communication among physicians and their patients is an actively growing research topic. Results supplied by such studies have provided effective recommendations for oncologists and their team. These recommendations include the patient-physician relationship, how physicians utilize medical information, how physicians deal with patient emotions, physician self-management, and educational conferences designed to sharpen communication.

 

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Modern day Healthcare has increasingly embraced concepts of client-centred practice and empowerment. However, Taylor (2003) posits that existing literature on the subject does not give clear and unambiguous descriptions of the ways by which nurses can empower clients. Nonetheless, nursing practice is inclusive of people from very different backgrounds. In my ward for example, a high proportion of the nurses did not get their initial qualifications and experience in the UK, and my mentor too did not start of as a nurse from the UK. As a result of this, in the absence of well defined guidance for patient empowerment as a practice concept (by regulatory authorities), nurses and other healthcare practitioners will always encounter difficulties in the performance of their duties – in recognition of patient empowerment as a concept.Project Basic Patient Care graduate paper help

The way patient care is manifest in hospitals has evolved over time and now centres around collaborative working with different teams coming together to ensure that client care and outcomes are improved (Hansson et al 2008), (Hewison and Stanton 2003). Working in this way requires that the patient is an inclusive and active partner in his care planning and care delivery. This new way of working has also been emphasised by the government introducing the agenda for patient-centred care and patient empowerment. The Department of Health stipulates that the NHS needs to empower patients more and give them control over their healthcare (DoH 2008) and the World Health Organisation (WHO) also requires that patients are always consulted before any procedure is carried out on them (WHO website). The whole concept of empowering patients may not be new to healthcare practitioners because some healthcare practitioners are known to have spoken about making efforts to carry the clients along in the process of their care delivery (Stewart et al. 2002), but Paterson (2001) claims that some healthcare professionals have also been known to use subtle and covert ways to avoid fully implementing the patient empowerment requirement even at the risk of going against regulation to empower patients. Empowerment has been (in essence) practitioner defined to suit the practitioners. As an example, at the MDT meetings I attended, the patients’ views were not adequately promoted, and considering the requirements of the patient empowerment agenda, the patient is supposed be in charge of his healthcare.

I raised this with my mentor and the ward manager, and recommended that the patient be consulted before, and updated after every meeting that has to do with his care delivery. Acknowledging client empowerment as a way forward and in emphasising the need for this modern way of working, the Prime Minister in a key message in January 2008 said that patients are to be treated as active partners in their care. Brown et al (2006) consider that for care to be client-centred, care delivery must be focused on the client and empower and engage the client to his/her full potential as a partner in his/her care delivery. Whereas the client-centred concept requires that what is best for the patient is done, patient empowerment requires providing clients with adequate information and the knowledge required to make informed decisions and take control of their lives (Kielhofner 2002). The issue of patient empowerment raises an issue about empowering intellectually disabled persons who cannot make such decisions on their own. If an adult with intellectual disability does not have complete ability to communicate, their choices can be diminished which in turn can make it particularly difficult to ensure that their opinions are heard (Cameron and Murphy 2002); and even in instances where a nurse is designated the health facilitator for the client, there is no guidance as to how much decision making can be undertaken on his behalf (Martin and Carey 2009). These further complicate issues in nursing management for a qualified nurse and will call on good managerial skills. Modern healthcare practice environment is a highly regulated one with stringent requirements of the healthcare practitioners. The continued drive for improvement in both healthcare delivery service and the patient’s experience and quality of life (DoH 2005) have led to the promotion of improved integration between healthcare disciplines and agencies, and regulatory requirements to promote the concept of patient empowerment (DoH 2008), (Corsello and Tinkelman 2008), (Glasby and Parker 2008). Empowerment is a natural phenomenon and is essential to humans.Project Basic Patient Care graduate paper help

Patient empowerment may be resisted by nurses because of existing nurse-patient relationships (Nyatanga and Dann 2002) and so a deliberate cultural shift needs to be pursued to inculcate nurses with the shift in paradigm. To achieve, the nurse will need additional training, and the clients ought to be carried along in drawing up treatment plans. The more the client is involved in the treatment planning, the more the client appreciates his/her part in the patient empowerment agenda, and the more the satisfaction with the care delivery service. I have used simple courtesies like saying ‘thank you’ to the client, and realised it brightens their day very much and also makes them much happier and willing to discuss their feelings and opinions with me. The convergence of management and nursing has evolved over the past few decades and management is often cited as the reason for failings, and also as the likely solution (Pollitt 1993) to many of the problems in the NHS. Management was first formally defined by Henry Fayol (1949) as the composite function of planning, organizing, coordinating, commanding and controlling activities or events. More recent definitions in management theory look at management from the perspective of empowerment, total quality management, organizational culture etc. (Hewison and Stanton 2003). Leadership and management skills in nursing overlap to a very large extent but whereas leadership skills are needed in the more personal aspects like mentoring and motivation, management skills are needed to meet organizational targets and the management of available resources.

With the problems associated with recruitment and retention of nurses in the health sector, and the attendant high turnover of nurses came an additional expectation of nurse-managers to help reverse the trend (even though several of the pioneering nurse-managers had not had formal managerial training) (Contino 2004). Contino (2004) described the managerial skills required of a good nurse manager to include change management, communicating plans, managing the flow of information, managing nursing ROTAs and managing finances (income and expenses). Courtney et al (2002) rate financial management knowledge as one of the top requirements for a nurse manager in order to understand financial forecasts, financial plans, financial ratios and financial performance ratios. A nurse manager needs to be very conversant with current practices and concepts. A good understanding of service improvement and knowledge (and use) of the available developmental resources for nurse improvement like the Leadership at Point of Care programme (Janes and Mullan 2007) are essential for successful nurse-management.Project Basic Patient Care graduate paper help

The following three areas chosen that as a student nurse will be discussing in this essay are: Confidentiality, Accuracy of Information and Working in Partnership. Some examples will be given to explain and underpin some of the concepts that will be explained later in the assay.

What is a Person centred care?

Starting with what (Ponte et al, 2003) state that the Person Centred Care (PCC) is the consideration of the patient’s point of view and taking into account their decision on meeting their goals.

How people try to define it?

Unfortunately there is not a definite definition, but as a student nurse, the understanding of the person-centred care is when the Health Care Profession put the patient at the centre of the whole process, give the possibility to have the best treatment regarding their illness, give them the choice to receive the treatments, respect their decision making and keep all the information confidential.

One of the areas very important for the PCC is Confidentiality.

(Department of Health 2003), saying that

responsibility of confidentiality occurs when one person releases information to another, for example to a multidisciplinary team, this is happen in situation where it is reasonable to expect that the information will be held in confidence.

As the definition suggests, confidentiality is the key to form a trusted relationship between patients and Health Care Profession.

There are some exceptions to this duty.

Sometime it is allowed or even obligatory to violate a patient’s confidentiality, for example when a patient suffers from a notifiable illness. (Mcferrant, 2008).

Information has to be shared or disclosed to other health care professionals to provide the best solution of treatment for the patient with their permission. This is done because the patient can receive care from different member of the team.

Unfortunately is no always easy to obtain consent from the patient; because for mental health issues or because is under age to give consent, however it is important that the patient or his family understand that some data have to be disclosed around the medical team.

How confidentiality relates to the two Principals A and D?

Confidentiality is the centre of connection (relationship) between the health care providers and the patient, allowing an honest and open line of communication between the two parties; also it helps in the understanding needs and how to proceed with their treatments.Project Basic Patient Care graduate paper help

Confidentiality means privacy, means dignity and there are important aspects of our personal life and when a patient is admitted to hospital the staffs take very seriously this element of care.

To keep the patient’s information confidential is quite challenging and is very much influenced by the ward arrangement and available space. In particular when the discussion takes place behind the curtains or at the bedside, may result in breaches of confidentiality. We all are aware where to discuss patient information.

The key priority is guarding the dignity and the confidentiality of the patient using coded curtains pegs or signs.

Another significant element of PCC is accuracy of information, because without it, the patient cannot receive the correct treatment and medication.

Every person that comes to hospital has to be assessed by the professional staff, to ensure that the best quality care is given to the patient. This is reviewed as minimum every week or as frequently as the condition require. When all these information are correct and updated all the time we can say that the delivery of the quality care is effective and safe.

Also when a patient is transferred from one ward to another the notes and the debriefing have to be done in a correct way to avoid mistake.

For example, at the end of every shift, the hand over is given to the relative nurses with the relevant information regarding each patient on her bay. To keep the patient save, the NHS’s system assigned a unique number together with date of birth and names, to identify each person correctly, making sure that the right patient get the correct medication and the medical records are recorded and tracked correctly.

As a student nurse is very important to learn how to write and keep written records in order and updated, detailed about the care and treatment provided and for future plans. The clinical notes also contains x-rays, photographs and anything can be use to support treatments. These are to be kept accurate, secure and confidential. It is a good practice according to the NMC (Nursing Midwifery Council) to keep valuable data, to maintain high standard of clinical care, good communication and also help to notice any changes in the patient’s condition.

The practice of nursing is a dynamic and evolving profession. Engaging and negotiate with the patient has shown to be effective in achieving cooperation in result of more participation in the therapy to accomplish specific goals.

As a student nurse we are part of a wider health care team that includes: assistant practitioner, health care assistant and nurses, we are accountable for good record keeping. All these information which includes all different forms regarding care and treatments, must be accurate, use simple terminology (for the patient to understand), no abbreviations should be used, signed, timed, and dated if are handwritten to provide support in communication and decision making.

There are keys principals that must be followed to keep the records clear and effective.Project Basic Patient Care graduate paper help

These are produced by the Royal College of Nursing (RCN).

For example if some information have been omitted in the patient’s notes, regarding the administration of medication, and another medical staff will give another dose of the same medication, this will result in overdose the patient and consequence make the patient ill even more and breach the duty of care.

The PCC involved working in partnership.

Lyotard (1992) argue that since the new national schemes has been created, the social problems such as poor housing and poverty have increased rather than diminished.

Health care professionals and Social Services have been pushed to involve more the consumers in their decision making regarding their services rather than passively received them. The current policy highlights a three-way partnership between health, social care providers and services users, in which determine the combination of services that must be provided and by whom, with join services to break down barriers and responding to the local requirements.

Working successful in partnership is one of the keys to improve Person centred-care treatments.

Families, friends, doctors and health care professionals are called together to put in place an optimum plan to best interest of the patient. Involving the patients’ families contribute to expand the knowledge about that specific patient, to know more about their routine and their personality.

(Joint Improvement Team 2009) defined that working in partnership consist in two or more independent professional, working together to accomplish more successful results, than they could by working independently with the willing to share their achievements and failures.

Multidisciplinary team is formed by several different qualified professional who are involved in diverse areas of expertise, that are able to coordinate and response to patients needs.

Working in partnership means plan a method to support individuals, allowing them to take charge and meet their goals, also guide them to have a better quality life in every aspect form good mental health to physical disabilities.

For example: if we have a good relationship with a patient there will be a possibility that he/she will open himself to you and tell you about the abused received from the family or from the Home he is living. In any of this case we have a duty to report the abuse to the ward manager or is in charge and the relevant profession team will be call in to intervene and put a plane together to protect the patient.

The Healthcare Quality Strategy for NHS Scotland (Scottish Government 2010) was a further development from ‘Better Health, Better Care’ (Scottish Government 2007). In this reflective account I wish to concentrate on the peoples priorities for the people of Scotland outlined within this document, the ultimate aim is to provide the highest quality of care. It has as their objectives that care given should be consistent, person centered, clinically effective and safe and equitable with patients receiving clear communication with regards to conditions and treatment (Scottish Government 2010). Hubley and Copeman, (2008) state communication skills are paramount in healthcare to ensure that tailored advice is delivered effectively.Project Basic Patient Care graduate paper help

 

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This reflective account is based on an experience from my 3rd year management placement. Using Gibbs’s Reflective Model (1988) I aim to outline what occurred throughout the incident which involved providing clear communication and patient centered care and how this can be linked to the Quality Strategy in relation to the people’s priorities. This reflective model has been selected as it enables reflection on practice in a structured way allowing one to identify critical learning and development from their experience to enhance future practice (Bullman and Schutz, 2008). This scenario will consider how this incident will aid in my transition from student nurse to staff nurse.

To comply with patients’ rights to confidentiality and in accordance with the Nursing and Midwifery Council (NMC), (2010) I will use the pseudonym Mrs Wade.

DESCRIPTION

This reflection involves a 78 year old lady Mrs Wade who was an inpatient on the ward for 10 days after being diagnosed as having a cerebral haemorrhage. This had left Mrs Wade with a left sided weakness and aphasic. It was during afternoon visiting and taking the routine observations I noted Mrs Wade to be scoring one on the National Early Warning Score chart (NEWS) due to reduced oxygen saturation levels of 95%. However, on comparing this with previous readings this was within the parameters of her levels taken over the previous days. . I had just moved on to the next patient when Mrs Wade’s son who was visiting asked me to come back as his mother was indicating that she had pain in her chest radiating to her left jaw. I immediately took another set of observations and Mrs Wade was now scoring 10 on the NEWS chart. I immediately went to seek guidance from my mentor who instructed me to show my findings to the doctor whilst she administered GTN spray. The doctor came and assessed Mrs Wade and instructed me to administer 5mg of morphine, 15 liters of oxygen and commence an initial 250ml bag of normal saline and if Mrs Wades BP had still not risen I was to continue with a second bag, whilst he arranged an ECG and chest X-ray.Project Basic Patient Care graduate paper help

At this time my mentor advised me that I was to take control of the situation and she would assist me if I required help.

FEELINGS

My initial feeling was one of complete fear. However, I felt within seconds I regained my composure and I took control of the situation. I was relieved that training had indeed prepared me for a situation like this where I automatically began to use the ABCDE assessment (Jevon, 2010). I was also anxious but relieved in being able to communicate effectively with the doctor, my mentor, team members and Mrs Wades son. I felt I was able to handover clearly and concisely. I feel that I was able to do this as I had been dealing with Mrs Wade on each of my days on duty over the previous two weeks.

EVALUATION

The negative aspect from this incident is how a patient in one’s care can deteriorate so rapidly. However, in the case of Mrs Wade I repeatedly asked myself if I had missed some signs and this incident could have been avoided.

The positive aspect of this incident was that Mrs Wade’s deterioration had been caught instantly. I had the opportunity to discuss this incident with my mentor. At this time she praised me on how I had taken control of the situation in a calm and professional manner. I was competent when communicating with team explaining the background to Mrs Wade’s condition thus aiding an effective result in Mrs Wade’s condition being stabilized. It was also reiterated that this was an unavoidable situation and there was nothing I could have done differently to alter the outcome.Project Basic Patient Care graduate paper help

ANALYSIS

The people’s priorities outlined by The Healthcare Quality Strategy for NHS Scotland (Scottish Government 2010) and in caring for Mrs Wade on reflection I wanted to be establishing if I covered all areas and were I could improve. The priorities are to be caring and compassionate, have clear communication skills and be able to explain conditions and treatment have effective collaboration between clinicians, patients and others; A clean and safe care environment; Continuity of care; and Clinical excellence.

Jones (2012) advocates that it is essential in nursing to have good communication skills. This is also advocated by Dougherty and Lister (2008) who states that communication is an integral part of maintaining a high quality of record keeping which is regarded as a vital standard of practice by the NMC (2008). Communication and written care records aid to establish a continuity of care.

As I found Mrs Wade to have deteriorated it is stated by Hill (2012) that the outcome for a deteriorating patient is dependent on the knowledge and skills of the person or persons who find and care for them and the recognition of the acutely ill. As I was the first responder and having called for help I used my mentor and other team members to assist myself in assessing and stabilizing Mrs Wades vital signs. At this time I also asked my colleague to ensure Mrs Wades son was taken to the day room and someone would come to speak with him as soon as possible. This is fundamental to patient centered-care to communicate openly and honestly with all concerned (Brooker and Nicol, 2008).

I used ABCDE approach recommended by Jevons (2010) and The Resuscitation Council (2010). The ABCDE approach is a systematic tool were by you assess your patient and deal with the life threatening situations first. During this time I endeavored to reassure Mrs Wade at all times through effective communication skills (Scottish Government 2010, p6). Although Mrs Wade was aphasic her airways were patent and no obstruction was noted. Therefore it was acceptable to move on to B (breathing) within the ABCDE. Patients presenting with Myocardial Infarction (MI) or Pulmonary Embolism can show an increased respiratory rate. As Mrs Wade’s respiratory rate had increased and was desaturating she was commenced on high flow oxygen (O’Driscoll 2008).Project Basic Patient Care graduate paper help

Mrs Wades heart rate 109 beats per minute and on palpating the radial pulse it was fast but strong and regular. Mrs Wade’s blood pressure had decreased to 89/56 therefore commenced on a 250ml bag of saline. Urine output was already being monitored and IV access was in place.

The next stage is Disability. AVPU is a tool used to assess levels of consciousness within acutely ill patients (Jevon 2009b). This is a quick assessment tool within the NEWS and ABCDE approach; However, NICE 2007 recommend the use of the Glasgow Coma Scale to give a full assessment. At this stage my mentor checked blood glucose levels. Blood glucose levels can rise in acutely ill patients due to a result of sympathetic activation (Floras 2009). However at this stage they were within the normal range of 4-7mmol/L (Diabetes UK 2013).

During this situation to communicate my findings I used a systematic approach based on situation, background, assessment and recommendation (SBAR) tool to share the necessary information effectively and concisely (Pope et al 2009).

In the emergency situation with Mrs Wade this highlights the involvement of nurses in collaboration with other healthcare professionals and coordinate all resources to provided effective timely care. I feel that I took on the role as lead nurse in this situation I knew it was my responsibility as a student nurse in my final placement to show that I could take control of this situation, whilst in the knowledge knowing I still had my mentor if I felt I required assistance. I felt I had to show I could effectively delegate, show leadership qualities, prioritise the care of Mrs Wade whilst being able to communicate effectively in a challenging situation.

The outcome was positive in the aspect that a holistic approach to Mrs Wade’s condition was taken in accordance with The Scottish Government’s Initiative (2010) on patient centered care. I felt empowered by incorporating the use of the SBAR framework in effective collaboration with the multidisciplinary team aided clear communicating in accordance with The Scottish Government (2010). This resulted in a consistent continuity of care for Mrs Wade.Project Basic Patient Care graduate paper help

ACTION PLAN

A result of this significant event was that it gave me the experience of dealing with an emergency situation. As stated by Scheffer and Rubenfeld (2000) “Critical thinking in nursing is an essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Critical thinkers in nursing practice the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge”. I was also given the opportunity afterwards to reflect on my role and the role each member of the team took in this situation and where appropriate to remove oneself from a situation

I feel for future development I will take responsibility for my own learning in areas where I felt I lacked knowledge. In this situation I had assumed that Mrs Wade was having an MI were in fact it was a PE. I believe that in the future and with more experience I may be able to differentiate and although I would not expect to be an expert I would be better equipped to deal with similar situations in the future (RCN 2013). I was particularly anxious as I know I have no experience in Basic Life Support other than what I had learned at university and knowing this woman was for resuscitation I was anxious that this situation may occur.Project Basic Patient Care graduate paper help

OVERALL CONCLUSION

On reflection of my own experience and in using this to aid in my transition from student nurse to staff nurse I feel I have enhanced my own knowledge on basic life support outlined by the British Resuscitation Council UK (2010) cited by (Dougherty and Lister, 2011) whilst reiterating the importance of good communication skills. It also highlighted the importance of having the confidence to acknowledge one’s own lack of knowledge and be able to admit to this and where to seek guidance to ensure that the correct protocol is followed to ensure patient safety at all times and to provide continuity of care. I feel that the care given to this patient is in line with the initiative of The Scottish Government’s Healthcare Quality Strategy for Scotland (2010).

In relation to how this incident reflects on my transition it shows that on graduating as a staff nurse I will immediately assume the role which includes leadership, delegation and supervision. Once NMC registered, a host of expectations are placed upon you. The RCN (2010) reported that newly qualified staff nurses feel unprepared and overwhelmed by their new responsibilities, making the period of transition very stressful rather than exciting and truly enjoyable. However, I hope to overcome these feelings by immersing myself in the knowledge that I will adhere to all policies and guideline by The Scottish Government (2010) to ensure the best possible care and service to all.

Carney (2009) reported that clients were more likely to be dissatisfied whenever they felt the nurse leader was incompetent. The Nursing and Midwifery Council (NMC) requires that the nurse is conversant with and aware of current developments in practice by way of continued professional development after qualifying as a trained nurse. To manage a team well, a nurse will need very good communication skills in addition to the authority to take decisions within the boundaries of his/her responsibility (Cross and Prusak 2002), (Carroll 2005) as and when necessary. A nurse manager should be a good team-player and able to multi-task (Jaynelle and Stichler 2006) and possess very good communication skills that go beyond language and/or grammar, to listening, being assertive and ensuring that the nurse’s decisions are enforced especially when the nurse speaks on behalf of a client (or helps to amplify the clients voice) (Harris 2003).Project Basic Patient Care graduate paper help

The nurse manager should ensure that adequate communication links are established between the client and the MDT so that client views are always considered. The nurse manager should patiently try to clearly understand the patient (Lynden 2006) so as to be able to ensure client’s views are accommodated in client’s care delivery. In situations of acute ailments, clients can present with intellectual disability or a moderated ability to communicate verbally which can make it difficult to understand their opinions or wishes (Cameron and Murphy 2002) for their care process. To be a leader, today’s nurse will need to be able to command the respect of other team members. To achieve acceptability nurse managers need to be people with high integrity and people management/motivation skills and be able to work in a collaborative setting (Carroll 2005). Integrity in this perspective is synonymous with honesty (Kouzes and Posner 2002) and several studies have highlighted the importance of honesty for nurse management or leadership because people (clients and nurses alike) will want to assure themselves that their leader is worthy of their trust (Kouzes and Posner 2003). During my placements in an adult care unit of a major hospital, from observation and interaction with patients and healthcare staff, my attention was drawn to a plight of some of the patients in my care: I realised that some of the patients were not being allowed to determine the course of their treatment as required by the patient empowerment agenda (DoH 2008) and this was more especial in patients with acute ailments.

There was a lack of full management implementation of the Patient empowerment agenda, with particular emphasis on the relevance given to the patient’s choice (or voice) in the patient’s care delivery. The quality of care delivery is assessed by its ability to improve patient care through the collaborative team work of healthcare professionals and how patient-focused the care delivery is. For the purposes of this work, I shall refer to a renal patient in my care during my placement as Mr. B (not real name). All references to him or a hospital do not identify either. When Mr. B was … and was refusing to be compliant, I approached him and had a talk with him. I discovered that his lack of compliance was in protest of the fact that he was not aware he was being put on … reinforcing the position of Corsello and Tinkelman (2008) that clients will respond better to care that encourages their participation and is considerate of their specific needs. To ensure that this did not happen again, I brought the patient’s complaint to the attention of my mentor and ensured that the multi-disciplinary team was made aware by adequately documenting my findings and observations. I regularly sought advice and guidance from my mentor because mentoring and role-modeling are active ways of knowledge transfer in large organizations (Carney 2009) and improves the care delivery service. Service improvement remains a core requirement for the Knowledge and Skills Framework for a registered nurse (DoH 2004) and requires an all-party embracing culture of seeking continuous improvement (Janes and Mullan 2007) where honest and periodic performance appraisals are evident.Project Basic Patient Care graduate paper help

Service improvement in the NHS has been an issue of high importance and has necessitated the establishment of groups that are charged with charting out improvements within the NHS – like the ‘NHS Improvement’ (NHS Improvement Programme 2008). Practicing nurses are encouraged to keep abreast with developments from such groups. A new service improvement concept of ‘patient-safety’ is gaining popularity in healthcare although regulatory definition is not yet specific (Feng et al 2008). Flin and Yule (2003) claim patients can be injured through the actions of healthcare staff, and Feng et al (2008) insist that a blame and shame culture inhibits learning from mistakes and can exacerbate incidences of mistakes. To this end (in the UK) an Expert group was established that recommended that the culture around error reporting shifted towards finding the cause of the error rather than the culprit (DoH 2000). Nurses are often under pressure from shortage of nursing staff, and a change in the nursing environment can improve patient safety and outcomes (Lin and Liang 2007). During my placements, I observed that Mr. B was often in bed for prolonged periods between nursing visits. I appraised the risk of the situation and ranked his needs by priority. He looked like he was beginning to get sore from immobility, so I delegated his need for exercise to the physiotherapist in the MDT, and having assessed the competency level of the HCA on the ward, I delegated the tasks of keeping Mr. B’s environment clean and regularly turning him to air his back to the HCA. The HCA had been previously supervised for this task and had been assessed as competent to perform it satisfactorily.

This is a reflective essay that will be focusing on my experience and feeling on how I related with a patient who was complaining of severe pain in the surgical ward during my posting there. I will be using the Gibbs (1998) reflective cycle as a guide on this essay. The Gibbs (1998) Reflective Cycle which is one of the most popular models of reflections consists of six steps: Description which describes as a matter of fact the situation and what happened during the incident. For my case the management of this patient who was admitted and was being managed pre-operatively for intestinal obstruction; secondly, feelings which is the description or the analysis of what my thoughts and feeling were at the time of this incident. Thirdly, the evaluation of my experience: this is about what was good and bad about my experience. Fourthly the analysis of my experience about what I can make out of the situation. Conclusion is the sixth step and it is about what else I could have done and what could I not have done. The final step is the action plan. The action plan will be about what I will do if this situation arose again or what I will do differently bearing in mind my experience from the steps above (Jasper 2003).Project Basic Patient Care graduate paper help

Reflective practice writing is a way of expressing and explaining one’s own and others stories crafting and shaping to and understanding and development and it enables practice development because the outcomes of reflection are taken back into practice, improving and developing (Bolton 2005). Reflection “is a way of learning from your direct experiences, rather than from the second-hand experiences of others” (Cottrel 2003, p6). There are several other models of reflective practice. In addition to the Gibbs (1998) models, there are the Johns’ model of reflection (1995); Kolb’s Learning Cycle (1984) and the Atkins and Murphy’s model of reflection (1994).

Description
During my placement at the acute surgical ward, I came across a patient who I will name Mr Jones (not real name). This is due to confidentiality. According to the NMC (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives article 5, 6 and 7, it states that ” You must respect people’s right to confidentiality; You must ensure people are informed about how and why information is shared by those who will be providing their care; You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising” (NMC 2008, p2). When I arrived at the ward on the 8th of October, the senior nurse briefed us about the cases on the ward. I learnt that Mr Jones was admitted into the surgical ward with severe abdominal pain and he has been diagnosed with small intestinal obstruction and is being managed pre-operative for surgical intervention. While attending to the patients in the ward under the supervision of my mentor (NMC 2008), Mr Jones called out to me that he is in severe pain. Walking up to him, I noticed the agony and pain he was in. Once he had my attention he was screaming and berating me that he is in terrible pain and that he need more pain killers. I approached Mr Jones and introduced myself with the aim of building an initial and good rapport with him and to establish a nurse-patient relationship (Holland et al 2008). I was so petrified with the signs and the way he communicated with me in such a way that really expressed he was in severe pain. I assured Mr Jones that I will have a word with a qualified nurse and will be back. I walked up to my mentor and ask that Mr Jones would need some pain killers as he is in severe pain.Project Basic Patient Care graduate paper help

I was very surprise when my mentor said to me “okay, where is Mr Jones drug chart”? And to my utmost surprise, instead of getting a cocktail of pain killers for Mr Jones, she was asking several questions. How do you know that he is in such severe pain as you have just described to me? Have you asked him with the trust policy of pain scale? What type of pain killers has been given to Mr Jones and for how long ago were these given to him? She went on and on and I felt embarrassed and at same time very eager to correct my mistakes. I was unable to answer any of the questions she has asked. I guess I must have been overwhelmed with sympathy rather than empathy for the patient. I went to bring Mr Jones’ drug chart and my mentor explained to me that from his drug chart recordings, he is on oral morphine 10mg 4 hourly and the last dosage was given in just an hour ago. He would need a doctor to review to see whether he might need another route and dosage of the analgesic she explain to me.

Feeling
My first feeling was that this patient could be in severe pain and there is need to administer some form of strong analgesics. Pain according to the International Association for the Study of Pain is, “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (IASP 1979). Pain may not be totally objective but subjective according to Braun et al (2003), they went on to further point out that included in pain are emotional as well as personal experiences. Pain could be divided simply into acute and chronic pain based on its duration (Shipton 1999). Acute pain is of short or limited duration usually associated with traumatic tissue injuries, whereas chronic pain is a pain or discomfort persisting for about 3 to 6 months and may persist beyond the healing period (Sinatra et al 2009; Ready and Edwards, 1992) and pain could progress from acute to chronic (Blyth et al, 2003). There is a psychological aspect to pain. According to Eccleston (2001), pain can be influenced among other things by culture, previous pain experience, mood, ability to cope or even belief. He concluded that pain is multifactorial and as such individuals should be treated differently. One of the underpinning principles of the Roper-Logan-Tierney model of nursing is the individualisation of nursing care and nursing practice (Roper et al 2000). My mentor showed me that Mr Jones is on 10mg oral morphine four hourly and that he may need a new review by the doctor so as to reassess his pain. I went to inform Mr Jones of this. On getting to him, I introduced myself with the aim of continuing our initial good rapport and also to obtain consent. According to the RCN “Informed consent is an ongoing agreement by a person to receive treatment, undergo procedures or participate in research, after risks, benefits and alternatives have been adequately explained to them” (RCN 2005, p5). Also, it has long been documented that information reduces anxiety (Byshee 1988 cited in Hughes 2005). I informed him that he will need a reassessment by the doctor in order to change his pain killer or if there is need to increase the dose and that the doctor has been notified of this. To my surprise, this seemed to calm him down a little as I explained and listened empathically to him. In a study carried out by Matthewson at the elderly care unit at New Cross Hospital in Wolverhampton, she concluded that nursing is the art of caring and as such we must listen empathically to what patients and service users want so we can give them the care that they deserve (Matthewson 2002).Project Basic Patient Care graduate paper help

Evaluation
This being my first encounter of meeting a patient with acute pain, I have so much to learn and gain especially about acute pain management. Having ask several questions and establish a good patient-nurse relationship (Holland et al 2008), I was involved in most of management of Mr Jones. Monitoring vital signs and recording them accurately. I learnt according to Mr Jones past medical history that he was first admitted in to the hospital in September 2009 for hernia repair and discharged home. He is now being treated for small intestinal obstruction which is one of the side effects of adhesions which could result from hernia repair (Ryan et al 2004). I asked the qualified nurse series of question and she informed me that caring for patients with intestinal obstruction require great deal of nursing skills. Patients suffering from small intestinal obstruction do have not only physical needs but also psychological and nurses should be aware of the fact that patients react differently to the fact that they are acutely ill (Hughes 2005). The ward sister informed me that some of the important factors to look out for when managing a patient with bowel obstruction are the presentation symptoms and vital signs such as pain, dehydration and fluid and electrolyte imbalance and nausea and vomiting. According to Anderson (2003) vital signs need to be monitored closely for changes by nurses and respond quickly and appropriately.

 

 

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After re-assessment by the resident doctor that responded to the summon, Mr Jones morphine was increased to 20mg, 4 hourly in titrated doses so as to minimize the effect of euphoria and unwanted effects. Also the route of administration was changed so as to quicken the onset of action. According to McQuay and Moore (1999) it is sometimes advisable to change the route of administration if the patient is still complaining of pain as oral and trans-dermal route may delay the onset in acute pain. All strong opioids require careful titration from an expert practitioner it is better to begin with a small dose and increase gradually in conjunction with careful assessment of its effectiveness (Hanks et al 2001).Project Basic Patient Care graduate paper help

Analysis
Despite the fact that Mr Jones has had a surgery to repair his hernia a year earlier and is about to undergo another one shortly, he was in very good spirit. The whole process from when I came into the ward and Mr Jones called out to me that he is in severe pain till now has all been eventful and educating at same time. Mr Jones was given morphine to manage his acute pain. Several preparations are available in the pre-operative period for pain management. These include intramuscular analgesics and opiates such as morphine (Hughes 2005). Morphine was used as a drug of choice in the management of Mr Jones acute pre operative pain. Though it has several advantages that are well suited for small intestinal obstruction management like its effect on slowing down the motility of the gut (Rodney 2010) which in the case of small intestinal obstruction is good, it causes nausea and vomiting as some of its side effect due to its direct action and stimulation of the chemoreceptor trigger zone of the brain (Daniels 2008). Though anti-emetics were prescribed to counter the effect of nausea and vomiting, their effect was not profound and this caused some delay in the operative process.

Under the supervision of my mentor, I actively participated in the monitoring of Mr Jones vital signs. In addition to recording the temperature, I was involved in the monitoring of the fluid and electrolyte balance. Fluid balance was monitored hourly as one of the senior sisters explain to me the importance of a maintaining its balance. Haemodynamic stability is crucial as hypovolaemia can occur quickly because of the obstruction, fluid levels can rise quickly due to decreased gut movement causing the bowel to distend and losing its functionality of absorbing water and minerals thereby leading to fluid and electrolyte imbalance (Torrance and Serginson 2004).Project Basic Patient Care graduate paper help

I feel that the whole process involved in the management of Mr Jones pre-operative acute pain went smoothly. Being my first placement in the surgical ward I asked several questions and mentor and senior nurses were on hand to explain and in some instances demonstrate this out. But what else could I have done or what could I have done differently? Well, from the first time I went to meet the patient and then relaying the patient concern to my mentor, I should have looked at the patient’s drug chart rather than being overwhelmed by self pity. All documentation with regard to the patients’ management is on the patients’ record and it is vital that I look at this. Effectual documentation according to Porter and Perry (2009) within a patient’s medical record is an imperative and fundamental aspect in the practice of nursing. To minimize the risk of errors in the management of a patient, there is the need for accurate documentation of all drug activities in the patients drug chart (Youm 2002). As I have come to realize, pain may not be totally objective but subjective and included in this are elements of emotion as well as personal experience (Braun et al 2003). Rating scale are the most commonly used method of accessing acute pain and its relief. The World Health Organisation (WHO 1996) modified analgesic ladder to control pain in that the simple principle is that the beginning of pharmacological intervention begins on the first step of the ladder and proceeds upward. Opioids are used extensively in the management of pain and believed capable of relieving severe pain more effectively than non steroid anti-inflammatory drugs (NSAIDs) (McQuay and Moore 1999).Project Basic Patient Care graduate paper help

Action Plan
My action plan should a situation such as this arose again will be significantly different. I will continue to reflect and study how acute pain is managed and the role of the nurse in such management and most especially to ensure I look at documentation for patients. Effective pain management is fundamental to quality care, good pain control speeds recovery. To increase the effectiveness of nursing interventions and to improve the management of pain, the use of pain assessment tools for acute pain has to be followed such as verbal description scales(VDS) which are based on numerically ranked words such as none mild, moderate severe and very severe for assessing both pain intensity and response to analgesia. Numerical Rating Scales (NRS) this is easily used as a verbal scale of 0-10 indicating no pain on one extremity of the line and 10 indicating severe pain at the other extremity (Hammer and Davies 1998). Uncontrolled pain can lead to increased anxiety, fear, sleeplessness and muscle tension which further exacerbate pain (Dougherty and Lister (2008). Perkins and Kehlet (2000) suggested that poorly controlled acute pain may lead to the development of chronic pain. I also learnt that there is a psychological aspect to pain. My nurse-patient relationship really helped in this area. According to Holland et al (2008) each patient should be regarded as unique in a nurse-patient relationship and that individuality should be taken into account when undertaking nursing care (Holland et al 2008 p11). Another aspect of nursing care that helped was effective communication which is an essential prerequisite for effective nurse-patient relationship (Robinson 2002). By talking to patient in an open, honest way about their pain made them feel more relaxed and in control which help them to cope better. I hope to increase my nurse-patient relationship and how to deal with acute cases. This will be a goal I will be aiming at in my next placement though discussion with my mentor and further research.

Action learning is described as a continuous process of learning and reflection, supported by colleagues, with an intention of getting things done. (McGill and Beatty 2001) It involves working together to learn, focusing on real problems and reflecting on experiences. The first action learning set involved discussions and ideas with colleagues supported by the facilitator. It was identified in our action learning set the need to focus on the two formative assessments, as part of the flexible learning module.Project Basic Patient Care graduate paper help

Following the first action learning set, my impressions were that I was uncertain that this method of learning would meet my learning needs as I found it difficult to understand how this concept would work with people choosing different topics for their projects. I also found it difficult to communicate, as I didn’t feel confident in talking in groups. Subsequently, we all discussed our ideas and set ourselves actions for the following week. Therefore, by the end of the session I had identified my actions were explore research around the topic of preventing health care associated infections and discuss with my mentor what the practice placement project involved and to make a decision on the topic.

After collating evidence I established that, hand hygiene is regarded as the most effective way of preventing healthcare associated infection’s (Gould 2010). Healthcare associated infections are infections acquired in hospitals or as a result of healthcare interventions (DOH 2008). I felt that this is an important factor in contributing to the prevention and control of infection as Health care associated infections affects patients and their. I feel to provide the best possible care, it is important to within your role, assess and minimise the risks, acting to protect people in your care (NMC 2008).Project Basic Patient Care graduate paper help

During my initial meeting with my mentor, we highlighted my learning needs and personal goals I wished to achieve during the placement. The NMC (2008) states that mentor are professionally accountable for students on placement and have a duty to help students develop nursing competencies. Therefore we explored ideas for the project and following completion of my action, I produced the evidence to my mentor. After discussing my rational for choice I was able to make the decision for the practice placement project. I explained that I didn’t feel confident in speaking in groups and that I was anxious about the presentation. I felt a professional relationship had been built were I was in a position to discuss my thought and feeling and felt I was fully supported by my mentor.

Learning opportunities were provided which included a spoke placement with the infection control nurse. Pellet (2006) states that the role of the mentor in clinical teaching is to facilitate learning experiences. During my spoke placement I had the opportunity to gain information on local and government policy in relation to infection control and was advised on how I could obtain the policies and infection control bacteraemia figures used in the original presentation which highlighted the increase. In the next action learning set I was able to share this information and create new actions to develop and increase my knowledge.

I found out that the hospice devised a policy on infection control however it linked with the local trust and followed their policy and procedure in regards to infection control. Therefore, in order to collate the policies and bacteraemia figures I was advised to contact the infection control nurse at the local trust by telephone. The information I requested was then e-mailed to me. The policy provided me with relevant evidence to use within the presentation; therefore I had developed my evidence base to support my presentation.Project Basic Patient Care graduate paper help

The evidence included government and local policy. The National Patient Safety Agency (NPSA) launched the campaign “clean hands safe care” in 2006 which highlighted the need the effective hand hygiene and identified area for improvement. The World Health Organisation (2010) defines clean hands lead to safer health care.

I decided that in order to produce the project I needed to explore information on learning styles, learning environments and how to create a PowerPoint presentation.

I noticed how the hospices presentation incorporated the importance of hand hygiene however it did not demonstrate the hand washing procedures. Therefore, my action was to research and identify my own learning style developing an understanding of how the audience will respond and learn from the presentation.

Kolb (1984) developed a learning theory which identifies four learning styles. The model provides individuals to understand their learning styles from experience to reflection observation. Kolb (1985) states that it is important for individuals to understand their learning styles, this then allow them to improve their effectiveness as learners. Honey and Mumford (1986, 1992) developed a variation on Kolb’s model and devised their learning styles questionnaire. The four learning styles included activist, reflector, theorist and pragmatist.

The Honey and Mumford questionnaire was discussed in our action learning set and was set as a group action to complete the questionnaire. On completion of the questionnaire, I identified that was a reflection. Honey and Mumford (1992) describe a reflector as observers of experiences, who prefer to analyse them thoroughly before taking action. They are good listeners, cautious and tend to adopt a low profile. Following this description I can relate to this as my initial thoughts of the action learning sets were that I didn’t feel confident talking within a group, therefore I tend to adopt a low profile.Project Basic Patient Care graduate paper help

A demographic questionnaire and Honey and Mumford’s (2000) learning styles questionnaire were administered to a sample of undergraduate nursing student. The results included a trend of reflector as a preferred learning style for undergraduate nurses. This information is also highlighted in previous studies (Alonso 1992, Cavanagh et al 1994 cited in Rasool et al 2007) Analysing the evidence provided me with a knowledge base which enabled me to understand the concept of learning styles, this contributed to my learning and development as I was able to utilise the information to focus on the how I would present the project to meet individuals different learning styles.

After I had completed the proposed actions from the previous action learning set I was able to return and present my findings to the group. The action learning sets provided a point of contact with other and enabled us to share information we had gathered and provided an opportunity to ask questions and set actions to continue with the task. As I had previously identified, according to Honey and Mumford my preferred learning style was a reflector. This enabled me to reflect on my initial thoughts around action learning and emphasised that I do tend to adopt a low profile in situations however following observing and analysing the situation I tend to take action.

Attending a study skills session on database searching within the university was a positive learning experience. I was able to learn new skills in order to development personally, which consequently provides professional development. I decided that utilising the resources within the clinical environment and the university I would continue to practise literature searching to increase and widen my knowledge of the topic and specifically the learning environment. Therefore, this contributed to my next action.

Hand (2006) states that the learning is affected by the environment where it takes place. This article highlighted key factors in promoting effective teaching focusing on characteristics of a good learning environment, the role of the practice placement and demonstrated the awareness of the role of the teacher. This enabled me to incorporate evidence based practise into my project presentation. The NMC (2008) states you must use evidence based practise to provide the best care, it also states the need for taking part in appropriate learning to ensure you develop your competencies. This links with the rationale of choice for my project presentation as the NMC (2008) states the need to provide a high standard and care at all times, delivering care on the best available evidence. Therefore the NPSA “clean your hands” campaign provides clear evidence based practise between hand hygiene and infection control.Project Basic Patient Care graduate paper help

Throughout the placement I had several opportunities to discuss with my mentor the project presentation. Gray and Smith (2000) state that the mentor’s qualities provide an important part of the learning environment and I was able to be supported by being set goals and facilitate my own learning. I had developed my practise placement project using a variety of different resources such as literature searching, clinical experiences, action learning sets. The information I located enabled me to link theory to practise to develop a PowerPoint presentation which incorporated audio and visual effects, as a result ensuring a variety of the audiences learning styles were able to be met. Utilising the evidence I had obtained I was able to provide an evidence based presentation to facilitate learning and development for myself and others in the clinical area. I have learned a lot from this experience from both personal development of preparing and presenting a presentation, enabling me to personally reflect, to reviewing evidence based literature applying this and using it for educational purposes within the clinical environment. This fulfilled my aim and rationale to highlight the importance of hand hygiene and demonstrate the correct procedures. Therefore, having a direct impact on patient care.

Although I had previously expressed anxiety due to not being confident in speaking in groups, the action learning sets along with my mentor had impacted on my development in confidence. Stuart (2007) describes how placements can be stressful and Moscaritolo (2009) states how increased anxiety can reduce learning. However, the delivery of the presentation was successful.Project Basic Patient Care graduate paper help

Pellatt (2006) states the mentors and responsible for the assessment of the students learning in practice. Throughout the placement the mentor provided opportunities were provide constructive feedback, Bennett (2003) states that assessment ensures the student is aware of strengths and weaknesses in practise, this is important so that the student is able enhance their practise. To ensure I received feedback on my presentation I devised a short questionnaire about the presentation and was able to reflect on the feed back I received.

As I have identified throughout this learning experience, I feel I still need to build my confidence. Westwood (2010) states that people are more likely to achieve their goals if they focus on the future instead of their present problem. In order to overcome this barrier I have formulated a SMART goal. A SMART goal is an acronym for Specific, Measurable, Attainable, Realistic and Time bound. My SMART goal is specific to myself as it will provide me with the opportunity to develop my personal and professional learning and development. Project Basic Patient Care graduate paper help

There is often misperception and confusion with the terms dementia and Alzheimer’s disease, but there is a distinctive difference. Dementia is a symptom that can be caused by many disorders and Alzheimer’s disease is the type and cause of dementia. When someone is told they have dementia, it means that they have significant memory problems as well as other cognitive difficulties, and that these problems are severe enough to get in the way of daily living.

Dementia may be caused by any of the followings: high fever, AIDS, dehydration, systemic lupus erythematosus, hydrocephalus, Lyme disease, vitamin deficiencies, long-term drug or alcohol abuse, poor nutrition, hypercalcemia, hypothyroidism, brain tumor and multiple sclerosis. Dementia can also result from a reaction to medication or a head injury that causes bleeding in the brain. Dementia includes deterioration in memory, and intellectual incapability such as inability to generate comprehensible speech and understand written or spoken language; inability to recognize objects; inability to think conceptually, plan, make sound judgments and carry out complex tasks. The deterioration in intellectual abilities must be severe enough to restrict with daily life. Different types of dementia are related with different symptom, patterns and microscopic brain abnormalities.

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Alzheimer’s disease causes drastic changes in the brain. As healthy brain substance degenerate people suffering from Alzheimer’s disease experience a decline in memory and the capability to use their brain to do tasks. Alzheimer’s disease is a progressive brain disorder. It destroys brain cells, causing problems with behavior, memory and thinking severe enough to affect work, or social life. Alzheimer’s disease is fatal and gets worse over time. Alzheimer’s disease is predominantly common in elder people. Because it is the most common cause of dementia, Alzheimer’s disease is frequently associated with the general term dementia. Though, there are many other causes of dementia. To be clear, Alzheimer’s is a type of dementia and that is the key difference between Alzheimer’s and dementia.

Even though Alzheimer’s disease is responsible for 60-70 percent cases of dementia, other conditions that cause dementia include: Parkinson’s disease, Vascular dementia, Frontotemporal dementia and dementia with Lewy Bodies. In the early phases of a disease, there may be some differences between the diseases. For instance, in dementia with Lewy Bodies early symptoms may not be forgetfulness, but recurrent visual hallucinations, lowered attention span and variability between phases of lucidity followed by phases of confusion. Nevertheless, as the specific disease progresses, more portions of the brain become affected, and the differences between one cause of dementia to another becomes vague and delicate.

Physicians at times prefer the word “dementia”, perchance because Alzheimer’s has become a heavy and complicated word. “Dementia” someway sounds less terrifying to many people, and now even the specialists have started using this word. Differentiating between other types of dementia and Alzheimer’s disease is not easy and direct as defining these terms. In reality, people and their disordered behaviors are more complicated than the simple definitions of the disorders. Remember, the chief difference among dementia and Alzheimer’s is that Alzheimer’s is a definite disease and dementia is an indication of Alzheimer’s.

Link to websites

http://www.alzheimersreadingroom.com/2009/09/dementia-and-eight-types-of-dementia.html

http://www.dementiaguide.com/community/dementia-articles/Difference_Alzheimer’s_and_Dementia

http://www.mayoclinic.com/health/alzheimers-disease-and-dementia/AZ00053

What Causes Dementia?

In a healthy brain, bulk and speed may deteriorate in adulthood, but the brain continues to form vital functions throughout the life. However, when the brain connections are lost due to inflammation, injury or disease, brain cells ultimately die and dementia may possibly result. Understanding cause of the dementia is the first step. In the preceding twenty years, scientists have explained the origins of dementia. Genetics might increase the risks, but scientists believe that a combination of hereditary, lifestyle and environmental factors are the most likely causes. Dementia has several different causes, some of which are hard to tell apart. Causes of dementia may be divided into reversible and irreversible dementias. Some of the conditions that cause dementia may be reversible, even though unluckily most types of dementia do not recover with medical treatment. So, it is very important to assess dementia symptoms carefully, so as not to miss possibly treatable conditions.

In order to be diagnosed with dementia, one must suffer a decline in mental ability severe enough to interfere with daily life. While symptoms of dementia can vary greatly, the most common indicators are memory issues, communication and language impairment, and the loss of ability to focus and pay attention. Symptoms of dementia often tend to start out slowly and then gradually progress over time. Most of the types of dementia continue to worsen and are usually irreversible. Observable dementia signs may include: asking the same questions repeatedly, becoming lost in familiar locations, being unable to follow simple directions, getting disorientated about time, people and places, and a loss in attentiveness for personal hygiene. There is no distinct test that can show whether a person has dementia.

Irreversible causes

The main irreversible causes of dementia are given below. Treatment emphases on slowing progress of the underlying disorder and relieving symptoms.

Alzheimer disease: This is the most commonly occurring cause of dementia. Alzheimer tends to run in families. In this disease, atypical protein deposits in the brain and destroy brain cells in the areas that control memory and intellectual functions. Alzheimer disease is irreversible, and no known treatment exists. Though, certain medicines can slow its progress.

Vascular dementia: This is another most common cause of dementia. This dementia is caused by hardening of the arteries, in the brain. Deposits of fats, dead cells, and other debris inside the wall of arteries, partially or completely block the blood flow. This blockage causes disruptions of blood flow, to the brain. Vascular dementia is related high cholesterol, to high blood pressure, diabetes, heart disease, and related conditions. Treating those conditions can slow the development of vascular dementia.

Parkinson disease: Patients with this disease characteristically have limb stiffness, speech problems, and tremor (shaking at rest). Dementia might develop late in this disease, but not everybody with Parkinson disease has dementia. Speech, reasoning, memory, and decision making are most likely to be affected.

Lewy body dementia: This dementia is caused by abnormal deposits of protein, called Lewy bodies, which destroy brain cells. The deposits can cause symptoms like tremor and muscle rigidity. Lewy body dementia affects concentration thinking and attention more than language and memory. Lewy body dementia has no known cure.

Huntington disease: This is an inherited disease and causes degenerative of certain types of brain cells that control movement and thinking. Dementia occurs in the late stages of the disease. Personality changes are characteristic feature. Reasoning, judgment memory and speech may also be affected.

Creutzfeldt-Jakob disease: This disease occurs most often in young and middle-aged people. Infectious agents which are called prions kill brain cells, causing memory loss and behavior changes. The disease progresses quickly and is fatal.

frontotemporal dementia: This is a rare disorder that harms cells in the front area of the brain. It causes memory loss, language problems and personality changes.

Treatable/reversible Causes

The dementia in these disorders may be reversible or partially reversible.

Head injury: This mentions to brain damage from accidents, for example from road traffic accidents; gunshot wounds; or from activities such as boxing. The resultant damage of brain cells can cause dementia.

Infections: Infections such as meningitis and encephalitis are main causes of dementia. Other infections, such as HIV and syphilis, can also affect the brain in advanced stages. In all such cases, inflammation in the brain harms the cells.

Hydrocephalus: The brain fluid is called cerebrospinal fluid. If too much fluid accumulates outside the brain substance, it causes hydrocephalus. This condition raises the pressure on the brain and compresses it. It might cause severe damage and death. Hydrocephalus may cause dementia symptoms or coma. Patients have trouble walking and they can’t control urination. At the same time they start to lose memory.

Brain tumors: A tumor can press on brain structures which control hormone secretion. They can also press the brain cells, causing damage. Treating the tumor can reverse the symptoms.

Toxic exposure: People who work around heavy metal dust and fumes especially lead without protective equipment may develop dementia because these substances can damage brain cells.

Metabolic disorders: Diseases of pancreas, liver or kidneys can lead to dementia by disturbing the amount of salts and other chemicals in the blood. These alterations occur rapidly and affect the patients’ level of consciousness. Treatment of the underlying disease may fully reverse the disorder. If the underlying disease continues, brain cells may die, and the patient will have dementia.

Hormone disorders: Diseases of organs such as thyroid gland, parathyroid glands, pituitary gland, or adrenal glands can cause hormone imbalances, which results in dementia if not treated.

Poor oxygenation: People who do not have enough oxygen in their blood may develop dementia because the blood brings oxygen to the brain cells, and brains cells need oxygen to live. The most common causes of hypoxia are lung diseases such as emphysema or pneumonia. Cigarette smoking is a frequent cause of emphysema. Heart disease leading to congestive heart failure may also lower the amount of oxygen in the blood. Sudden, severe hypoxia may also cause brain damage and symptoms of dementia. Sudden hypoxia may occur if someone is comatose or has to be resuscitated.

Drug reactions or drug abuse: Certain drugs can cause temporary problems with memory as side effects in aged people. Misuse of drugs, whether deliberate or unintentional, can cause dementia. The common culprits are tranquilizers and sleeping pills. Illegal drugs, especially cocaine and heroin may also cause dementia, particularly in high doses and if taken for long periods.

Nutritional deficiencies: Lack of certain nutrients, particularly B vitamins, can cause dementia if not improved.

Chronic alcoholism: Prolong use of alcohol can causes dementia due to complications of alcohol misuse such as liver disease and nutritional deficiencies.

Link to websites

http://www.emedicinehealth.com/dementia_overview/page3_em.htm#dementia_treatable_causes

http://www.webmd.com/alzheimers/guide/alzheimers-dementia

http://www.helpguide.org/elder/alzheimers_dementias_types.htm

http://my.clevelandclinic.org/disorders/dementia/hic_types_of_dementia.aspx

What are the types of dementia?

Dementia develops when the areas of the brain that are involved with memory, learning, language and decision-making are affected by infections or diseases. When life’s encounters include dementia or memory loss, perceptions, priorities and relationships inevitably change. But the good news is that some types of dementia can be reversed or treated if caught in time. With dementia, there will be noticeable decline in learning, communication, problem solving and remembering. These changes may happen quickly or very slowly over time. The development and outcome of dementia differ, but are mostly determined by which area of the brain is affected and the type of dementia and.

It is appropriate to categorize most dementias as Alzheimer type and non-Alzheimer type. The Alzheimer type are characterized primarily by memory loss, supplemented by impairment in other intellectual functions such as language function, skilled motor functions or perception, visual or other. Non-Alzheimer dementias include the frontotemporal lobar degenerations, which generally are of two main types. One primarily affects speech and the other is characterized mainly by changes in behavior, and personality change. In both of these types, memory loss is comparatively mild, if present. Other types of dementia, comprising vascular disorders, normal pressure hydrocephalus, Parkinson’s dementia and dementia with Lewy bodies would be categorized under the non-Alzheimer disorders.

Dementias can be categorized in a variety of ways and are frequently grouped by common similarities, such as the brain is affected, or deterioration over time which is termed as progressive dementias. According to most professionals, there are two main types of dementia, depending upon the area of brain affected, that are called cortical and subcortical dementias. Brain disorders causing dementia are situated either in the cortical area or within subcortical regions of brain.

Cortical Dementia – In cortical dementia, the cerebral cortex of the brain is affected. This is the outer region of the brain. The cerebral cortex is important for intellectual processes, such as memory and language. The distinctive convolutions of the cortex play an important role in processing information. Patients with cortical dementia are unable to recall words and understand language. Creutzfeldt-Jakob disease, Pick’s disease, Binswanger’s disease and Alzheimer’s disease are included in cortical dementia.

Subcortical Dementia – In subcortical dementia, the region of the brain below the cortex becomes impaired or damaged. Memory and language are not typically affected. A person with subcortical dementia will experience changes in his behavior, his thinking might slow down, and his concentration span may be shortened. Dementias which result from Parkinson’s disease, AIDS and Huntington’s disease are subcortical dementias.

In multi-infarct dementia, both the cortical and subcortical areas of the brain are affected or damaged. Multi-infarct dementia is caused by a sequence of small strokes. A stroke is a disruption in or obstruction of the blood supply to any portion of the brain. When the strokes affect a small area, there may be no signs of a stroke. Over time, when more areas of the brain are involved, the symptoms of multi-infarct dementia begin to appear.

Link to websites

http://my.clevelandclinic.org/disorders/dementia/hic_types_of_dementia.aspx

http://www.medicalnewstoday.com/articles/142214.php

What are sign & symptoms of dementia?

Symptoms of dementia differ considerably by the patients, the primary cause of the dementia and the part of brain that is affected. Most patients affected by dementia have some of these symptoms. The symptoms may be evident, or they may possibly be very subtle and remain unrecognized for some time. The first indication of dementia is generally loss of short-term memory. Other symptoms and signs are as follows:

Early dementia

Memory loss; this is typically the earliest and most obvious symptom.

Trouble in identifying people and places

Word-finding trouble – May be able to compensate by using synonyms or defining the word

Fail to recall names, recent events, or losing things

Trouble in performing familiar activities – household tasks, driving, cooking a meal

Personality changes – such as a sociable person becomes quiet or a quiet person is silly

Unusual behavior

Poor decision making

Mood swings, often with momentary periods of anger

Behavior disorders – Distrust and suspiciousness

Deterioration in level of functioning but able to follow conventional routines at home

Confusion, disorientation in strange surroundings

Depression is common, and anxiety or violence may occur.

Intermediate dementia

Deterioration of symptoms that are seen in early dementia

Incapable to carry out daily activities e.g. bathing, grooming, dressing, feeding etc

Disturbed sleep

Increasing confusion and disorientation even in familiar environments

Incapable to learn new information

Hallucinations

Risk of accidents and falls due to confusion and poor judgment

Behavior disorders – aggressiveness, misunderstandings, suspicious, nervousness and inappropriate sexual behavior

Believing the person has completed or experienced things that never occurred

Distraction, poor concentration

Lack of interest in the world

Abnormal moods; depression, anxiety

Severe dementia

Worsening of symptoms that are seen in early and intermediate dementia

Complete dependency on others for daily activities

Unable to walk or move from one place to other place independently

Weakening of other movements such as swallowing

Increases risk of malnutrition, choking, and inhaling foods and drinks into lungs

Complete loss of both short- and long-term memory – unable to recognize even friends and close relatives

Complications – malnutrition, dehydration, infections, problems with bladder control, aspiration, pressure sores, seizures, injuries from falls or accidents

The person may not be aware of these problems, especially the behavior problems. This is especially true in the later stages of dementia.

Depression in aged people may cause dementia like symptoms. Approximately 40% of patients with dementia are also depressed. Common symptoms of depression are depressed mood, sleep disturbances, weight gain or loss, loss of interest in activities once enjoyed, withdrawal from others, suicidal thoughts, loss of ability to think clearly or concentrate and feelings of worthlessness.

People with untreated dementia present a gradual decline in intellectual functions and movements. Complete dependence and death are the last stages.

Some types of dementia cause certain symptoms: Patients who have dementia with Lewy bodies have visual hallucinations. And they might fall frequently. In frontotemporal dementia the first symptom may be unusual behavior or personality changes. Patients with this disease may not express any concern for others, or they may say impolite things, make sexually explicit remarksor expose themselves.In vascular dementia there is abrupt onset of symptoms.

It is important to know that memory loss can be caused by conditions other than dementia, such as depression, and that those conditions can be treated. Also, occasional trouble with memory (such as briefly forgetting someone’s name) can be a normal part of aging. But if you are worried about memory loss or if a loved one has memory loss that is getting worse, see your doctor.

Link to websites

http://www.emedicinehealth.com/dementia_overview/page4_em.htm#dementia_symptoms

http://www.webmd.com/alzheimers/tc/dementia-symptoms

Care for patients with dementia

When an individual with dementia finds that their intellectual abilities are deteriorating, they often feel helpless and in need of encouragement, support and assurance. The persons closest to them, including their family members and friends, must do everything to help the individuals to retain their feelings of self-worth and sense of identity. A person with dementia may follow these steps to improve quality of life.

Quiet, peaceful and steady surroundings

A quiet, peaceful and even surrounding reduces problems such as anxiety, nervousness and confusion. Unfamiliar situations or people, disturbed routines, feeling rushed, loud noises, or being asked to finish multistep tasks can cause frustration. When a patient has dementia, becoming distressed reduces the capability to think clearly even more.

Sleeping pattern

Dementia behaviors may become worse at night when the patient is more tired, stressed by the demands of the day or maybe confused because of darkness. Try to establish calming sleeping routine. It can be helpful to avoid the noise of television or family members. Leaving lights on helps prevent confusion. Exercising during the day, avoiding daytime napping and limiting caffeine during the day may help prevent nighttime agitation.

Reminder

A patient can use a reminder for upcoming events and tasks that needed to be completed on daily basis. The patient may check off those tasks when done.

Make a plan

A patient should make a comprehensive plan that identifies objectives for care. Various support agencies, legal advisers, primary and specialty doctors, care centers, and family members can help achieve these objectives. The families should consider about the followings:

The plan for treatment

Primary caregiver

Caretaking at a family home or a nursing home

Support in daily routine such as meal preparation, taking medications and daily hygiene

Put labels on everything to help them with the forgetfulness

Treat them with affection and respect

Plan activities that are stress free such as music therapy and walks to the garden or park

Legal issues such as power of attorney for health care issues and a living will

The disease will progress over time, and the care needs to be adjusted with symptoms. Patients with dementia should be encouraged to carry on their daily activities as long as the activities don’t cause confusion or frustration. Mental, physical and social activities help maintain a individual’s health and well-being.

Lifestyle modification

Leading a healthy lifestyle is vital to lowering your risk of dementia and other diseases. Recent research proposes that good mental stimulation and health habits may delay the onset of dementia. Plans to improve mental clearness are:

Regular exercise: Exercising regularly will make the heart and circulatory system more effective. It will also help lower the cholesterol and blood pressure, decreasing the risk of developing dementia.

Challenge your mind

Eat a healthy diet: A low-fat, high-fiber diet is recommended, comprising fresh fruit and vegetables and whole grains. Limit the amount of salt in the diet. Too much salt will increase the blood pressure, which increases the risk of developing dementia. Avoid eating foods that are rich in the cholesterol, which also increases the risk of developing dementia.

Minimize stress

Get regular and peaceful sleep

Avoid smoking and reduce drinking: Smoking and excessive alcohol consumption increases blood pressure and blood cholesterol level. Both are major risk factor for developing cardiovascular diseases and dementia.

Maintain a healthy weight: Overweight may increase the blood pressure, which increases the risk of dementia.

Keep the blood pressure at a healthy level.

Link to websites

http://www.mayoclinic.com/health/dementia/DS01131/DSECTION=lifestyle-and-home-remedies

http://www.nhs.uk/Conditions/Dementia/Pages/Prevention.aspx

How is dementia treated?

Because dementia can be caused by any number of disorders, obtaining a precise diagnosis is important for the management and treatment. However dealing with dementia is a challenge, the doctor can assess the personal risk factors, evaluate symptoms, offer tips on healthy lifestyle, and help to obtain suitable care. For most of the dementias, treatments to reverse or stop disease development are not available. However, treatment with available medications and other measures, such as cognitive training can benefit the patients to some extent.

Drugs to specifically treat Alzheimer’s disease and other progressive dementias are available and are prescribed for several patients. Though these drugs do not stop the disease or reverse the brain damage, they can improve sign and symptoms and slow the advancement of the disease. This may possibly improve the person’s quality of life, ease the liability on caregivers, and delay the admission to a nursing home. The researchers are also evaluating whether these drugs are useful for treating other types of dementia.

Many individuals with dementia, mostly those in the early stages of the disease, may possibly benefit from practicing tasks intended to improve performance in particular aspects of intellectual functioning. For instance, individuals can sometimes be educated to use memory supports, such as reminders, note taking or computerized recall devices.

Behavior amendment – rewarding suitable or positive behavior and disregarding inappropriate behavior may help control intolerable or dangerous behaviors.

Treatment of dementia possibly will help slow or reduce the development of symptoms.

Cholinesterase inhibitors: These medicines work by increasing levels of chemical messengers involved in judgment and memory. Side effects can comprise diarrhea, nausea or vomiting. Though mostly used in Alzheimer’s disease, they’re also used to treat Parkinson’s, Lewy body and vascular dementias.

Memantine: This drug is widely used for the treatment of dementia. It works by regulating the action of glutamate, which is a chemical messenger involved in almost all brain functions, such as memory and learning. Its common side effect is lightheadedness or dizziness. Some studies have shown that combining cholinesterase inhibitor with a memantine may have even improved results. However, it is primarily used to cure Alzheimer’s disease, but it may also be helpful in improving signs and symptoms in other dementias.

Additional medications: However, no standard treatment for dementia is available, but some symptoms can be treated. Other treatments aim to decrease the risk factors for advanced brain damage and impairment.

Management of the underlying causes of dementia may also slow or at times stop its progression. For example, to prevent a stroke, the clinician may prescribe medicines to control raised cholesterol levels, high blood pressure, diabetes mellitus and heart disease. Clinicians may also prescribe medicine to treat disorders such as blood clots, sleeplessness and anxiety for individuals with vascular dementia.

In addition, some particular symptoms and behavioral issues can be managed with antidepressants, sedatives and other medications, but certain drugs may possibly worsen other symptoms.

There is no treatment available for Creutzfeldt-Jakob disease. Care should be focused on making sure that the person is contented and relaxed.

Link to websites

http://www.mayoclinic.com/health/dementia/DS01131/DSECTION=treatments-and-drugs

http://www.medicinenet.com/dementia/page16.htm#is_there_any_treatment_for_dementia

http://www.helpguide.org/elder/alzheimers_dementias_types.htm

TESTS USED IN DIAGNOSING DEMENTIA

Memory impairment and other dementia symptoms have numerous causes, so diagnosis may be challenging and it involves a number of tests.

Medical history

The doctor will ask about the onset of symptoms and any other health problems that might help in diagnose, for example diabetes mellitus, hypertension or a family history of dementia. The doctor may also request information from the family member.

Physical examination

A physical examination helps to rule out causes of dementia and other disorders that may cause similar symptoms. This examination can also help recognize signs of other diseases, such as vitamin deficiency, heart disease, hormonal diseases, infection and any side effects of medication, which can overlap with dementia. These other causes are easily treated.

Cognitive tests

Intellectual functions should be evaluated to diagnose dementia. A number of tests measure general intellectual skills, coordination, academic skills, spatial skills, language skills, attention, memory, judgment and reasoning. The objective is to determine presence of dementia is present, its severity and affected part of the brain. Some of the commonly applied cognitive tests comprise:

Mini-Mental Status Examination

This test is conducted by a doctor and takes around 5 minutes to complete. The Mini-Mental Status Examination is the most common test for detecting dementia. It evaluates skills such as writing, reading, coordination and short-term memory.

Alzheimer’s Disease Assessment Scale-Cognitive

This test can be used for individuals with mild symptoms. It is the best brief examination for language and memory. It takes approximately 30 minutes and is conducted by a specialist or a psychologist.

Neuropsychological evaluation

This involves very sensitive tests conducted by a neuropsychologist. The usual testing session will take at least 2 hours and may be conducted over more than one visit. A number of tests will be used and may comprise tests of memory, reasoning, comprehension and writing.

Radiological tests

X-rays may be taken and those who are chronic smoker will commonly need a chest X-ray to rule out lung tumor, which may cause a secondary brain tumor.

Brain imaging techniques

Brain imaging techniques are necessary to identify tumors, strokes or other conditions that can cause dementia. Alzheimer’s disease alters brain structure and can be seen with a brain scan. Several kinds of scans are in use.

CT and MRI scans. The best imaging techniques for detecting dementia are magnetic resonance imaging (MRI) and computerized tomography (CT). Magnetic resonance imaging is a technique that uses a radio waves and magnetic field to create thorough images of the tissues and organs. Computerized tomography is an X-ray technique that creates images of body and shows internal structures in cross section. These scans help to identify strokes, brain-size changes and other problems such as hydrocephalus.

Electroencephalogram (EEG). This device can detect and record outlines of electrical activity and abnormalities. These abnormalities can indicate intellectual dysfunction, which is common in individuals with moderate and severe Alzheimer’s disease. An EEG can also identify Creutzfeldt-Jakob disease, seizures and other conditions associated with dementia.

Positron Emission Tomography and Single-Photon Emission Computerized Tomography

In these tests, a radioactive material is injected into the patient and emissions from the brain are detected through the detectors in the scanner. Positron Emission Tomography provides visual images of activity in the brain. Single-Photon Emission Computerized Tomography is used to see the blood flow to different regions of the brain.

Laboratory tests

Different types of lab tests can help rule out dementia and other conditions, such as kidney failure, that can cause similar symptoms. Treatable medical diseases are often associated with dementia. Tests that can help in detecting treatable medical diseases include:

Complete blood count to rule out anemia and infection

Blood glucose test to rule out diabetes

Blood or urine test to detect drugs or alcohol

Renal function test

Serum electrolytes

Liver function test

Tests for Vitamin B12 deficiency

Thyroid hormone levels to rule out hypothyroidism

Cerebrospinal fluid examination to rule out brain infections

Psychiatric evaluation

This test may be performed to rule out depression or other psychiatric disorder.

Link to websites

http://www.fightdementia.org.au/understanding-dementia/tests-used-in-diagnosing-dementia.aspxhttp://www.mayoclinic.com/health/dementia/DS01131/DSECTION=tests-and-diagnosis

Understanding the Various Dementia Stages

Dementia is a disorder that is characterized by a group of signs and symptoms that results in weakening of the function of brain. There are distinct dementia stages and each has its characteristic symptoms. Several symptoms may possibly be experienced by nearly all patients affected with this condition but it must be noted that sign and symptoms of dementia stages may also differ from person to person. It will be appropriate to look at various stages of dementia along with the proper dementia care that is required.

Main Stages of Dementia

There are three main stages of dementia which categorizes the disorder into general signs and symptoms.

Mild: In this stage, affected persons still have the ability to live independently and they can still perform day-to-day hygiene activities such as taking a bath. They can also make sensible judgment but their ability to socialize and work is impaired.

Moderate: In this stage, working somewhere is not possible any longer. In this stage, the independent living begins to diminish. Therefore, supervision may be beneficial.

Severe: In this, affected persons needs total observation since their independent functions and everyday activities are severely damaged.

Dementia can also be classified into different stages by concentrating on the intellectual function of the patients experiencing dementia. This classification consists of seven stages and comprises a wide-ranging list of signs and symptoms.

The Seven Stages of Dementia

Stage 1/No Cognitive Decline

In this stage there are no clinical and personal complaints of memory loss.

Stage 2/Very Mild Cognitive Decline

This stage is characterized by memory weakening related to aging for example individuals forget where they placed things and even names.

Stage 3/Mild Cognitive Decline:

In this stage clear cut impairments occur. Patient may perform poorly at work and may be lost when going to familiar places. They may also forget names and items as well as forget valuable things.

Stage 4/Moderate Cognitive Decline:

This stage is manifested by reduced knowledge of recent happenings, familiar persons, personal history and even reduced concentration.

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Stage 5/Moderate Dementia:

Individuals are totally dependent on others. They can’t remember names such as their family member names and phone numbers.

Stage 6/Moderately Severe Dementia:

The patients may retain some awareness of their past but may at times forget name of family members and latest experiences. They might also slow delusional behavior along with preoccupied and anxiety symptoms.

Stage 7/Very Severe Cognitive Decline:

In this stage, verbal skills, urine control and motor skills such as walking are totally lost.

Link to websites

http://www.dementiacarecentral.com/node/540

http://www.dementiastages.net/

What is the definition of dementia?

Dementia is a broad-spectrum term that defines a group of symptoms-like loss of memory, language, judgment, and intellectual function. The word dementia comes from the Latin word meaning “apart from mind”. Dementia is a group of disorders that cause a permanent deterioration of individual’s ability to reason, think and manage his own life. Dementia is triggered by biological processes inside the brain that cause the permanent destruction or death of the brain’s cells.

The number of patients with dementia is progressively increasing. Dementia is considerably more common among aged people. Though, dementia can affect people of any age but it is comparatively infrequent in people under the age of 65. In the world there are approximately 36 million people with dementia. Almost 28 million individuals living with dementia do not have a diagnosis. It is predicted that numbers of patients living with dementia worldwide double every 20 years.

Dementia causes an individual to have weakened memory, absent-mindedness, an inability to remember new information, to lose the capability to speak and the capability to understand spoken or written language. The patient also loses the aptitude to plan, make good decisions and perform multi-step jobs. This means that the patient cannot manage his daily routine. With this diagnosis, the consequences for the patient and his family can be shocking.

Dementia is the continuous decline in intellectual functions that is the ability to process thought or intelligence. Continuous decline means the symptoms will progressively become worse. The worsening is more than might be predictable from normal aging and is due to the disease or damage. Dementia isn’t a particular disease. Instead, dementia refers to a set of symptoms affecting intellectual and social capabilities severely enough to effect daily functioning. Generally, memory loss occurs in dementia; however only memory loss doesn’t mean you have dementia. Dementia specifies problems with at least two brain functions, for example memory loss and impaired language or judgment. Dementia can make the patient confused and incapable to remember individuals and names. Patient may experience alterations in personality and social conduct. Though, some causes of dementia are curable.

Many reasons of dementia symptoms are present. Diseases like Alzheimer’s disease, Vacular dementia or Lewy body disease that are categorized as dementias have some factors in common. Alzheimer’s disease represents about 60 percent of all dementias and in individuals over the age of 65, it is the common cause of dementia. The other common causes of dementia are Lewy bodies and vascular dementia. Vascular dementia is caused by blockage of blood supply. Other forms include alcohol dementia which is caused by continuous use of alcohol; trauma dementia which is caused by head injury; and an infrequent form of dementia that is fronto-temporal dementia.

Dementia, contrasting Alzheimer’s, is not an ailment in itself. In dementia, the higher intellectual functions of the patient are involved in the beginning. In the later stages, the patient might not know what day of the week it is, and might not be able to recognize the people around him. The clinical signs, symptoms and the course of dementia differ, depending on the type of illness causing it, and the site and number of impaired brain cells. Some types progress gradually over years, whereas others may result in abrupt loss of intellectual function. All types of dementia are characterized by different structural or pathologic alterations in the brain, such as collection of atypical plaques and tangles in patients with Alzheimer’s disease, and accumulation of abnormal tau protein in patients with fronto-temporal dementia.

When a patient is diagnosed with dementia, the patient or the family members have no information regarding the type of dementia. Each type disease related to dementia has a different sequence of illness, different signs and different encounters. The managements and mediations may be different as well.

Dementia is a group of symptoms affecting intellectual and social abilities, severely enough to interfere with daily functioning. It is caused by conditions or changes in the brain. Dementia is the loss of mental functions such as thinking, memory, and reasoning that interferes with a person’s daily life and activities, Different types of dementia exist, depending on the cause. Alzheimer’s disease is the most common type. Dementia is a loss of the mind, it could be static which results from global brain injury or it could be progressive which results in long term decline in cognitive function (Hopkins). Dementia indicates problems with at least two brain functions, such as memory loss along with impaired judgment or language. Dementia has never been known to be a disease but a group of symptoms that causes diseases and conditions, some symptoms are changes in personality, mood, and behavior. Dementia can make someone confused and unable to remember the names and important people in their lives like the name of children, husband, sisters and brothers. Some cases of dementia can be treated or cured because the cause is treatable, like dementia caused by substance abuse e.g. street drugs, alcohol, controlled substances, dementia caused by severe depression. This is known as pseudo-dementia (false dementia) and is treatable. In most cases, a true dementia cannot be cured, because of some causes that are curable and partially treated; doctors must be thorough in making the decisions so as not to miss potentially treatable conditions. The frequency of treatable causes of dementia is believed to be about 10 % (WebMD 2010). Dementia is classified as cortical or sub cortical depending on the area that is affected. Cortical dementia affects the cerebral cortex or the outer layer of the brain; the cortex is a sheet of neural tissue that is outermost to the cerebrum of the mammalian brain. It plays a key role in memory, attention, thinking, awareness, consciousness and language.it could lead to problems with memory, thinking, and language, difficulty comprehending written or spoken material. Subcortical dementia results from dysfunction in the other brain areas below the cortex; it is the portion of the brain immediately below the cerebral cortex, this is a categorized dementia which can also bring about memory loss, degradation in thinking ability as well as changes in movement and emotions (Hopkins 2010).

There are some related Dementia; Mild cognitive impairment is a transition stage between the cognitive decline of normal aging and the more serious problems caused by Alzheimer’s disease. This disorder can affect the language, writing and reading and could probably cause memory loss. Vascular dementia is the form of dementia that the condition is more than one; it is a group of syndromes relating to different vascular mechanisms. It is preventable and the early detection and an accurate diagnosis are important. Mixed dementia is a condition in which Alzheimer’s disease and vascular dementia occur at the same time, Dementia with Lewy body is a progressive declined disease or syndrome of the brain with several diseases, especially with two common diseases of older adults, Alzheimer’s and Parkinson’s. Parkinson disease is a degenerative disorder of the central nervous system that often impairs the sufferer’s motor skills, speech, and other functions, Huntington disease, it is a genetically programmed degeneration of nerve cells in certain areas of the brain. This degeneration causes uncontrolled movements, loss of intellectual faculties, and emotional disturbance. Creutzfeldt-jacob disease Creutzfeldt-Jakob disease is a rare, degenerative, neurological disorder that is invariably fatal and incurable. Normal pressure hydrocephalus is a condition in which there is too much cerebrospinal fluid in the ventricles. This occurs when the natural system for draining and absorbing extra cerebrospinal fluid does not work right. Wernicke-korsakoff syndrome is a neurological disorder that could be acute or chronic which is caused by the deficiency in the B vitamin thiamine, Frontotemporal dementia is a degenerative condition of the part of the brain it is a clinical syndrome caused by degeneration of the frontal lobe of the brain and may extend back to the temporal lobe, It is one of three syndromes caused by frontotemporal lobar degeneration. Dementia has lots of symptoms and all varies depending on the cause, the common ones are memory loss, difficulty in performing activities of daily living, inappropriate behavior, aggitation, personality changes, difficulty with coordination and motor function. Dementia can be diagnoses in different ways; the doctor determines the kind of test, it is important for the doctors to rule out the curable dementia, like depression, normal pressure hydrocephalus, or vitamin B12 deficiency which can cause the same symptoms. Early diagnosis and treatment is important for the patient. The different ways of diagnosing is autopsy to confirm or refine the clinical diagnosis of Alzheimer disease, the patient history so as to help the doctor rule out some conditions, physical examination to help the doctor rule out the treatable and curable cause of dementia and identify some other illness in the body which and coincide with dementia, neurological examination to assess the sensory neuron and motor neuron, especially reflexes to determine if the nervous system is functioning and to determine a movement disorder or stroke that may affect the patient’s diagnosis, lab test to rule out some symptoms like kidney failure that could contribute to the cause of dementia, the test includes complete blood count, urinalysis, blood glucose test, cerebrospinal fluid analysis etc. Brain scan to detect abnormalities of the brain the size of 5 mm and larger, it can also be used by doctors to identify stroke, tumor or other problems that causes dementia, there are different kinds of brain scan which are, computed tomography (CT) which combines special x-ray equipment with complicated computers to produce multiple images or pictures of the inside of the brain. These images of the area being studied can then be examined on a computer monitor, printed or transferred to a CD and magnetic resonance imaging (MRI) used in radiology to visualize detailed internal structure and limited function of the body. Psychiatric evaluation used to determine there is depression including sad, hopeless or worthless, or another form of psychiatric disorder which may be contributing to the symptoms of dementia, and presymptomatic testing is used when no treatment available stands in contrast to genetic testing done for the diagnosis of the dementia (White).

There is no specific treatment for dementia; the treatment is to treat the cause. Patient with dementia needs to be under the supervision of medical care to focus on the quality care, medication and treatments such as therapy, and family members to help in activities of daily living, and to help the patient cope with many challenges. The goal of treatment is to control the symptoms of the disease; some patient might be hospitalized for a short period of time. The available drugs that the Food and Drug Administration (FDA) approved to determine the treatment of behavioral disorder in patient with dementia is antipsychotic medication which includes, Risperdal, Seroquel, Zyprexa and Abilify, they are used to reduce the psychotic symptoms of dementia and allow the patient to function effective and appropriately (FDA 2005). Drugs for treatment of dementia should be avoided unless they are really necessary, before any of these drugs are prescribed doctors make sure the patient is physically healthy, comfortable and well taken care of. Some symptoms that also be treated is when patient is pain, have problems with sight and have difficulty hearing, all this can make patient more confused and increase their vulnerability. It is essential for patients to take the drugs exactly as prescribed to make it effective, but if the symptoms are not controlled the doctor may refer the patient to a specialist for further advice. There are some possible side effects of these drugs that may worsen the symptoms which are muscle stiffness, tremor, anemia, depression, heart failure, infection, nutritional disorder, hypoxia and abnormal movements, which must be listed on the drug guide. The doctor usually starts the medication with low dose and gradually increase the dose until the desired outcome is achieved. It is important to inform the doctor about any other drug that the patient is taking to avoid contraindications and once treatment is established it is important to review it regularly. In most cases these drugs should not be prescribed for more than three months and patient should not assume that if the has been proved to be effective does not mean it is going to be effective on them. There are some more drugs that can be prescribed which are mood stabilizer (citalopram, fluoxetine, and imipramine), stimulant (methylphenidate) and serotonin affecting drugs (trazodone, buspirone), information on how to take this drugs must be provided by the doctor or pharmacist.

What is Alzheimer?

Alzheimer’s disease is a brain disorder named after German physician Alois Alzheimer, who first described it in 1906 Alzheimer’s, it is irreversible, slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, perception memory and thinking skills, and even the ability to carry out the simplest tasks. It is cited as number one mental health among people age 60 and the risk goes up as you get older. The risk is also higher if a family member has had the disease. Alzheimer is a progressive disorder that starts in the brain in the area that involves thought, memory and language. It is characterized by the stage of increasing impairment and dependency (alz.org2010). People with Alzheimer disease may have trouble remembering things that happened recently or names of people. The earliest sign of Alzheimer disease is behavior such as suspiciousness and a thought process heavily influenced by anxiety or fear, often to the point of irrationality and delusion, angry, outburst, withdrawal. Over the time the symptoms of Alzheimer gets worse, they tends to forget how to speak, write, read, brush their teeth, comb their hair and even forget family members this might make them aggressive, wander around, and get stressed. The cause of Alzheimer disease is unknown but lots of factors have been explored. There is no single test that can detect Alzheimer but the disease is diagnosed by some symptoms, some findings on neurological examination and some result from diagnostic test. The tests show the possible sign and symptoms. The pathological hallmark associated with Alzheimer’s disease is amyloid plaque and neurofibrillary tangles, amyloid is found between nerve cells in the brain. Amyloids are insoluble fibrous protein aggregates sharing specific structural traits that the body produces normally, in an healthy brain the amyloid are broken and diminishes but in an Alzheimer’s disease the amyloid form hard and insoluble plaques. Neurofibrillary tangles are also found in the brain of Alzheimer disease patients, this is the accumulation of twisted protein filaments within neurons of the cerebral cortex; a characteristic pathological feature found in the brains of Alzheimer’s disease patients. In Alzheimer’s disease, there is an overall shrinkage of brain tissue and theories have proved that there is no cure for it. The part of the brain called sulci are widened while the part called gyri shrunk. The ventricle that contains the cerebrospinal fluid is enlarged. The disease Alzheimer is affecting over 5.3 millions of Americans; it cost over $148 billion annually to take care of an Alzheimer’s patient (Alazraki).

In the early stages of Alzheimer’s disease, the short-term memory begins to fade, when the cells in the brain begins to diminishes, the ability to perform routine tasks declines. As Alzheimer’s disease spreads through the cerebral cortex judgment declines, emotional outbursts may occur and language is impaired. As the disease progresses, more nerve cells die, leading to changes in behavior, such as wandering and agitation. In the final stages of the disease, people may lose the ability to recognize faces and communicate; they normally cannot control bodily functions and require constant care.

Physicians discuss with the patient and family which tests are most appropriate to establish the correct diagnosis but there is no test that diagnose Alzheimer disease, but the disease is diagnosed by the symptoms, firstly patients have to complete a physical examination to rule out some symptoms, the patient the patient mental status and neuropsychological will be assessed to determine which thinking and memory function may be affected. The patient may have a psychiatric assessment to rule out some mental illness and depression. The patient may be asked to do a brain scan (MRI, CT scan, and PET scan) to help detect signs and symptoms of stroke that can bring changes to the structure of brain associated with thinking. Blood test may be ordered to check for infection, kidney and liver function, electrolyte level, thyroid disorder and other factors that can cause memory loss. Other tests that sometimes provide important diagnostic information include electroencephalogram (EEG), urine tests, and tests on cerebrospinal fluid (CSF) obtained by a lumbar puncture. The possible drugs approved by the Food and Drug Administration (FDA) are tacrine which should be taken on an empty stomach, one hour before, or two hours after meals. If stomach upset occurs, it may be taken with meals; however, food can decrease tacrine blood levels significantly. The possible side effect of this drug is diarrhea, nausea, vomiting, muscle ache and loss of appetite. Donepezil is expected to delay the onset of Alzheimer disease for about one year in people suffering from mild cognitive impairment; it belongs to a class of drugs called cholinesterase inhibitors, it inhibits acetylcholinesterase, an enzyme responsible for the destruction of one neurotransmitter, acetylcholine. The possible side effects associated with this drug include headache, generalized pain, fatigue, nausea, vomiting, loss of appetite, weight loss, dizziness, muscle cramping, joint pain, diarrhea, insomnia, and increased frequency of urination. Namenda was actually prescribed for moderate to severe stage Alzheimer disease but now is being prescribed even in earlier stages of the disease, Namenda is an orally active receptor antagonist that regulates the activity of glumate in the brain. Cholinesterase inhibitors are used to treat cognitive functions and behavioral symptoms in Lewy body disease. Clonazepam is a benzodiazepine derivative with anticonvulsant and muscle relaxant, it is generally considered to be among the long-acting benzodiazepines and Opiate drugs used to relieve pain. Antipsychotic drugs not approved by FDA are sometimes used to treat agitation include, Risperidone Benzodiazepines and drugs such as Olanzapine , Quetiapine , Ziprasadone .The drugs increase the risk of death in elderly patients and the side effects include sedation, confusion and increased muscle tone.

Cryptography And Encryption graduate paper help

Cryptography is the discipline of cryptography and cryptanalysis and of their interaction. The word “cryptography” is derived from the Greek words “Kryptos” means concealed, and “graphien” means to inscribe. It is the science of keeping secrets secret. One objective of cryptography is protecting a secret from adversaries. Professional cryptography protects not only the plain text, but also the key and more generally tries to protect the whole cryptosystem. Cryptographic primitives can be classified into two classes: keyed primitives and non-keyed primitives as in the figure. The fundamental and classical task of cryptography is to provide confidentiality by encryption methods. Encryption (also called enciphering) is the process of scrambling the contents of a message or file to make it unintelligible to anyone not in possession of key “key” required to unscramble the file or message. Providing confidentiality is not the only objective of cryptography. Cryptography is also used to provide solutions for other problems: Data integrity, Authentication, Non-repudiation.Cryptography And Encryption graduate paper help

Encryption methods can be divided into two categories: substitution ciphers and transposition ciphers. In a substitution cipher the letters of plaintext are replaced by other letters or by symbols or numbers. Replacing plaintext bit pattern with cipher text bit patterns is involved in substitution when plaintext is viewed as a sequence of bits. Substitution ciphers preserve the order of plaintext symbols but disguise them. Transposition ciphers, do not disguise the letters, instead they reorder them. This is achieved by performing some sort of permutation on the plaintext letters. There are two type of encryption :symmetric(private/secert) encryption key and asymmetric(public) key encryption.

 

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Conventional encryption model

A conventional encryption model can be illustrated as assigning Xp to represent the plaintext message to be transmitted by the originator. The parties involved select an encryption algorithm represented by E. the parties agree upon the secret key represented by K. the secret key is distributed in a secure manner represented by SC. Conventional encryption’s effectiveness rests on keeping the secret. Keeping the key secret rests in a large on key distribution methods. When E process Xp and K, Xc is derived. Xc represents the cipher text output, which will be decrypted by the recipient. Upon receipt of Xc, the recipient uses a decryption algorithm represented by D to process Xc and K back to Xp. This is represented in the figure. In conventional encryption, secrecy of the encryption and decryption algorithm is not needed. In fact, the use of an established well known and tested algorithm is desirable over an obscure implementation. This brings us to the topic of key distribution.Cryptography And Encryption graduate paper help

Cryptanalysis

Code making involves the creation of encryption products that provide protection of confidentiality. Defeating this protection by some men’s other than the standard decryption process used by an intended recipient is involved in code breaking. Five scenarios for which code breaking is used. They are selling cracking product and services, spying on opponents, ensure accessibility, pursuing the intellectual aspects of code breaking and testing whether one’s codes are strong enough. Cryptanalysis is the process of attempting to identify either the plaintext Xp or the key K. discovery of the encryption is the most desired one as with its discovery all the subsequent messages can be deciphered. Therefore, the length of encryption key, and the volume of the computational work necessary provides for its length i.e. resistance to breakage. The protection get stronger when key size increases but this requires more brute force. Neither encryption scheme conventional encryption nor public key encryption is more resistant to cryptanalysis than the other.

Cryptographic goals

However, there are other natural cryptographic problems to be solved and they can be equally if not important depending on who is attacking you and what you are trying to secure against attackers. Privacy, authentication, integrity and non-repudiation are the cryptographic goals covered in this text.

These three concepts form what is often referred to as the CIA triad? The three notations represents the basic security objectives for both data and for information and computing services. FIPS PUB 199 provides a useful characterization of these objectives in terms of requirements and the definition of a loss of security in each category:

Confidentiality: Preserving authorized restrictions on information access and disclosure, together with means for shielding personal secrecy and copyrighted material. A damage of privacy is the illegal disclosure of information.
Integrity: Guarding against improper information modification or destruction, and includes ensuring information non-repudiation and authenticity. A loss of integrity is the unauthorized modification of information.
Availability: Ensuring timely and reliable access to and use of information. A loss of availability is the disruption of access to an information system.
Although the use of the CIA tried to define security objectives is well established, some in the security field feel that additional concepts are needed to present a complete picture. Two of the most commonly mentioned are:

Authenticity: The property of being genuine and being able to be verified and trusted; confidence in the validity of a transmission, a message, or message originator.
Accountability: The security goal that generates the requirement for actions of an entity to be traced uniquely to that entity.
Generally there are two types key present  Cryptography And Encryption graduate paper help

1 Symmetric-key

2 Asymmetric-key

Symmetric key encryption

The universal technique for providing confidentiality for transmitted data is symmetric encryption. Symmetric encryption is also known as conventional encryption or single-key encryption was the only type of encryption in use prior to the introduction of public-key encryption. Countless individuals and groups, from Julius Caesar to the German U-boat force to present-day diplomatic, military and commercial users, use symmetric encryption for secret communication. It remains by far the more widely used of the types of encryption. A symmetric encryption scheme has five ingredients as follows-

Plaintext: This is the original data or message that is fed into the algorithm as input.
Encryption algorithm: the encryption algorithm performs various transformations and substitutions on the plaintext.
Secret key: The secret key is input to the encryption algorithm. The exact transformations and substitutions performed by the algorithm depend on the key.
Ciphertext: This is the scrambled message produced as output. It depends on the plaintext and the secret key. For a given message, two different keys will produce two different ciphertexts.
Decryption algorithm: This is reserve process of encryption algorithm. It takes the ciphertext and secret key and produces the original plaintext.

Cryptography is a method of protecting information and communications through the use of codes so that only those for whom the information is intended can read and process it. The pre-fix “crypt” means “hidden” or “vault” and the suffix “graphy” stands for “writing.”

Cryptography, which translates as “secret writing,” refers to the science of concealing the meaning of data so only specified parties understand a transmission’s contents. Cryptography has existed for thousands of years; for most of history, however, the users of cryptography were associated with a government or organized group and were working to conceal secret messages from enemies. These days, millions upon millions of secure, encoded transmissions happen online each day — and cryptographic standards are used to protect banking data, health information, and much more. Without cryptography, e-commerce as we know it would be impossible. Since online security threats evolve so quickly, there are dozens of different schools of thought on how best to use encryption to enhance network security — not just for governments, but for businesses and end users, too.Cryptography And Encryption graduate paper help

Classical Encryption Techniques

Classical Encryption Techniques Explained at Purdue University (PDF): These lecture notes describe historical encryption methods and how they are used today.
Analysis and Elements of Various Classical Encryption Techniques (PDF): This presentation provides detailed historical information on various forms of encryption.
Introduction to Classical Cryptography by Noted Textbook Author: This overview includes information on how classical cryptography techniques relate to the modern day.
Integration of Classical and Modern Encryption Techniques (PDF): This research report seeks to discover and discuss effective ways to integrate classical and new encryption.
Finite Fields

Basic Introduction to Cryptographic Finite Fields: This detailed inquiry discusses both finite fields and alternative ways of implementing the same forms of cryptography.
Storing Cryptographic Data in the Galois Field (PDF): This report discusses the Galois Field, an important evolution on the concept of cryptographic finite fields.
Comparing Finite Fields to Elliptic Curve Encryption (PDF): This essay focuses on how elliptic curve encryption could be used to build on and enhance finite fields.
Finite Field Arithmetic for Cryptography (PDF): This essay describes advanced methods of using finite field arithmetic to develop algorithms for cryptographic purposes.
Advanced Encryption Standard

Overview and Presentation on the History of AES (PDF): This series of presentation slides serves as an introduction to the very powerful AES encryption standard.
Detailed Technical Review of the Advanced Encryption Standard: This page provides a historical background of AES and summary of how the different components work.
Research Report Reviewing AES and Different Implementations (PDF): This illustrated guide demonstrates one conventional method of implementing AES in programming.
Technical Guide to Intel’s Implementation of AES (PDF): This official Intel white paper discusses how AES is implemented within modern Intel technology.
Confidentiality Using Symmetric Encryption

Symmetric Versus Asymmetric Encryption Discussed (PDF): This set of lecture notes discusses the pros and cons of “secret key” versus “public key” encryption.
Detailed Discussion of Symmetric Encryption and RSA Algorithms (PDF): This technical review of symmetric encryption implementation discusses algorithms in detail.
Number Theory and Hash Algorithms

Hash Functions in Cryptography (PDF): These detailed, illustrated notes meant for college students introduce hash algorithms and their function in data security.
Number Theory and Cryptography at Cornell (PDF): This set of notes and problems introduces advanced number theory concepts and tests comprehension.
Applied Number Theory in Cryptography (PDF): This introduction to number theory goes into great depth about its many applications in the cryptographic world.
Report on Hash Function Theory, Attacks, and Applications (PDF): This research report examines and compares cryptographic hash functions like MD5 and SHA-1.
Hash Functions and Cryptography in Business: This article specifically discusses the importance and applications of hash functions in the business world.Cryptography And Encryption graduate paper help
Digital Signatures

Verifiable Encryption of Digital Signatures (PDF): This scholarly essay reports on the current methods of digital signature verification and offers one new potential alternative.
Overview of Digital Signatures: This page includes a straightforward introduction to digital signatures, their usage, and the various aspects of making them work.
Discussion of Digital Signature Implementation and Issues (PDF): These notes approach the problems of digital signatures in terms of replicating the authenticity of “real” ones.
Overview of Public Key Encryption: This discussion of public key encryption and the RSA algorithm draws from classic digital signature literature and theories.
Basics of Understanding Digital Signatures: This overview from the U.S. federal government’s “US-CERT” security team provides accessible information for consumers.
Future Applications of Quantum Digital Signatures (PDF): This essay is an interpretation of how advanced digital signatures can be implemented with current technology.
Authentication Applications

Authentication Applications: Kerberos and Public Key Infrastructure (PDF): This report discusses two of the most powerful authentication applications and how they can be implemented to enhance security.
Information on Kerberos Protocol from MIT: This detailed overview of the Kerberos protocol provides information on its various releases and how to implement it.
The Official Kerberos Consortium: This is the official “watchdog” organization that develops and publishes standards for the authentication application named Kerberos.
Public Key Infrastructure Defined and Described at PC Magazine: This is an overview of Public Key Infrastructure (PKI) and how it is used to secure information.
Public Key Infrastructure Approaches to Security: This documentation from Oracle discusses the elements of PKI and how they can be used in different technical scenarios.
Auditing and Certification of a Public Key Infrastructure: This report defines the structure and process of using PKI and delves into some of its historical issues.
Electronic Mail Security

 

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The OpenPGP Alliance for Electronic Mail Encryption: This is the site of a nonprofit organization that maintains OpenPGP, a popular email encryption standard.
Berkeley Lab Recommendations on Implementing Electronic Mail Security: These recommendations from the Lawrence Berkeley National Laboratory can be adapted for use by consumers and enterprises by using the cryptographic resources suggested.
GnuPG Nonprofit Privacy Application for Linux-Based Systems: Based on the PGP concept, GnuPG is a nonprofit method of implementing email encryption in Linux-based systems.
Basic Primer on Email Security for Consumers from CNBC: This report from news network CNBC discusses the issues around email encryption and security as they relate to consumers in a world of ever-increasing electronic spying.
IP Security and Web Security

IP Security and Encryption Overview from Cisco Systems: This detailed information on the IPSec protocol and related security matters comes from Cisco, one of the top brands in hardware and software for online security.
HTTP vs. HTTPS Comparison: This page is an introduction to “secure” HTTP connections (HTTPS) and how they differ from basic HTTP connections.
What is SSL and What Are Certificates?: This page expands further on the concept of SSL and how “security certificates” work to authenticate the transfer of sensitive data.
Summary Overview of SSL and How Related Protocols Work Together (PDF): This illustrated guide goes a step further by describing how SSL interacts with other protocols.Cryptography And Encryption graduate paper help
Firewalls

What is a Firewall and What Types of Firewalls Are There?: This introduction serves to define and compare the different kinds of firewalls and how they operate.
Basic Concepts for Managing a Firewall: Aimed at network administrators, this guide digs deep into the fundamental concepts to master in order to make a firewall effective.
How Firewalls Work and How to Use Them: This introduction summarizes the basics of firewalls, some specialized types, and how a firewall “rule” should be designed.
Basic Firewall Information and Use for Consumers: This overview from the nonprofit “Get Safe Online” helps consumers understand fundamental firewall concepts and use.

In computer science, cryptography refers to secure information and communication techniques derived from mathematical concepts and a set of rule-based calculations called algorithms to transform messages in ways that are hard to decipher. These deterministic algorithms are used for cryptographic key generation and digital signing and verification to protect data privacy, web browsing on the internet and confidential communications such as credit card transactions and email.

Cryptography techniques
Cryptography is closely related to the disciplines of cryptology and cryptanalysis. It includes techniques such as microdots, merging words with images, and other ways to hide information in storage or transit. However, in today’s computer-centric world, cryptography is most often associated with scrambling plaintext (ordinary text, sometimes referred to as cleartext) into ciphertext (a process called encryption), then back again (known as decryption). Individuals who practice this field are known as cryptographers.

Modern cryptography concerns itself with the following four objectives:

Confidentiality: the information cannot be understood by anyone for whom it was unintended
Integrity: the information cannot be altered in storage or transit between sender and intended receiver without the alteration being detected
Non-repudiation: the creator/sender of the information cannot deny at a later stage his or her intentions in the creation or transmission of the information
Authentication: the sender and receiver can confirm each other’s identity and the origin/destination of the information
Procedures and protocols that meet some or all of the above criteria are known as cryptosystems. Cryptosystems are often thought to refer only to mathematical procedures and computer programs; however, they also include the regulation of human behavior, such as choosing hard-to-guess passwords, logging off unused systems, and not discussing sensitive procedures with outsiders.

Cryptography process
Cryptographic algorithms
Cryptosystems use a set of procedures known as cryptographic algorithms, or ciphers, to encrypt and decrypt messages to secure communications among computer systems, devices such as smartphones, and applications. A cipher suite uses one algorithm for encryption, another algorithm for message authentication and another for key exchange. This process, embedded in protocols and written in software that runs on operating systems and networked computer systems, involves public and private key generation for data encryption/decryption, digital signing and verification for message authentication, and key exchange.

Types of cryptography
Single-key or symmetric-key encryption algorithms create a fixed length of bits known as a block cipher with a secret key that the creator/sender uses to encipher data (encryption) and the receiver uses to decipher it. Types of symmetric-key cryptography include the Advanced Encryption Standard (AES), a specification established in November 2001 by the National Institute of Standards and Technology as a Federal Information Processing Standard (FIPS 197), to protect sensitive information. The standard is mandated by the U.S. government and widely used in the private sector.Cryptography And Encryption graduate paper help

In June 2003, AES was approved by the U.S. government for classified information. It is a royalty-free specification implemented in software and hardware worldwide. AES is the successor to the Data Encryption Standard (DES) and DES3. It uses longer key lengths (128-bit, 192-bit, 256-bit) to prevent brute force and other attacks.

Public-key or asymmetric-key encryption algorithms use a pair of keys, a public key associated with the creator/sender for encrypting messages and a private key that only the originator knows (unless it is exposed or they decide to share it) for decrypting that information. The types of public-key cryptography include RSA, used widely on the internet; Elliptic Curve Digital Signature Algorithm (ECDSA) used by Bitcoin; Digital Signature Algorithm (DSA) adopted as a Federal Information Processing Standard for digital signatures by NIST in FIPS 186-4; and Diffie-Hellman key exchange.

To maintain data integrity in cryptography, hash functions, which return a deterministic output from an input value, are used to map data to a fixed data size. Types of cryptographic hash functions include SHA-1 (Secure Hash Algorithm 1), SHA-2 and SHA-3.

History of cryptography
The word “cryptography” is derived from the Greek kryptos, meaning hidden. The origin of cryptography is usually dated from about 2000 B.C., with the Egyptian practice of hieroglyphics. These consisted of complex pictograms, the full meaning of which was only known to an elite few. The first known use of a modern cipher was by Julius Caesar (100 B.C. to 44 B.C.), who did not trust his messengers when communicating with his governors and officers. For this reason, he created a system in which each character in his messages was replaced by a character three positions ahead of it in the Roman alphabet.

In recent times, cryptography has turned into a battleground of some of the world’s best mathematicians and computer scientists. The ability to securely store and transfer sensitive information has proved a critical factor in success in war and business.

Because governments do not wish certain entities in and out of their countries to have access to ways to receive and send hidden information that may be a threat to national interests, cryptography has been subject to various restrictions in many countries, ranging from limitations of the usage and export of software to the public dissemination of mathematical concepts that could be used to develop cryptosystems. However, the internet has allowed the spread of powerful programs and, more importantly, the underlying techniques of cryptography, so that today many of the most advanced cryptosystems and ideas are now in the public domain.

Cryptography concerns
Attackers can circumvent cryptography, hack into computers that are responsible for data encryption and decryption, and exploit weak implementations, such as the use of default keys. However, cryptography makes it harder for attackers to access messages and data protected by encryption algorithms.

Cryptography is an interesting field in the world of computer security. This has been boosted by the increase in computer attacks emanating from the Internet. With large and confidential data being transferred over the Internet, its security must be addressed. It is because of this that encryption techniques are continually evolving. With computer hackers being IT experts who are hungry to get at personal data on the Internet, IT security experts have also made sure that they come up with products to combat and stay ahead of the hackers.
With the availability of good network infrastructure, many people are turning to the Internet to send and store their information. What is more, with the development and the emergence of cloud computing, it is imperative that both individuals and organizations are responsible for the safety and privacy of the data being transferred.
E-mail messages have been one of the main targets for attackers on the Internet. Email usage has increased over many years and phishing attacks have become more frequent and more targeted resulting in dramatic increases in computer fraud. All of these developments require that good security measures be implemented. Cryptography has therefore been given a greater emphasis in the computer security world. Web 2.0 applications which have been aggressively rolled out have created a rise in complicated and secure cryptographic techniques which are hard to crack. Cryptography And Encryption graduate paper help
2.2 Definition
Cryptography is the concept and process of hiding information. The process of converting the data into a disguised form so that it is hard to understand is called encryption.

There are two necessities for protected use of symmetric encryption:

We need a strong encryption algorithm.
Sender and receiver must have secured obtained, & keep secure, the secret key.
Stream Ciphers

The stream ciphers encrypt data by generating a key stream from the key and performing the encryption operation on the key stream with the plaintext data. The key stream can be any size that matches the size of the plaintext stream to be encrypted. The ith key stream digit only depends on the secret key and on the (i-1) previous plaintext digits. Then, the i­th ciphertext digit is obtained by combining the ith plaintext digit with the ith key stream digit. One desirable property of a stream cipher is that the ciphertext be of the same length as the plaintext. Thus, a ciphertext output of 8 bits should be produced by encrypting each character, if 8-bit characters are being transmitted. Transmission capacity is wasted, if more than 8 bits are produced. However, stream ciphers are vulnerable to attack if the same key is used twice or more.

From e-mail to cellular communications, from secure Web access to digital cash, cryptography is an essential part of today’s information systems. Cryptography helps provide accountability, fairness, accuracy, and confidentiality. It can prevent fraud in electronic commerce and assure the validity of financial transactions. It can prove your identity or protect your anonymity. It can keep vandals from altering your Web page and prevent industrial competitors from reading your confidential documents. And in the future, as commerce and communications continue to move to computer networks, cryptography will become more and more vital.

But the cryptography now on the market doesn’t provide the level of security it advertises. Most systems are not designed and implemented in concert with cryptographers, but by engineers who thought of cryptography as just another component. It’s not. You can’t make systems secure by tacking on cryptography as an afterthought. You have to know what you are doing every step of the way, from conception through installation.

Billions of dollars are spent on computer security, and most of it is wasted on insecure products. After all, weak cryptography looks the same on the shelf as strong cryptography. Two e-mail encryption products may have almost the same user interface, yet one is secure while the other permits eavesdropping. A comparison chart may suggest that two programs have similar features, although one has gaping security holes that the other doesn’t. An experienced cryptographer can tell the difference. So can a thief.

Present-day computer security is a house of cards; it may stand for now, but it can’t last. Many insecure products have not yet been broken because they are still in their infancy. But when these products are widely used, they will become tempting targets for criminals. The press will publicize the attacks, undermining public confidence in these systems. Ultimately, products will win or lose in the marketplace depending on the strength of their security.

Threats to computer systems
Every form of commerce ever invented has been subject to fraud, from rigged scales in a farmers’ market to counterfeit currency to phony invoices. Electronic commerce schemes will also face fraud, through forgery, misrepresentation, denial of service, and cheating. In fact, computerization makes the risks even greater, by allowing attacks that are impossible against non-automated systems. A thief can make a living skimming a penny from every Visa cardholder. You can’t walk the streets wearing a mask of someone else’s face, but in the digital world it is easy to impersonate others. Only strong cryptography can protect against these attacks.Cryptography And Encryption graduate paper help

Privacy violations are another threat. Some attacks on privacy are targeted: a member of the press tries to read a public figure’s e-mail, or a company tries to intercept a competitor’s communications. Others are broad data-harvesting attacks, searching a sea of data for interesting information: a list of rich widows, AZT users, or people who view a particular Web page.

Criminal attacks are often opportunistic, and often all a system has to be is more secure than the next system. But there are other threats. Some attackers are motivated by publicity; they usually have significant resources via their research institution or corporation and large amounts of time, but few financial resources. Lawyers sometimes need a system attacked, in order to prove their client’s innocence. Lawyers can collect details on the system through the discovery process, and then use considerable financial resources to hire experts and buy equipment. And they don’t have to defeat the security of a system completely, just enough to convince a jury that the security is flawed.

Electronic vandalism is an increasingly serious problem. Computer vandals have already graffitied the CIA’s web page, mail-bombed Internet providers, and canceled thousands of newsgroup messages. And of course, vandals and thieves routinely break into networked computer systems. When security safeguards aren’t adequate, trespassers run little risk of getting caught.

Attackers don’t follow rules; they cheat. They can attack a system using techniques the designers never thought of. Art thieves have burgled homes by cutting through the walls with a chain saw. Home security systems, no matter how expensive and sophisticated, won’t stand a chance against this attack. Computer thieves come through the walls too. They steal technical data, bribe insiders, modify software, and collude. They take advantage of technologies newer than the system, and even invent new mathematics to attack the system with.

The odds favor the attacker. Bad guys have more to gain by examining a system than good guys. Defenders have to protect against every possible vulnerability, but an attacker only has to find one security flaw to compromise the whole system.Cryptography And Encryption graduate paper help

What cryptography can and can’t do
No one can guarantee 100% security. But we can work toward 100% risk acceptance. Fraud exists in current commerce systems: cash can be counterfeited, checks altered, credit card numbers stolen. Yet these systems are still successful because the benefits and conveniences outweigh the losses. Privacy systems–wall safes, door locks, curtains–are not perfect, but they’re often good enough. A good cryptographic system strikes a balance between what is possible and what is acceptable.

Strong cryptography can withstand targeted attacks up to a point–the point at which it becomes easier to get the information some other way. A computer encryption program, no matter how good, will not prevent an attacker from going through someone’s garbage. But it can prevent data-harvesting attacks absolutely; no attacker can go through enough trash to find every AZT user in the country. And it can protect communications against non-invasive attacks: it’s one thing to tap a phone line from the safety of the telephone central office, but quite another to break into someone’s house to install a bug.

The good news about cryptography is that we already have the algorithms and protocols we need to secure our systems. The bad news is that that was the easy part; implementing the protocols successfully requires considerable expertise. The areas of security that interact with people–key management, human/computer interface security, access control–often defy analysis. And the disciplines of public-key infrastructure, software security, computer security, network security, and tamper-resistant hardware design are very poorly understood.

Companies often get the easy part wrong, and implement insecure algorithms and protocols. But even so, practical cryptography is rarely broken through the mathematics; other parts of systems are much easier to break. The best protocol ever invented can fall to an easy attack if no one pays attention to the more complex and subtle implementation issues. Netscape’s security fell to a bug in the random-number generator. Flaws can be anywhere: the threat model, the system design, the software or hardware implementation, the system management. Security is a chain, and a single weak link can break the entire system. Fatal bugs may be far removed from the security portion of the software; a design decision that has nothing to do with security can nonetheless create a security flaw.

Once you find a security flaw, you can fix it. But finding the flaws in a product can be incredibly difficult. Security is different from any other design requirement, because functionality does not equal quality. If a word processor prints successfully, you know that the print function works. Security is different; just because a safe recognizes the correct combination does not mean that its contents are secure from a safecracker. No amount of general beta testing will reveal a security flaw, and there’s no test possible that can prove the absence of flaws.Cryptography And Encryption graduate paper help

Threat models
A good design starts with a threat model: what the system is designed to protect, from whom, and for how long. The threat model must take the entire system into account–not just the data to be protected, but the people who will use the system and how they will use it. What motivates the attackers? Must attacks be prevented, or can they just be detected? If the worst happens and one of the fundamental security assumptions of a system is broken, what kind of disaster recovery is possible? The answers to these questions can’t be standardized; they’re different for every system. Too often, designers don’t take the time to build accurate threat models or analyze the real risks.

Threat models allow both product designers and consumers to determine what security measures they need. Does it makes sense to encrypt your hard drive if you don’t put your files in a safe? How can someone inside the company defraud the commerce system? Are the audit logs good enough to convince a court of law? You can’t design a secure system unless you understand what it has to be secure against.

System design
Design work is the mainstay of the science of cryptography, and it is very specialized. Cryptography blends several areas of mathematics: number theory, complexity theory, information theory, probability theory, abstract algebra, and formal analysis, among others. Few can do the science properly, and a little knowledge is a dangerous thing: inexperienced cryptographers almost always design flawed systems. Good cryptographers know that nothing substitutes for extensive peer review and years of analysis. Quality systems use published and well-understood algorithms and protocols; using unpublished or unproven elements in a design is risky at best.

Cryptographic system design is also an art. A designer must strike a balance between security and accessibility, anonymity and accountability, privacy and availability. Science alone cannot prove security; only experience, and the intuition born of experience, can help the cryptographer design secure systems and find flaws in existing designs.

Implementation
There is an enormous difference between a mathematical algorithm and its concrete implementation in hardware or software. Cryptographic system designs are fragile. Just because a protocol is logically secure doesn’t mean it will stay secure when a designer starts defining message structures and passing bits around. Close isn’t close enough; these systems must be implemented exactly, perfectly, or they will fail. A poorly designed user interface can make a hard-drive encryption program completely insecure. A false reliance on tamper-resistant hardware can render an electronic commerce system all but useless. Since these mistakes aren’t apparent in testing, they end up in finished products. Many flaws in implementation cannot be studied in the scientific literature because they are not technically interesting. That’s why they crop up in product after product. Under pressure from budgets and deadlines, implementers use bad random-number generators, don’t check properly for error conditions, and leave secret information in swap files. The only way to learn how to prevent these flaws is to make and break systems, again and again.

Cryptography for people
In the end, many security systems are broken by the people who use them. Most fraud against commerce systems is perpetrated by insiders. Honest users cause problems because they usually don’t care about security. They want simplicity, convenience, and compatibility with existing (insecure) systems. They choose bad passwords, write them down, give friends and relatives their private keys, leave computers logged in, and so on. It’s hard to sell door locks to people who don’t want to be bothered with keys. A well-designed system must take people into account.Cryptography And Encryption graduate paper help

Often the hardest part of cryptography is getting people to use it. It’s hard to convince consumers that their financial privacy is important when they are willing to leave a detailed purchase record in exchange for one thousandth of a free trip to Hawaii. It’s hard to build a system that provides strong authentication on top of systems that can be penetrated by knowing someone’s mother’s maiden name. Security is routinely bypassed by store clerks, senior executives, and anyone else who just needs to get the job done. Only when cryptography is designed with careful consideration of users’ needs, and then smoothly integrated, can it protect their systems, resources, and data.

The state of security
Right now, users have no good way of comparing secure systems. Computer magazines compare security products by listing their features, not by evaluating their security. Marketing literature makes claims that are just not true; a competing product that is more secure and more expensive will only fare worse in the market. People rely on the government to look out for their safety and security in areas where they lack the knowledge to make evaluations–food packaging, aviation, medicine. But for cryptography, the U.S. government is doing just the opposite.

When an airplane crashes, there are inquiries, analyses, and reports. Information is widely disseminated, and everyone learns from the failure. You can read a complete record of airline accidents from the beginning of commercial aviation. When a bank’s electronic commerce system is breached and defrauded, it’s usually covered up. If it does make the newspapers, details are omitted. No one analyzes the attack; no one learns from the mistake. The bank tries to patch things in secret, hoping that the public won’t lose confidence in a system that deserves no confidence. In the long run, secrecy paves the way for more serious breaches.

Laws are no substitute for engineering. The U.S. cellular phone industry has lobbied for protective laws, instead of spending the money to fix what should have been designed correctly the first time. It’s no longer good enough to install security patches in response to attacks. Computer systems move too quickly; a security flaw can be described on the Internet and exploited by thousands. Today’s systems must anticipate future attacks. Any comprehensive system–whether for authenticated communications, secure data storage, or electronic commerce–is likely to remain in use for five years or more. It must be able to withstand the future: smarter attackers, more computational power, and greater incentives to subvert a widespread system. There won’t be time to upgrade them in the field.

History has taught us: never underestimate the amount of money, time, and effort someone will expend to thwart a security system. It’s always better to assume the worst. Assume your adversaries are better than they are. Assume science and technology will soon be able to do things they cannot yet. Give yourself a margin for error. Give yourself more security than you need today. When the unexpected happens, you’ll be glad you did.

In computing, encryption is the method by which plaintext or any other type of data is converted from a readable form to an encoded version that can only be decoded by another entity if they have access to a decryption key. Encryption is one of the most important methods for providing data security, especially for end-to-end protection of data transmitted across networks.Cryptography And Encryption graduate paper help

Encryption is widely used on the internet to protect user information being sent between a browser and a server, including passwords, payment information and other personal information that should be considered private. Organizations and individuals also commonly use encryption to protect sensitive data stored on computers, servers and mobile devices like phones or tablets.

How encryption works
Unencrypted data, often referred to as plaintext, is encrypted using an encryption algorithm and an encryption key. This process generates ciphertext that can only be viewed in its original form if decrypted with the correct key. Decryption is simply the inverse of encryption, following the same steps but reversing the order in which the keys are applied. Today’s most widely used encryption algorithms fall into two categories: symmetric and asymmetric.

Block Ciphers

A block ciphers fragments the message into blocks of a predetermined size and performs the encryption function on each block with the key stream generated by cipher algorithm. Size of each block should be fixed, and leftover message fragments are padded to the appropriate block size. Block ciphers differ from stream ciphers in that they encrypted and decrypted information in fixed size blocks rather than encrypting and decrypting each letters or word individually. A block ciphers passes a block of data or plaintext through its algorithm to generate a block of ciphertext.

Asymmetric Key Cryptosystems

In Asymmetric Key Cryptosystems two different keys are used: a secret key and a public key. The secret key is kept undisclosed by the proprietor and public key is openly known. The system is called “asymmetric” since the different keys are used for encryption and decryption, the public key and private key.

If data is encrypted with a public key, it can be decrypted only by using the corresponding private key. Public Key Encryption shown in fig.Cryptography And Encryption graduate paper help

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Classical encryption techniques

The technique enables us to illustrate the basic approaches to conventional encryption today. The two basic components of classical ciphers are transposition and substitution. Combination of both substitution and transposition is described in others systems.

Substitution techniques

In this technique letters of plaintext message are placed by symbols and numbers. If plaintext is in the form of a sequences of bits, then substituting plaintext bit patterns with ciphertext bit patterns.

Transposition techniques

Transposition instantly moves the position around within it but does not alter any of the bits in the plaintext. If the resultant ciphertext is then put through more transpositions, the end result has increasing security.

Cryptography was used only for military and diplomatic communication until the development of public key cryptography. Secrecy is one of most important requirement for any communication and it becomes more important when the content of communication is for military and diplomatic purpose.

Hieroglyphs used by Egyptians are earliest known example of cryptography in 1900 BC. These hieroglyphics were used to write the stories of the life of kings and describe the great acts of his life. Around 500 BC Hebrew scholars used mono alphabetic substitution cipher such as “Atbash cipher”. Around 400 BC the Spartans also developed a “Scytale cipher” that used ribbons of parchment for writing any secret message after wrapping it around a cylindrical rod named as Scytale. In second century BC Greek historian Polybius invented “Polybius Square” a type of substitution ciphers. Around 1st century BC the Roman emperor Julius Ceaser used the substitution cipher named after him as “Ceaser Cipher”. The Caesar Cipher is a Monoalphabetic type Cipher.

Around 9th century AD the Arab Mathematician AbÅ« YÅ«suf YaÊ»qÅ«b ibn Isḥāq al-KindÄ« popularly known as “Al-Kindi” published the first text book on cryptnalysis of ciphers named “Risalah fi Istikhraj al-Mu’amma (On Deciphering Cryptographic Messages)”. This book can be stated as the pioneer of the medieval cryptography. In this book Al-Kindi described the frequency analysis technique for deciphering substitution ciphers and some polyalphabetic substitution ciphers. The relative frequency of symbols is used in Frequency analysis to decode the message. Al-Kindi used this technique on “Qur’an” to understand the meaning for religious purpose.

The field of cryptography had not made any significant development until 15th century when the Italian mathematician Leon Battista Alberti known as “The Father of Western Cryptology,” developed the concept of polyalphabetic substitution. Although he had not made any practical cipher but by using this concept a practical Poly-Alphabetic substitution cryptographic system was developed by French cryptographer BLAISE DE VIGENERE, which was named after him and called as VIGENERE SQUARE. For a long time this cipher was believed to be secure but around 1854, CHARLES BABBAGE, an English mathematician and engineer, better known as father of Computer Science for his development work of difference engine that become the first mechanical computer, successfully cracked the Vigenere Square Cipher by using the method of statistical analysis.

Cryptography was widely used in World War I and II. The most famous incident of World War I is of German foreign Minister Zimmerman Telegram that changed the whole World War I and involved the America in world war which was neutral till that date and Germany was finally defeated.Cryptography And Encryption graduate paper help

Unlike the past cryptographic algorithms in which the main concentration was on hiding the algorithm or technique the modern ciphers needed the technique or algorithm which can be widely used and whose security should not be compromised if the algorithm is known.

To encrypt and decrypt the information, a key is used in modern cryptographic algorithms which convert the message and data in such format which are senseless to the receiver through encryption and then return them to the original form through decryption process.

Claude E. Shannon, father of modern cryptography has contributed his work to cryptography in the form of “A mathematical theory of cryptography” and “A Communications Theory of Secrecy Systems” which are considered as the foundation of modern cryptography.

In seventies the field of cryptography has witnessed two major developments. First was the development of Data Encryption Standard (DES) by IBM, which was accepted as standard after some modification by the NSA in 1977 and it was later replaced by the Advanced Encryption Standard (AES) in 2001. The second development which is more important and that changed the whole working process and use of cryptography is the development of Public Key Cryptography. It was started with the publication of the paper titled “New Directions in Cryptography”, by Whitfield Diffie and Martin Hellman and similar development made by Ron Rivest, Adi Shamir and Leonard Adleman, who were the first to publicly describe the algorithm in 1977 and it was named after them as RSA algorithm.

An Introduction to Cryptology:
The word cryptology is a combination of two greek words, “kryptos”, which means hidden and “logos” means “study”. Cryptology is as old as writing itself and it has been primarily for thousands of years it had been used for securing military and diplomatic communications.

The field of Cryptology can be further classified into two main fields, namely: Cryptography and Cryptanalysis. On the one hand the cryptographers try to develop a system or algorithm that will be safe and secure for communication while on the other hand the cryptanalysts seek weaknesses in the developed system and try to breach the security of the system. The two works can be considered against each other but the work of cryptanalysts cannot be always negative and they can work for the betterment of the developed system by trying to find out the weaknesses in the cryptographic algorithm and fix it.

Cryptography:
Cryptography is the technique for writing secretly so that the unintended recipients cannot comprehend the original message. It transforms the information into such an unintelligible form so that illegitimate or unintended users cannot devise the original meaning of the message and it looks like a garbage value for them. But the main consideration during the transformation is that the process must be reversible so that the intended user can get the original information after applying the original key and process. This is the traditional use of cryptography but in modern times the scope of cryptography has widened.

Cryptanalysis:
Cryptanalysis is the field of study that deals with the techniques that verify and assert the security of the protocol or system. The objective of the cryptanalysis techniques is to assess the security claims of the cryptographic algorithm or system. Cryptanalysts try to develop an attack to show that claimed security level is not achieved due to weaknesses in the cryptographic system.Cryptography And Encryption graduate paper help

It is difficult to define when a cryptosystem is broken. Generally, efficiency of an attack is compared with the efficiency of exhaustive key search attack and if the efficiency of attack is less than it then it is considered an attack on the cryptographic system.

Classification of attacks can be made on the basis of the amount of information available to attacker:

• Ciphertext-only attack: The attacker has access to the ciphertext only.

• Known-plaintext attack: In this case the attacker has access to both the plaintext and the corresponding ciphertext. This attack can be employed when the attacker has limited access to the encrypting device.

• Chosen-Plaintext attack: The attacker selects a plaintext and generates corresponding ciphertext using the correct key. This can only be applied if the attacker has access to encryption device and is able to encrypt a message of choice using this device. The goal of such type of attack is to discover the secret key or algorithm for any given encrypted text.

• Chosen-Ciphertext attack: The attacker selects a ciphertext and generates corresponding plaintext using the correct key. This can only be possible if the attacker has access to decryption device and is able to decrypt a message of choice using this device. The goal of such type of attack is also to discover the secret key or algorithm for any given encrypted text.

The goals of such attacks in general can be classified as secret key recovery, plaintext recovery without recovering the key or the discovery of the encryption/decryption algorithm.

Classification of Cryptographic primitives:
Unkeyed Cryptography:
Unkeyed cryptosystem is that cryptosystem which does not use any key or parameter for application. Examples of such system are one-way functions, cryptographic hash functions, and random bit generators.

Public Key or Asymmetric Cryptography:
Public Key or Asymmetric Key cryptography is the latest addition to the cryptographic techniques that has changed the basic uses of cryptography. Two different keys are used for encryption and decryption in Public or asymmetric key cryptography. Public key is being used for encryption and it is known to everyone and is freely distributable but the encrypted message can only be decrypted by using the private key corresponding to public key which is known only to the authorized person. Public key cryptography evolved to solve the problems of Secret key cryptography but it is very slow in comparison to secret key cryptography. Public key cryptography cannot be used for high volume encryption. Therefore we use combination of Public and Private Key cryptography for practical applications.

Secret Key or Private Key or Symmetric Key Cryptography:
In Symmetric Key or Secret Key cryptography, only a single key is used to encrypt and decrypt. It is also called Private Key cryptography. The main problem of the secret key cryptography is the sharing of same key by sender and receiver. In the case of unsecure channels, there is no mean to exchange key securely. The secret key must be shared using any secure channel before communication take place and for such purpose Public Key cryptography is generally used.

An overview of Symmetric Algorithms:
Symmetric key cryptography is still highly used due to its efficiency and is generally used where high volume of data is encrypted. Symmetric key primitives can be classified into two basic designs; namely Block Cipher and Stream Cipher.Cryptography And Encryption graduate paper help

Block Ciphers:
Block cipher is a symmetric key encryption which divides the input stream of plaintext into fixed size of blocks, generally 64, 128 or 256 bits long and using a fixed transformation (substitutions and permutations) on every block on by one. These transformations are repeated many times to obtain highly nonlinear output bits. The two most popular block ciphers are DES and AES.

Modes of operation:
A block cipher performs fixed transformations on any block of data and results in same ciphertext for same plaintext, hence can only be considered secure for a single block of data. A mode of operation is actually a way of encryption using a block cipher securely for data more than one block. The Block ciphers are used in one of the five modes to operate for breaking the linearity. A cryptographic mode usually consists of basic cipher, some sort of feedback, and some simple operations.

Electronic Code Book (ECB) Mode

Cipher block Chaining (CBC) Mode

Cipher Feedback (CFB) Mode

Output Feedback (OFB) Mode

The counter (CTR) Mode

Stream Ciphers:
Symmetric Cryptographic systems encrypt plaintext messages unit by unit, and unlike block ciphers, which encrypt block of plaintext using fixed transformation, Stream Ciphers encrypt individual units or character of plaintext using a time-varying transformation.

It takes the secret key and initialization vector (IV) as input and generates a pseudo random sequence of digits called keystream using pseudo random generator, usually part of Stream Ciphers. ciphertext digits are generated by XORing the keystream digits with the plaintext digits.

The stream ciphers are classified into two parts as synchronous and asynchronous stream ciphers on the basis of application of internal state in further encryption of digits. Stream ciphers have played an important role in cryptography and still being used due to its efficiency and especially, in hardware implementations where hardware resources are restricted.

Stream ciphers are the main topic of research in this thesis and it will be discussed more comprehensively in later chapters. For a general description of stream ciphers, see chapter 2.

Scope of Cryptology:
Today the cryptology is not just limited to data encryption and decryption as mentioned above, it has a wide range of usages. The field of cryptology is an emerging field in which continuous expansions and modifications are taking place. The field of cryptography was evolved for military usage but it has now expanded and is highly used in civilian applications also. Cryptography is the study of mathematical techniques, algorithms and protocols that can provide four basic services for information security, namely privacy, authentication, data integrity and non-repudiation.Cryptography And Encryption graduate paper help

Privacy or confidentiality: The basic goal of cryptography is to keep the information secret from unauthorized persons. Cryptography is the most common mean to provide confidentiality or privacy to the information.

Data Integrity: Data integrity means that system must be able to detect the unauthorized manipulation of the data. Data manipulation refers to insertion, deletion or substitution of data.

Authentication: Authentication service provides the ability to correctly identify the parties in the communication and origin of the data.

Non-Repudiation: Non-repudiation service prevents an entity from denying any activity done by itself or existence of a communication at any later stage in case of any dispute.

Stream Cipher Standardization:
Major effort towards standardization of cryptographic primitives was started by European Commission research project funded from 2000-2003 in form of NESSIE (New European Schemes for Signatures, Integrity and Encryption). In March 2000 NESSIE urged the public for submissions of cryptographic primitives, and against this call 42 primitives were submitted in February 2003. The submissions were selected in different categories for standardization. Various cryptographic primitives were standardized except Stream Ciphers and none of the six submitted stream ciphers were considered as upto standard. During this period another organization, the International Standards Organization’s ISO/IEC 18033 also initiated a similar project for standardization and selected two stream ciphers: SNOW 2.0 and MUGI. Other than these two efforts a Cryptography Research and Evaluation Committee was set up by the Japanese Government which started a project CRYPTREC in 2001 to evaluate and recommend the cryptographic primitives in different category for use. In the stream cipher category, three ciphers were recommended that are MUGI, MULTI-S01 and RC4 (128-bit keys only). But, Later on these ciphers were also found to be susceptible to the cryptanalytic attacks

This failure on the side of cryptographic primitives in stream cipher category prompted Adi Shamir in 2004 RSA Data Security Conference to question, whether there is a need for Stream Ciphers or not. He also defined two areas were Stream Ciphers can still be useful where exceptionally high throughput is required in software and exceptionally low resource consumption is required in hardware.

To explore the Stream Cipher condition and to develop a state of art stream cipher which can secure and fulfill the above mentioned requirements, ECRYPT launched the eSTREAM project in 2004.

eSTREAM made a call for submission in two categories; hardware based and software based stream ciphers. In response to this call 34 ciphers were submitted in both the categories. In different phases of this project, cipher profiles were declared. The final profile issued in January 2012, seven ciphers were selected. The selected ciphers are HC-128, Rabbit, Salsa20/12 and SOSEMANUK in profile 1 (Software based Ciphers) and Grain v1, MICKEY 2.0 and Trivium in profile 2 (Harware based cipher). Even after these standardization efforts, many weaknesses were found in these ciphers.

This state of Stream Ciphers has led me to involve in the research of the Stream Cipher and work towards a secure and efficient Stream Cipher. Cryptography And Encryption graduate paper help

WMBA 6030 MANAGING BUSINESS INFORMATION SYSTEMS

WEEK 1 DISCUSSION QUESTION 1: HOW TECHNOLOGY CHANGES HOW WE LIVE AND WORK

Technology has had a big impact in my professional and personal life which I am encouraged daily to take advantage of the newest programming or gadget to help make my life easier and more proficient.  Since I have been back in school, I have been introduced to DocuSign, which allows you to sign important documents on the spot and send them back to the respective parties immediately.  I use my laptop and ipad constantly for school assignments, church projects, school projects, downloading music, some work related projects as well as a personal entertainment tool.  iCloud has changed my life in a way where I can backup important information such as pictures, music, etc.

Technology has changed human existence by extending life spans, improving communication, simplifying manufacturing and improving transportation (Nickson, 2016).  As I look at technology in the professional lifestyle, I assemble documents and reports on computers, use them for Powerpoint presentations, take laptops and ipad/tablets on the road so that I can have access to information and most of my communications are by emails and texting to where now I can use Snapchat, Skype, FaceTime and a new app called Marco Polo.

As a business manager, I would apply the technologies by storing data that is needed for day-to-day operations.  Use the technologies for marketing purposes to set up a Web page for the company so that clients will have access to the service that the company provide as well as potential employees.  A marketing tool that uses information technology is the Quick Response (QR) that looks like a bar code but is square (Richard, n.d.).  I would also use the technologies to communicate with employees and clients.  Communication by email is faster and costs less than sending a paper letter in the mail as well as saving the environment.  Information technology allows me to organize email file folders by client or by type of communication.

References:

Nickson, C. (2016).  Technology & The Way We Work.  Retrieved from http://www.atechnologysociety.co.uk/technology-way-we-work.html

Richard, L. (n.d.). Information Technology & Its Uses in Business management: Chron.  Retrieved from http://smallbusiness.chron.com/information-technology-its-uses-business-management-51648.html

 

WMBA 6030 DISCUSSION QUESTION 2 SHARED PRACTICE: ROLE OF BUSINESS INFORMATION SYSTEMS

In my current job as a Career Coordinator for Job Corps, the two most important business information systems used in my organization are Human Resource Management and Center information System (CIS).  The Human Resource Management is used to allow easy attendance being kept, vacation and short-term absence time is accumulated and used, maximize employees’ performance, focuses on policies and systems, employee benefits and employee recruitment training and development.  The Center Information System (CIS) is used to track students’ progress in the program, performances of the program, attendance and students’ payroll.   It promotes cooperation and interchange between national, regional and corporate offices.

One example of how the Human Resource Management and Center Information System (CIS) is affecting the organization is by taking employment actions for employees and students.  This process must be fair and objective to assure the best results and shield the organization and students from legal repercussions (Marshall, n.d.).  Another example is development and training.  The HRM system is affective in development and training by providing employees with ongoing training to keep pace with ever-evolving legal, regulatory and technological landscapes.  The CIS system is affective because it develop and train the students as well as the organization to keep up with the progress and services that it takes to make the organization successful in its mission goal.  The individual behaviors are changing in ways that could better the organization.  Employees and students changed their behaviors in a positive way as to abiding by the HRM system and using the CIS system to improve the services.

I have learned that the importance of business information systems is gained by processing the data from company inputs to generate information that is useful for managing operations.  It comprises the analysis and organization of business information through the application of technology.  Managers need to understand how systems can be used to the organizations advantage because information systems enables a number of business initiatives, such as business process re-engineering, total quality management, global expansion and even downsizing.  Also to understand information system so that dollars are not wasted on automating ineffective processes.

 

Reference:

Marshall, D. (n.d.).  How Does Human Resource Management Affect the Success of a Health Care Organization? Chron.  Retrieved from http://smallbusiness.chron.com/human-resource-management-affect-success-health-care-organization-72631.html

 

 

 

Week 1 Discussion 1

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Shared Practice—How Technology Changes How We Live and Work

Digital technology seems ubiquitous, touching nearly every aspect of our personal and professional lives. Its rapid evolution continues to significantly affect how people live and work, and how they communicate with one another, within increasingly diverse, complex social networks. And the information lifecycle today moves much faster than it did 30, 20, even 10 years ago. Just as we adopt a new device or learn a new piece of software, the next best and greatest innovation comes along that renders our new tool or toy obsolete.

By Day 3

Post your insights about how information and information technology have changed your daily life, both professionally and personally. Focus on the technologies that have helped you increase your effectiveness at work and in business, and how you might apply these technologies as a business manager.

General Guidance: Your initial Shared Practice Discussion post, due by Day 3, will typically be 2–3 paragraphs in length as a general expectation/estimate. Refer to the rubric for the Week 1 Shared Practice Discussion for grading elements and criteria. Your Instructor will use the rubric to assess your work.

By Day 5

Respond to two of your colleagues in one or more of the following ways:

• Explore additional ways that the technology experiences of your colleagues might impact you or change your practices.
• Share with your colleague ideas for how they might adopt other technologies to enable them to further improve their effectiveness as business managers.
• Compare your colleague’s experience with your own, and share additional insights you gained.

General Guidance: Your Shared Practice Discussion responses, due by Day 5, will each typically be 1–2 paragraphs in length as a general expectation/estimate. Refer to the rubric for the Week 1 Shared Practice Discussion for grading elements and criteria. Your Instructor will use the rubric to assess your work.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

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