Current Medical Diagnosis and Treatment †MyAssignmenthelp.com

Question: Discuss about the Current Medical Diagnosis and Treatment. Answer: Introduction The following is a case assessment for patient Kasim, aged 49 years old suffering from cholecystitis. The report will be based on clinical reasoning cycle. It is a model which nurses and clinicians use to collect cues, information processing, understanding patient problem and implementing interventions, outcome evaluations and reflection on the learning process of a case study. The outline below shows a detailed assessment report for the patient. Cholecystitis is the inflammation of the gall bladder, (ICGT, 2014) and it occur major on patience of previous history of gall stones. Blockage of cystic duct contributes to the inflammation of the gall bladder. Common symptoms of the condition are the abdominal pain and severe prolonged pain. The patient is admitted with right upper quadrant abdominal pain, fever and vomiting. The patients vitals are the blood pressure is 100/45; heart beat rate is 126 and temperature measuring 38.8oc. The patient further has pale dry mucous membrane his score on pain at the shoulder is at 7/10. For typical confirmed case, inflammation causes effects on the outside body. Pain occurs deeply with inspiration which often leads to breathe termination when the right upper quadrant causes pain. Another key observation is the yellowing of skin pr jaundice which is often a mild appearance. Patience who may have multiple conditions like diabetes and chronic illness and those with immune compromised immune ma y have vague symptoms which include fever and tenderness at a specific region, (Demehri Alam, 2014). The highest risk factor for cholecystitis is gall stones due to increased inflammation. The risk factors for gall stone s include gender, pregnancy, obesity , age, oral contraceptives and eight loss, (Greenberger Paumgartner, 2012). Typical examination for cholecystitis reveals presence of fever, tachycardia and tenderness in the right upper quadrant with rebounding, palpability of the gall bladder or fullness by 30%-40% and jaundice occurrence however it occurs on 25% of the patients. Symptoms of cholecystitis often appear suddenly or develop slowly for a period of time. These symptoms include severe abdominal pains, nausea, vomiting, loose, light coloured tools, fever, abdominal cramp, chills, jaundice and itching, typical attacks last for 2-3 days depending on the person status. Complications can occur which include, pancreatic due to the inflammation, gall bladder perforation due t the infection, enlarged gall bladder, infection build upper and tear of the gall bladder. The most prevalent observed symptoms of cholecystitis are the upper pain in the abdomen, physical examination has tachycardia and the type of tenderness on right upper quadrate is missing from the information. In the case study blood tests are missing, in a case of cholecystitis, blood tests are done for the biomarkers of inflammation. These test include complete blood count and C- reactive protein and the assessment of levels of bilirubin for bile blockage assessment, (Friedman, 2015). In cholecystitis assessment of blood there is an increase in the white blood count with level range of 12,000- 15,000/mcL. The reactive protein is usually increased, bilirubin level is mildly elevated at 1-4 mg/Dl. Blood amino transferees are elevated. The elevation levels of the laboratory values depend on the degree of gall bladder inflammation. Abdominal upper quadrate on the right side is used as diagnosis for cholecystitis, (Strasberg, 2008). Ultra sound results suggest acute cholecystitis which illustrates gall stones, fluid with the gall bladder and the thickening of the gall bladder walls. CT scan diagnostics tests are also not utilised, however it is utilised in severe conditions such as gangrene or perforation. Boazs sign can be used for assessment as it applies on the right scapula and can be an alarm for acute cholecystitis. The patient is exhibiting various vital signs for cholecystitis however they are few for confirmation of diagnosis. Further diagnostic tests need to be done for the patient. A complete blood count should be conducted, and results obtained should be segregated into white blood cells, red blood cells, lymphocytes. The results obtained should be cross checked with reference values. the normal range of white blood cell is 4.3 10 g/l, red blood cell120-175 g/l and platelets 140-450g/l. Creatin levels should also be assessed, it is used as an indicator for renal function tests, normal values ranges at 0.60 1.7 mg/dl. Another focused assessment is BUN, which shows renal function perfusion and the dietary intake of carbohydrates and the level of protein metabolism, referenced based on the normal range values. Another important assessment to be carried is the urinalysis test. It is important for testing in acquisition of information regarding the disorders of the kidney and the lower urinar y tract, and associated disorders that affect urine composition. In the urinalysis assessment, data such as colour, gravity, the Ph and protein availability, red blood cells, white blood cells, bacteria, esterase, ketones, bilirubin and crystals casts are measured. In the preoperative assessment, the patient is experiencing pain at a scale score of 7/10, the acute pain is linked to the increased inflammation and the gall bladder dislocation. This can be largely attributed to the stone availability in the gall bladder, it causes blockage in the cystic duct thus causing acute pain in the right side. There is need for pre-operative assessment which is conducted to run from head to toe and running of objective assessments, which include test such as over the counter drugs, anti-coagulant drugs, smoking history, respiratory problems and nutritional status of the patient. Further focussed assessment of various body organs should be done, these include, the heat, abdomen and lungs. A complete ECG should be conducted so as to asses any previous myocardial infarction and chest x-rays. Full pain assessments and nausea should be done. The patient may appear to be ill with presence of fever and tachycardia, the patient pain score reveals elevated level of pain. Cholecystitis often results in the pain localized at the peritoneal area which causes inflammation and disturbance in the patient is characterized with a lot of pain. Physical examinations should be conducted efficiently and effectively. Accurate measurement soft he vital signs forms the basis of assessments. The physical exam guide should follow inspection, auscultation, percussion, palpation and relevant tests such pelvic positioning. Procedure involves assessing the general appearance of the patient, if the patient is moving around and is not able to find comfortable positions, can be an indicative of renal colic while abdominal scars may be an indicative of distension. Laboratory tests conducted can be no specific and are used to boost the evidence of clinical support, (Liau, Teh Serrablo, 2014). Initials test include complete blood count, leukocytosis is observable in cholecystitis. Urinalysis tests can be able to identify any urinary infection. Chest x rays can be done on the patent as this will assist in ruling respiratory causes of pain. Fluid balance measure can be used to assess the patient, the ratio of intake and output of the patient are used. This data on the patient reflects causes of fluid imbalance such as decrease and increase in fluid levels. Even though laboratory findings may appear to suggest presence of cholecystitis, imaging might be conducted. Procedures such as ultra sonography might be conducted, which asses the right upper quadrate, gall stones can be observed using the ultrasound. Conducting Murphy sign by sonographic method is done by applying pressure on the transducer of the ultra sound linking to the gall bladder and displayed on the screen. Computer tomography can be utilized to assess the patient. Acute condition state, with similarities as gall bladder, edema on the walls and fluid in the periphery can be displayed. Ultra sonography is the readily and more accurate tool for assessment of cholecystitis, (RUQ, 2017) In a more precise manner on tests and assessments for the patient, maintenance of accurate records of intake and output data in fluid management are essential. Skin assessments and the mucous membranes for this patient are evident; they provide clear information on the fluid state and circulating volume of fluid. Monitoring of vital signs and the presence of nausea, cramps on the abdomen, seizures and depressions on the respirations are useful for identification of deficiencies which are associated like decline in sodium, potassium, and chloride. Encourage the patient to perform regular oral hygiene proper treatment mouth wash, this assist in decreasing the dryness of the mucous membrane of the oral cavity. Conclusion Hence in the patient assessment there is need to focus planning goals on pain management with an aim of alleviating pain. Prompt diagnosis of the patient is effective in the overall care strategy, (Baron Grimm, 2015). There is need for maintaining balance of the fluid and the electrolytes in the body of the patient. Clear respiratory are essential for respiratory ability of the patient. In patient assessment, there is need for comprehensive history evaluation and effective physical and laboratory examinations, as this ensures clear and appropriate diagnosis of cholecystitis condition. Reference Baron, T. H., Grimm, I. S. (2015). Nonsurgical management of cholecystitis: a tailored approach. Gastrointestinal endoscopy, 82(6), 1037-1038. Demehri, FR; Alam, HB, (2014). "Evidence-Based Management of Common Gallstone-Related Emergencies". Journal of intensive care medicine. doi:10.1177/0885066614554192. PMID25320159. Friedman L.S. (2015). Liver, Biliary Tract, Pancreas Disorders. In Papadakis M.A., McPhee S.J., Rabow M.W. (Eds), Current Medical Diagnosis Treatment 2015. Greenberger N.J., Paumgartner G (2012). Chapter 311. Diseases of the Gallbladder and Bile Ducts. In Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J, Loscalzo J (Eds), Harrison's Principles of Internal Medicine, 18e Internal Clinical Guidelines Team, (2014). "Gallstone Disease: Diagnosis and Management of Cholelithiasis, Cholecystitis and Choledocholithiasis. Clinical Guideline 188": 101. PMID25473723. Liau, K. H., Teh, C., Serrablo, A. (2014). Management of acute cholecystitis and acute cholangitis in emergency setting. Central European Journal of Medicine, 9(3), 357-369. RUQ Acute Cholecystitis -The Medical University of South, (2017). Carolinaacademicdepartments.musc.edu/surgery/education/medstudents/.../ruqacutechole.pps. Accessed online 2017-05-04. Strasberg, SM, (2008). "Clinical practice. Acute calculous cholecystitis.". The New England Journal of Medicine. 358 (26): 280411. doi:10.1056/nejmcp0800929. PMID18579815.

The Leaked Secret to Writing Essay Topics Samples Uncovered

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How to Focus Your Topic For a Paper

How to Focus Your Topic For a PaperThe trick of how to focus your topic for the paper is to come up with a topic that you're passionate about and try to focus on it. In this article I'll talk about why this can be difficult and what you can do to make it easier.I've noticed that when I'm dealing with it, I tend to put everything else aside and focus on a topic. This is an automatic response and I can't really be bothered with it. If I don't like a topic, it doesn't have much impact on me.What you need to learn when you want to learn how to focus your topic for the paper is to understand that the world of 'intellectual gratification' is the opposite of passion. Passion is when you get worked up in an area where you're passionate about and you work through problems. Intellectual gratification is when you're able to get excited about something without any emotional attachment.You see, people are happier when they're solving something that they care about and when they're passionate abou t it. If you're learning how to focus your topic for a paper, you will learn how to identify a problem and then find solutions to it. Passion will motivate you to go beyond the technical aspect of the paper.Intellectual gratification is when you solve problems and you are excited about it because you want to find a solution. It's when you don't have time to consider how the problem may not turn out because you feel like you are in the solution.To put it another way, you need to be able to focus on a problem that you're passionate about. This can be hard to do if you're passionate about something that you don't understand and if you don't know what you're passionate about.What you can do to make it easier is to find an interesting topic to write about and to use some tools to get started with intellectual gratification. The most important tool you should use is a good book to read. The problem is, many books just don't offer the depth of information necessary to help you understand y our topic and how to focus your topic for a paper.Once you've identified a topic, find a good book and start reading it. And, make sure that you pay attention to what the author is saying. This is the best way to get you started.

The Downside Risk of Prompt 1 College Essay That No One Is Talking About

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Benefits of a Synthesis Sample Essay

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To what extent is Of Mice and Men more effective t Essay Example For Students

To what extent is Of Mice and Men more effective t Essay han Rainman in giving us understandings of loneliness and friendshipSteinbecks novel Of Mice and Men cannot accurately be compared in effectiveness of its themes with the movie Rainman. The importance of each theme differs in both- in Steinbecks novel, loneliness is the most dominant theme, and in Rainman the major theme is friendship. Levinson and Steinbeck both do a brilliant job at showing the major themes in both materials to the greatest of their potential, and the minor themes are somewhat overpowered because of this. One extremely clever way that Steinbeck has more effectively conveyed the theme of loneliness to the reader is by never letting the characters develop or change in Of Mice and Men. Very early in the novel we are introduced to George and Lennie as they are about to start new jobs on the ranch. The reader is made aware directly that Lennie has a mental disability, and really has no attachment to anyone or anything except George. We will write a custom essay on To what extent is Of Mice and Men more effective t specifically for you for only $16.38 $13.9/page Order now Throughout the novel, this fact never changes. Lennies disability never alters, and he only cares for George. George is also never developed in the story. He feels greatly burdened by the responsibility of caring for Lennie. On page 7, he says, I could get along so easy and nice if I didnt have you on my tail. George almost wishes that he could lead a normal life; not the one hes living now. This mindset of wishing for more than he has continues throughout the novel. As well as wishing to not have to look after Lennie, he and Lennie share a common wish- to one day own their own land. Although George is a lot less enthusiastic (and a lot more realistic) about achieving this, he still longs for it. Its still something he hopes can be accomplished in his lifetime. Through the main characters thinking and acting the same for the course of the story, it doesnt give the reader any window of opportunity to bond or become closer to them- therefore escalating the overall feeling of loneliness much more effectively than Rainman does. The character development in Rainman is much more obvious. One of the main characters, Charlie, is extremely materialistic and self absorbed when we are first introduced to him. Throughout the course of the story we view major changes in his attitude and ways of thinking. An example of such an instance would be in the beginning of the story. We are shown Charlies ignorant, narrow minded way of thinking towards Rays disability, and as the story continues, Charlies thoughts towards Ray, and how he perceives his mental condition drastically change. By the end of the movie, we see to the full extent of how Charlies way of thinking and life in general have been changed and affected by Ray. Because of the actions of Charlie throughout the movie, and the way his character has developed, the writer does not accurately portray the theme of loneliness. This is because the viewer is shown and made aware of the growing love and friendship that develops between Ray and Charlie. The main characters, however, are not the only characters who have limited change and growth in Steinbecks novel. Crooks, the black man, is a prime example. He has to live in the harness room, away from the other men. Because racism was socially acceptable in the books time frame, he was isolated and degraded. This was a constant in the novel. He was referred to as Nigger constantly, and was even verbally assaulted by Curleys Wife- a character who was also slandered and labelled, but because of her gender. Well, you keep your place then, Nigger. I could get you strung up on a tree so easy it aint even funny. pg 85. None of the characters change their opinion on Crooks in the novel- hes always the crippl ed old Nigger. Of Mice and Men has limited development in the characters thoughts towards other characters, which more effectively fuels the sense of detachment and loneliness. This heightens the feeling of loneliness much more than Rainman does, because in Levinsons movie the minor characters also grow and show some development as the plot continues. The minor character Susanna, from Rainman, shows major changes in her mindset towards Ray by the end of the movie. Looking back in the film to when she is initially introduced to Ray, she extended her kindness towards him only as a means of keeping the peace between the two brothers, rather then through a genuine wish to make him feel welcome. As the story evolves, Susannas friendship towards Ray becomes something of her own free will rather then a forced gesture. This shows a strong development in Susannas mindset towards Ray, and because of this it does not effectively convey the theme of loneliness as powerfully as Steinbeck has in his novel. .ucb48207e17d2b4d91dd0435c6f18bcdf , .ucb48207e17d2b4d91dd0435c6f18bcdf .postImageUrl , .ucb48207e17d2b4d91dd0435c6f18bcdf .centered-text-area { min-height: 80px; position: relative; } .ucb48207e17d2b4d91dd0435c6f18bcdf , .ucb48207e17d2b4d91dd0435c6f18bcdf:hover , .ucb48207e17d2b4d91dd0435c6f18bcdf:visited , .ucb48207e17d2b4d91dd0435c6f18bcdf:active { border:0!important; } .ucb48207e17d2b4d91dd0435c6f18bcdf .clearfix:after { content: ""; display: table; clear: both; } .ucb48207e17d2b4d91dd0435c6f18bcdf { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .ucb48207e17d2b4d91dd0435c6f18bcdf:active , .ucb48207e17d2b4d91dd0435c6f18bcdf:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .ucb48207e17d2b4d91dd0435c6f18bcdf .centered-text-area { width: 100%; position: relative ; } .ucb48207e17d2b4d91dd0435c6f18bcdf .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .ucb48207e17d2b4d91dd0435c6f18bcdf .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .ucb48207e17d2b4d91dd0435c6f18bcdf .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .ucb48207e17d2b4d91dd0435c6f18bcdf:hover .ctaButton { background-color: #34495E!important; } .ucb48207e17d2b4d91dd0435c6f18bcdf .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .ucb48207e17d2b4d91dd0435c6f18bcdf .ucb48207e17d2b4d91dd0435c6f18bcdf-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .ucb48207e17d2b4d91dd0435c6f18bcdf:after { content: ""; display: block; clear: both; } READ: Kabuki A Japanese Form EssayAnother way Steinbeck effectively conveys the feeling of loneliness throughout his novel is by having only slight changes in the setting of the story The very beginning and the very end take place in the brush- the place George told Lennie to go if he did anything wrong. However, the rest of the book is set at the ranch, where Lennie and George work picking barley. This limited setting change gives Steinbeck a solid foundation, from which he can build upon to effectively portray loneliness to the reader through other means- such as the characters. This works excellently, because in Rainman, the backdrop is constantly changing, and this presents the viewer with a broad range of changing scenery. By having restricted setting change in Of Mice and Men, it lets the reader focus fully on the more important things, and therefore the themes are presented more efficiently. An additional theme that both these pieces share is the theme of friendship. Of Mice and Men, however, is nowhere near as effective in presenting this theme as Rainman is. Levinson lets us watch as Charlie and Ray go from not knowing each other, to forming a deep bond with one another. This development in their characters reels us further into the story, and the journey. Through the growth and change we can clearly see in Charlie and Ray, the theme of friendship is much more successfully displayed in Rainman. Because of Steinbecks intention to expand on the theme of loneliness, the friendship that George and Lennie have is left in the background. Rather then concentrating on the strong bond between the two, he instead chooses to pounce on the flaws which other characters possess. This, in turn, makes the reader somewhat forget about the special friendship of George and Lennie. Because both of these characters were never developed, the reader doesnt feel a part of their relationship. This pushes George and Lennies friendship even further out of the readers mind- making it very hard for them to identify with it. This greatly differs from the presentation of this theme in Rainman. The journey- both physically and emotionally- portray the theme of friendship much more effectively, through its gradual change. The physical journey, that is, the trip from Rays institute to Charlies car company, invites the viewer to see the bond that slowly develops throughout the film between Charlie and Ray. If this part of the plot never came to be, it would be extremely hard for the viewer to identify with their growing friendship. Because of the car trip, the viewer feels like they are right there with Charlie and Ray- through the good times and the bad- and feels extremely close to them. We bond with the characters and truly embrace the friendship they eventually possess. This varies from Of Mice and Men, because George and Lennies friendship was a constant, and like many other things in the novel, never changed. This factor isolated the reader away, which in effect amplified the sense of loneliness, rather than friendship. The emotional journey of Charlie and Ray also effectively showed the viewer the theme of friendship. Through meeting Ray, Charlie transformed himself spiritually into everything Ray needed- a loving, caring companion. Ray also changed slightly- which is amazing for an autistic person who bases their lives around routine and familiarity. By developing the characters personalities and thoughts on one another, the viewer is taken on the journey of change too. In Of Mice and Men, the reader is looking down on the happenings at the ranch, rather than being in the heart of the action. These differences overall portray the theme of friendship a lot more effectively in Rainman than in Of Mice and Men. In conclusion, the differing importance of loneliness and friendship in both pieces make it extremely difficult to say exactly how effective Of Mice and Men is in conveying these themes to the reader, in comparison with Rainman. Initially, superficial comparisons are made about each conveying a n equal amount of significance for both of the themes. However, after exploring what the major and minor themes were in the novel and film, and how both Steinbeck and Levinson efficiently portrayed only their major theme, it is easy to see that these two cannot be effectively compared to one another because of these differences.

Reinforcement in Applied Behavior Analysis

Reinforcement in Applied Behavior Analysis Reinforcement can mean lots of things to different people. In the science of Applied Behavior Analysis, it has a very specific and narrow definition. That it is narrowly defined by its function does not narrow the range of possibilities: it can be money, smiles, warm water or an infinite number of things. Reinforcement and ABA Reinforcement is any stimulus (something that a sensory organ can experience) that will increase the likelihood of a behavior reappearing. Can a high pitched noise be a reinforcer? Yes, if the organism finds it pleasurable. Can a punch in the face lead to reinforcement? Yes, if it eliminates some of the throbbing pain of a toothache. A practitioner of Applied Behavior Analysis will seek out the function of a behavior by questioning how a consequence of the behavior creates reinforcement for the client/patient/student. Reinforcement on a Continuum Reinforcement happens along a continuum from primary reinforcement ( food, water, other physical reinforcers ) to social reinforcers, such as social attention, praise or recognition. Many children with disabilities do not respond to secondary or social reinforcers since they dont actually function to provide reinforcement. A child who has spent money will find a quarter reinforcing whereas a child with severe autism or cognitive disabilities will not find a quarter reinforcing. Typical children and most adults generally respond to secondary and social reinforcement. We work long hours for monetary amounts that are deposited electrically into bank accounts we access online or with a credit card. The goal of ABA is to move children along the continuum to secondary reinforcers, so that they, too, will work for a paycheck and learn to make choices about how they use the result of their own labor. For many children with disabilities, that needs to be taught, and it is often learned by pairing primary reinforcers with social or secondary reinforcers. Choosing Reinforcement Once the replacement or target behavior is defined in an operational way, the ABA practitioner needs to find reinforcers that will drive the students/clients behavior. Children with significant disabilities may need to be reinforced with primary reinforcers, such as favorite foods, but unless this reinforcement is paired with social or secondary reinforcers, it can create an unhealthy and unsustainable reinforcement strategy. Many sensory reinforcers can be successful with children with significant disabilities, such as low functioning autism when you can discover what sort of sensory toy appeals to children. I have used buzzing toys, spinning toys, and even water play successfully as reinforcers with students with significant language and developmental disabilities. Some of these children like to play with musical toys. It is important to create a rich menu of reinforcers, and continuously add items into a childs reinforcement menu. Reinforcement, like all matters of taste, change. Also, students can sometimes become satiated by too much of a single reinforcer, whether its Blues Clues or Reeses Pieces. Often, practitioners will begin with a Reinforcer Assessment which can be done a number of different ways. A successful practitioner will ask parents or caregivers for the childs preferred foods, television shows or characters, activities, and toys. These are often a good place to start. Reinforcers can then be presented in a structured or unstructured way. Sometimes two or three items are placed in front of the child at a time, often pairing preferred items with new items. Sometimes you can present a child with a large number of reinforcers at one time, and eliminate items a child ignores. Reinforcement Schedules Research has evaluated regular reinforcement (on a schedule, from each correct response to every three or four responses) as well as variable reinforcement (within a range, such as every 3 to 5 correct behaviors.) It has shown that variable reinforcement is the most powerful. When a child/client discovers that they are reinforced for every third correct response, they rush to the third response. When they dont know exactly when they will be reinforced, they tend to have stronger responses, tend to generalize across environments and tend to retain the new behavior. The ratio is important: too high a ratio too early may not help the subject learn the target behavior, too low a ration may lead to reinforcement dependence. As a child/subject learns the target behavior, the practitioner can thin the reinforcement schedule, increasing the ratio, and spreading out the reinforcement over more correct responses. Discrete Trial Teaching Discrete Trial Training or Teaching (more acceptable now) is the principal delivery method for instruction in ABA, though ABA is increasingly employing more naturalistic methods, such as modeling and role-playing. Still, each trial is a three-step process: Instruction, Response, and Feedback. The reinforcement happens during the feedback part of the trial. During feedback, you want to name the target behavior ¸ and in initial trials, you want to begin with a one to one reinforcement schedule. You will reinforce every correct response in a one to one schedule, so your student understands that he/she gets the goodies every time they give you the behavior you want. Success in Reinforcement The most successful reinforcement is when a child/client begins to reinforce themselves. That is the intrinsic reinforcement that some of us receive for doing the things that we value or enjoy the most. But lets face it. None of us would go to work without the paycheck, though many of us accept a lower paycheck (as lowly teachers) because we do love what we do. Success, for many students with disabilities, is to learn to find social interaction, praise and appropriate social interaction as reinforcers, so that they acquire age-appropriate social skills and function. Our hope is that our students will gain the level of social and cognitive function that will give them full and meaningful lives. Appropriate reinforcement will help them achieve that.