check prescription on patient's record
prepare the required equipment
check expiry date of blood glucose test strips
ensure the blood glucose analyzer and the test strips are matched with each other (confirm the code of the test strips is same as the code of the blood glucose analyzer)
check patient's identity
communicate with patient on the aim and steps of the procedure
hand hygiene and dry hands completely
(wear clean gloves?)
get the test strip from the bottle (close the bottle cap immediately)
cleanse the selected site with alcohol swab
wait until the site is dry and perform the puncture procedure
collect enough blood sample with the test strip as recommended
use dry swab to press on the puncture site
the blood glucose value will be displayed on the analyzer
to prevent injury, discard the used lancet into the sharp box
observe the puncture site to ensure bleeding has stopped
hand hygiene and dry hands completely
document the time and test result into the patient's record
aftercare and cleansing of the equipment
report on abnormal results
2014年7月31日星期四
blood pressure measurement
wash hands or rub hands
identify client; introduce self to client
explain procedure to client and gain verbal consent
where possible, measure blood pressure under the same conditions each time
allow client to rest several minutes after exercise or smoking before the procedure
expose upper part of client's arm and ensure client is in the desired position
i) lying, sitting or (standing?)
ii) palm of the hand facing upward
iii) sphygmomanometer position at heart level
according to the client's arm, choose an appropriate cuff size
wrap the deflated cuff snugly and smoothly around the upper part of the arm. The bottom of the cuff approximately 3cm above the antecubital space (the depression in front of the elbow) with centre of cuff bladder over brachial artery
to establish a baseline, locate the radial pulse with the fingertips of your non-dominant hand. Inflate the cuff while simultaneously palpating the artery and note the point on the manometer where the radial pulse can no longer be felt (this provides an estimate of the systolic blood pressure)
deflate the cuff completely and wait 1-2 minutes before continuing to measure
locate and palpate the brachial artery with fingertips (medial aspect of antecubital fossa), and place the stethoscope over the brachial artery
inflate the cuff rapidly to a pressure 30 mmHg higher than the estimated systolic blood pressure
deflate the cuff gradually at a rate of 2-3 mmHg per second until the first korotkoff sound (Phase I) is heard
[systolic blood pressure (Phase I sounds): the appearance of faint, clear tapping sounds, which gradually increase in intensity]
read pressure on manometer at eye level
continue to deflate cuff until the sound changed to a muffled sound (Phase IV)
[diastolic blood pressure (Phase IV sounds): when sound changes from a distinct tapping to a muffled sound which becomes soft and blowing]
remove cuff from client's arm
check that client is comfortable
compare blood pressure reading with previous recording
document the assessment data accurately
report any abnormalities to appropriate staff
inform client of reading
clean stethoscope after use
wash hands or rub hands
identify client; introduce self to client
explain procedure to client and gain verbal consent
where possible, measure blood pressure under the same conditions each time
allow client to rest several minutes after exercise or smoking before the procedure
expose upper part of client's arm and ensure client is in the desired position
i) lying, sitting or (standing?)
ii) palm of the hand facing upward
iii) sphygmomanometer position at heart level
according to the client's arm, choose an appropriate cuff size
wrap the deflated cuff snugly and smoothly around the upper part of the arm. The bottom of the cuff approximately 3cm above the antecubital space (the depression in front of the elbow) with centre of cuff bladder over brachial artery
to establish a baseline, locate the radial pulse with the fingertips of your non-dominant hand. Inflate the cuff while simultaneously palpating the artery and note the point on the manometer where the radial pulse can no longer be felt (this provides an estimate of the systolic blood pressure)
deflate the cuff completely and wait 1-2 minutes before continuing to measure
locate and palpate the brachial artery with fingertips (medial aspect of antecubital fossa), and place the stethoscope over the brachial artery
inflate the cuff rapidly to a pressure 30 mmHg higher than the estimated systolic blood pressure
deflate the cuff gradually at a rate of 2-3 mmHg per second until the first korotkoff sound (Phase I) is heard
[systolic blood pressure (Phase I sounds): the appearance of faint, clear tapping sounds, which gradually increase in intensity]
read pressure on manometer at eye level
continue to deflate cuff until the sound changed to a muffled sound (Phase IV)
[diastolic blood pressure (Phase IV sounds): when sound changes from a distinct tapping to a muffled sound which becomes soft and blowing]
remove cuff from client's arm
check that client is comfortable
compare blood pressure reading with previous recording
document the assessment data accurately
report any abnormalities to appropriate staff
inform client of reading
clean stethoscope after use
wash hands or rub hands
Difference between occupational therapist and physiotherapy
職業治療師透過不同的活動和治療，幫助病患者或有特殊需要的人士，增強體能及心智功能，發展日常生活或工作所需能力，協助他們重新投入家庭、工作和社會。
物理治療師是利用人體生理對物理刺激所作出的反應，治療病患和恢復身體活動功能。
兩者大致分別在於，物理治療師著重提升人的活動功能，職業治療師著重按照病人的生活或工作需要提供康復治療，而且還會協助提升病患者的心智功能。
(source: Housing Authority Elderly Resources Centre)
occupational therapist: functional, activities of daily living, home environment
道德經譯文9
(經) 聖人先人後己, 反而能得到人們的擁戴; 將自己置之度外, 反而能保全生命。這不是因為他無私嗎? 反而能成就自身。
(傳) 堯到華地觀遊。華地守封疆人說: "啊, 聖人, 請接受我的祝福。"
"祝聖人長壽。" 堯說: "不要。" "祝聖人富有。" 堯說: "不要。" " 祝聖人多男孩。" 堯說: "不要。"
守封疆人說: "長壽、富有、多男孩, 這是人們都想得到的, 你獨不想要, 為什麼呀?"
堯說: "多男孩便多恐懼, 富有便多事, 長壽則多辱。這三種東西, 都不是培養德性的, 所以不想要。"
守封疆人說: "起初我以為你是聖人, 現在看來竟是個君子。天生萬民, 必定會授予其職事, 多男孩而授予其職事, 還會有什麼恐懼? 富有而使人分享, 還會有什麼繁事? 聖人居無常處, 隨寓而安, 無心於食, 如鳥飛行於天空而沒有蹤跡, 天下有道, 便同萬物一起昌盛; 天下無道, 就修德閒居; 高齡時饜足於世, 便離開人間, 乘著那白雲, 到天地之鄉, 病、老、死三種禍患不來, 災殃不見, 還有什麼困辱?"
守封疆人離去。堯跟隨著他, 說: "請問應怎樣做?"
守封疆人說: "回去吧!"
(傳) 堯到華地觀遊。華地守封疆人說: "啊, 聖人, 請接受我的祝福。"
"祝聖人長壽。" 堯說: "不要。" "祝聖人富有。" 堯說: "不要。" " 祝聖人多男孩。" 堯說: "不要。"
守封疆人說: "長壽、富有、多男孩, 這是人們都想得到的, 你獨不想要, 為什麼呀?"
堯說: "多男孩便多恐懼, 富有便多事, 長壽則多辱。這三種東西, 都不是培養德性的, 所以不想要。"
守封疆人說: "起初我以為你是聖人, 現在看來竟是個君子。天生萬民, 必定會授予其職事, 多男孩而授予其職事, 還會有什麼恐懼? 富有而使人分享, 還會有什麼繁事? 聖人居無常處, 隨寓而安, 無心於食, 如鳥飛行於天空而沒有蹤跡, 天下有道, 便同萬物一起昌盛; 天下無道, 就修德閒居; 高齡時饜足於世, 便離開人間, 乘著那白雲, 到天地之鄉, 病、老、死三種禍患不來, 災殃不見, 還有什麼困辱?"
守封疆人離去。堯跟隨著他, 說: "請問應怎樣做?"
守封疆人說: "回去吧!"
2014年7月30日星期三
暢通氣道
按額托顎法
創傷推顎法:
1) place one hand on each side of the victim's head, resting your elbows on the surface on which the victim is lying
2) place your fingers under the angles of the victim's lower jaw and lift with both hands, displacing the jaw forward
3) if the lips close, push the lower lip with your thumb to open the lips
創傷推顎法:
1) place one hand on each side of the victim's head, resting your elbows on the surface on which the victim is lying
2) place your fingers under the angles of the victim's lower jaw and lift with both hands, displacing the jaw forward
3) if the lips close, push the lower lip with your thumb to open the lips
dual diagnosis
people with substance use disorders also tend to have other mental health problems such as anxiety, depression or psychosis
people may be using substance to "self-medicate" - to cope with distress and symptoms of mental health problems
in the long term, this makes symptoms worse
it is important to seek help for both the substance use disorder and mental illness at the same time
people may be using substance to "self-medicate" - to cope with distress and symptoms of mental health problems
in the long term, this makes symptoms worse
it is important to seek help for both the substance use disorder and mental illness at the same time
symptoms in mania
increased energy and overactivity
elated mood
need less sleep than usual
irritability
rapid thinking and speech
lack of inhibitions
grandiose delusions
lack of insight
elated mood
need less sleep than usual
irritability
rapid thinking and speech
lack of inhibitions
grandiose delusions
lack of insight
psychotic disorders
lost some contact with reality
characterized by delusions, hallucinations and thought disorder
severe disturbances in thinking, emotion and behavior
psychosis severely disrupts person's life
relationship, work, study and self-care are difficult to initiate or maintain
not as common as depression and anxiety disorders
characterized by delusions, hallucinations and thought disorder
severe disturbances in thinking, emotion and behavior
psychosis severely disrupts person's life
relationship, work, study and self-care are difficult to initiate or maintain
not as common as depression and anxiety disorders
symptoms of a panic attack
increased awareness of heart beat
sweating
trembling or shaking
feeling of choking, shortness of breath or something
chest pain or discomfort
nausea or abdominal distress
feeling of unreality or feeling detached from oneself or from the surroundings
feeling dizzy, unsteady, light-headed or faint
fear of losing control or going crazy
fear of dying
numbness, tingling or pins and needles
chills or hot flushes
sweating
trembling or shaking
feeling of choking, shortness of breath or something
chest pain or discomfort
nausea or abdominal distress
feeling of unreality or feeling detached from oneself or from the surroundings
feeling dizzy, unsteady, light-headed or faint
fear of losing control or going crazy
fear of dying
numbness, tingling or pins and needles
chills or hot flushes
talk with a person about self-injury
tell the young person that you care, and want to help
express empathy
do not (only) focus on stopping the self-injury,
focus on other ways to alleviate the distress
encourage the young person to call someone they trust next time they feel the urge to injure themselves
express empathy
do not (only) focus on stopping the self-injury,
focus on other ways to alleviate the distress
encourage the young person to call someone they trust next time they feel the urge to injure themselves
three key actions
if you think someone may be suicidal, ask him
if he says yes, do not leave him alone
link them with professional help
if he says yes, do not leave him alone
link them with professional help
immediate safety concerns (suicide)
do not put yourself in danger
if the young person is consuming alcohol or drugs, try to stop them from using any more
try to ensure person does not have ready access to some means to take their life
if the person has a weapon which could be used to injure someone else, and is becoming aggressive, call the police
if the young person is consuming alcohol or drugs, try to stop them from using any more
try to ensure person does not have ready access to some means to take their life
if the person has a weapon which could be used to injure someone else, and is becoming aggressive, call the police
suicide warning signs
expressions of hopelessness or helplessness
an overwhelming sense of shame or guilt
a dramatic change in personality or appearance
irrational or bizarre behavior
changed eating or sleeping habits
a severe drop in school or work performance
a lack of interest in the future
written or spoken notice of intention to commit suicide
giving away possessions or putting affairs in order
an overwhelming sense of shame or guilt
a dramatic change in personality or appearance
irrational or bizarre behavior
changed eating or sleeping habits
a severe drop in school or work performance
a lack of interest in the future
written or spoken notice of intention to commit suicide
giving away possessions or putting affairs in order
symptoms of a depressive disorder
an usually sad mood
loss of enjoyment and interest in activities that used to be enjoyable
lack of energy and tiredness
feeling worthless or feeling guilty when they are not really at fault
thinking about death a lot or wishing to be dead
difficulty concentrating or making decisions
moving more slowly or sometimes becoming agitated and unable to settle
having sleeping difficulties or sometimes sleeping too much
loss of interest in food or sometimes eating too much;
changes in eating habits may lead to either loss of weight or putting on weight
loss of enjoyment and interest in activities that used to be enjoyable
lack of energy and tiredness
feeling worthless or feeling guilty when they are not really at fault
thinking about death a lot or wishing to be dead
difficulty concentrating or making decisions
moving more slowly or sometimes becoming agitated and unable to settle
having sleeping difficulties or sometimes sleeping too much
loss of interest in food or sometimes eating too much;
changes in eating habits may lead to either loss of weight or putting on weight
action plan
approach the young person, assess and assist with any crisis
listen non-judgmentally
give support and information
encourage the young person to get appropriate professional help
encourage other supports
impact of mental health problems on social development
withdrawal from school and social activities
dependence on family as main source of socialization
reduces autonomy and personal identity
dependence on family as main source of socialization
reduces autonomy and personal identity
Why MHFA training?
mental health problems are common
many people are not well-informed
people do not know how to respond
there is a stigma associated with mental health problems
early detection facilities professional intervention, on-going support and overall recovery
many people are not well-informed
people do not know how to respond
there is a stigma associated with mental health problems
early detection facilities professional intervention, on-going support and overall recovery
types of incontinence
stress incontinence: urine leaks when increased abdominal pressure
urge incontinence: occurs when you have a strong, sudden need to urinate. The bladder then squeezes, or spasms, and you lose urine. (http://www.nlm.nih.gov)
overflow incontinence (benign prostatic hyperplasia)
functional incontinence: cannot reach the toilet on time due to functional or cognitive defectmixed incontinence (stress + urge)
urge incontinence: occurs when you have a strong, sudden need to urinate. The bladder then squeezes, or spasms, and you lose urine. (http://www.nlm.nih.gov)
overflow incontinence (benign prostatic hyperplasia)
functional incontinence: cannot reach the toilet on time due to functional or cognitive defectmixed incontinence (stress + urge)
assessment of incontinence
onset of problem
physical examination
history
urinalysis, uroflowmetry and bladder residual urine
frequency of micturition
number of pads used in day and night
fluid intake
patient's response to the problem
bowel assessment
physical examination
history
urinalysis, uroflowmetry and bladder residual urine
frequency of micturition
number of pads used in day and night
fluid intake
patient's response to the problem
bowel assessment
advanced directives
formal means of expressing refusal of some form of medical treatment in future should incapacity prevail, and are means by which individuals express their wishes about how they would like to be treated if they become mentally incapacitated
ethical issues in gerontological setting
do not resuscitate order
decision making for demented patient
withholding / withdrawing life prolonging medical treatment
advanced directives / health care decision
elder abuse
decision making for demented patient
withholding / withdrawing life prolonging medical treatment
advanced directives / health care decision
elder abuse
ethical theories and decision making
ethical theories frequently appears in daily life
ethics helps people understand the routine morality and strengthen moral judgement in face of moral dilemmas
what should I do or not?
people are in dilemma as they do not understand their ethical preferences in decision making
ethics helps people understand the routine morality and strengthen moral judgement in face of moral dilemmas
what should I do or not?
people are in dilemma as they do not understand their ethical preferences in decision making
Possible causes in domestic settings (elder abuse)
Social and value changes
caregiver stress
caregiver was abused/victim
family conflict/relationship
substance abuse by caregiver
low education level
poor social network support
poor economic condition
lack of space
caregiver stress
caregiver was abused/victim
family conflict/relationship
substance abuse by caregiver
low education level
poor social network support
poor economic condition
lack of space
bereavement support
counselling and support to families who are facing death of their loved ones;
provided by hospitals/community e.g. Jessie and Thomas Tam centre
provided by hospitals/community e.g. Jessie and Thomas Tam centre
palliative care
an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual
2014年7月28日星期一
conditions that could cause pain
cancer
depression
diabetes
enlarged prostate
heart disease
hypertension
arthritis
osteoporosis
pulmonary conditions
stroke
depression
diabetes
enlarged prostate
heart disease
hypertension
arthritis
osteoporosis
pulmonary conditions
stroke
pain rating scales
verbal descriptor scale
numerical rating scale
Wong-Bake FACES scale
Abbey pain scale
numerical rating scale
Wong-Bake FACES scale
Abbey pain scale
pain assessment
provoking factors, causes, history
quality: how the pain feel
region/radiation: site or does it radiate elsewhere
severity: how severe or intense?
temporal: change during the day? present all the time, come and go?
treatment: what has been tried to help? what's its effect?
quality: how the pain feel
region/radiation: site or does it radiate elsewhere
severity: how severe or intense?
temporal: change during the day? present all the time, come and go?
treatment: what has been tried to help? what's its effect?
types of pain
nociceptive pain: caused by damage of tissues
neuropathic pain: altered stimuli usually caused by nerve damage
neuropathic pain: altered stimuli usually caused by nerve damage
effects of chronic pain on cognition
forgetfulness
minor accidents
difficulty in finishing tasks
attention difficulties
minor accidents
difficulty in finishing tasks
attention difficulties
elements of physical fitness
aerobic exercise
body structure
body composition
balance
flexibility
muscle strength
body structure
body composition
balance
flexibility
muscle strength
three aspects of health promotion
positive health education (media, professionals)
prevention (regular exercise, diet)
health protection (screening, assessment)
prevention (regular exercise, diet)
health protection (screening, assessment)
community-based gerontological care in HK
community geriatric assessment team
psycho-geriatric team
community nursing service
community psychiatric nursing service
enhanced home and community care service
integrated care model
integrated discharge service program
nurse-clinics in general out-patient clinics
public-private partnership program
psycho-geriatric team
community nursing service
community psychiatric nursing service
enhanced home and community care service
integrated care model
integrated discharge service program
nurse-clinics in general out-patient clinics
public-private partnership program
hospital-based gerontological care in HK
acute care
rehabilitation
long-stay
respite
geriatric day hospital
specialty consultation
domiciliary care
rehabilitation
long-stay
respite
geriatric day hospital
specialty consultation
domiciliary care
occupational therapy
activities of daily living assessment and training
home management skill
home assessment
splints
aids and devices
functional training
home management skill
home assessment
splints
aids and devices
functional training
physical therapy
mobilization
range of motion exercise
posture training
gait training
muscle training
chest rehabilitation
heat and cold therapy
pain relief
electro-therapy (e.g. transcutaneous electrical nerve stimulation)
hydrotherapy
pressure-relieving devices
range of motion exercise
posture training
gait training
muscle training
chest rehabilitation
heat and cold therapy
pain relief
electro-therapy (e.g. transcutaneous electrical nerve stimulation)
hydrotherapy
pressure-relieving devices
functional independence measure
The FIM instrument is a basic
indicator of severity of disability. The functional ability of a patient
changes during rehabilitation and the FIM instrument is used to track those changes which are a key
outcome measure of rehabilitation episodes.
http://ahsri.uow.edu.au/aroc/whatisfim/index.html
ADL and IADL
Activities of daily living:
ambulation, bed/chair mobility, urinary and bowel, dressing, toileting, hygiene
Instrumental activities of daily living:
list of advanced functions: shopping, food preparation, housekeeping, laundry, using telephone, outdoor travel, use of transportation, handle financial matters, responsibility of medications
ambulation, bed/chair mobility, urinary and bowel, dressing, toileting, hygiene
Instrumental activities of daily living:
list of advanced functions: shopping, food preparation, housekeeping, laundry, using telephone, outdoor travel, use of transportation, handle financial matters, responsibility of medications
comprehensive multidisciplinary approach
medical: diagnosis, drugs, risk factors
nursing: case management, monitoring, identifying problems, coordination of care
occupational therapist: functional, activities of daily living, home environment
physiotherapist: musculoskeletal
social: support system
nursing: case management, monitoring, identifying problems, coordination of care
occupational therapist: functional, activities of daily living, home environment
physiotherapist: musculoskeletal
social: support system
conditions that require long term care
chronic diseases: e.g. stroke, diabetes mellitus, coronary heart disease, renal, chronic obstructive pulmonary disease
cancer
mental illness
disabilities: e.g. post-fractured hip
cancer
mental illness
disabilities: e.g. post-fractured hip
2014年7月24日星期四
道德經譯文8
(經) 虛空的變化永不停息, 這就是微妙的母性。微妙的母性, 是天地萬物產生的根源。它連綿不絕地永存著, 作用無窮無盡。
(傳) 孔子去見老聃, 老聃剛洗完頭, 正披散著頭髮等待晾乾, 凝定而立好像是木頭人。孔子屏隱於門下等待他。過了一會兒見了面, 孔子說: "是我的眼睛花了呢, 還是真的呢? 剛才先生形體直立不動有如枯木, 好像超然物外而立於大 '道' 之中。"
老聃說: "我遊心於萬物的本始。"
孔子說: "這是什麼意思呢?"
老聃說: "心困而不能知曉, 口合而不能言說, 試著為你講個大概的情形。至陰嚴寒, 至陽炎熱, 嚴寒出於天, 炎熱出於地, 兩者相互交融而萬物化生, 也許是萬物的規律而看不到它的形象。死生盛衰, 時隱時顯, 日遷月移, 無時不在起作用, 然而卻看不到它的功績。生有所由起, 死有所歸趨, 始終循環無端而不知道它的窮盡。如果不是這樣, 又有什麼是它的根本呢?"
孔子說: "請問遊心於此的情形?"
老聃說: "達到這樣的境界, 至美至樂, 得到至美而遊心於至樂, 稱為至人。"
孔子說: "希望聽聽如何才能達到這樣的境界。"
老聃說: "吃草的動物不怕變換草澤, 水生的蟲兒不怕變換水塘, 只作小的變化而沒有失去其根本的需要, 喜怒哀樂之情就不會侵入胸中。天下萬物都有一致之處。了解它們的一致之處而同等地看待萬物, 那麼四肢百骸如同塵垢, 而死生終始的變化如同晝夜的循環, 沒有什麼能擾亂其心, 何況是得失禍福的分別呢! 捨棄得失禍福如同丟泥土一樣, 是因為知道自身比得失禍福更可貴, 知道可貴在於我自身就不會在得失禍福的變化中喪失自我。而且事物千變萬化沒有窮盡, 有什麼值得困擾於心的呢! 得道之人明白這個道理。"
孔子說: "先生德配天地, 還用最高明的道理來修心, 古代的君子, 誰能脫離 (最高明的道理而不修心) 呢?"
老聃說: "不是這樣。水自然湧流, 不是有意去做, 自然而然。至人養德, 不修而德不離, 就像天自然高, 地自然厚, 日月自然明, 又何必修呢?"
孔子出去, 告訴顏回: "我對於大道的了解, 豈不像酒甕中的小飛蟲麼! 如果不是先生啟發我的蒙蔽, 我真不知道天地的大全呀!"
(傳) 孔子去見老聃, 老聃剛洗完頭, 正披散著頭髮等待晾乾, 凝定而立好像是木頭人。孔子屏隱於門下等待他。過了一會兒見了面, 孔子說: "是我的眼睛花了呢, 還是真的呢? 剛才先生形體直立不動有如枯木, 好像超然物外而立於大 '道' 之中。"
老聃說: "我遊心於萬物的本始。"
孔子說: "這是什麼意思呢?"
老聃說: "心困而不能知曉, 口合而不能言說, 試著為你講個大概的情形。至陰嚴寒, 至陽炎熱, 嚴寒出於天, 炎熱出於地, 兩者相互交融而萬物化生, 也許是萬物的規律而看不到它的形象。死生盛衰, 時隱時顯, 日遷月移, 無時不在起作用, 然而卻看不到它的功績。生有所由起, 死有所歸趨, 始終循環無端而不知道它的窮盡。如果不是這樣, 又有什麼是它的根本呢?"
孔子說: "請問遊心於此的情形?"
老聃說: "達到這樣的境界, 至美至樂, 得到至美而遊心於至樂, 稱為至人。"
孔子說: "希望聽聽如何才能達到這樣的境界。"
老聃說: "吃草的動物不怕變換草澤, 水生的蟲兒不怕變換水塘, 只作小的變化而沒有失去其根本的需要, 喜怒哀樂之情就不會侵入胸中。天下萬物都有一致之處。了解它們的一致之處而同等地看待萬物, 那麼四肢百骸如同塵垢, 而死生終始的變化如同晝夜的循環, 沒有什麼能擾亂其心, 何況是得失禍福的分別呢! 捨棄得失禍福如同丟泥土一樣, 是因為知道自身比得失禍福更可貴, 知道可貴在於我自身就不會在得失禍福的變化中喪失自我。而且事物千變萬化沒有窮盡, 有什麼值得困擾於心的呢! 得道之人明白這個道理。"
孔子說: "先生德配天地, 還用最高明的道理來修心, 古代的君子, 誰能脫離 (最高明的道理而不修心) 呢?"
老聃說: "不是這樣。水自然湧流, 不是有意去做, 自然而然。至人養德, 不修而德不離, 就像天自然高, 地自然厚, 日月自然明, 又何必修呢?"
孔子出去, 告訴顏回: "我對於大道的了解, 豈不像酒甕中的小飛蟲麼! 如果不是先生啟發我的蒙蔽, 我真不知道天地的大全呀!"
non-pharmacological treatment of delirium
optimize environment
personal belongings e.g. photos
quiet surroundings
sitter
follow a consistent routine
nutritionally balanced diet
maintain hydration
personal belongings e.g. photos
quiet surroundings
sitter
follow a consistent routine
nutritionally balanced diet
maintain hydration
causes of delirium
medications
substance withdrawal
unfamiliar environment
infections
dehydration
hypoxia
electrolyte disorders, anemia
hepatic/renal, lung, brain dysfunction
poisoning
injury, pain, stress
stroke
catheter, faecal impaction
genetic association
substance withdrawal
unfamiliar environment
infections
dehydration
hypoxia
electrolyte disorders, anemia
hepatic/renal, lung, brain dysfunction
poisoning
injury, pain, stress
stroke
catheter, faecal impaction
genetic association
definition of delirium
develops acutely and a disturbance of consciousness with impaired attention and disorganized thinking or perceptual disturbance that has a fluctuating course, and with evidence that there is an underlying physiologic or medical condition causing the disorder
overview of delirium
disorder of attention and global cognitive function
acute and fluctuating course
treatable
often diagnosis is missed
acute and fluctuating course
treatable
often diagnosis is missed
create dementia-friendly communities
policy
supporting businesses
campaign bring people aware of dementia and dispel the myth
get the business and public involved
better, large-scale participatory clinical research
supporting businesses
campaign bring people aware of dementia and dispel the myth
get the business and public involved
better, large-scale participatory clinical research
schedule of the day
old habits and routines
patterns in 24 hours
time to rest, work, play, socialize
patterns in 24 hours
time to rest, work, play, socialize
assessment (dementia)
type and stage of dementia
personal background, personality
health history
caregiver's approach and assistance
environment
schedule and flow of the day
personal background, personality
health history
caregiver's approach and assistance
environment
schedule and flow of the day
risk factors of dementia
old age
head injury with history of impaired consciousness
fewer years of education
female
cardiovascular disease
genetics
head injury with history of impaired consciousness
fewer years of education
female
cardiovascular disease
genetics
Progressive symptoms of dementia
loss of memory
mood changes
problems with communication and reasoning
mood changes
problems with communication and reasoning
2014年7月23日星期三
Prevention of suicide
relationship: trustful and respectful
isolation: prevent isolation, build up social network
communication: allow to express feeling
history: any recent loss, change of mental status, history of suicide, any physical illnesses
mental health: manage depression and other mental problems (delusion, anxiety, dementia)
pain: effective pain control
follow-up: frequent home visit, telephone contact, frequent routine treatment appointment
isolation: prevent isolation, build up social network
communication: allow to express feeling
history: any recent loss, change of mental status, history of suicide, any physical illnesses
mental health: manage depression and other mental problems (delusion, anxiety, dementia)
pain: effective pain control
follow-up: frequent home visit, telephone contact, frequent routine treatment appointment
risk factors of suicide
depression
sick or chronic illness
social factors
personality
life events (death of spouse, moving to nursing home)
sick or chronic illness
social factors
personality
life events (death of spouse, moving to nursing home)
risk factors of depression in old age
female
lower socioeconomic status
family history
living alone
widowhood
new stressful losses
chronic medical illness, disability, functional decline
dementia
bereavement
caregiving
previous episode depression
admission to long-term care or other change in environment
medication
alcohol or substance abuse
lower socioeconomic status
family history
living alone
widowhood
new stressful losses
chronic medical illness, disability, functional decline
dementia
bereavement
caregiving
previous episode depression
admission to long-term care or other change in environment
medication
alcohol or substance abuse
clinical assessment for chronic cognitive impairment
abbreviated mental test
mini-mental state examination
clock drawing test
mini-mental state examination
clock drawing test
Observable features of cognitive decline
verbal fluency
logical analysis
selective attention
object naming
complex visuospatial skills
logical analysis
selective attention
object naming
complex visuospatial skills
consequences of immobility
increase in-hospital mortality
increase institutionalized mortality
male urinary incontinence
pressure sore
venous thromboembolism
contracture
increase institutionalized mortality
male urinary incontinence
pressure sore
venous thromboembolism
contracture
risk factors of osteoporosis
age
gender
family history
race
body size
loss of height
back pain
menopause
gender
family history
race
body size
loss of height
back pain
menopause
Consequences of falls (morbidity)
significant declines in balance, gait and activities of daily living function
major soft tissue injury and fracture
fallers had more hospitalizations, visit to specialty clinics and emergency department than non-fallers
major soft tissue injury and fracture
fallers had more hospitalizations, visit to specialty clinics and emergency department than non-fallers
Iatrogenic factors of fall
adverse drug reactions
use of restraints
use of wheelchair
hypnotic drugs
use of restraints
use of wheelchair
hypnotic drugs
Extrinsic factors of fall
poor lighting
slippery floor
lack of handrails in corridor
uneven
obstructed walking surfaces
slippery floor
lack of handrails in corridor
uneven
obstructed walking surfaces
Intrinsic factors of fall
Factors that are related to clients' functional and health status
status of activity of daily living
instrumental activity of daily living
visual impairment
balance disorders
foot problems
insomnia
depression
anxiety
hypotension
hypoglycemia
dizziness
status of activity of daily living
instrumental activity of daily living
visual impairment
balance disorders
foot problems
insomnia
depression
anxiety
hypotension
hypoglycemia
dizziness
道德經譯文7
(經) 多說話必然招致禍患, 還不如持守虛靜。
(傳) 莊子在山中行走, 看見一棵大樹, 枝葉長得很茂盛, 伐木的人停在樹旁而不去砍伐。問他是什麼緣故, 他回答: "沒有一點用處。"
莊子說: "這棵樹因為不中用, 所以能享盡自然的壽命吧!"
莊子從山上出來, 到朋友家去。朋友很高興, 叫童僕殺一隻鵝宴請他。童僕說: "一隻鵝會叫, 另一隻不會叫, 請問殺哪一隻?" 主人說: "殺那隻不會叫的。"
第二天, 弟子問莊子說: "昨天山上的樹木, 因為 '不材' 而享盡自然的壽命; 現在主人的鵝, 因為 '不材' 被殺, 請問先生要怎麼自處呢?"
莊子笑著說: "我將處於 '材' 與 '不材' 之間。'材' 和 '不材' 之間, 似乎是妥當的位置, 其實不然, 這樣還是不能免於禍害。如果順應自然而浮遊於人世間就不是這樣了。既沒有讚譽也沒有譭辱, 時現時隱如龍出蛇蟄, 順著時序的變化而變化, 不偏執於任何一點; 時進時退, 以順任自然為原則, 遊心於萬物的本始之處, 主宰外物而不被外物所役使, 這樣怎麼會受到禍害呢? 這是神農、黃帝的處世法則呀! 至於萬物的私情, 人倫的習慣, 就不是這樣了。聚合則被分離, 完成則被毀掉, 清廉則被挫傷, 尊貴則受非議, 有為則遭虧損, 賢能則被謀算, 不肖則受欺侮, 怎麼可以偏執於一方呢? 可悲啊! 弟子要記住, 凡事只有順應自然啊!"
(傳) 莊子在山中行走, 看見一棵大樹, 枝葉長得很茂盛, 伐木的人停在樹旁而不去砍伐。問他是什麼緣故, 他回答: "沒有一點用處。"
莊子說: "這棵樹因為不中用, 所以能享盡自然的壽命吧!"
莊子從山上出來, 到朋友家去。朋友很高興, 叫童僕殺一隻鵝宴請他。童僕說: "一隻鵝會叫, 另一隻不會叫, 請問殺哪一隻?" 主人說: "殺那隻不會叫的。"
第二天, 弟子問莊子說: "昨天山上的樹木, 因為 '不材' 而享盡自然的壽命; 現在主人的鵝, 因為 '不材' 被殺, 請問先生要怎麼自處呢?"
莊子笑著說: "我將處於 '材' 與 '不材' 之間。'材' 和 '不材' 之間, 似乎是妥當的位置, 其實不然, 這樣還是不能免於禍害。如果順應自然而浮遊於人世間就不是這樣了。既沒有讚譽也沒有譭辱, 時現時隱如龍出蛇蟄, 順著時序的變化而變化, 不偏執於任何一點; 時進時退, 以順任自然為原則, 遊心於萬物的本始之處, 主宰外物而不被外物所役使, 這樣怎麼會受到禍害呢? 這是神農、黃帝的處世法則呀! 至於萬物的私情, 人倫的習慣, 就不是這樣了。聚合則被分離, 完成則被毀掉, 清廉則被挫傷, 尊貴則受非議, 有為則遭虧損, 賢能則被謀算, 不肖則受欺侮, 怎麼可以偏執於一方呢? 可悲啊! 弟子要記住, 凡事只有順應自然啊!"
2014年7月21日星期一
Tinetti balance assessment scale
Balance section:
sitting balance
rises from chair
attempts to rise
immediate standing balance (first 5 seconds)
nudged
eyes closed
turning 360 degrees
sitting down
Gait section:
indication of gait
step length and height
foot clearance
step symmetry
step continuity
path
trunk
walking time
Source: http://www.bhps.org.uk/falls/documents/TinettiBalanceAssessment.pdf
sitting balance
rises from chair
attempts to rise
immediate standing balance (first 5 seconds)
nudged
eyes closed
turning 360 degrees
sitting down
Gait section:
indication of gait
step length and height
foot clearance
step symmetry
step continuity
path
trunk
walking time
Source: http://www.bhps.org.uk/falls/documents/TinettiBalanceAssessment.pdf
Timed up and go test
Instructions:
1. Begin the test with the patient sitting correctly in a chair with arms, the patient's back should resting on the back of the chair. The chair should be stable and positioned such that it will not move when patient moves from sitting to standing.
2. Mark on the floor 3 metres away from the chair so that it is easily seen by the patient.
3. Ask the patient to perform the following series of manoeuvres:
4. Start timing when patient rise from the chair and stop timing when the patient is seated
again correctly in the chair.
5. The patient may use any walking aid that usually use during ambulation, but may not
be assisted by another person.
6. The patient can be given a practice trial that is not timed before testing.
Interpretation:
Different studies had identified different cut off values (which may reflect different subject
characteristics). It has been shown that a score of more than 14 seconds has been shown to
indicate high risk of falls with reasonable sensitivity and specificity.
Source: http://www.pco.gov.hk/english/resource/files/Module_on_Health_Assessment_Older_adults.pdf
1. Begin the test with the patient sitting correctly in a chair with arms, the patient's back should resting on the back of the chair. The chair should be stable and positioned such that it will not move when patient moves from sitting to standing.
2. Mark on the floor 3 metres away from the chair so that it is easily seen by the patient.
3. Ask the patient to perform the following series of manoeuvres:
- Rise from the chair
- Walk at regular pace for 3 metres to the mark on the floor
- Turn around and walk back to the chair
- Sit down in the chair
4. Start timing when patient rise from the chair and stop timing when the patient is seated
again correctly in the chair.
5. The patient may use any walking aid that usually use during ambulation, but may not
be assisted by another person.
6. The patient can be given a practice trial that is not timed before testing.
Interpretation:
Different studies had identified different cut off values (which may reflect different subject
characteristics). It has been shown that a score of more than 14 seconds has been shown to
indicate high risk of falls with reasonable sensitivity and specificity.
Source: http://www.pco.gov.hk/english/resource/files/Module_on_Health_Assessment_Older_adults.pdf
Barthel Index
Barthel Index of Independence in Activities of Daily Living (ADL) refers to basic self-care
activities that a person performs daily (e.g., eating, dressing, bathing, transferring, using the
toilet, controlling bladder and bowel functions). Inability to independently perform even
one activity may indicate a need for supporting services.
Source: http://www.pco.gov.hk/english/resource/files/Module_on_Health_Assessment_Older_adults.pdf
activities that a person performs daily (e.g., eating, dressing, bathing, transferring, using the
toilet, controlling bladder and bowel functions). Inability to independently perform even
one activity may indicate a need for supporting services.
Source: http://www.pco.gov.hk/english/resource/files/Module_on_Health_Assessment_Older_adults.pdf
Geriatric Depression Scale
老人抑鬱短量表 (GDS-15) – 廣東話口語化版本
你基本上對自己的生活感到滿意嗎？
你是否已放棄了很多以往的活動和嗜好？
你是否覺得生活空虛？
你是否常常感到煩悶？
你是否很多時感到心情愉快呢？
你是否害怕將會有不好的事發生在你身上呢？
你是否大部份時間感到快樂呢？
你是否常常感到無助？
你是否寧願留在院舍 / 屋企裏，而不出外做些有新意的事情？
你是否覺得你比大多數人有多些記憶的問題呢？
你認為現在活著是一件好事嗎？
你是否覺得自己現在一無是處呢？
你是否感到精力充足？
你是否覺得自己的處境無望？
你覺得大部份的人的境況比自己好嗎？
(總分≧ 8 指示有抑鬱的傾向 )
Source: http://www.pco.gov.hk/english/resource/files/Module_on_Health_Assessment_Older_adults.pdf
Snellen's chart
The visual acuity test is used to determine the smallest
letters you can read on a standardized chart (Snellen chart) or a card held 20
feet away.
You will be asked to remove your glasses or contact lenses
and stand or sit 20 feet from the eye chart. You will keep both eyes open.
You will be asked to cover one eye with the palm of your
hand, a piece of paper, or a small paddle while you read out loud the smallest
line of letters you can see on the chart. Numbers or pictures are used for people
who cannot read, especially children.
If you are not sure of the letter, you may guess. This test
is done on each eye, one at a time. If needed, it is repeated while you wear
your glasses or contacts.
2014年7月19日星期六
道德經譯文5
(經) 道體虛空, 然而作用卻沒有窮盡。淵深啊, 像是萬物的宗主; 幽隱啊, 似無而又實存。我不知道它是從哪裡產生的, 似乎在有天帝之前就存在。
(傳) 道, 淵深而幽隱,清澈而澄明。鐘磬之類的樂器, 不得道便無由鳴響。所以, 鐘磬能發聲, 但不敲它也不會發聲。萬物的感應誰能確定它呢! 那盛德的人, 抱樸而行, 不願周旋於世俗的事務之間; 立身於本原, 而智慧通達於神妙不測的境界。因而他的德行廣大, 他的心思發動, 乃是由於外物的作用。因此, 形體沒有道就不會產生, 生命沒有道就不能彰明。保存形體, 充實生命, 立身於德而彰明於道,豈不就是盛德嗎? 浩大啊! 忽然而出, 勃然而動, 萬物都依從於他! 這就是盛德的人。(道,) 看它幽冥深遠, 聽它沒有聲音。幽冥深遠之中, 卻能看到光明; 寂靜無聲之中, 卻能聽到和音。所以, (道) 深遠又深遠卻能產生萬物,玄妙又玄妙而能成精氣; 道和萬物相接, 道虛寂卻能供應萬物的需求, 馳騁不已卻能為萬物的歸宿。
(傳) 道, 淵深而幽隱,清澈而澄明。鐘磬之類的樂器, 不得道便無由鳴響。所以, 鐘磬能發聲, 但不敲它也不會發聲。萬物的感應誰能確定它呢! 那盛德的人, 抱樸而行, 不願周旋於世俗的事務之間; 立身於本原, 而智慧通達於神妙不測的境界。因而他的德行廣大, 他的心思發動, 乃是由於外物的作用。因此, 形體沒有道就不會產生, 生命沒有道就不能彰明。保存形體, 充實生命, 立身於德而彰明於道,豈不就是盛德嗎? 浩大啊! 忽然而出, 勃然而動, 萬物都依從於他! 這就是盛德的人。(道,) 看它幽冥深遠, 聽它沒有聲音。幽冥深遠之中, 卻能看到光明; 寂靜無聲之中, 卻能聽到和音。所以, (道) 深遠又深遠卻能產生萬物,玄妙又玄妙而能成精氣; 道和萬物相接, 道虛寂卻能供應萬物的需求, 馳騁不已卻能為萬物的歸宿。
2014年7月18日星期五
criteria for referring occupational therapist (examples)
sitting assessment
ADL assessment
assistive device assessment e.g. feeding utensils, side-rails, toileting device
home assessment (domiciliary visits) e.g. modification of ramping, furniture
sensory stimulation therapy
reminiscent therapy
comprehensive mental assessment
ADL assessment
assistive device assessment e.g. feeding utensils, side-rails, toileting device
home assessment (domiciliary visits) e.g. modification of ramping, furniture
sensory stimulation therapy
reminiscent therapy
comprehensive mental assessment
common iatrogenic disorders
loss of mobility
temporary incontinence
confusion
pressure sores
fluid overload
nosocomial infection
urinary tract infection
upper respiratory tract infection
fluid and electrolyte imbalance
falls
impaired sleep
malnutrition
temporary incontinence
confusion
pressure sores
fluid overload
nosocomial infection
urinary tract infection
upper respiratory tract infection
fluid and electrolyte imbalance
falls
impaired sleep
malnutrition
Iatrogenesis
The process of inducing unfavorable response to medical and surgical treatments.
Untoward event while hospitalized
For example, falls, immobility, incontinence
The longer the elderly stay in the hospital, the more likely to occue
Untoward event while hospitalized
For example, falls, immobility, incontinence
The longer the elderly stay in the hospital, the more likely to occue
comprehensive gerontological assessment
consciousness and cognition
medication
medical history
communication (Snellen's chart)
mood and behavior (Geriatric Depression Scale)
functional level (Barthel Index)
fall (Time-up-and-go test, Tinetti)
pain (Numeric Rating Scale, Visual Descriptive Scale, Wong-Baker Faces Scale, Abbey Pain Scale)
nutrition (water swallowing test)
elimination (incontinent: stress, overflow, urge, functional, mixed)
skin (Norton Scale, Pressure Ulcer Stage of Healing tool)
psychosocial (Quality of life- (SF12 health survey))
progress of special care program
medication
medical history
communication (Snellen's chart)
mood and behavior (Geriatric Depression Scale)
functional level (Barthel Index)
fall (Time-up-and-go test, Tinetti)
pain (Numeric Rating Scale, Visual Descriptive Scale, Wong-Baker Faces Scale, Abbey Pain Scale)
nutrition (water swallowing test)
elimination (incontinent: stress, overflow, urge, functional, mixed)
skin (Norton Scale, Pressure Ulcer Stage of Healing tool)
psychosocial (Quality of life- (SF12 health survey))
progress of special care program
caring for older people
interaction patterns based on reciprocity and obligation
marriage = care of partners for entire life
parental love leads to filial piety caregiving as the norm of Chinese tradition
marriage = care of partners for entire life
parental love leads to filial piety caregiving as the norm of Chinese tradition
family caregiver
committed to job entirely
>88 working hours a week
24-hour stand-by
care of mentally agitated and functionally dependent person
competent in performing personal care e.g. bathing, feeding, changing soiled linen, escorting
>88 working hours a week
24-hour stand-by
care of mentally agitated and functionally dependent person
competent in performing personal care e.g. bathing, feeding, changing soiled linen, escorting
2014年7月16日星期三
arrhythmia occurs due to
significant interference with the blood flow to the SA node, either by occlusion and by narrowed arteriosclerotic vessels
temperature regulation
sweat glands of elderly are reduced and inactive, not able to perspire freely, susceptible to heat stroke
signs and symptoms of aging
decreased muscle mass
decreased bone density
decreased vision
decreased hearing
increased susceptibility of infection
decreased bone density
decreased vision
decreased hearing
increased susceptibility of infection
Myths and misconceptions
Monotype (people over 65 are the same)
Deterioration (ageing = deterioration)
Sickness (age = sick)
Stubborn (typical personality)
Dependent (they cannot live independently)
Retirement (they should retire)
Burden (they live on others' support)
Useless (they have no contribution)
Deterioration (ageing = deterioration)
Sickness (age = sick)
Stubborn (typical personality)
Dependent (they cannot live independently)
Retirement (they should retire)
Burden (they live on others' support)
Useless (they have no contribution)
Theories of aging
Biologic theories of aging:
a) gene theory
b) somatic mutation theory
c) biological clock theory
d) immunological theory
e) free radical theory
f) cross-link theory
g) wear and tear theory
Psychosocial theories of aging:
a) disengagement theory
b) activity theory
c) continuity theory
d) subculture theory
e) structural dependency theory
Developmental stages of aging:
a) Erik Erikson
b) Peck
c) Havighurst
a) gene theory
b) somatic mutation theory
c) biological clock theory
d) immunological theory
e) free radical theory
f) cross-link theory
g) wear and tear theory
Psychosocial theories of aging:
a) disengagement theory
b) activity theory
c) continuity theory
d) subculture theory
e) structural dependency theory
Developmental stages of aging:
a) Erik Erikson
b) Peck
c) Havighurst
Myths about ageing
Gerontology includes biologic, sociologic, psychologic, economic aspects.
Gerontological nursing aims to enhance quality of life for older adults through health promotion, support of independence, support for development throughout life, and peaceful death.
Common myths about aging:
a) most older people are sick and need help with daily activities;
b) most older people are senile or demented;
c) most older people feel miserable and depressed.
Gerontological nursing aims to enhance quality of life for older adults through health promotion, support of independence, support for development throughout life, and peaceful death.
Common myths about aging:
a) most older people are sick and need help with daily activities;
b) most older people are senile or demented;
c) most older people feel miserable and depressed.
2014年7月15日星期二
道德經譯文4
(經) 不崇尚賢能, 使民眾不爭求功名; 不珍視難得的財貨, 使民眾不做盜賊; 不彰顯令人貪求的東西, 使民眾的心思不惑亂。
(傳) 小的迷惑會錯亂方位, 大的迷惑會錯亂本性。怎麼知道是這樣的呢? 虞舜標榜仁義來撓擾天下, 天下沒有人不奔命於仁義, 這不是用仁義錯亂本性嗎? 現在試作申論, 自從三代之後, 天下沒有人不以外物錯亂本性的。小人則為利而死, 士人則為名而犧牲, 大夫則為家而死, 聖人則為天下而犧牲。這幾種人, 所從事的事情不同, 名聲也各不相同, 但是傷害本性而為某種目的犧牲自己, 卻是一樣的。男僕和小孩一起去放羊, 而都把羊丟了。問男僕放羊的時候在做什麼, 他是手執竹簡在讀書; 問小孩放羊的時候在做什麼, 他是在擲骰子遊戲。這兩個人, 在放羊的時候做的事情不同, 但同樣都把羊丟了。伯夷為了名而死在首陽之山, 盜跖為了利而死在東陵山上。這兩個人, 所為之而死的事情不一樣, 但同樣都是殘生傷性。何必認定伯夷是對的而盜跖是錯的呢? 天下之人都在為某種目的而死, 為仁義而死的人, 世俗稱之為君子; 為財貨而死的人, 世俗則稱之為小人。為某種目的而死是一樣的, 而有的被稱為君子, 有的被視為小人。如果就殘生損性來看, 則盜跖和伯夷都是一樣的, 又何必從中分別出君子、小人來呢!
(傳) 小的迷惑會錯亂方位, 大的迷惑會錯亂本性。怎麼知道是這樣的呢? 虞舜標榜仁義來撓擾天下, 天下沒有人不奔命於仁義, 這不是用仁義錯亂本性嗎? 現在試作申論, 自從三代之後, 天下沒有人不以外物錯亂本性的。小人則為利而死, 士人則為名而犧牲, 大夫則為家而死, 聖人則為天下而犧牲。這幾種人, 所從事的事情不同, 名聲也各不相同, 但是傷害本性而為某種目的犧牲自己, 卻是一樣的。男僕和小孩一起去放羊, 而都把羊丟了。問男僕放羊的時候在做什麼, 他是手執竹簡在讀書; 問小孩放羊的時候在做什麼, 他是在擲骰子遊戲。這兩個人, 在放羊的時候做的事情不同, 但同樣都把羊丟了。伯夷為了名而死在首陽之山, 盜跖為了利而死在東陵山上。這兩個人, 所為之而死的事情不一樣, 但同樣都是殘生傷性。何必認定伯夷是對的而盜跖是錯的呢? 天下之人都在為某種目的而死, 為仁義而死的人, 世俗稱之為君子; 為財貨而死的人, 世俗則稱之為小人。為某種目的而死是一樣的, 而有的被稱為君子, 有的被視為小人。如果就殘生損性來看, 則盜跖和伯夷都是一樣的, 又何必從中分別出君子、小人來呢!
2014年7月13日星期日
道德經譯文3
(經) 有道之人以 "無為" 的態度來處理世事, 實行 "不言" 的教化。任萬物興起而不加倡導, 生養萬物而不據為己有, 化育萬物而不自恃己能, 功成事就而不居其功。正因為不居其功, 所以他的功績不會泯沒。
(傳) 魯國有個斷足的人名叫王駘, 跟從他遊學的人與跟從孔子求學的人相當。常季問孔子說: "王駘是一個斷足之人, 而跟從他遊學的人和跟從您遊學的人在魯國各佔一半。他站著的時候不施教於人, 坐著的時候也沒有什麼議論, 跟他學的人空虛而往, 充實而歸。難道真有不用言語的教導, 無形感化而達到潛移默化之功嗎? 這是什麼樣的人呀?"
孔子說: "這位先生是個得道的聖人, 我也落後在後面還沒有去請教他。我都準備拜他為師, 更何況不如我的人呢! 何止是魯國, 我要引導天下的人都去跟他學。"
季常說: "他是一個斷足的人, 而能勝過先生, 那麼他比普通人一定高明多了。像這樣的人, 他怎麼運用自己的心智呢?"
孔子說: "死生是極大的事了, 卻不能影響到他; 即使天覆地墜, 他也不會隨之一同消隕。他處於無所依恃的境地而不受外物變遷的影響, 順應萬物的變化而執守事物的根本。"
季常說: "這是什麼意思呢?"
孔子說: "從萬物相異的角度看, 肝與膽就像楚國和越國那麼遙遠而不同; 從萬物相同的角度看, 萬物都是一樣的。如果明白這個道理, 就不會去關心耳目適宜於何種聲色, 而只求心靈遊放於德的和諧的境界; 從萬物相同的一面去看, 就看不見有什麼喪失了, 所以看自己斷了足就像丟掉了一塊泥土一般。"
季常說: "王駘修己罷了, 他用智慧去理解分別一切的心, 再根據這個心返回到不起分別作用的 '常心', 人們又為什麼跟從他呢?"
孔子說: "人們都不在流動的水面上觀察自己, 而在靜止的水面上觀照自己, 只有靜止的東西才能使他物靜止。接受生命於地, 只有松柏稟自然之正, 無論冬夏都枝葉長青; 接受生命於天, 唯有堯舜獨得性命之正, 在萬物之中為首。幸而他們能自正性命, 才能引導眾人各正性命。保全本始有徵驗, 譬如勇者有無所畏懼之實。勇敢的武士, 一個人敢於衝入千軍萬馬之中。將士為了求名尚且能夠如此, 何況主宰天地, 包藏萬物, 以六骸為寄生的寓所, 以耳目為形跡, 智慧能夠燭照所知的境域, 而心中未嘗有死生變化觀念的人呢! 這樣超塵絕俗的人, 人們都樂意跟隨他。他哪裡肯以吸引眾人為事呢!"
(傳) 魯國有個斷足的人名叫王駘, 跟從他遊學的人與跟從孔子求學的人相當。常季問孔子說: "王駘是一個斷足之人, 而跟從他遊學的人和跟從您遊學的人在魯國各佔一半。他站著的時候不施教於人, 坐著的時候也沒有什麼議論, 跟他學的人空虛而往, 充實而歸。難道真有不用言語的教導, 無形感化而達到潛移默化之功嗎? 這是什麼樣的人呀?"
孔子說: "這位先生是個得道的聖人, 我也落後在後面還沒有去請教他。我都準備拜他為師, 更何況不如我的人呢! 何止是魯國, 我要引導天下的人都去跟他學。"
季常說: "他是一個斷足的人, 而能勝過先生, 那麼他比普通人一定高明多了。像這樣的人, 他怎麼運用自己的心智呢?"
孔子說: "死生是極大的事了, 卻不能影響到他; 即使天覆地墜, 他也不會隨之一同消隕。他處於無所依恃的境地而不受外物變遷的影響, 順應萬物的變化而執守事物的根本。"
季常說: "這是什麼意思呢?"
孔子說: "從萬物相異的角度看, 肝與膽就像楚國和越國那麼遙遠而不同; 從萬物相同的角度看, 萬物都是一樣的。如果明白這個道理, 就不會去關心耳目適宜於何種聲色, 而只求心靈遊放於德的和諧的境界; 從萬物相同的一面去看, 就看不見有什麼喪失了, 所以看自己斷了足就像丟掉了一塊泥土一般。"
季常說: "王駘修己罷了, 他用智慧去理解分別一切的心, 再根據這個心返回到不起分別作用的 '常心', 人們又為什麼跟從他呢?"
孔子說: "人們都不在流動的水面上觀察自己, 而在靜止的水面上觀照自己, 只有靜止的東西才能使他物靜止。接受生命於地, 只有松柏稟自然之正, 無論冬夏都枝葉長青; 接受生命於天, 唯有堯舜獨得性命之正, 在萬物之中為首。幸而他們能自正性命, 才能引導眾人各正性命。保全本始有徵驗, 譬如勇者有無所畏懼之實。勇敢的武士, 一個人敢於衝入千軍萬馬之中。將士為了求名尚且能夠如此, 何況主宰天地, 包藏萬物, 以六骸為寄生的寓所, 以耳目為形跡, 智慧能夠燭照所知的境域, 而心中未嘗有死生變化觀念的人呢! 這樣超塵絕俗的人, 人們都樂意跟隨他。他哪裡肯以吸引眾人為事呢!"
道德經譯文2
(經) 天下都知道美之所以為美, 醜的認識就產生了; 都知道善之所以為善, 不善的觀念也就產生了。
(傳) 馬, 蹄可以踐霜踏雪, 毛可以擋風禦寒, 吃草飲水, 翹足跳躍, 這是馬的真性。雖然有高台大殿, 對它並沒有什麼用處。等到伯樂出來, 說: "我擅長治理馬。" 於是用鐵燒它們, 剪它們的毛, 削它們的蹄, 在它們身上烙上印記, 用絡首絆腳把它們拴起來, 編到馬槽裡, 馬就死掉十分之二三了; 然後不讓它們吃飽, 不給它們喝足水, 讓它們為人所用, 讓它們奔跑, 訓練它們, 讓它們行動一致, 先有口銜鑣纓的禍患, 然後有皮鞭竹筴的威脅, 馬就死掉大半了。陶工說: "我善於捏陶土, 做出來的東西圓的符合規, 方的合乎矩。" 木匠說: "我擅長削木頭, 使曲的合乎鉤, 直的合於繩。" 粘土和樹木的本性, 難道是想合乎規矩鉤繩嗎? 然而, 人們世世代代都傳頌說 "伯父樂善於治理馬, 陶工、木匠善於利用陶土和木材", 這也和治理天下的人一樣的錯誤呀!
(傳) 馬, 蹄可以踐霜踏雪, 毛可以擋風禦寒, 吃草飲水, 翹足跳躍, 這是馬的真性。雖然有高台大殿, 對它並沒有什麼用處。等到伯樂出來, 說: "我擅長治理馬。" 於是用鐵燒它們, 剪它們的毛, 削它們的蹄, 在它們身上烙上印記, 用絡首絆腳把它們拴起來, 編到馬槽裡, 馬就死掉十分之二三了; 然後不讓它們吃飽, 不給它們喝足水, 讓它們為人所用, 讓它們奔跑, 訓練它們, 讓它們行動一致, 先有口銜鑣纓的禍患, 然後有皮鞭竹筴的威脅, 馬就死掉大半了。陶工說: "我善於捏陶土, 做出來的東西圓的符合規, 方的合乎矩。" 木匠說: "我擅長削木頭, 使曲的合乎鉤, 直的合於繩。" 粘土和樹木的本性, 難道是想合乎規矩鉤繩嗎? 然而, 人們世世代代都傳頌說 "伯父樂善於治理馬, 陶工、木匠善於利用陶土和木材", 這也和治理天下的人一樣的錯誤呀!
2014年7月12日星期六
道德經譯文1
(經) 可以用語言表述的道, 就不是恆常之道; 可以講出來的名, 就不是真常之名。
(傳) 少知說: "四方之內, 六合之中, 萬物從哪裡產生?"
大公調說: "陰陽相應, 相消相長; 四時更迭, 相生相殺。欲、惡、去、就, 於是萬物突然而起; 雌雄相分相合, 於是萬物常存。安危相互更易, 禍福相互產生, 緩急相互交替, 聚散因此形成。這是有名實可以識別的, 有精微可以記認的。依隨時序的規律, 橋起而運行的變化, 物極則反, 終而有始, 這是萬物所具有的現象。言論所能窮盡的, 智慧所能達到的, 限於物的範圍罷了。識道的人, 不追究萬物的消逝之所, 不探求萬物的起源, 這是議論的終止之處。"
少知說: "季真所說的 '莫為', 接子所講的 '或使', 兩家的觀點, 哪個符合萬物生成的情狀, 哪個偏離了萬物生成的道理?"
大公調說: "雞鳴狗吠, 這是人人都知道的事情。然而, 即使有大智慧的人, 並不能用語言來說明它們為什麼會嗚、吠, 也不能用心意去猜測它們嗚、吠之後會做什麼。由此分析起來, 精微至於無比, 廣大至於無限, 斷言或有所使, 肯定莫有所為, 都不免是在物上立論, 終究是過而不當。'或使' 的說法太拘泥, '莫為' 的觀點則太玄虛。有名有實, 是物的範圍; 無名無實, 不屬於物的範圍。這可以言說, 可以意會, 但越說就越遠。沒有產生的不能禁止, 已經死亡的無法阻止。萬物的死生對人來講並不是遙遠之事, 但其中的道理卻並不可見。或有所使, 莫有所為, 都是疑惑所立的假設。我觀察萬物的本源, 它們的來源無窮; 我尋求萬物的跡象, 它們的未來無盡。無窮無盡, 語言無從表達, 這和萬物的生成是同一個道理。'或使' 與 '莫為', 是人們言論的依據, 而與物相終始, 不離於物。道不可以執著於有, 有也不執著於無。道這個名稱, 乃是權宜之稱。'或使'、'莫為' 的主張, 都局限於物的一隅, 怎麼能明白大道? 言論如果足以明曉大道, 那麼終日所言都是道; 言論如果不足以明曉大道, 那麼整天所講的都是物而已。道是物的極至, 言論和沉默都不足以表達; 既不言說又不沉默, 這是議論的極限。"
(傳) 少知說: "四方之內, 六合之中, 萬物從哪裡產生?"
大公調說: "陰陽相應, 相消相長; 四時更迭, 相生相殺。欲、惡、去、就, 於是萬物突然而起; 雌雄相分相合, 於是萬物常存。安危相互更易, 禍福相互產生, 緩急相互交替, 聚散因此形成。這是有名實可以識別的, 有精微可以記認的。依隨時序的規律, 橋起而運行的變化, 物極則反, 終而有始, 這是萬物所具有的現象。言論所能窮盡的, 智慧所能達到的, 限於物的範圍罷了。識道的人, 不追究萬物的消逝之所, 不探求萬物的起源, 這是議論的終止之處。"
少知說: "季真所說的 '莫為', 接子所講的 '或使', 兩家的觀點, 哪個符合萬物生成的情狀, 哪個偏離了萬物生成的道理?"
大公調說: "雞鳴狗吠, 這是人人都知道的事情。然而, 即使有大智慧的人, 並不能用語言來說明它們為什麼會嗚、吠, 也不能用心意去猜測它們嗚、吠之後會做什麼。由此分析起來, 精微至於無比, 廣大至於無限, 斷言或有所使, 肯定莫有所為, 都不免是在物上立論, 終究是過而不當。'或使' 的說法太拘泥, '莫為' 的觀點則太玄虛。有名有實, 是物的範圍; 無名無實, 不屬於物的範圍。這可以言說, 可以意會, 但越說就越遠。沒有產生的不能禁止, 已經死亡的無法阻止。萬物的死生對人來講並不是遙遠之事, 但其中的道理卻並不可見。或有所使, 莫有所為, 都是疑惑所立的假設。我觀察萬物的本源, 它們的來源無窮; 我尋求萬物的跡象, 它們的未來無盡。無窮無盡, 語言無從表達, 這和萬物的生成是同一個道理。'或使' 與 '莫為', 是人們言論的依據, 而與物相終始, 不離於物。道不可以執著於有, 有也不執著於無。道這個名稱, 乃是權宜之稱。'或使'、'莫為' 的主張, 都局限於物的一隅, 怎麼能明白大道? 言論如果足以明曉大道, 那麼終日所言都是道; 言論如果不足以明曉大道, 那麼整天所講的都是物而已。道是物的極至, 言論和沉默都不足以表達; 既不言說又不沉默, 這是議論的極限。"
2014年7月10日星期四
莊子譯文42
莊子到楚國去,看見一顆骷髏頭, 乾枯枯的, 不過還有頭部的形狀。莊子用馬鞭敲了敲, 於是問骷髏頭說: "先生是由於貪財悖理, 而落到這般境地呢? 還是由於國亡家破, 遭到刀殺斧砍而落到這般境地呢? 或是由於有了不善的行為, 深怕給親人留下恥辱, 羞愧之下, 自然而如此的吧? 您是缺吃少穿, 受凍捱餓而落得如此呢? 還是您的年壽到了, 而自然如此呢?"
說完了,就把骷髏頭搬來枕在頭下睡了。半夜裡, 骷髏頭在夢中出現, 對莊子說: "白天您談起那一套真像個能言善辯的人。看您說的那些事情, 全是活人所遭受的牽累, 死後就沒有這些了。您願意聽我談談死後的情況嗎?"
莊子說: "好吧!"
骷髏頭說: "死了, 上面沒有君主, 下面沒有臣僕, 也沒有一年四季勞苦憂患, 悠然自得, 與天地共長久, 即使南面稱王的快樂, 也無以超過。"
莊子不相信, 說: "我叫司命之神再歸還您的形體, 讓您重新長上筋骨皮肉, 把您的父母妻兒、鄰里朋友等都送還給您, 這樣您願意嗎?"
骷髏頭緊皺眉頭, 哭喪著臉說: "我怎肯放棄這君王般的快樂, 再去忍受人間的痛苦呢!"
說完了,就把骷髏頭搬來枕在頭下睡了。半夜裡, 骷髏頭在夢中出現, 對莊子說: "白天您談起那一套真像個能言善辯的人。看您說的那些事情, 全是活人所遭受的牽累, 死後就沒有這些了。您願意聽我談談死後的情況嗎?"
莊子說: "好吧!"
骷髏頭說: "死了, 上面沒有君主, 下面沒有臣僕, 也沒有一年四季勞苦憂患, 悠然自得, 與天地共長久, 即使南面稱王的快樂, 也無以超過。"
莊子不相信, 說: "我叫司命之神再歸還您的形體, 讓您重新長上筋骨皮肉, 把您的父母妻兒、鄰里朋友等都送還給您, 這樣您願意嗎?"
骷髏頭緊皺眉頭, 哭喪著臉說: "我怎肯放棄這君王般的快樂, 再去忍受人間的痛苦呢!"
2014年7月9日星期三
莊子譯文40
宋國有個叫曹商的人, 替宋王出使秦國。他去的時候, 從宋王那裡得到幾輛車子; 到秦國後, 秦王很喜歡他, 又加賜給他百輛車子。他非常得意地返回宋國來。
有一次他遇到莊子, 自炫地說:"住在偏僻窄陋的街巷, 依靠編織麻鞋維持生活, 營養不良, 脖子乾枯, 面黃肌瘦, 這是我曹商做不到的。有機會與萬乘大國的君主見上一面, 一下子就得到百輛車子跟從著, 這才是我的特長啊!"
莊子說:"聽說秦王有病,召請醫生診治。凡是替他破膿穿癤的便可得車一輛; 凡是替他舔乾淨痔瘡的血的, 可得車五輛。治病的部位越是卑下, 得到的車子也就越多。你難道治療過秦王的痔瘡嗎?不然怎麼會得到這麼多輛車子呢?你走吧!"
有一次他遇到莊子, 自炫地說:"住在偏僻窄陋的街巷, 依靠編織麻鞋維持生活, 營養不良, 脖子乾枯, 面黃肌瘦, 這是我曹商做不到的。有機會與萬乘大國的君主見上一面, 一下子就得到百輛車子跟從著, 這才是我的特長啊!"
莊子說:"聽說秦王有病,召請醫生診治。凡是替他破膿穿癤的便可得車一輛; 凡是替他舔乾淨痔瘡的血的, 可得車五輛。治病的部位越是卑下, 得到的車子也就越多。你難道治療過秦王的痔瘡嗎?不然怎麼會得到這麼多輛車子呢?你走吧!"
2014年7月4日星期五
莊子譯文39
莊子去見魯哀公。
哀公說:"我們魯國有很多儒士,學先生道術的卻很少。"
莊子說:"魯國少儒士。"
哀公說:"全魯國的人幾乎都穿儒士的服裝,怎麼能說很少呢?"
莊子說:"我聽說,所謂儒士,頭戴圓頂的帽子,表示上通天文;
腳穿方形的鞋子,表示下曉地理;
身上佩帶玉玦,表示遇事處置果斷。
其實,真正具有這些知識才能的人,未必都穿著這樣的服裝;
穿著這樣服裝的人,未必就真正有這樣的知識才能。
您當然一定不信。
那麼為什麼不在國內發佈這樣一項命令:
'凡是沒有這種道術修養而冒穿這樣服裝的人,一律處以死刑!'"
於是,魯哀公真的發佈了這樣一道命令,
過了五天,魯國便沒人敢穿儒士服裝了,
唯獨有這麼一個人,穿著儒士服站在宮殿門前。
哀公立刻召見他,問以國家大事,千變萬化,對答如流。
莊子說:"以魯國這樣大,真正稱得起儒士的,不過只有這一個人罷了,可以說是多嗎?"
哀公說:"我們魯國有很多儒士,學先生道術的卻很少。"
莊子說:"魯國少儒士。"
哀公說:"全魯國的人幾乎都穿儒士的服裝,怎麼能說很少呢?"
莊子說:"我聽說,所謂儒士,頭戴圓頂的帽子,表示上通天文;
腳穿方形的鞋子,表示下曉地理;
身上佩帶玉玦,表示遇事處置果斷。
其實,真正具有這些知識才能的人,未必都穿著這樣的服裝;
穿著這樣服裝的人,未必就真正有這樣的知識才能。
您當然一定不信。
那麼為什麼不在國內發佈這樣一項命令:
'凡是沒有這種道術修養而冒穿這樣服裝的人,一律處以死刑!'"
於是,魯哀公真的發佈了這樣一道命令,
過了五天,魯國便沒人敢穿儒士服裝了,
唯獨有這麼一個人,穿著儒士服站在宮殿門前。
哀公立刻召見他,問以國家大事,千變萬化,對答如流。
莊子說:"以魯國這樣大,真正稱得起儒士的,不過只有這一個人罷了,可以說是多嗎?"
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