Over-spending and under-spending of the public sector budget

Over-spending and under-spending of the public sector budget The over-spending and under-spending of a budget is the positive or negative variance between what was actually spent and what was budgeted. Overspending Budgets overruns are the underestimation of costs and time or by the nonconformity of budget managers with the spending maximum defined in the budget, when projected. There are several explanations for overspending. Sometimes, it is simply bad forecasting on part of the budget manager. There was incomplete information or poor forecasting methods that led to an underestimation and/or unreal optimism of costs, expenses and revenues. Often there is change in scope of the project and costs associated with scope change are neither captured nor covered in the risk mitigation or contingency plan. Funds are allocated to the cost centers for spending, it is controlled. Overspent fund accumulate in arrears. Overruns could also be a result of off-budget spending which not considered part of the budget and is not included in budget totals. Off budget spending is often for political reasons. For example, after a request from President Reagan, Congress placed strategic petroleum reserve spending off-budget in 1982. Instead of using other means to control the deficit raising revenues or cutting spending placing this program off-budget gave the appearance of a smaller deficit, even though the government still needed to finance this spending. Source: Office of Management and Budget, Budget of the United States Government, Historical Tables and Mid-session Review, FY2006. Sometimes the expenditure processes are complicated and difficult. To circumvent this process exceptional procedures are development to speed to the process to release the funds. These exceptional procedures are tolerated by the treasury for politically sensitive expenditures. The procedures are frequently abused and should be discouraged. These procedures are used my officials to order supplies without making a formal request and much later the year un-forecasted invoices appear. Sometime fund are unavailable to make this invoices which leads to generation of arrears for the following year. The compounding of exceptional procedures also has long-term implications, incentivizing spending agencies to go outside the budget system to avoid control altogether. Such procedures are associated with or result in corruption. Often past experiences can lead to overspending. If a department head under spent the previous year and the budget for the following year was lost. The department is highly likely to spend the entire amount for the fear of losing funds for the next year. The way in which performance is reported can have a significant effect on the camaraderie and coordination between departments. If participation of the managers implementing the budget was absent, then managers can blame this for the file to abide by the budget. In addition impact of inflation and a sense of entitlement towards certain funds are also factors to be considered in budget planning. Overruns can be caused by such deficiencies in budget preparation. Under spending Many governments do not spend their full annual budget. The reasons for this under spending can be various and can result in many outcomes. Lack of timely spending or under spending can affect the citizens not receiving essential government services. Certain areas have more economic impacts such as jobs created through the timely initiation of new infrastructure project. Under spending can often obstruct resources from other departments/managers which/who are spending their budget more productively, preventing them to reach their complete potential of success in delivery of the intended service. Under spending in particular year frequently leads to rollovers and modifications in the subsequent years. These modifications are irregular and are cumbersome to be forecasted leaving the department ill-equipped to spend these rollovers. Factors that result in under spending include insufficiencies in budget preparation and project/program planning, unrealistic projections of revenues, poor governance and off-budget spending. Virement is another factor that fuels under spending: It is the transfer of funds from one budget head to another. To achieve efficiency or prevent the need for a supplementary estimate as an under spending from one head may be transferred to another head which has overspending. One problem with unrestricted virement is that managers would inevitably spend al their budget allocation for fear of a budget reduction in the subsequent year. Example: Within the ministry of education budgets are transferred from primary education to higher education it can result in the delay of programs starting in the K-12 grades. Example: The latest un-audited expenditure reports from the National Treasury indicate that R3.48 billion of the national government budget went unspent in 2000/01 financial year- about R1.7billion on both the recurrent and the capital side of the budget. The under spend in provincial government was far greater at R5.5 billion. The latest available data indicate that this picture has not changed significantly in 2001/02. Although the government is moving in the right direction, most initiatives to address under spending appear rather general and details have yet to emerge on how the Treasury will specifically tackle the problem. In the meantime, under-spending seems set to remain with us. Source: Government under spending remains a problem February 2002 By Marritt Claassens and Paul Whelan, Budget Information Service, Idasa, http://www.idasa.org.za/bis/ Different kinds of variances A variance is the difference between a budgeted, planned or standard amount and the actual amount. Variances can be divided according to their nature of the underlying amounts and is determined by the needs of users of the variance information. These include : Variable cost variances Direct material variance Price variance: is the difference between the standard cost and the actual cost for the actual quantity of material used or purchased. Usage Variance: is the difference between the standard quantity of materials that should have been used for the number of units actually produced, and the actual quantity of materials used, valued at the standard cost per unit of material. Direct labour variance Rate Variance is the difference between the standard cost and the actual cost paid for the actual number of hours. Efficiency variance is the difference between the standard labour hour that should have been worked for the actual number of units produced and the actual number of hours worked when the labour hours are valued at the standard rate. Overhead variances Fixed overhead variances: identifies what proportion of the total fixed overhead variance is due to actual fixed overhead being different from the budgeted fixed overhead. Variable overhead variance measures the change between actual expenditure and the allowed overhead for actual labour hours. Income variance is the difference between actual income and budget income. It is used to measure the performance of a income function, and/or analyze business results to better understand market conditions. Actual income can differ from budgeted income either due to the variance in volume sold or the variance in the price point of the budgeted price point. Best Practices The following are some key good practice for prevention and minimization of the variances: Broad goals should be established to guide government decision making. Budgeting methods are developed to achieve these goals. An appropriate budget is developed to achieve the goals and the performance criterion is determined at the beginning. Close interaction between the financial information system and the budgeting systems is essential. There should be a control on collective spending and any deficit, a overarching prioritization of strategies with regards to expenditures and better use of the budgeted resources. The approved budget should be entered into the financial information system. In addition to a full commitment system, memorandum notes should be included the system that capture records of commitment but does not amend the financial records. Timely comparative financial statements on a regular basis. These statements should include original and revised budget, capture variances and explain major variances. The audited and reliable statements are based in solid accounting standards with regular external reporting. Budget Monitoring: Monitoring and controlling consists of those processes are performed to observe that potential problems can be identified in a timely manner and corrective action can be taken, when necessary. The key benefit is that the actuals are observed and measured regularly to identify variances from the budget. During the course of the year, instance may arise where the income or expenditure is very large that may require and supplementary estimate. The better the level of control and intelligence available the earlier this situations can be detected and more swiftly and appropriate an action can be taken to minimize the variance. However if is determined there has to be a change then the financial information systems can be updated as soon as possible. If a department become aware that it will overspend at any time during the year it must notify the Treasury department immediately. It is possible that a supplement estimate is provided if deemed appropriate. Transparency is key publish the State accounting policies, establish system of internal controls, and keep doors open for public and parliamentary scrutiny. Flexible budgeting is a performance evaluation tool. It is not be prepared before the end of the fiscal period. A flexible budget adjusts the initial budget for the actual level of output. The flexible budget answers the question: If the department had known at the beginning of the period what would the output volume (units delivered or sold) would be, what the budget would have looked like? If the department actually delivered X units, then treasury should compare actual delivery costs for X units to what it should have spent to make X units, not to what the department should have spent to deliver X-1000 units or X+1000 units etc. The flexible budget provides a better opportunity for planning and controlling than does a static (initial) budget.

A Citizen’s Guide to Democracy Inaction

How far can humor go? This question is often asked regarding ribald, lewd, or obscene humor. In these cases, critics often ask whether humor has gone far enough.Critics and questioners ask whether what the comedian presents as humor has crossed the line into the offensive and revolting. How far has a particular bit humor gone to the bottom of the barrel and how do we know if it has reached the bottom.How far can humor go? That same question may be asked for Jon Stewart’s 2004 humor book America (The Book): A Citizen’s Guide to Democracy Inaction. However, instead of asking how the degenerate the humor is, after reading Stewart’s book, we are forced to ask how enlightening humor can be?Can humor be a tool to scrutinize? To question? To criticize? The likelihood of these possibilities are astonishing, especially when you consider that Stewart’s book is about America and its government and political system.Jon Stewart is the host of the popular comedy program The Daily Show with Jon Stewart. The Daily Show is a satire news program, complete with the familiar news program introduction, faux field reporters and even interviews with current newsmakers. Instead of glorifying news programs, The Daily Show takes pride in crucifying it and the political culture it inculcates.The late-night show is notorious for its no holds barred treatment of politicians and pundits from all sides of the political spectrum. The show prides itself as an equal opportunity offender as it makes fun of all political entities from all sides. This has resulted in great popularity for the show as well as for its host, even generating a spin off show from one of its faux pundits.That said, there are many parallels to be drawn between the Daily Show and America (The Book). While The Daily Show pretends to be a nightly news program, America (The Book) pretends to be a high school social studies textbook. In this regard, America (The Book) is successful as it really does look and feel like a social studies textbook. Its content and outline matches that of common high school textbooks.Its layout is also befitting that of a high school textbook, complete with margin notes, sidebars, interviews with â€Å"noted† individuals and numerous illustrations and figures. It is even complete with end of chapter questions and classroom activities.

Bianca & skill

Although after three months of total immersion of a language, most people should show significant progress, Bianca’s lack of progress does not necessarily mean she has a learning disability. There are a number of possible causes for her lack of progress and a learning disability is only one of them. In Bianca’s specific case, her history should be considered. She was orphaned due to a tragic event and traumatized.This life event at the age of five, the time when reading often begins, could significantly affect her rate of developing reading skills without factoring in the second language. An additional social factor that could affect Bianca’s language and reading acquisition skills could be her recent adoption and move to a new country and environment. Anyone would have some difficulty adjusting to a new family, home, culture and language at the same time.It would undoubtedly be more difficult for a traumatized eight-year-old to adapt to and thrive in a short amo unt of time. The adoptive parents have legitimate concerns about how extensive testing for a specific learning disability during her adjustment to her new life could cause additional trauma. If, however, Bianca does have a learning disability, it would be important to find this out and treat her accordingly. The teacher could do some basic observations in order to get an idea about possible learning disabilities.It would be important to observe her development in other areas such as motor, social, and cognitive. If she is delayed in other developmental areas, the problem could easily be due to her trauma and adjustment. In spite of the school total immersion policy, a few age-level books should be acquired for her in her native language. By listening to her read in her native language a teacher could determine if she struggled in the language she understood as well as she did in English.The teacher could recognize a struggling reader even if she is not familiar with the language. If Bianca reads well in her native language the problem is probably not a learning disability, and the best assistance in her development would be time and attention dedicated to her. If Bianca is discovered to have significant difficulty in her native language, it would warrant the need for additional testing to determine if the problems are due to a learning disability and if a way can be found to help her overcome it.If she does have an actual learning disability, the earlier intervention can be found, the better her chances of effectively developing new language and reading skills. Bianca is a unique child, who should not be caught up in a standard school policy of total immersion. She might require some special attention due to her traumatic past and extensive changes. Some of this special attention could involve some translation and allowing her to do some of her work in her native language in order to help her catch up to her grade level.

The Paradox Of Science A Contrivance For Childrens...

Part a: The paradox of science: a contrivance for children’s learning A cornerstone of the sciencing discourses evident in early childhood education and care settings revolves significantly around the children, educators and families of the service. It is therefore essential to explore teaching methods utilised with children to harness optimum engagement of children’s interest in science. Within this paper teaching methods are explored and discussed with an emphasis on the sciencing of sociology with children three to five years from a constructivist based approach. Sociology for children: Conceptualised thinking of one’s self Sociology can be explained as having two components, macrosociology and microsociology. Macrosociology†¦show more content†¦Therefore the brain response of sensory input such as the child’s curiosity, emotions and feelings are a conduit for children to learn about themselves, others and the world around them (Harlan Rivkin, 2012, p. 10). Children are developing and are eager to learn about themselves and as they develop it is appropriate to foster and link new concepts to the knowledge which the child may have in regards to their social world (Harlin Rivkin, 2012, p. 14). So crucial is sociology studies in early childhood education and care settings that the Early Years Learning Framework underpins the most essential perspectives of the relationships to family, community, culture and place (DEEWR, 2009, p. 7) core components of sociology. Action concepts include: †¢ I wonder what makes us the same as other people. What makes us different? †¢ I wonder if the things you do now were harder when you were a baby. †¢ Who is in your family? Let’s find a way to see if your family is like other families? †¢ Where do you live? Is it the same as others children at Preschool? Part B: Active learning I wonder how ... A leading question based on a constructivist theoretical pedagogy where active and guided learning are recognised as ways that children three to five years of age learn about the science of sociology discussed within this paper. The perspective of active learning from a sociology point of view consists of many factors including the construction of knowledge children obtain through their

Democratic Government A System Of Checks And Balances

Wichita Area Technical College Democratic Government: A System of Checks and Balances Kyle Wiebe American Government LeArta Watkins 2/11/2016 In America today, most people are familiar with the president and his role in the country. What other people are less familiar with, however, are the other branches of government that play a significant part in the decision-making process of our country. The government is divided into the three branches: the Executive Branch, the Legislative Branch, and the Judicial Branch. The president, who is the head of the Executive Branch, plays arguable the most important role of any one-person in the United States. However, the Legislative and Judicial branches are very important too. The Founding Fathers created this country’s political system in such a way that the government could operate effectively, but no one branch would have an advantage over the others. Each branch has its own responsibilities, and its power is checked by that of the other branches. The first branch to discuss is the Executive Branch. The Executive Branch is comprised of the President, his cabinet, and other government agencies. One of the President’s main jobs in the White House is to carry out the laws of the country. He is able to do this because he is in control of many governmental agencies; some of these include the CIA, the Environmental Protection Agency, and the Department of Defense (The Executive). The President can either pass or veto billsShow MoreRelatedThe Constitution Of The United States1593 Words   |  7 PagesConstitution of the United States that established the national government and certain basic fundamental laws apart from guaranteeing some basic rights to the citizens of the United States. 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The Protest Of The United States - 1576 Words

The activists feel like this disruptive protest is needed in order to disturb not only the public but to disturb politicians and people in high places. They feel like in this way they will grab the attention, sympathy, and support of citizens and will force politicians to face these issues and propose solutions to them like police reform and will also remind the police force and all other authorities that they are aware of these injustices and that they are never ignored (Mather). The main point of the Two Treaties of Government was to illustrate John Locke’s idea that all men were created equal and naturally free. He went against the ideals of Robert Filmer who believed that humans were born to be subjugated by the monarchs of their†¦show more content†¦John Locke believed that since men were all equal that this makes, â€Å"the foundation of that obligation to mutual love amongst men on which he builds the duties they owe one another from whence he derives the grea t maxims of justice and charity,† (Locke, 106). This is an idea shared by the Black Lives Matter movement as well as they believe on evoking humanity in order to express their frustration against police brutality. Yates, a BLM activists explains that, â€Å"at the very core of this is humanity- Black Lives Matter. We matter. Black lives matter because they are lives..because we are human..† (Harris). Both Yates and John Locke use humanity in order to support their arguments. Another belief Locke had was that â€Å".. men are naturally in, and that is, a state of perfect freedom to order their actions, and dispose of their possessions and persons as they think fit, within the bounds of the law of Nature..† (Locke, 106). BLM activists can argue that these men being brutalized had no need for such exertion of power. The police should never be expected to terrorize the black community, even though that is what it has come to in many black communities. Since people ar e expected to have perfect freedom as Locke stated, there is no need for harsh authority since people naturally act in the best interest of themselves which is typically the best interest of the community. Knowing this, John Locke and the BLM

Chronic Obstructive Pulmonary Disease System

Question: Discuss about the Chronic Obstructive Pulmonary Disease System. Answer: Introduction Chronic- obstructive pulmonary disease (COPD)is a condition that is characterized bythe air-flow limitation, which is not completely reversible (GOLD, 2010). It includes airflow obstructive diseases such as chronic- bronchitis and emphysema. In-spite of effective COPD control, the patients may experience many episodes of exacerbations affecting their physical as well as mental health. Additionally, COPD exacerbations incur a high cost and affect the pulmonary function and quality-of-life (Toy, 2010). This case study discusses about Mr. Bill McDonald, a 65 year old male who has got admitted in the hospital with chief complaints of dyspnea even at rest, increased lethargy, wheezing with chronic- productive cough producing excessive purulent- sputum and was diagnosed to have acute exacerbations of COPD. He is found to smoke one pocket of cigarettes per day for 35 years and has history of recurrent- bronchial infections. This essay discusses in detail about the pathophysiology, medical a nd nursing management for Mr. Bill with acute exacerbations including home-care considerations, community resources available and educational plan. Pathophysiology of acute and chronic COPD COPD is a condition in which the airway is obstructed by chronic bronchitis and emphysema or a combination of both (Hinkle, 2014). Any damage or inflammation in the larger airways of lungs can result in chronic- bronchitis which is referred to as a condition in which an excessive production of sputum with recurrent cough persisting for at-least three months/year for two consecutive years due to chronic smoking (Lewis, 2013). As, Mr. Bill is a chronic smoker for 35 years, the cigarette smoke has irritated the walls of bronchioles causing hyperplasia of mucous-secreting glands (including goblet cells) in the bronchi leading to increased mucus production. Moreover, the hyperplasia of cells has reduced the diameter of the airway resulting in reduced clearance of mucus. Smoking has reduced the ciliary movements causing reduced clearance of secretion resulting in sputum accumulation leading to the multiplication of micro-organism bronchiolar infections (Barnes, 2014). Because of inadequate clearance, Bill has experienced chronic cough with production of purulent sputum. Because of recurrent bronchiolar infections, more number of neutrophils with macrophages were released, which in-turn has released proteolytic enzymes leading to the destruction of alveolar tissues that again increases inflammation, edema and infectious process causing formation of exudates. More frequently, the micro- organisms have colonized in Bill leading to recurrent bronchial- infections causing excessive mucus accumulation resulting in occlusion of smaller bronchioles (Hinkle, 2014). This has increased resistance to airflow that in-turn has increased the effort of breathing leading to decreased oxygen supply to tissues causing hypoxemia. Additionally, there was a diminished respiratory drive with increased tendency to hypo-ventilate and retain CO2. Because of this, most of the lung areas are not ventilated and so oxygen diffusion could not occur leading to dyspnea both at rest and activities. Hence, Bill with chronic bronchitis requires oxygen both at rest and activities as the disease progresses. As Bill is a smoker, bronchospasm develops frequently that adds to the already existing airway resistance results in further increase in work of breathing and impaired gas exchange which is manifested by dyspnea and lethargy than usual. On auscultation, because of increased CO2 retention in lungs, the lung sounds such as scattered crackles, ronchi and wheezes were heard (Lewis, 2013). Because of smoking, an acute exacerbation of COPD has occurred in Bill, which is an event in the course of COPD that is characterized by the acute- changes in the usual clients dyspnea, cough and sputum production (Hurst, 2009, Eisner, 2010). Its severity has been ranked as level-I (treated at home), level-II (needs hospitalization), level-III (results in respiratory failure) in which Bill lies in level-II (Ghoshal, 2012). Medical management The first step to treat acute-exacerbations involves increasing the dose and frequency of short-acting bronchodilators. If it is unresponsive, bronchodilators with oral corticosteroids should be given. Short-acting 2- agonist (e.g. Salbutamol- 100-to-200 mcg) with nebulizer and Tab. Prednisolone (30mg) OD was administered for 7 days for Bill (Hurst, 2009). If there are changes in the characteristics of sputum, antibiotics should be added based on the causative bacterial-pathogen. Antibiotics should be started only for patients with sputum (Garvey, 2012). In regard to Bill, Levofloxacin (500mg daily) was administered for 11days because of the presence of Pseudomonasspp. in his sputum specimen (Currie, 2009). Theophylline might be administered in patients who are unresponsive to treatment which is not administered for Bill. Oxygen should be administered at any stage of exacerbation in the presence of hypoxemia to improve his base-line oxygenation to at-least 60 mmHg and to maintain oxygen saturation of at-least 90% (Garvey, 2012). Bill was administered with 2 liters/min of oxygen through nasal-cannula and his O2 saturation was 88% and PaO2 55 in ABG. Non-invasive positive-pressure ventilation could be used to reverse acute- respiratory failure which was not used for Bill. Nursing management As Bill was having COPD exacerbation, he was monitored for PaO2, PaCO2 with pH, at the time of admission, treatment and at the time of changes in patients condition. Pulse oximeter was connected to monitor the oxygen saturation. Oxygen was administered to Bill at the rate of 2 liters/min through nasal-cannula to maintain normal oxygen-saturation thereby to prevent occurrence of respiratory acidosis/hypercapnia. Mechanical ventilation should be started only when pH 7.35 (Ghoshal, 2012). He was monitored carefully to prevent increased CO2 washout that may lead to respiratory depression as CO2 act as a respiratory-drive for Bill (Lewis, 2013). Therefore, oxygen should be given at lower rate to prevent CO2-narcosis. Upright position was provided to expand the lungs to promote oxygenation. Bill was demonstrated to perform pursed-lip-breathing that was helpful to increase expiration so as to prevent bronchiolar-collapse with air-trapping (Lewis, 2013). He was guided to practice abdominal-breathing that helped him to use diaphragm in-stead of accessory-muscles so as to promote maximal inspiration as well as to reduce the respiratory rate. In case of abdominal-breathing, the abdomen will protrude at inspiration and contract at expiration, where the diaphragm pushes the air outside the lungs and promotes control over Bills breathing especially during dyspnea and exercises. Deep-breathing with coughing-exercise was demonstrated to promote expulsion of lung secretions so as to promote normal breathing. His position was changed once in 2 hours to prevent aspirations. Chest physiotherapy (bronchial tapping) was performed to remove excess lung secretions (Hinkle, 2014). Bill has experienced difficulty in breathing and consuming food simultaneously and hence small and frequent diet (six meals) was encouraged (Seo, 2014). He was encouraged to drink 3 liters of fluid/day to promote hydration so as to liquefy the lung secretions and promote mucus expulsion (Hanania, 2010). The fluid was given only in-between the meals but not with meals to avoid abdominal distention that might increase his dyspnea. Gas-forming and carbonated foods were avoided as they will cause abdominal distention causing dyspnea. Very cold and hot foods were avoided as it may cause coughing spasms. Home-care considerations The role of nurse is crucial in educating home-care considerations to COPD patients (Zakrisson, 2011). Bill is discharged with portable oxygen to prevent hypoxemia as he is a chronic COPD patient. Nasal-cannula (2 liters/min) was arranged for Bill as it is safe and simple to use at home and is comfortable and acceptable. It will not interfere with eating, talking, coughing, walking or moving. But, its position should be maintained to avoid dislodgement. Long-term oxygen therapy (LTOT) will help to improve neuro-psychological function, increase activity- tolerance, reduce hematocrit and decrease pulmonary-hypertension. As, Bill was stable with PaO2 of 55 mmHg and SaO2 (less than 88%), LTOT was allowed. Regular nasal-cannula was arranged to deliver O2 from central source at home. He was given with liquid O2 as it is portable and holds 6-8 hr O2 supply at 2 L/min and the reservoir will lasts for 7-10 days (Lewis, 2013). He was instructed about the methods of using oxygen at home, its importance, advantages, disadvantages and precautions to be followed. He was instructed to put the nasal straps properly and not to be too tight. Observe the ear-tops for skin breakdown and pad it, if needed (Hanania, 2010). Bill was educated to assess oral as well as nasal mucous membrane for 2-3 times/ day and advised to apply water-based gel over the nasal membrane and lips (Lewis, 2013). Encouraged to wash mouth frequently and use humidifier to avoid dryness in skin resulting in skin breakdown and infection. He was advised to remove the nasal-cannula and clean it with water for 2-3 times/ day and clean the skin carefully and observe for bruises, scratches and cuts. He was instructed to change disposable equipments regularly and to remove sputum that is coughed-out. He was advised to post No Smoking boards at home and not to use electric razors, open flames, mineral oils, blankets (wool) or portable- radios near the oxygen area and not to allow smoking in home (Lewis, 2013). He was encouraged to remain active and travel normally. Oxygen could be arranged by private companies at the destination point. If, he wishes to travel by bus, train or flight, notifications should be given to make O2 reservations. High-altitude stimulation-test should be performed in a hospital to determine the amount of O2 needed for traveling in flight. Resources available In Government, COPD National-Program as well as Lung-cancer programs are the major programs available within Lung- Foundation. They are supported by the Information with Support-Centre of Lung- Foundation which operates a toll-free telephonic number for COPD patients, care-takers and physicians to make a call and speak with team member (who can guide them to get resources and get link to the support- services) or to talk to a Lung-Care Nurse. There are other foundation areas as Respiratory-infectious diseases, Bronchiectasis registry, Multi-centre clinical-trial network, telephonic support- group and community- awareness events (Harper, 2013). Usually, home oxygen- systems are also rented from a private company, which sends a pulmonary nurse and/or respiratory therapists to the patients home. These therapists will teach about the method of using O2 system, method of caring O2 system and how to identify, when the system is getting low and needs to re-order (Lewis, 2013). The staff nurse has to make arrangements with the community-health nurse to obtain O2 equipments from an agency and receive follow-up home-care regularly. The agency will make arrangements to receive an O2 concentrator with portable tanks and concentrated O2 with oxygen regulators and supplies (20m of tubing with nasal-cannula). He was educated about basic anatomy with physiology of lung along with pathophysiology, features with complications for COPD through Australian Lung Association videos. Breathing retraining techniques as pursed-lip breathing and abdominal-breathing techniques were demonstrated. Energy-conservation methods as pacing the activities and performing pursed- lip breathing while performing activities was educated. The medication list with all the medications such as oral/ inhalant corticosteroids, antibiotics, -adrenergic receptors and anti-cholinergics was given with instructions for dosage, frequency, route, mode of action and side effects. He was demonstrated about the method of using inhaler (Lewis, 2013). He was educated about method of using oxygen at home with precautions. His family was guided to manage emotional issues as depression, anxiety, panic attacks, dependency, intimacy and interpersonal relationship issues. He was educated about COPD management plan that involves focusing on self-management and knowing features of exacerbations that may exacerbate in winter (Jenkins, 2012, Bruce, 2007). He should be educated with the need to report changes with reasons for flare-ups, recognizing features of respiratory infection and yearly follow-up. He was advised about the support and rehabilitative sources available (Casey, 2011). He was advised to avoid crowds and contact with persons with respiratory infections and to obtain influenza immunization. Conclusion Epidemiologic data indicate that chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Patients with poorly managed COPD are likely to experience exacerbations that require emergency department visits or hospitalizationtwo important drivers contributing to escalating healthcare resource use and costs associated with the disease. Exacerbations also contribute to worsening lung function and negative outcomes in COPD. The aim of this review is to present the perspective of nurse practitioners and physician assistants in terms of providing the pharmacologic and non-pharmacologic modalities needed to treat current and prevent future exacerbations. Major respiratory guidelines recommend treatment of acute exacerbations with short-acting bronchodilators, oral corticosteroids and antibiotics, as appropriate. Supplementary oxygen and/or ventilatory support may also be beneficial to selected patients. Treatments to minimize the risk of future exacerbations should include maintenance pharmacotherapies, risk-reduction measures (e.g. smoking cessation, influenza and pneumonia vaccinations), pulmonary rehabilitation, self-management support and follow-up care. Thus, this case study discusses in detail about chronic and acute COPD. I have learnt about the pathophysiological sequence of acute and chronic COPD that is caused by chronic smoking. I have learnt about the medical as well as nursing management plans of a patient with acute exacerbations of COPD. I understood about the home-care considerations of patient with portable oxygen and community-support services available with discharge plan for COPD patients. Reference Barnes, P.J. (2014). COPD, An Issue of Clinics in Chest Medicine. Retrieved from https://books.google.co.in/books?isbn=0323260918 Bruce, M.L. McEvoy, P. (2007). 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