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By H. Cyrus. Concordia University, Portland Oregon.

A note on theory and health psychology Health psychology draws upon a range of psychological perspectives for its theories purchase cheap zithromax line. Further cheap 250 mg zithromax amex, it utilizes many key psycho- logical concepts such as stereotyping purchase zithromax 100mg otc, self-identity, risk perception, self-efficacy and addiction. This book describes many of these theories and explores how they have been used to explain health status and health related behaviours. Some of these theories have been used across all aspects of health psychology such as social cognition models and stage theories. In contrast, other theories and constructs have tended to be used to study specific behaviours. However, as cross-fertilization is often the making of good research, many of these theories could also be applied to other areas. A note on methodology and health psychology Health psychology also uses a range of methodologies. It uses quantitative methods in the form of surveys, randomized control trials, experiments and case control studies. A separate chapter on methodology has not been included as there are many comprehensive texts which cover methods in detail. The aim of this book is to illustrate this range of methods and approaches to data analysis through the choice of examples described throughout each chapter. The contents of the first half of this book reflect this emphasis and illustrate how different sets of beliefs relate to behaviours and how both these factors are associated with illness. Chapter 2 examines changes in the causes of death over the twentieth century and why this shift suggests an increasing role for beliefs and behaviours. The chapter then assesses theories of health beliefs and the models that have been developed to describe beliefs and predict behaviour. Chapter 3 examines beliefs individuals have about illness and Chapter 4 examines health professionals’ health beliefs in the context of doctor–patient communication. Chapters 5–9 examine health-related behaviours and illustrate many of the theories and constructs which have been applied to specific behaviours. Chapter 5 describes theories of addictive behaviours and the factors that predict smoking and alcohol consumption. Chapter 6 examines theories of eating behaviour drawing upon develop- mental models, cognitive theories and the role of weight concern. Chapter 7 describes the literature on exercise behaviour both in terms of its initiation and methods to encourage individuals to continue exercising. Health psychology also focuses on the direct pathway between psychology and health and this is the focus for the second half of the book. Chapter 10 examines research on stress in terms of its definition and measurement and Chapter 11 assesses the links between stress and illness via changes in both physiology and behaviour and the role of moderating variables. Chapter 12 focuses on pain and evaluates the psychological factors in exacerbating pain perception and explores how psychological interventions can be used to reduce pain and encourage pain acceptance. Chapter 13 specifically examines the interrelationships between beliefs, behaviour and health using the example of placebo effects. Chapter 16 explores the problems with measuring health status and the issues surrounding the measurement of quality of life. Finally, Chapter 17 examines some of the assumptions within health psychology that are described throughout the book. Each chapter could be used as the basis for a lecture and/or reading for a lecture and consists of the following features: s A chapter overview, which outlines the content and aims of the chapter. Each ‘focus on research’ section takes one specific paper that has been chosen as a good illustration of either theory testing or practical implications. In addition, there is a glossary at the end of the book, which describes terms within health psychology relating to methodology. Discuss the extent to which factors other than biological ones may have contributed to your illness. This paper discusses the problematic relationship between inequality and health status and illustrates an integration of psychological factors with the wider social world. This chapter describes the different skills of a health psychologist, where they might be employed and the types of work they might be involved in. This paper provides an interesting discussion about the aims of health psychology and suggests that rather than focusing on biological outcomes, such as longevity and cell pathology, researchers should aim to change behaviour and should therefore evaluate the success of any interventions on the basis of whether this aim has been achieved. This paper discusses the interrelationship between research, theory and practice in health psychology and focuses on the specific skills involved in being a research health psychologist. This chapter first examines lay theories of health and then explores theories of health behaviours and the extent to which health behaviours can be predicted by health beliefs such as the attributions about causes of health and behaviour, perceptions of risk and the stages of change model. In particular, the chapter describes the integration of these different types of health beliefs in the form of models (health belief model, protection motivation theory, theory of reasoned action, theory of planned behaviour, health action process approach). It explores problems with these models and describes studies that address the gap between behavioural intentions and actual behaviour. Finally, the chapter explores how these theories can be used for developing interventions designed to change behaviour. They suggested that: s a health behaviour was a behaviour aimed to prevent disease (e. Health behaviours were further defined by Matarazzo (1984) in terms of either: s health impairing habits, which he called ‘behavioural pathogens’ (e. In short, Matarazzo distinguished between those behaviours that have a negative effect (the behavioural pathogens, such as smoking, eating foods high in fat, drinking large amounts of alcohol) and those behaviours that may have a positive effect (the behavioural immunogens, such as tooth brushing, wearing seat belts, seeking health information, having regular check-ups, sleeping an adequate number of hours per night). Generally health behaviours are regarded as behaviours that are related to the health status of the individual. Over the past century health behaviours have played an increasingly important role in health and illness. McKeown’s thesis The decline of infectious diseases In his book The Role of Medicine, Thomas McKeown (1979) examined the impact of medicine on health since the seventeenth century. In particular, he evaluated the widely held assumptions about medicine’s achievements and the role of medicine in reducing the prevalence and incidence of infectious illnesses, such as tuberculosis, pneumonia, measles, influenza, diphtheria, smallpox and whooping cough. He showed, however, that the reduction in such illnesses was already underway before the development of the relevant medical interventions. McKeown therefore claimed that the decline in infectious diseases seen throughout the past three centuries is best understood not in terms of medical intervention, but in terms of social and environmental factors. He argued that: The influences which led to [the] predominance [of infectious diseases] from the time of the first agricultural revolution 10,000 years ago were insufficient food, environmental hazards and excessive numbers and the measures which led to their decline from the time of the modern Agricultural and Industrial revolutions were predictably improved nutrition, better hygiene and contraception. To support this thesis, McKeown examined the main causes of death in affluent societies and observed that most dominant illnesses, such as lung cancer, coronary heart disease, cirrhosis of the liver, are caused by behaviours. Behaviour and mortality It has been suggested that 50 per cent of mortality from the ten leading causes of death is due to behaviour. For example, Doll and Peto (1981) reported estimates of the role of different factors as causes for all cancer deaths.

The incidence of Down syndrome is estimated at 1 per 800 to 1 discount 100mg zithromax free shipping,000 births generic 100mg zithromax free shipping, although its prevalence rises sharply in those born to older mothers discount generic zithromax canada. People with Down syndrome typically exhibit a distinctive pattern of physical features, including a flat nose, upwardly slanted eyes, a protruding tongue, and a short neck. Societal attitudes toward individuals with mental retardation have changed over the past decades. We no longer use terms such as “moron,‖ “idiot,‖ or “imbecile‖ to describe these people, although these were the official psychological terms used to describe degrees of retardation in the past. Supreme Court ruled that the execution of people with mental retardation is “cruel and unusual [6] punishment,‖ thereby ending this practice (Atkins v. It is often assumed that schoolchildren who are labeled as “gifted‖ may have adjustment problems that make it more difficult for them to create social relationships. This study found, first, that these students were not unhealthy or poorly adjusted but rather were above average in physical health and were taller and heavier than individuals in Attributed to Charles Stangor Saylor. The students also had above average social relationships—for instance, [8] being less likely to divorce than the average person (Seagoe, 1975). Terman‘s study also found that many of these students went on to achieve high levels of education and entered prestigious professions, including medicine, law, and science. Of the sample, 7% earned doctoral degrees, 4% earned medical degrees, and 6% earned law degrees. These numbers are all considerably higher than what would have been expected from a more general population. As you might expect based on our discussion of intelligence, kids who are gifted have higher scores on general intelligence (g). Some children are particularly good at math or science, some at automobile repair or carpentry, some at music or art, some at sports or leadership, and so on. There is a lively debate among scholars about whether it is appropriate or beneficial to label some children as “gifted and talented‖ in school and to provide them with accelerated special classes and other programs that are not available to [10] everyone. Although doing so may help the gifted kids (Colangelo & Assouline, 2009), it also may isolate them from their peers and make such provisions unavailable to those who are not classified as “gifted. The fact that women earn many fewer degrees in Attributed to Charles Stangor Saylor. On the other hand, it is possible that the differences are due to variability in intelligence, because more men than women have very high (as well as very low) intelligence. Women tend to do better than men on some verbal tasks, including spelling, writing, and pronouncing words [12] (Halpern et al. On average, men do better than women on tasks requiring spatial ability, such as the mental [14] rotation tasks shown in Figure 9. Boys tend to do better [15] than girls on both geography and geometry tasks (Vogel, 1996). Although these differences are real, and can be important, keep in mind that like virtually all sex group differences, the average difference between men and women is small compared to the average differences within each sex. There are many women who are better than the average man on spatial tasks, and many men who score higher than the average women in terms of emotional intelligence. Sex differences in intelligence allow us to make statements only about average differences and do not say much about any individual person. Although society may not want to hear it, differences between men and women may be in part genetically determined, perhaps by differences in brain lateralization or by hormones (Kimura & [17] Hampson, 1994; Voyer, Voyer, & Bryden, 1995). As infants, boys and girls show no or few differences in spatial or counting abilities, suggesting that the differences occur at least in part as a result of Attributed to Charles Stangor Saylor. Furthermore, the number of women entering the hard sciences has been increasing steadily over the past years, again suggesting that some of the differences may have been due to gender discrimination and societal expectations about the appropriate roles and skills of women. The bell curves for some groups (Jews and East Asians) are centered somewhat higher than for Whites in general (Lynn, 1996; [20] Neisser et al. Other groups, including Blacks and Hispanics, have averages somewhat lower than those of Whites. The observed average differences in intelligence between groups has at times led to malicious and misguided attempts to try to correct for them through discriminatory treatment of people [22] from different races, ethnicities, and nationalities (Lewontin, Rose, & Kamin, 1984). One of the most egregious was the spread of eugenics, the proposal that one could improve the human species by encouraging or permitting reproduction of only those people with genetic characteristics judged desirable. Eugenics became immensely popular in the United States in the early 20th century and was supported by many prominent psychologists, including Sir Francis Galton. Dozens of universities, including those in the Ivy League, offered courses in eugenics, and the topic was [23] presented in most high school and college biology texts (Selden, 1999). Congress to pass laws designed to restrict immigration from other countries supposedly marked by low intelligence, particularly those in eastern and southern Europe. Fortunately, the practice of sterilization was Attributed to Charles Stangor Saylor. By bias, what psychologists mean is that a test predicts outcomes—such as grades or occupational success—better for one group than it does for another. Another way that tests might be biased is if questions are framed such that they are easier for people from one culture to understand than for people from other cultures. For example, even a very smart person will not do well on a test if he or she is not fluent in the language in which the test is administered, or does not understand the meaning of the questions being asked. But modern intelligence tests are designed to be culturally neutral, and group differences are found even on tests that only ask about spatial intelligence. Although some researchers still are concerned about the possibility that intelligence tests are culturally biased, it is probably not the case that the tests are creating all of the observed group differences (Suzuki & Valencia, [25] 1997). Research Focus: Stereotype Threat Although intelligence tests may not be culturally biased, the situation in which one takes a test may be. One environmental factor that may affect how individuals perform and achieve is their expectations about their ability at a task. In some cases these beliefs may be positive, and they have the effect of making us feel more confident and thus better able to perform tasks. For instance, research has found that because Asian students are aware of the cultural stereotype that ―Asians are good at math,‖ reminding them of this fact before they take a difficult math test can [26] improve their performance on the test (Walton & Cohen, 2003). On the other hand, sometimes these beliefs are Attributed to Charles Stangor Saylor. Because Black students are aware of the stereotype that Blacks are intellectually inferior to Whites, this stereotype might create a negative expectation, which might interfere with their performance on intellectual tests through fear of confirming that stereotype. In support of this hypothesis, the experiments revealed that Black college students performed worse (in comparison to their prior test scores) on standardized test questions when this task was described to them as being diagnostic of their verbal ability (and thus when the stereotype was relevant), but that their performance was not influenced when the same questions were described as an exercise in problem solving. And in another study, the researchers found that when Black students were asked to indicate their race before they took a math test (again activating the stereotype), they performed more poorly than they had on prior exams, whereas White students were not affected by first indicating their race. Steele and Aronson argued that thinking about negative stereotypes that are relevant to a task that one is performing createsstereotype threat—performance decrements that are caused by the knowledge of cultural stereotypes. That is, they argued that the negative impact of race on standardized tests may be caused, at least in part, by the performance situation itself. Because the threat is ―in the air,‖ Black students may be negatively influenced by it.

There is no reliable way of knowing when an injury will reveal the most detail zithromax 250mg mastercard, and purchase zithromax 100mg with visa, therefore order genuine zithromax line, repeat photography (e. Photograph Protocol • Anatomical location of bite mark (and identification of bitten person). Ultimately, the forensic dentist will select the best photographs and have them reproduced to life-size (1:1) for analysis and comparison work. At the time of writing, conventional film photography is still widely used, but the use of digital photography is progressing rapidly. Whatever the future brings, it is essential that standards, protocols, and appropriate training are in place. Dental Impressions Dental impressions taken from the potential biter by the dentist (or appropriately qualified person) after a thorough dental examination will be cast into hard dental models. Dental impressions taken of an individual in custody are intimate samples and require the appropriate authority and con- sent for your jurisdiction. Currently, the best method for overlay production to achieve accuracy and reproducibility is the computer-generated method (17). The importance of following the correct procedures for evidence docu- mentation, collection, preservation, and storage with continuity of evidence cannot be overstressed. It can establish contact between two people or, of equal importance, exclude an innocent party. Early suspicion and recognition by personnel involved with the investigation, followed by prompt and appropri- 158 Payne-James et al. Awareness by all concerned and early referral to the forensically trained dentist with experience in this field promote teamwork and best practice. Lack of agreement on color description between clinicians examining childhood bruising. Recapturing a five-month-old bite mark by means of reflective ultraviolet photography. Accuracy of bite mark overlays: a comparison of five common methods to produce exemplars from a suspect’s dentition. Nonaccidential Injury in Children 159 Chapter 5 Nonaccidental Injury in Children Amanda Thomas 1. Definition Child abuse is difficult to define, and although many definitions exist in the legal and scientific literature, there is no consensus on an absolute defini- tion. Issues that arise in the debate include the influence and attitudes of soci- eties, cultural differences in child rearing, politics, and religious beliefs. In addition, there is a need to examine the factors involved in particular epi- sodes, the context in which the episodes occurred, the opinion of the profes- sionals who are describing or judging these episodes, the current knowledge of the long-term outcomes of particular behaviors to children, and the effec- tiveness of current interventions. However, definitions are important because they provide a general framework for policy setting, statutory and legal inter- ventions, gathering statistical information, and an understanding of current and future research. The parent or caretaker may not have intended to hurt the child; rather, the injury may have resulted from over-discipline or physical punishment. Effects of Child Abuse There is extensive literature on the effects of child abuse. It is generally accepted that child abuse carries a significant mortality and morbidity with consequences that include the following: • Death or disability in severe cases. The authors found that 10 years after diagnosis, abused children were more likely to show behavior problems at home and at school, had greater difficulties with friendships, and scored lower on certain cognitive tests. There was evidence that persistent abuse, a combination of different kinds of abuse, or abuse and neglect together had a poorer progno- sis. Isolated incidents of physical abuse in the context of a nonviolent family and in the absence of sexual abuse or neglect did not necessarily lead to poor long-term outcomes for children. What has emerged from this research has been the importance of the style of parenting in families: children exposed to a harshly punitive, less reliable, and less warm environments are the children with the poorest outcomes. Risk Factors for Abuse The picture of child abuse is complex, with social, psychological, eco- nomic, and environmental factors all playing a part. Often there is evidence of family stress followed by a triggering event leading to abuse. Newberger (5) pinpointed the following three categories of predisposing family stress: 1. Parental factors—mental health problems, alcohol or drug abuse, domestic vio- lence, previous abuse as a child. Sociosituational factors—single parent, young parent, new partner, poverty, unemployment. A substantial minority of parents had histories of mental illness, criminal behavior, or substance abuse. Substance abuse is more common worldwide and is associated with an elevated risk of neglect in the children of substance- abusing parents. Children with disabilities are at greater risk of becoming victims of abuse and neglect than children without disabilities, estimated at 1. The harmful effect of socioeconomic deprivation on children is well estab- lished. Poverty is associated with postnatal and infant mortality, malnutrition and ill health, low educational attainment, delinquency, teenage pregnancy, and family tension and breakdown. Parental stress leads to greater vulnerabil- ity of the children, and common stress factors include unemployment and debt, which are linked to poverty. Abuse occurs throughout all social classes, but children from the most disadvantaged sectors of society are brought to the attention of child protection agencies more frequently (8) than those from nondisadvantaged sectors. Extent of Abuse The true prevalence of child abuse is difficult to determine in all coun- tries. Official estimates will only represent a fraction of the total number of cases, because many go unreported or unrecognized, and information systems are incomplete or track just one limited part of the picture. In the United States, the referral rate for child abuse investigations is three times higher than in the United Kingdom, and twice as many children are in state care, with four times as many child abuse deaths (9). In the United Kingdom, child protection registers hold statistical infor- mation on children identified by agencies as at risk of significant harm and for 162 Thomas whom a child protection plan has been developed. However, these figures record professional activity and the numbers of children registered, not the numbers of children who have been abused. They exclude cases where abuse has occurred but the child is otherwise protected or no longer at risk, cases where abuse has not been recognized, or cases where the child has not been registered but may still be subject to abuse. In 2002, there were 23 children per 10,000 aged less than 18 years on the child protection register, and 19% were registered under the category of physical injury, the second most fre- quent type of maltreatment (10). Neglect is the most common category of registration or type of maltreat- ment in both the United Kingdom and the United States. Injury may occur in the context of neglect, such as leaving a child unsupervised and exposed to dangerous situations.

If the hypoglycemia is not caused by diabetes or overproduction of insulin order zithromax cheap, it is important to work with your doctor to determine the underlying causes and develop a treatment order generic zithromax from india. For example buy zithromax 500 mg otc, if it is caused by a medication you are taking, your doctor may recommend changing the medication. If it is due to a tumour or glandular disor- der, a surgical procedure may be necessary. Those with organ disease or other serious health problems need to work with their health care provider for specific recommendations. Dietary Recommendations Foods to include: • Eat quality proteins (tofu, eggs, fish, and poultry) and healthy fats (fish, nuts, and seeds) with your carbohydrates as this will slow down the rate of digestion. Those that break down quickly have a high glycemic index and those that break down slowly have a low glycemic index. Foods to avoid: • Alcohol can impair blood sugar control and trigger hypoglycemia by interfering with normal glucose utilization and increasing insulin secretion. Lifestyle Suggestions • Regular exercise helps to improve blood sugar control and improve insulin sensitivity. Have a light snack 30 minutes before exercising to sustain your energy levels and prevent hypoglycemia. Top Recommended Supplements B-vitamins: Play a role in metabolizing carbohydrates and converting blood glucose into energy. Look for a B-complex that provides 20–50 mg each of B1, B2, B3, B5, and B6 and 100 mcg of vitamin B12. Fibre: Soluble fibre forms a gel in your stomach and slows the rate of digestion and absorp- tion. Vitamin C: Plays an important role in blood sugar regulation; levels are depleted by chronic stress, which is a factor in hypoglycemia. Eat small, frequent meals of low-glycemic carbohydrates along with quality pro- teins and fats. It produces two hormones, triiodothyronine (T3) and thyroxine (T4), which circulate through your bloodstream and control metabolic activity in every cell in the body, from your heartbeat to body temperature to how fast you burn calories. Hypothyroid- ism or underactive thyroid occurs when the thyroid gland cannot produce enough thyroid hormones to meet the body’s demands. This causes all bodily functions to slow down and you feel tired, sluggish, achy, and gain weight. However, today people are encouraged to reduce salt intake for health reasons (hypertension), and most of the salt that we get comes from processed foods that contain non-iodized sodium, so it is possible that low iodine levels are again partly contributing to thyroid disease. The most common cause of hypothyroidism is Hashimoto’s disease, which is an autoimmune disorder in which the body makes antibodies that attack the thyroid gland. Hypothyroidism can also result from treatment of Graves’ disease (hyperthyroid- ism) with radioactive iodine, which destroys the thyroid gland, leaving it unable to produce hormones, and from surgical removal of the thyroid gland due to thyroid cancer. These glands are involved in the regulation of the thyroid gland and the amount of thyroid hormone that is released. Hypothyroidism is easily treated today with thyroid hormones, supplements, and various lifestyle approaches. Many people do not realize that they have low thyroid because in the early stages the symptoms can be very mild and vague, such as fatigue. It may cause a large, pro- truding tongue, choking, yellowing of the skin and whites of the eyes, constipation, poor muscle tone, and excessive sleepiness. Doctors typically prescribe synthetic thyroid hormone (T4), such as Eltroxin or Synthroid. Too much thyroid hormone can cause symptoms of racing heart, increased appetite, insomnia, and shakiness. Some people do not convert T4 to T3 adequately and do better with a form of T3, which is called Cytomel. Natural thyroid hormones can be compounded by a pharmacist to provide T3 and T4 or just T3, depending on your needs. Compounded thyroid hormones are available through a compounding pharmacy with a doctor’s prescription. The advantage of this form is that the dosage can be tailored to your needs and many people do better with the natural over the synthetic form. Calcium and iron supplements may reduce the absorption of thyroid hormone, so take these products six hours away from your thyroid medication. A person may have no symptoms or vague symptoms, such as fatigue, dry skin, or H weight gain. Anyone at risk of hypothyroidism or who has any of the symptoms should consider testing beyond basic bloodwork. The thyroid regulates metabo- lism and low body temperature can indicate hypothyroidism. Here is what you do: • Place a digital thermometer, paper, and pen beside your bed. Iodine through food or supplements is helpful only if you are deficient this nutrient. Cooking usually inactivates these goitrogens, so this is the rare case where cooked is preferred over raw. Other factors that may worsen the effects of soy on thyroid function are iodine deficiency, consumption of other goitrogens, and other problems synthesizing thyroid hormones. Until more is known, if you have hypothyroidism, limit intake of soy foods and avoid supplements containing soy. Drastically reducing your calorie intake can lower metabolism, which can make weight management more difficult. Physical activity stimulates the thyroid to secrete more hormone and makes the body more sensitive to any thyroid hormone that is circulating. Top Recommended Supplements Compounded thyroid hormones: Provide the body with biologically active, natural hormones. Both T3 and T4 can be made into delayed-release capsules and tailored to your needs. Multivitamin/mineral complex: Many nutrients are required to produce thyroid hormone, such as vitamin C, E, A, and the B-vitamins. Many people are deficient in selenium, which may hamper thyroid hormone levels, so a complete multivitamin can ensure that all essential nutrients requirements are met. Complementary Supplements Ashwaganda: An herbal product that helps boost thyroid function and also reduces stress. Consider compounded thyroid hormones and guggul, and take a daily multivita- min/mineral complex. An estimated 10–15 percent of couples are infertile, which means they are unable to conceive after one year of frequent, unprotected intercourse. While once thought of as primarily a woman’s problem, infertility can affect men too. Infertility may be due to a single cause in either you or your partner, or a combi- nation of factors. When a woman’s body is functioning as it should, each month the ovaries prepare an egg, which is released during ovulation.

If you stop calling yourself useless trusted zithromax 100mg, hurtful names generic 250mg zithromax with visa, and replace the labels with more reason- able perspectives generic 100 mg zithromax visa, you’ll feel better. Therefore, we recommend that you complete the Label Replacement Exercise in Worksheet 5-15 each time you hear those destructive labels in your mind: 1. Tune into what you’re telling yourself when you feel upset, and listen for any time that you tag yourself with a hurtful label. Come up with alternative perspectives to the labels and record them in the right- hand column. In creating label replacements, try to accept any portion of the event that has truth in it, such as having gained some weight, but look at the issue more real- istically. Because labels tend to be overarching ratings (that is, they imply a bigger problem than the event that triggered them), your replacement thoughts should be specific and look for positive possibilities. Chapter 5: Untangling Twisted Thinking 71 Worksheet 5-15 My Label Replacement Exercise Event Corresponding Label Label Replacement Thought Now that you’ve completed the Label Replacement Exercise, take a few minutes to reflect on what self-labels have been doing to you and how it feels to change them (see Worksheet 5-16). You may accuse yourself of being inept, inca- pable, or inadequate and therefore fully culpable for all your suffering. When the Self-Blame Reality Scrambler is at work, you attribute all fault and blame to yourself. In this section, we give you a tool for figuring out if you use the Self-Blame Reality Scrambler. After you begin to understand that your problem isn’t completely your fault, you can take action on the portion for which you own responsibility. The Rating Responsibility Exercise helps you see that most problems have many causes and that you only own a portion of the responsibility. After you understand the causes of the problem, you’ll be more ready to do something produc- tive about it. Robin blames herself for her recent divorce and believes that she is almost entirely respon- sible for her husband leaving the marriage for another woman. Robin considers herself boring and unattractive, and she berates herself for not seeing the signs early enough to prevent what happened. Robin decides to take the Rating Responsibility Exercise (see Worksheet 5-17), focusing on the blame she places on herself for her divorce. Worksheet 5-17 Robin’s Rating Responsibility Exercise I blame myself for: My recent divorce I rate the blame at: 95% All Possible Causes of Your Problem Percentage of Responsibility My husband’s roving eye. My husband’s grief over losing his 10%: He could never talk about mother, father, and brother over the last these losses, and I know they got year and a half. My husband can easily find women more 5%: Yeah, but I do look better than attractive than me. Chapter 5: Untangling Twisted Thinking 73 All Possible Causes of Your Problem Percentage of Responsibility We had stopped talking about our days. As you can see, Robin initially assigns 95 percent of the blame for the divorce on herself. At the end of the quiz, Robin reassesses her level of responsibility because she’s able to see things a bit more objectively. She re-rates the level of blame she puts on herself and identi- fies that 20 percent seems more appropriate — she’s only partly responsible. Now that you’ve seen the Rating Responsibility Exercise in action, it’s time to evaluate the level of responsibility you feel you carry. Complete your Rating Responsibility Exercise in Worksheet 5-18 by fol- lowing these steps: 1. Using a percentage from 1 to 100, rate how much blame you put on yourself for this problem. At the top of the worksheet, write this percentage under the problem you’ve identified. In the right-hand column, using a number from 1 to 100, estimate the percentage of actual responsibility for this problem that each cause in the left-hand column owns. These folks usu- ally find a convenient scapegoat such as a mother, father, significant other, society, or event to blame for all their woes. Failing to accept any responsibility for your troubles makes you see yourself as helpless and the world as unfair and unjust (check out Chapter 3 for more information about such self-sabotaging beliefs). Realize that you don’t want to fall into that trap — read the next section to see how to avoid it. Doing What You Can to Solve the Problem In this section, you face your problem and take action to change it. By assessing your responsibility and determining what you can do about your problem, you avoid immersing yourself in self-loathing and harsh self-blame. This approach allows you to take respon- sibility for an appropriate portion of the problem and do what you can with it. If your responsibility involves something that’s over and done with, no action is possible. But you can still try to let go of the shame that leads nowhere and does nothing to help you. Robin reviews her Rating Responsibility Exercise (see Worksheet 5-17) and notices that she owns partial responsibility for some of the problems that led to her divorce. She lists those contributions and then plans steps for productive action on the Action Strategy Worksheet shown in Worksheet 5-19. Chapter 5: Untangling Twisted Thinking 75 Worksheet 5-19 Robin’s Action Strategy Worksheet The problem: My divorce. My Specific Contributions to the Problem Specific Actions I Can Take I am ten pounds overweight. It won’t help this divorce, but my counselor said exer- cise will lift my spirits, and I’ll be healthier. I’m not the most attractive I can’t do a lot about my appearance other woman in the world. I ignored our lack of When I find another relationship, I need to communication in the marriage. After completing your Rating Responsibility Exercise in Worksheet 5-18, the next step is to create an action strategy to determine how you can begin solving your problem. By identify- ing productive actions to address the problem, you’re able to move forward and stop berating yourself. Name the problem you’re blaming yourself for and write it at the top of the worksheet. In the left-hand column, list the specific contributions you’ve identified that you have some control over. In other words, record anything you did that may have led to the problem or made it worse. In the right-hand column, list any steps you can take now or in the future that may be useful in solving this problem. Worksheet 5-21 My Reflections Chapter 6 Indicting and Rehabilitating Thoughts In This Chapter Investigating and charging thoughts Putting thoughts on trial Repairing thoughts ost people simply assume that thoughts they have about themselves and the world Mare true. But thoughts don’t always reflect reality, just as funhouse mirrors don’t reflect the way you really look.

The be repeated for 1 minute best purchase for zithromax, followed by a chest wall is so thin that the ribs cheap zithromax, sternum order genuine zithromax online, and 2-minute rest. Place “No Smoking” signs in conspicuous places neous fat is deposited on the chest wall, so in the patient’s room. Check to see that electric equipment is in good preschool child’s eustachian tubes, bronchi, working order. Avoid wearing and using synthetic fabrics, than in an infant, so the number of routine which build up static electricity. Older adult: Bony landmarks are more promi- cular tube of plastic or rubber inserted into the nent; kyphosis contributes to appearance of back of the pharynx through the mouth or nose leaning forward; barrel chest deformity may in a spontaneously breathing patient; used to result; senile emphysema may be present; power keep the tongue clear of the airway and to per- of respiratory and abdominal muscles is reduced. Endotracheal tube: Polyvinylchloride tube that one’s hands on the patient’s posterior thorax at is inserted through the nose or mouth into the the level of the 10th rib, with both thumbs trachea, using a laryngoscope as guide; used to almost touching the vertebrae. While patient administer oxygen by mechanical ventilator, to takes a few deep breaths, the nurse’s thumbs suction secretions easily, or to bypass upper air- should move 5 to 8 cm symmetrically at maxi- way obstructions mal inspiration. The curved tracheostomy tube palm’s surface on each side of the patient’s is inserted into this opening to replace an endo- chest wall, avoiding bony areas; the nurse tracheal tube, provide a method to mechanically should detect equal vibrations as the patient ventilate the patient, bypass an upper airway says a multisyllable word. B: Breathing: If the victim does not start to deviation from normal color, pulse, and respira- breathe spontaneously after the airway is tory rates to physician. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. If the victim Intellectual: knowledge of developmental variables has no pulse, artificial circulation must be affecting respiratory function started with breathing. The nurse is responsible for collecting the baseline necessary to diagnose and treat respiratory problems data before the examination. Pain medication Ethical/Legal: knowledge of patients’ and families’ should be administered before the test if rights related to refusal of care requested. Objective data are underlined; subjective data are in procedure, the nurse should observe the patient boldface. A chest x-ray is usually Toni is a 14-year-old girl who is in the adolescent done to verify the absence of complications. Help the patient assume a position that allows chart reveals that on several occasions when her free movement of the diaphragm and expansion mother was visiting, she began hyperventilating of the chest wall to promote ease of respiration. Keep the patient’s secretions thin by asking the ing for breath on these occasions, she nevertheless patient to drink 2 to 3 quarts of clear fluids daily. Perform cupping on the patient’s lungs to the midst of a divorce and that it hasn’t been easy loosen pulmonary secretions. Use vibration to help loosen respiratory rough time at school, and I guess I’ve been too secretions. McIntyre’s chart for ratory rate and rhythm (not to exceed 24) during advance directives or a living will and if one is not her mother’s visits. A counselor could be called in to facilitate the its probable cause, and its effect on her lifestyle. Demonstrate consciously controlled breathing should take into consideration age-related changes and encourage her to use it during periods of that may be increasing Ms. What would be a successful outcome for this patient and maintain eye contact during conver- patient? If fear is the cause of her anxiety, encourage her to of, and signs, an advance directive to direct her express concerns. What intellectual, technical, interpersonal, and/or with the patient the possibility of developing effec- ethical/legal competencies are most likely to bring tive coping skills with professional counseling. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Osmosis: The solvent water passes from an area of lesser solute concentration to an area of greater solute concentration until an equilibrium is established. The solute moves from an area of higher concentration to an area of lower concentration until an equilibrium is established. Active transport: A process that requires energy for the movement of substances through a cell membrane from an area of lesser concentration to an area of higher concentration. Ingested liquids: Fluid intake is regulated by the thirst mechanism and is stimulated by intracel- lular dehydration and decreased blood volume. Metabolic oxidation: Water is an end product of oxidation that occurs during the metabolism of food. Kidneys: Approximately 170 L of plasma is filtered daily in the adult, while only 1. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Increased hematocrit: Severe dehydration and vessels are responsible for pumping and carry- shock (when hemoconcentration rises consider- ing nutrients and water throughout the body. Thyroid: Thyroxine, released by the thyroid of incompatible blood gland, increases blood flow in the body. Increased hemoglobin: Hemoconcentration of turn increases renal circulation, which results the blood in increased glomerular filtration and urinary d. Nervous system: The nervous system acts as a select electrolytes switchboard and inhibits and stimulates mecha- c. Respiratory acidosis: An excess of carbonic acid attempt to prevent losses when possible. Physiologic changes that accompany the aging and resulting in the retention of carbon diox- process may affect the patient’s ability to main- ide. Select a vein large enough to accommodate the concentration increases, the kidneys retain needle. Select a site while moving toward the heart and carbon dioxide is being excreted faster than away from a damaged vein. The kidneys attempt to alleviate this changes, assessing patient for evidence of imbalance by increasing bicarbonate excretion infection or other complications, and maintaining and hydrogen retention. The kidneys excrete potas- should also be aware that fluid restriction may be sium and sodium along with excess bicarbonate ordered and prepare the patient by explaining the and retain hydrogen within carbonic acid. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The nurse could fluid/day; (2) urine specific gravity within normal then work with the patient to develop short-term range (1. Fluids could be served in small Nursing Interventions: cups to make the cup appear to contain more liquid a. Give oral fluids that are nonirritating, as nurse should provide oral hygiene at regular inter- tolerated. What intellectual, technical, interpersonal, and/or output average 2,700 mL fluid/day; pulse returned ethical/legal competencies are most likely to bring to baseline; skin turgor improved; mucous about the desired outcome? Patient strengths: Previously healthy; concerned maintain fluid, electrolyte, and acid–base balance friends; highly motivated to correct deficit Technical: ability to use the equipment and proto- Personal strengths: Strong knowledge of fluid, elec- cols necessary to maintain and restore fluid, trolyte, and acid–base balance; good interpersonal electrolyte, and acid–base balance skills Ethical/Legal: strong sense of accountability for the 4.

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