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The parenteral route is used to inject medication directly into the dermal or subcutaneous tissue generic viagra sublingual 100mg otc, muscle cheap viagra sublingual amex, or into the veins cheap viagra sublingual 100mg free shipping. If the dose of a transdermal patch is more than the prescriber’s medica- tion order (a) cut the patch to an appropriate length. The Z-Track injection is used (a) to prevent medication from leaking back onto the tissue. Although the prescriber specifies a dose in the medication order, the dose prescribed may not be the same as the dose that is on hand, requir- ing the nurse to calculate a comparable dose based on available medication. The nurse is responsible for weighing the patient and then applying a formula provided by the prescriber to calculate the actual dose. The Metric System and Medication Medication is prescribed in measurements of the metric system. Unit Purpose Equivalents Gram Weight 1 kilogram (kg) = 1000 grams (g) 1 gram (g) = 1000 milligrams (mg) 1 milligram = 1000 micrograms (mcg) 1 kilometer = 1000 liters Liter Volume 1 liter (L) = 1000 milliliters (mL) = 1000 cubic centimeters (cc) 1 milliliter (mL) = 1 cubic centimeter (cc) Medication calculation requires you to know how to multiply and divide. You’ll also need to know six metric measurements and five household measure- ments (ounces, teaspoon, tablespoon, cup and drop). The metric system uses grams to measure weight and liters to measure volume as shown in Table 7-1. Table 7-2 shows the commonly used prefixes that you’ll see when calculating medication. The prefix is placed before the unit of mea- sure such as 1 kilogram or 1 milliliter. The important point to remember is that the prefix of the measure implies the size of the measurement. Nurses encounter household measurements when providing home healthcare services and when determining a patient’s fluid intake and output in the hospital setting. Nurses also use pounds when calculating a dose that is based on a patient’s weight. Patients should use measuring spoons for medication administration at home and avoid using tableware. Patients are usually more comfortable self-administering medication if the dose is in household measurements. Therefore, a nurse must be able to convert household measure- ments to metric measurements. The nurse must convert that to milliliters (mL) or cubic centimeters (cc) in order to record the intake volume in the patient’s fluid input and output chart. Commonly used conversion factors for household measurement and metric measurement. For example, if the dose is in milligrams and the prescriber’s medication order specifies grams, you’ll need to convert grams to milligrams before calculating the dose. Converting from one metric unit to another metric unit isn’t difficult if you remember these three rules. Determine if the desired measurement is larger or smaller than the given measurement. Remember that gram, liter, and meter are larger units and milligram, milliliter, and millimeter are smaller units. If you are converting from a smaller unit to a larger unit, then you multi- ply by moving the decimal three places to the left. If you are converting from a larger unit to a smaller unit, then you divide by moving the decimal three places to the right. Therefore, you divide by moving the decimal three places to the left, as shown here. Therefore, you multiply by moving the decimal three places to the right, as shown here. This is also the easiest conversion because one milliliter (mL) is equal to 1 cubic centimeter (cc). Always place a zero to the left of the decimal when the quantity is not a whole number. There, you’ll use a teaspoon, tablespoon, or cups mea- sured in ounces to administer medication. When converting from milliliters or cubic centimeters to ounces, divide by 30, as shown here: [Remember 30 cc (30 mL) = 1 oz. For example, the medication prescription is for a 15-mg tablet of Inderal and the hospital has on hand a 15-mg tablet of Inderal. In the real world, the dose specified in the medical prescription may not be available. The hospital might have 10-mg tablets of Inderal and not the 15-mg tablets prescribed. Instead of asking the prescriber to change the medication order, the nurse calculates the proper medication to give the patient based on the medication order and the dose that is on hand. When applying either method, make sure that all the terms are in the same units before calculating the desired dose. For example, the medication order might be in grams and the dose on hand might be in milligrams. The nurse will need to convert the grams to milligrams before calculating the desired dose to give. D × V = A Quantity (Desired dose divided by dose you have H multiplied by vehicle of drug you have equals the amount calculated to be given to the patient) D = desired dose H = dose you have V = vehicle you have (tablets or liquids) A = amount calculated to be given to the patient Ratio and proportion method H V :: D x Means Extremes H is the drug on hand (available) V is the vehicle or drug form (tablet, capsule, liquid) D is the desired dose (as prescribed) x is the unknown amount to give, and :: stands for “as” or “equal to. Example: Give 500 mg of ampicillin sodium by mouth when the dose on hand is in capsules containing 250 mg. For example, use mg following a value in the formula if the value is in milligrams. Parenteral Medications Parenteral medication is a medication that is administered to a patient by an injection or by an intravenous flow. The dose for an injection is calculated using the formula method or the ratio-proportion method that is described previously in this chapter. The nurse must calculate the number of milliliters that should be administered to the patient. The intravenous order directs the nurse to administer a specific vol- ume of fluid to the patient over a specific time period. In order the calculate the drip rate you need to know: • The volume of fluid that is to be infused. This is found in the medication order in milliliters (mL) or cubic centimeters (cc). It is important to remember that although we use milliliters in the following examples, you can substitute cubic centi- meters (cc) for milliliters (mL) if cc is specified in the order.

Excerpted from the book Discovering that psychiatrists remained singularly disinterested Osteopathy (Berkeley order viagra sublingual 100mg with amex, Calif cheap viagra sublingual 100mg with visa. This is not limited to the cell—it involves the ing_osteopathy) recounts that an example might functioning of the whole of the physical body—and be “a six-year-old boy who order viagra sublingual 100 mg line, while playing, falls it gives us an insight into our mechanisms for sur- very hard on his bottom. A ory” contained by bodily cells, according to kiss and ‘rub it better’ console him. During a sud- osteopathic theory, leads to the idea of the body’s den growth spurt as a teenager, the same boy com- requirement for the least possible therapeutic or plains of low backache. In his late twen- itself—within certain limits—the capacity for self- ties, married with a young child and a stressful job, repair and correction. It can create its own reme- he begins to have an irritable colon and attacks of dies, provided that good circulation is maintained, cystitis. At a balanced diet is eaten, a positive attitude is held, the age of forty, he has a major attack of low back and—as far as possible—the individual lives in a pain and sciatica and is in bed for two weeks. The self-healing this point, hoping to avoid surgery, he visits an mechanism is the backbone and sustainer of the osteopath. Since the time of Hippocrates, the belief in the Osteopaths believe that disease primarily originates self-healing capacity of the body has been acknowl- in the individual, and so they concentrate on the edged. Still resurrected the innate healing con- person who is suffering rather than on the cept before the discovery of the law of homeostasis. Homeostasis, a scientific term for balance, is the There are, however, some stages of disease when process by which every living thing adapts in order the changes it has brought about have passed the to keep itself stable and function to the best of its point of return. Homeostasis is a self-regulating activity, with people to function to the best of their ability, given preset limits such as, in the blood there must be a the circumstances. Where necessary, an osteopath precise quantity of dissolved oxygen within maxi- will refer a patient for further specialist examina- mal and minimal levels that keeps body tissues tion and treatment. His work was carried was there in the two persons that caused one to have on and extended by his son, Bartlett J. This discovering the principles which comprise the question had worried thousands for centuries and method known as Chiropractic,” Palmer wrote in was answered in September, 1895. I had discovered that many dis- years that he could not hear the racket of a wagon eases were associated with derangements of the on the street or the ticking of a watch. In the dim ages inquiry as to the cause of his deafness and was of the past when man lived in rude huts and rocky informed that when he was exerting himself in a eaves, even up to the present time, he resorted to cramped, stooping position, he felt something give charms, necromancy and witchcraft for the relief of way in his back and immediately became deaf. His whole object examination showed a vertebra racked from its was to find an antidote, a specific for each and normal position. I reasoned that if that vertebra every ailment which could and would drive out the was replaced, the man’s hearing should be intruder, as though the disorder was a creature of restored. I tion and prolong his existence, he has searched the racked it into position by using the spinous process heavens above, he has gone into the deep blue sea, as a lever and soon the man could hear as before. There was nothing ‘accidental’ about this, as it was He has tried animal and mineral poisons, pene- accomplished with an object in view, and the result trated the dark forest with superstitious rite and expected was obtained. There was nothing ‘crude’ with incantations, has gathered herbs, barks and about this adjustment; it was specific, so much so roots for medicinal use. I desired to I examined the spine and found a displaced vertebra 123 124 Palmer Method pressing against the nerves which innervate the Paracelsus The pseudonym of the German-Swiss heart. I adjusted the vertebra and gave immediate physician and alchemist Philippus Aureolus relief—nothing ‘accidental’ or ‘crude’ about this. Theophrastus Bombast von Hohenheim (1493– Then I began to reason if two diseases, so dissimilar 1541), who claimed to have received his doctoral as deafness and heart trouble, came from impinge- degree at the University of Ferrara. He adopted the ment, a pressure on nerves, were not other disease name para-Celsus—meaning “beyond Celsus” (the due to a similar cause? Thus the science (knowl- Roman authority on medicine)—and wandered edge) and art (adjusting) of Chiropractic were throughout Europe and the Middle East, studying formed at that time. He valued the common sense of tigation for the cause of all diseases and have been common people more than the dry teachings of amply rewarded. He gave open lectures in German at osteology, neurology, and functions of bones, the University of Basel and was eventually forced to nerves, and the manifestations of impulse, and flee the city as his broadmindedness scandalized originated the art of adjusting vertebrae and the authorities. His written works include Der grossen knowledge of every principle included in the con- Wundartzney (Great surgery book, 1536). The kind of disease depends upon what particulars Symptoms described in homeopathic nerves are too tense or too slack. Palmistry may have originated experiences in past lives thought to influence ill- in ancient India, and it was probably from their orig- ness and wellness in the present lifetime of an indi- inal Indian home that the traditional fortune-telling vidual. It was also practiced in psychotherapy/psychiatry has been popularized by China, Tibet, Persia, Mesopotamia, Egypt, and Brian Weiss, M. In medieval Europe it was used to Institute in Florida and author of several books, discover witches, who were thought to have pig- including Many Minds, Many Masters (New York: mentation spots as signs of a pact with the devil. Through Time Into Healing (New Though palmistry is still practiced, there is no York: Simon & Schuster, 1992), and Messages from known scientific basis for it. According to Denise Linn in Past Lives, Present Dreams (New York: Ballantine Books, 1997), “Past- panchakarma The Ayurvedic term for the five life therapy can sometimes give answers that nei- types of therapeutic internal cleansing: vomiting, ther traditional medicine nor traditional therapy purging, two kinds of enemas, and nasal inhala- provides. These therapies are meant to restore balance ing reasons for our problems in life, and it can be and prevent disease. Nevertheless, past-life exploration has proved pet therapy 125 incredibly powerful in many cases where other 48-page magazine, under the direction of Ruth types of therapy have failed. Past-life exploration Peale, is the 13th largest paid-circulation magazine can assist the process of gradually realizing our full in the United States with a circulation of more than potential as conscious, loving beings. His sermons were said ble Collegiate Church), 1898–1993, who was one to be mailed to more than 750,000 people per of the earliest proponents of the mind-body con- month, and in 1964 a movie was made of his life, nection through his theories of positive thinking One Man’s Way. Born in a rural Ohio town, With the educator Kenneth Beebe in 1947 Peale Peale grew up helping to support his family by cofounded the Horatio Alger Association, dedicated delivering newspapers, working in a grocery store, to honoring contemporary Americans who have and selling pots and pans door to door. The Guideposts family of nonprofit orga- Protestant clergymen in the United States. He nizations includes the Peale Center, the Positive applied Christianity to everyday problems and had Thinking Foundation, and Guideposts Publications. He Their mission is to be the world leader in commu- was a reporter on the Findlay, Ohio, Morning Repub- nicating positive, faith-filled principles that lic before entering the ministry and went on to empower people to reach their maximal personal write 40 books. Over the years he developed and refined the message that anyone could put the principles of peculiars The homeopathic description of odd positive thinking and strong faith into practice and and rare symptoms that correspond to the individ- improve his or her own life dramatically. Peale, his wife, Ruth Stafford Peale, and Raymond Thornburg, a pet therapy A combination of all the forms of Pawling, New York, businessman founded Guide- holistic medicine used in animal healing, which are posts magazine. With little money and a strong almost identical with the forms used for human vision they managed to raise $1,200 from Frank health. Professionals in both fields often study Gannett, founder of the Gannett newspaper chain, together and learn from one another. Howard Pew, the Philadelphia industrialist, and practices differ only in that the humans responsible Branch Rickey, owner of the Brooklyn Dodgers.

After completing the Emotional Origins form discount viagra sublingual online master card, Tyler has a better understanding of why he copes with stress the way he does buy viagra sublingual no prescription. He sees that there’s a reason he shuts down when facing certain types of situations order cheap viagra sublingual online. The exercise isn’t about blame and faultfinding; rather, it helps Tyler forgive himself for being the way he is. If you happen to be receiving counseling or psychotherapy, your therapist will no doubt find this information useful and informative. You may jump-start your memory by talking with rela- tives or by looking through old photo albums. Then move on to answer the questions about your parents or caregivers as well as the questions about your childhood and adolescence. Memories aren’t always completely accurate, but, in a powerful way, they impact the way you feel today. Please realize that the intent of this exercise is not to place blame on your parents or other important people in your life. These people indeed may have made significant contributions to your problems, and that’s useful to know. Part I: Analyzing Angst and Preparing a Plan 24 Worksheet 2-2 My Emotional Origins Questions About Mother (or other caregiver) 1. Were there special circumstances (for example, illness, death, divorce, military service, etc. Does anything else important about her come to mind, whether positive or negative? Were there special circumstances (for example, illness, death, divorce, military service, etc. Does anything else important about him come to mind, whether positive or negative? From daily traffic hassles to major losses, stressful events deplete your coping resources and even harm your health. Complete The Current Culprits Survey in Worksheet 2-3 to uncover the sources of your stress. You can’t make your world less stressful unless you first identify the stress-causing culprits. In the past year or so, have I lost anyone I care about through death, divorce, or prolonged separation? Are there problems at work such as new responsibilities, longer hours, or poor management? Have I made any major changes in my life such as retirement, a new job, or a new relationship? Do I have daily hassles such as a long commute, disturbing noises, or poor living conditions? However, all major changes, whether positive or negative, carry significant stress that tags along for the ride. Part I: Analyzing Angst and Preparing a Plan 30 Drawing Conclusions You didn’t ask for depression or anxiety. Your distress is understandable if you examine the three major contributors: biology/genetics, your personal history, and the stressors in your world. Take a moment to summarize in Worksheet 2-4 what you believe are the most impor- tant origins and contributors to your depression or anxiety. Physical contributors (genetics, drugs, illness): ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 2. My personal history: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 3. The stressors in my world: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ As you review your summary, we sincerely hope you conclude that you’re truly not at fault for having depression or anxiety. At the same time, you’re responsible for doing something about your distress — no one can do the work for you. Just remember that working on your emotional distress rewards you with lifelong benefits. Chapter 3 Overcoming Obstacles to Change In This Chapter Uncovering change-blocking beliefs Busting beliefs Sleuthing self-sabotage Slicing through self-sabotage ou don’t want to feel depressed or anxious. You want to do something about your distress, but you may feel overwhelmed and incapable. But first, you have to understand and overcome the obstacles in your mind that prevent you from taking action and moving forward. In this chapter, we help you uncover assumptions or beliefs you may have that make it hard for you to tackle your problems. After you identify the beliefs that stand in your way, you can use a tool we provide to remove these obstacles from your path. We also help you dis- cover whether you’re unconsciously sabotaging your own progress. If you discover that you’re getting in your own way, we show you how to rewrite your self-defeating script. Discovering and Challenging Change-Blocking Beliefs You may not be aware that people hold many beliefs about change. Others think they don’t deserve to be happy and there- fore don’t change their lives to improve their situations. By stealing your motivation to change, assumptions such as these can keep you stuck in a depressed or anxious state. And, unfortunately, most people aren’t aware of when and how these underlying assump- tions can derail the most serious and sincere efforts for making changes. The quizzes in this section are designed to help you discover whether any change-blocking beliefs create obstacles on your road to change. After the quizzes, you can find an exercise that assists you in ridding yourself of these beliefs through careful, honest analysis of whether each belief helps or hurts you. Detecting beliefs standing in your way People resist change because they are afraid, feel they don’t deserve something better, and/or view themselves as helpless to do anything about their circumstances. Unknowingly holding any of these beliefs will inevitably impede your progress toward change. So take the following three quizzes to see which, if any, of these barriers exist in your mind. Put a check mark next to each statement in Worksheets 3-1, 3-2, and 3-3 that you feel applies to you. Part I: Analyzing Angst and Preparing a Plan 32 Worksheet 3-1 The Fear of Change Quiz ❏ 1. Doing something about my problems would somehow discount the importance of the trauma that has happened in my life.

A group in Phoenix assessed the metabolic rates of 126 Pima Indians by monitoring their breathing for a 40-minute period buy viagra sublingual 100 mg mastercard. The study was carried out using Pima Indians because they have an abnormally high rate of obesity (about 80–85 per cent) and were considered an interesting population generic viagra sublingual 100mg with visa. The subjects remained still and the levels of oxygen consumed and carbon dioxide produced was measured generic 100mg viagra sublingual visa. The researchers then followed any changes in weight and metabolic rate for a four-year period and found that the people who gained a substantial amount of weight were the ones with the lowest metabolic rates at the beginning of the study. In a further study, 95 subjects spent 24 hours in a respiratory chamber and the amount of energy used was measured. The subjects were followed up two years later and the researchers found that those who had originally shown a low level of energy use were four times more likely to also show a substantial weight increase (cited in Brownell 1989). These results suggest a relationship between metabolic rate and the tendency for weight gain. If this is the case, then it is possible that some individuals are predisposed to become obese because they require fewer calories to survive than thinner individuals. Therefore, a genetic tendency to be obese may express itself in lowered metabolic rates. However, in apparent contrast to this prediction, there is no evidence to suggest that obese people generally have lower metabolic rates than thin people. To explain these apparently contradictory findings it has been suggested that obese people may have lower metabolic rates to start with, which results in weight gain and this weight gain itself results in an increase in metabolic rate (Ravussin and Bogardus 1989). Fat cell theory A genetic tendency to be obese may also express itself in terms of the number of fat cells. People of average weight usually have about 25–35 billion fat cells, which are designed for the storage of fat in periods of energy surplus and the mobilization of fat in periods of energy deficit. Mildly obese individuals usually have the same number of fat cells but they are enlarged in size and weight. Severely obese individuals, however, have more fat cells – up to 100–125 billion (Sjostrom 1980). Cell number is mainly determined by genetics; however, when the existing number of cells have been used up, new fat cells are formed from pre-existing preadipocytes. Most of this growth in the number of cells occurs during gestation and early childhood and remains stable once adulthood has been reached. Although the results from studies in this area are unclear, it would seem that if an individual is born with more fat cells then there are more cells immediately available to fill up. In addition, research suggests that once fat cells have been made they can never be lost (Sjostrom 1980). An obese person with a large number of fat cells, may be able to empty these cells but will never be able to get rid of them. Appetite regulation A genetic predisposition may also be related to appetite control. Over recent years researchers have attempted to identify the gene, or collection of genes, responsible for obesity. Although some work using small animals has identified a single gene that is associated with profound obesity, for humans the work is still unclear. Two children have, however, been identified with a defect in the ‘ob gene’, which produces leptin which is responsible for telling the brain to stop eating (Montague et al. To support this, researchers have given these two children daily injections of leptin, which has resulted in a decrease in food intake and weight loss at a rate of 1–2 kg per month (Farooqi et al. Despite this, the research exploring the role of genetics on appetite control is still in the very early stages. Behavioural theories Behavioural theories of obesity have examined both physical activity and eating behaviour. Further, at present only 20 per cent of men and 10 per cent of women are employed in active occupations (Allied Dunbar National Fitness Survey 1992) and for many people leisure times are dominated by inactivity (Central Statistical Office 1994). Although data on changes in activity levels are problematic, there exists a useful database on television viewing which shows that whereas the average viewer in the 1960s watched 13 hours of television per week, in England this has now doubled to 26 hours per week (General Household Survey 1994). This is further exacerbated by the increased use of videos and computer games by both children and adults. In a survey of adolescent boys in Glasgow in 1964 and 1971, whereas daily food diaries indicated a decrease in daily energy intake from 2795 kcals to 2610 kcals, the boys in 1971 showed an increase in body fat from 16. This suggests that decreased physical activity was related to increased body fat (Durnin et al. To examine the role of physical activity in obesity, research has asked ‘Are changes in obesity related to changes in activity? This question can be answered in two ways: first using epidemiological data on a population and second using prospective data on individuals. In 1995, Prentice and Jebb presented epidemiological data on changes in physical activity from 1950 to 1990, as measured by car ownership and television viewing, and compared these with changes in the prevalence of obesity. The results from this study suggested a strong association between an increase in both car ownership and televi- sion viewing and an increase in obesity (see Figure 15. They commented that ‘it seems reasonable to conclude that the low levels of physical inactivity now prevalent in Britain must play an important, perhaps dominant role in the development of obesity by greatly reducing energy needs’ (Prentice and Jebb 1995). Therefore, it remains unclear whether obesity and physical activity are related (the third factor problem – some other variable may be determining both obesity and activity) and whether decreases in activity cause increases in obesity or whether, in fact, increases in obesity actually cause decreases in activity. In addition, the data is at the population level and therefore could miss important individual differ- ences (i. In an alternative approach to assessing the relationship between activity and obesity a large Finnish study of 12,000 adults examined the association between levels of physical activity and excess weight gain over a five-year follow-up period (Rissanen et al. The results showed that lower levels of activity were a greater risk factor for weight gain than any other baseline measures. However, although this data was pro- spective it is still possible that a third factor may explain the relationship (i. Unless experimental data is collected, conclusions about causality remain problematic. Research has also examined the relationship between activity and obesity using a cross-sectional design to examine differences between the obese and non-obese. In particular, several studies in the 1960s and 1970s examined whether the obese exercised less than the non-obese. They reported that during swimming the obese girls spent less time swimming and more time floating, and while playing tennis the obese girls were inactive for 77 per cent of the time compared with the girls of normal weight, who were inactive for only 56 per cent of the time. In addition, research indicates that the obese walk less on a daily basis than the non-obese and are less likely to use stairs or walk up escalators. However, whether reduced exercise is a cause or a consequence of obesity is unclear. The relationship between exercise and food intake is complex, with research suggesting that exercise may increase, decrease or have no effect on eating behaviour.

Narrow perception field learn order genuine viagra sublingual on-line, concentrates only on the present sit- uation purchase cheapest viagra sublingual and viagra sublingual, and often experiences feelings of 11 buy cheap viagra sublingual 100 mg online. Defense mechanisms are conscious reactions eral task for a patient adapting to acute and to stressors. Projection occurs when a person’s thoughts or impulses are attributed to another d. Despair tries to give questionable behavior a logical or socially acceptable explanation. Depression Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. As the duration, intensity, or number of stressors increases, a person’s ability to adapt is lessened. A teenager being offered a cigarette by a method of preparing the body to either fight friend off a stressor or run away from it. A person who develops diarrhea while under armed services prolonged stress is said to be experiencing a(n) 5. Introjection Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A patient bangs his hand on the bed waste products tray in frustration over his rehabilitation 14. Functions under normal conditions and anger over a lack of privacy gives the at rest nurse a box of candy. A patient who continually forgets to calcitonin take his medications complains, “There are too many pills to take. A patient who cannot stop smoking responses to stress, and give an example of becomes a fitness fanatic. Match the homeostatic regulators of the body listed in Part A with their action listed in a. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. An 18-year-old boy is admitted to your unit your practice, have you experienced any of with a broken leg and facial lacerations from these levels of anxiety? You are a visiting nurse for a patient recover- ing from a stroke who is being taken care of by her daughter-in-law, who is also the mother of 2-year-old twins. Severe anxiety: you notice that your patient’s daughter is restless and unfocused. Give an example of a situation in which you experienced the following coping mechanisms personally or witnessed them in a friend, rela- tive, or patient. List three examples of situations in which stress may have a positive impact on an 11. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Scenario: Joan Rogerrio is a middle-aged woman with a history of inflammatory bowel c. What would be a successful outcome for this if he can make his mortgage and school patient? He put pressure on himself to be “the best” in sports and schoolwork and says he couldn’t handle the stress without getting high. What intellectual, technical, interpersonal, and/or ethical/legal competencies are most How would you use your knowledge of the likely to bring about the desired outcome? Think of a period in your life when you were under a considerable amount of stress, such as during exams, following a death, or during an illness. What resources might be helpful for to compensate for the effects of stress on your Ms. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Read the following patient care study and use your nursing process skills to answer the questions below. Scenario: Tisha Brent, age 52, comes to the clinic complaining of feelings of nervousness and an inability to sleep. Brent works full time as a social worker but is finding it more and more difficult to help others because of her own worries. What are the steps of crisis intervention that because she must care for her husband. Findings from the physical assessment included a weight loss of 10 pounds in the past 3 months (with weight 5% below normal for height), tachycardia, slightly elevated blood 7. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Which of the following stages of grief, accord- will help establish a trusting nurse–patient ing to Engel, involve the rituals surrounding relationship? The nurse should encourage family express his feelings of loss and at times denies members to assist in his nursing care. The nurse should arrange a visit from a of grief would the husband be experiencing? A nurse informs a woman that there is nothing more that can be done medically for c. The coroner must be notified to determine followed by acceptance of the loss, is which of the need for an autopsy. Explain the entire condition in detail complained of frequent headaches and loss of regardless of what the patient may already appetite. Which of the following diagnoses specifically the patient from your goal of dispensing addresses human response to loss and impend- information. In a living will, a patient appoints an agent Circle the letters that correspond to the best that he/she trusts to make decisions if answers for each question. Which of the following are impending signs of healthcare team to resuscitate a terminal death? Increased gastrointestinal activity describe the process of preparing a death certificate? Lowered blood pressure health department, which compiles many statistics from the information. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition.

Adrenaline and noradrenaline are secreted from the especially if these are repeated over several days 100mg viagra sublingual otc. The motor end-plate acetylcholine receptors of amphetamines can produce ‘amphetamine psychosis’ order 100mg viagra sublingual visa, which are initially stimulated and then blocked generic 100 mg viagra sublingual with amex, producing a paraly- is characterized by delirium, panic, hallucinations and feelings sis of voluntary muscle. The results of extensive central stimu- of persecution, and can be difficult to distinguish from acute lation include wakefulness, tremor, fits, anorexia, nausea, schizophrenia. Anxiety, irritability and restlessness are also com- vomiting, tachypnoea and secretion of antidiuretic hormone mon. The most commonly used amphetamine is amphetamine Adverse effects of smoking sulphate in oral or injectable forms, which are only available Smoking is a potent risk factor for malignant and cardiovascu- illegally. Some of the specific causes of death which are available (‘ice’), which can be smoked, and this has pharmaco- related to smoking are listed in Table 53. There are no specific drug treatments for bronchitis and emphysema are also associated with smoking amphetamine dependence, and the mainstay of therapy as is peptic ulcer disease. In house- powerful stimulant properties which are related to its action holds where the parents smoke, there is an increased risk in blocking synaptic re-uptake of dopamine, and to a lesser of pneumonia and bronchitis in preschool and school-age extent noradrenaline and serotonin. As the salt it is most com- children, which is most marked during the first year of life. Pharmacokinetics The pharmacokinetics of smoked crack cocaine are almost About 90% of nicotine from inhaled smoke is absorbed, while identical to those of intravenous cocaine. A high concentration of nicotine may be Repeated large doses commonly precipitate an extreme surge present in the breast milk of smokers. Myocardial infarction or arterial lating nicotine is metabolized in the liver, kidneys and lungs. Nicotine and its oids, which addicts tend to use on a regular basis, cocaine is metabolites are excreted in the urine. The metabolite cotinine used in binges, where doses may be taken several times an can be used to quatitate exposure. However, upon stopping a cocaine binge, withdrawal symp- toms including excessive sleep, fatigue and mild depression, Table 53. Repeated cocaine use may produce adverse effects including anorexia, confusion, exhaustion, palpitations, dam- Ischaemic heart disease (strongest correlation) age to the membranes lining the nostrils and, if injected, Cancers of the lung, other respiratory sites and the oesophagus, blood-borne infections. Use of cocaine in pregnancy is associ- lip and tongue ated with damage to the central nervous system of the fetus. Chronic bronchitis and emphysema, respiratory tuberculosis ‘Crack babies’ can usually be cured of their ‘addiction’ by Pulmonary heart disease abstinence over a few weeks. Currently, there are no specific Aortic aneurysm drug treatments for cocaine dependence. Effect of smoking on drug disposition and effects Caffeine dependence The most common effect of tobacco smoking on drug dispos- Tolerance is low grade and dependence is not clinically ition is an increase in elimination consistent with induction of important. Withdrawal can lead temically, but is of great medical importance because of its to an abstinence syndrome consisting of craving, irritability and pathological and psychological effects when used as a bever- sometimes physical features (e. Alcohol is the most important drug of dependence, and Substitution of nicotine via skin patches or nicotine gum as in Western Europe and North America the incidence of alco- part of a smoking cessation programme significantly increases holism is about 5% among the adult population. The antidepressant bupropion appears to reduce the desire to smoke and is licensed as an adjunct to motivational Pharmacokinetics support in smoking cessation. It is contraindicated in patients Ethyl alcohol is absorbed from the buccal, oesophageal, gastric with a history of seizures or of eating disorders, or who are and intestinal mucosae – approximately 80% is absorbed from experiencing acute alcohol or benzodiazepine withdrawal. Alcohol delays gastric emptying and in Varenicline, a selective nicotinic receptor partial agonist, is high doses delays its own absorption. It is started 1–2 weeks tration, alcohol can usually be detected in the blood within five before stopping smoking. Peak concentrations occur between 30 minutes and Side effects include gastro-intestinal disturbances, headache, two hours. Hepatic This group of compounds includes caffeine (present in tea oxidation to acetaldehyde is catalysed by three parallel and colas, as well as coffee), theobromine (present in choco- processes. The major effects of these com- Alcohol elimination follows Michaelis–Menten kinetics, pounds are mediated by inhibition of phosphodiesterase, with saturation occurring in the concentration range encoun- resulting in a raised intracellular cyclic adenosine monophos- tered during social drinking. Its use does not lead to Nervous system: Alcohol decreases concentration, judgement, improved intellectual performance except perhaps when discrimination, and reasoning and increases self-confidence. Progressively increasing plasma concentrations are associated Circulatory effects include direct myocardial stimulation with sensations of relaxation followed by mild euphoria, producing tachycardia, increased cardiac output, ectopic beats incoordination, ataxia and loss of consciousness. Caffeine use should be curtailed in patients concentrations, the gag reflex is impaired, vomiting may occur who suffer paroxysmal dysrhythmias. Its effect on blood pres- and death may result from aspiration of gastric contents. Cerebral vasoconstriction provides some importance of alcohol as a factor in road traffic accidents is rationale for use of caffeine in migraine. The central depressant actions of muscle relaxes and respiration is stimulated centrally. Mild alcohol greatly enhance the effects of other central depressant diuresis occurs due to an increased glomerular filtration rate drugs. In patients with organic brain damage, alcohol may subsequent to dilatation of the afferent arterioles. Chronic neurological accompaniments of persistent alcohol abuse include various forms of central Cytoplasmic and peripheral neurodegeneration, most commonly involving Catalase alcohol Microsomal the vermis of the cerebellum, and a peripheral neuropathy. Any evidence of Wernicke’s encephalopathy should be immediately treated with intravenous thiamine followed by oral thiamine for several Acetate months. Hyperuricaemia occurs (particularly, it is said, in beer drinkers) and can cause acute gout. Neutrophil dysfunction is common even when the neutrophil count is 20 normal, predisposing to bacterial infections (e. There are characteristic facial features which include microcephaly, micrognathia and a short upturned 0 20 40 60 80 100 120 140 160 180 nose. This so-called fetal alcohol syndrome is unlike that Blood alcohol concentration (mg/100 mL) reported in severely undernourished women. The patient should be nursed in a quiet environment with careful attention to fluid and electrolyte Acute effects of alcohol balance. Benzodiazepines (intravenous if necessary, Chapters • Central effects include disinhibition, impaired 18 and 22) are usually effective in terminating prolonged with- judgement, inco-ordination, trauma (falls, road traffic drawal seizures – if they are ineffective the diagnosis should accidents), violence and crime. Psychiatric assessment and social support • Convulsions, enhancement of sedative drugs. Delirium tremens occurs in less • Dependence than 10% of alcoholic patients withdrawing from • Behavioural changes alcohol. Psychological and social management: Some form of psychological and social management is important to help the patient to remain abstinent. Whatever approach is used, Medical uses of alcohol the focus has to be on abstinence from alcohol. Systemic alcohol is minority of patients may be able to take up controlled used in poisoning by methanol or ethylene glycol, since it drinking subsequently, but it is impossible to identify this competes with these for oxidation by alcohol dehydrogenase, group prospectively, and this should not be a goal of slowing the production of toxic metabolites (e.

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