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In so doing discount beloc 50 gm online, they hope to be able to draw inferences about the likely functions of human brains from the effects of the lesions in animals buy cheap beloc 50 gm line. For instance discount beloc 50 gm on-line, when an individual suffers a stroke, a blood clot deprives part of the brain of oxygen, killing the neurons in the area and rendering that area unable to process information. For instance, if the stroke influences the occipital lobe, then vision may suffer, and if the stroke influences the areas associated with language or speech, these functions will suffer. In fact, our earliest understanding of the specific areas involved in speech and language were gained by studying patients who had experienced strokes. It is now known that a good part of our moral reasoning abilities are located in the frontal lobe, and at least some of this understanding comes from lesion studies. For instance, consider the well-known case of Phineas Gage, a 25-year-old railroad worker who, as a result of an explosion, had an iron rod driven into his cheek and out through the top of his skull, causing major damage [2] to his frontal lobe (Macmillan, 2000). Although remarkably Gage was able to return to work after the wounds healed, he no longer seemed to be the same person to those who knew him. The amiable, soft-spoken Gage had become irritable, rude, irresponsible, and dishonest. Although [3] there are questions about the interpretation of this case study (Kotowicz, 2007), it did provide [4] early evidence that the frontal lobe is involved in emotion and morality (Damasio et al. More recent and more controlled research has also used patients with lesions to investigate the [5] source of moral reasoning. In one of the scenarios the participants were asked if they would be willing to kill one person in order to prevent five other people from being killed. Persons with lesions in the frontal lobe were more likely to be willing to harm one person in order to save the lives of five others than were control participants or those with lesions in other parts of the brain. Recording Electrical Activity in the Brain In addition to lesion approaches, it is also possible to learn about the brain by studying the electrical activity created by the firing of its neurons. Research using these techniques has found, for instance, that there are specific neurons, known as feature detectors, in [8] the visual cortex that detect movement, lines and edges, and even faces (Kanwisher, 2000). Furthermore, by following electrical impulses across the surface of the brain, researchers can observe changes over very fast time periods. The patient lies on a bed within a large cylindrical structure containing a very strong magnet. Neurons that are firing use more oxygen, and the need for oxygen increases blood flow to the area. Often, the images take the form of cross-sectional “slices‖ that are obtained as the magnetic field is passed across the brain. The images of these slices are taken repeatedly and are superimposed on images of the brain structure itself to show how activity changes in different brain structures over time. When the research participant is asked to engage in tasks while in the scanner (e. There is still one more approach that is being more frequently implemented to understand brain function, and although it is new, it may turn out to be the most useful of all. Then the electrical stimulation is provided to the brain before or while the participant is working on a cognitive task, and the effects of the stimulation on performance are assessed. If the participant‘s ability to perform the task is influenced by the presence of the stimulation, then the researchers can conclude that this particular area of the brain is important to carrying out the task. Research Focus: Cyberostracism Neuroimaging techniques have important implications for understanding our behavior, including our responses to [10] those around us. Naomi Eisenberger and her colleagues (2003) tested the hypothesis that people who were excluded by others would report emotional distress and that images of their brains would show that they experienced pain in the same part of the brain where physical pain is normally experienced. In the first part of the experiment, the participants were told that as a result of technical difficulties, the link to the other two scanners could not yet be made, and thus at first they could not engage in, but only watch, the game play. Then, during a second inclusion scan, the participants played the game, supposedly with the two other players. In the third, exclusion, scan, however, the participants initially received seven throws from the other two players but were then excluded from the game because the two players stopped throwing the ball to the participants for the remainder of the scan (45 throws). The results of the analyses showed that activity in two areas of the frontal lobe was significantly greater during the exclusion scan than during the inclusion scan. Because these brain regions are known from prior research to be active for individuals who are experiencing physical pain, the authors concluded that these results show that the physiological brain responses associated with being socially excluded by others are similar to brain responses experienced upon physical injury. People who feel that they are excluded, or even those who observe other people being excluded, not only experience Attributed to Charles Stangor Saylor. Consider the different ways that psychologists study the brain, and think of a psychological characteristic or behavior that could be studied using each of the different techniques. The return of Phineas Gage: Clues about the brain from the skull of a famous patient. Cortex: A Journal Devoted to the Study of the Nervous System and Behavior, 46(6), 769– 780; Van den Eynde, F. Repetitive transcranial magnetic stimulation reduces cue-induced food craving in bulimic disorders. Disruption of the right temporoparietal junction with transcranial magnetic stimulation reduces the role of beliefs in moral judgments.

Most occur in the presence of an enlarged ovary (ie beloc 50gm with visa, as a result of cyst cheap 50gm beloc with amex, abscess buy discount beloc 50gm online, or tumor). The first choice to diagnose ovarian torsion is with Doppler ultrasound to demonstrate decreased or absent blood flow to the ovary. If suspicion is high for ovarian torsion, the patient may immediately undergo laparoscopy, which is diagnostic and potentially therapeutic. How- ever, if torsion is suspected, the individual should undergo a laparoscopy, which is the definitive diagnostic procedure. If there is high enough clinical suspi- cion, and diagnostic tests are equivocal, laparoscopy (e) can be used to visu- alize the ovaries in vivo. Perforation of the colon with pneumoperitoneum is usually evident immediately, but can 112 Emergency Medicine take several hours to manifest. Perforation is usually secondary to intrinsic disease of the colon (eg, diverticulitis) or to vigorous manipulation during colonoscopy. However, expec- tant management is appropriate in some patients with a late presentation (1-2 days later), or without signs of peritonitis. The radiograph in the fig- ure demonstrates air under the diaphragm, which is pathognomonic for pneumoperitoneum. Obstruction is commonly secondary to a stone, but may be because of malignancy or stricture. There is overlap in the clinical presentation with cholecystitis (a), how- ever, the presence of jaundice and evidence of dilated common and intra- hepatic ducts—which are not characteristic of cholecystitis—is helpful to distinguish it from cholangitis. Acute hepatitis (b) will not have the same sonographic findings seen in cholangitis. Bowel obstruction (e) generally pre- sents with intermittent crampy abdominal pain, vomiting, and distention. A positive pregnancy test in the setting of abdominal pain and vaginal bleeding demands that the physician rule out an ectopic pregnancy. Even though the patient states she always uses condoms during intercourse, there is still a small risk of pregnancy. This Abdominal and Pelvic Pain Answers 113 is used to detect an intrauterine pregnancy. If no intrauterine pregnancy is detected, the suspicion for an ectopic pregnancy increases. It is imperative that the clinician rule out an ectopic pregnancy in this individual. The most common findings are curvilinear calcification of the aortic wall or a paravertebral soft tissue mass. In the presence of pancreatic inflammation it increases within 4 to 8 hours and peaks at 24 hours. At five times the upper limits of normal, lipase is 60% sensitive and 100% specific for pancreati- tis. The diagnosis is usually made with a lipase of two times the normal limit, thereby increasing its sensitivity. It is often difficult to distinguish epididymitis from testicular torsion and the clinician should always rule out torsion first if the diagnosis is in doubt. The causative organism in men over 35 years old is E coli, while C trachomatis and Neisseria gonorrhoeae predominate in men less than 35 years old. Testicular torsion (b) should always be on the differential for a patient with scrotal pain. However, it is ruled out in this patient by the presence of blood flow on color Doppler. They usually occur in middle-aged men and have a higher prevalence in patients with cryptorchidism. A varicocele (e) is a painless scrotal swelling that is caused by dilation and elongation of the veins of the pampiniform plexus. Varicocele is more common on the left side because the left spermatic vein drains into the left renal vein, whereas the right one drains into the inferior vena cava. It was demonstrated in multiple studies that the two pathogens coexist in men with urethritis up to 50% of the time. However, a young man with dysuria and urethral discharge needs to be treated for a sexually transmitted disease. In addition, the patient should refer all of their sexual partners for evaluation and treatment. Entamoeba histolytica causes an intestinal infection, and the liver is seeded via the portal system. Patients present with profuse watery diarrhea, abdominal cramping, anorexia, nausea, and flatu- lence.

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Boys mature more slowly than girls at this age discount 50 gm beloc mastercard, and perhaps Zack will catch up in the next few years buy cheap beloc 50gm line. One possibility is for the parents and teachers to work with Zack to help him be more attentive order beloc discount, to put up with the behavior, and to wait it out. But many parents, often on the advice of the child‘s teacher, take their children to a psychologist for diagnosis. Other studies have also pointed to environmental factors, such as mothers‘ smoking and drinking alcohol during pregnancy and the consumption of lead and food additives by those who are affected (Braun, Kahn, Froehlich, [23] Auinger, & Lanphear, 2006; Linnet et al. Jared is able to maintain eye contact and enjoys mixing with other children, but he cannot communicate with them very well. He often responds to questions or comments with long-winded speeches about trucks or some other topic that interests him, and he seems to lack awareness of other children‘s wishes and needs. Jared‘s concerned parents took him to a multidisciplinary child development center for consultation. Here he was tested by a pediatric neurologist, a psychologist, and a child psychiatrist. The pediatric neurologist found that Jared‘s hearing was normal, and there were no signs of any neurological disorder. He diagnosed Jared with a pervasive developmental disorder, because while his comprehension and expressive language was poor, he was still able to carry out nonverbal tasks, such as drawing a picture or doing a puzzle. Based on her observation of Jared‘s difficulty interacting with his peers, and the fact that he did not respond warmly to his parents, the psychologist diagnosed Jared with autistic disorder (autism), a disorder of neural development characterized by impaired social interaction and communication and by restricted and repetitive behavior, and in which symptoms begin before 7 years of age. The psychologist believed that the autism diagnosis was correct because, like other children with autism, Jared, has a poorly developed ability to see the world from the perspective of others; engages in unusual behaviors such as talking about trucks for hours; and responds to stimuli, such as the sound of a car or an airplane, in unusual ways. The child psychiatrist believed that Jared‘s language problems and social skills were not severe enough to warrant a diagnosis of autistic disorder and instead proposed a diagnosis of Asperger‘s disorder, a developmental disorder that affects a child’s ability to socialize and Attributed to Charles Stangor Saylor. The symptoms of Asperger‘s are almost identical to that of autism (with the exception of a delay in language development), and the child psychiatrist simply saw these problems as less extreme. Clearly there is something wrong with their child, but even the experts cannot agree on exactly what the problem is. Diagnosing problems such as Jared‘s is difficult, yet the number of children like him is increasing dramatically. Disorders related to autism and Asperger‘s disorder now affect almost 1% of [25] American children (Kogan et al. The milder forms of autism, and particularly Asperger‘s, have accounted for most of this increase in diagnosis. Although for many years autism was thought to be primarily a socially determined disorder, in which parents who were cold, distant, and rejecting created the problem, current research suggests that biological factors are most important. The heritability of autism has been estimated [26] to be as high as 90% (Freitag, 2007). Scientists speculate that autism is caused by an unknown genetically determined brain abnormality that occurs early in development. It is likely [27] that several different brain sites are affected (Moldin, 2003), and the search for these areas is being conducted in many scientific laboratories. The problem is that diagnosis is not exact (remember the idea of “categories‖), and the experts themselves are often unsure how to classify behavior. Can you think of or find clips from any films or other popular media that portray mental illness positively or negatively? Is it more or less acceptable to stereotype the mentally ill than to stereotype other social groups? Generalized anxiety disorder and major depressive disorder comorbidity in the National Survey of Mental Health and Well Being. Presented to the Standing Senate Committee on Social Affairs, Science and Technology. Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed. Exposures to environmental toxicants and attention- deficit/hyperactivity disorder in U. Maternal lifestyle factors in pregnancy risk of attention- deficit/hyperactivity disorder and associated behaviors: Review of the current evidence. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: A randomised, double-blinded, placebo- controlled trial. Sources of covariation among attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder: The importance of shared environment. The genetics of autistic disorders and its clinical relevance: A review of the literature.

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The Brain Is Flexible: Neuroplasticity The control of some specific bodily functions generic 50gm beloc mastercard, such as movement order generic beloc canada, vision cheap beloc amex, and hearing, is performed in specified areas of the cortex, and if these areas are damaged, the individual will likely lose the ability to perform the corresponding function. For instance, if an infant suffers damage to facial recognition areas in the temporal lobe, it is likely that he or she will never be [13] able to recognize faces (Farah, Rabinowitz, Quinn, & Liu, 2000). The brain’s neurons have a remarkable capacity to reorganize and extend themselves to carry out particular functions in response to the needs of the organism, and to repair damage. As a result, the brain constantly creates new neural communication routes and rewires existing ones. Neuroplasticity refers to the brain’s ability to change its structure and function in response to experience or damage. Neuroplasticity enables us to learn and remember new things and adjust to new experiences. On the other hand, neuroplasticity continues to be [14] observed even in adults (Kolb & Fantie, 1989). The principles of neuroplasticity help us understand how our brains develop to reflect our experiences. For instance, accomplished musicians have a larger auditory cortex compared with the general population (Bengtsson et al. Plasticity is also observed when there is damage to the brain or to parts of the body that are represented in the motor and sensory cortexes. When a tumor in the left hemisphere of the brain impairs language, the right hemisphere will begin to compensate to help the person recover the [17] ability to speak (Thiel et al. And if a person loses a finger, the area of the sensory cortex that previously received information from the missing finger will begin to receive input from adjacent fingers, causing the remaining digits to become more sensitive to touch (Fox, [18] 1984). Although neurons cannot repair or regenerate themselves as skin or blood vessels can, new evidence suggests that the brain can engage in neurogenesis,the forming of new neurons (Van [19] Praag, Zhao, Gage, & Gazzaniga, 2004). These new neurons originate deep in the brain and may then migrate to other brain areas where they form new connections with other neurons [20] (Gould, 2007). This leaves open the possibility that someday scientists might be able to “rebuild‖ damaged brains by creating drugs that help grow neurons. Research Focus: Identifying the Unique Functions of the Left and Right Hemispheres Using Split-Brain Patients We have seen that the left hemisphere of the brain primarily senses and controls the motor movements on the right side of the body, and vice versa. This fact provides an interesting way to studybrain lateralization—the idea that the left and the right hemispheres of the brain are specialized to perform different functions. Because the left and right hemispheres are separated, each hemisphere develops a mind of its own, [22] with its own sensations, concepts, and motivations (Gazzaniga, 2005). By doing so, they assured that—because the two hemispheres had been separated—the image of the shape was experienced only in the right brain hemisphere (remember that sensory input from the left side of the body is sent to the right side of the brain). In split-brain patients, the severed corpus callosum does not permit information to be transferred between hemispheres, which allows researchers to learn about the functions of each hemisphere. In the sample on the left, the split-brain patient could not choose which image had been presented because the left hemisphere cannot process visual information. In the sample on the right the patient could not read the passage because the right brain hemisphere cannot process language. This research, and many other studies following it, has demonstrated that the two brain hemispheres specialize in different abilities. In most people the ability to speak, write, and understand language is located in the left hemisphere. It is also superior in coordinating the order of complex movements—for example, lip movements needed for speech. The right hemisphere, on the other hand, has only very limited verbal abilities, and yet it excels in perceptual skills. The right hemisphere is able to recognize objects, including faces, patterns, and melodies, and it can put a puzzle together or draw a picture. Although Gazzaniga‘s research demonstrated that the brain is in fact lateralized, such that the two hemispheres specialize in different activities, this does not mean that when people behave in a certain way or perform a certain activity they are only using one hemisphere of their brains at a time. We normally use both hemispheres at the same time, and the difference between the [23] abilities of the two hemispheres is not absolute (Soroker et al. Across cultures and ethnic groups, about 90% of people are mainly right-handed, whereas only 10% are primarily left- [24] handed (Peters, Reimers, & Manning, 2006). This fact is puzzling, in part because the number of left-handers is so low, and in part because other animals, including our closest primate relatives, do not show any type of handedness. The existence of right-handers and left-handers provides an interesting example of the relationship among evolution, biology, and social factors and how the same phenomenon can be understood at different levels of analysis (Harris, [25] 1990; McManus, 2002). Ultrasound scans show that 9 out of 10 fetuses suck the thumb of [26] their right hand, suggesting that the preference is determined before birth (Hepper, Wells, & Lynch, 2005), and the [27] mechanism of transmission has been linked to a gene on the X chromosome (Jones & Martin, 2000).

When the nurse compares the current status of a patient to the initial assessment performed 1 proven 50gm beloc. Place the following actions performed by a during the admitting process best order for beloc, he/she is nurse during a patient interview in the order in performing a(n) type of which they would most likely occur buy generic beloc 50 gm on line. The nurse gathers all the information must be collected from every patient in a needed to form the subjective database. The nurse prepares to meet the patient by reading current and past records and reports. The nurse ensures that the environment in which the interview is to be conducted is c. The primary source of patient data is the that can be seen, heard, or felt by some- patient, but two other sources of patient data one other than the person experiencing are and. The conscious and deliberate use of the performed during the nurse’s initial contact five physical senses to gather information with the patient and involves collecting data 3. Clearly identifies patient strengths and about all aspects of the patient’s health is weaknesses, health risks, and potential called the. A planned communication to obtain lected upon assessment to keep it free of error, patient data bias, or misinterpretation, he/she is performing the act of. When a nurse asks a patient how having a patient’s condition and help the nurse newborn at home will affect her lifestyle, she in planning care is asking a(n) type of a question. A nurse who gathers data about a newly diag- nosed case of hypertension in a 52-year-old 7. Compares a patient’s current status to African American patient is performing a(n) baseline data obtained earlier type of assessment. 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. An 85-year-old African American man is ended questions, and reflective questions that admitted to the coronary care unit after could be used to elicit information from your experiencing a possible stroke. A teenage boy is admitted to the hospital children who has recently been diagnosed with severe stomach pains and a possible with diabetes; she is admitted to the hospital ruptured appendix. Closed questions: questions (closed, open-ended, reflective, direct) resulted in the best interviews. Recall the last time you went to a doctor’s office for a checkup or medical problem. What would assessment priorities when collecting patient you do to incorporate this learning into your data. Patient’s developmental stage: Use the following expanded scenario from Chapter 12 in your textbook to answer the questions below. Patient’s need for nursing: Scenario: Susan Morgan is a 34-year-old woman newly diagnosed with multiple sclero- sis. Explain when the immediate communication year and planned to do lots of hiking and of data is indicated. It’s not fair for him to be tied down to me if I can’t be the wife and partner that he thought he married. A 50-year-old woman with diabetes and diabetic foot ulcers is admitted to the emer- gency room for observation after she expe- rienced a blackout. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. What resources might be helpful for and/or ethical/legal competencies are most Ms. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Which of the following nursing diagnoses Circle the letter that corresponds to the best would be written when the nurse suspects that answer for each question. Nursing diagnoses are written to describe clearly the responsibility of the nurse? Tailoring treatment and medication potential health problem that can be regimens for each individual prevented or resolved by an independent d. Which of the following statements describe ate nursing diagnosis for a toddler who has the purpose of diagnosing? To identify a disease in an individual, negligence in providing a safe environment? To identify how an individual, group, or parents community responds to actual or potential b. High Risk for Injury related to impaired health and life processes home management c. Make sure the patient problem and etiology performed by the nursing staff are linked by the phrase “related to. Make sure defining characteristics follow vidual, group, or community can draw on the etiology and are linked by the phrase to prevent or resolve problems “as manifested by” or “as evidenced by. Write nursing diagnoses in legally advisable ing interventions to achieve outcomes for terms.

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When this happens order discount beloc, the patient will exhibit specific signs and symptoms and the serum potassium will be outside the normal range purchase beloc 50gm without a prescription. Hyperkalemia Hyperkalemia occurs when a patient has a serum potassium level greater than 5 order beloc 50gm visa. A number of factors can cause this condition including: • Impaired renal excretion (most common). The nurse must respond quickly once signs and symptoms of hyperkalemia develop as the patient is at risk for seizures, injury related to muscle weakness, and cardiac arrhythmias. Hypokalemia Hypokalemia occurs when a patient has a serum potassium level of less than 3. The patient may have the following signs and symptoms when experienc- ing hypokalemia: • Leg cramps. The nurse must respond with the following interventions as the patient is a risk for injury related to muscle weakness and cardiac arrhythmias. Take with at least a half a glass of fluid (juice or water) because potassium is extremely irritating to the gastric and intestinal mucosa. The infusion should not exceed 10 to 20 mEq per hour or the patient may experience hyperkalemia and can experience cardiac arrest. Potassium Supplements Description 10% potassium chloride 20 mEq/15 mL oral 20% potassium chloride 40 mEq/16 mL oral 10% Kaochlor Oral Potassium triplex (potassium Oral, rarely used actetate, bicarbonate, citrate) Kaon (potassium gluconate) Enteric-coated tablet. Maintenance: 20 mEq in 1–2 divided dose Kaon-Cl (potassium chloride) Enteric-coated tablet. Maintenance: 20 mEq in 1–2 divided dose Slow-K (potassium chloride) Enteric-coated tablet. Maintenance: 8 mEq Kaochlor (potassium chloride) Correction: 40–80 mEq in 3–4 divided doses K-Lyte (potassium bicarbonate) Effervescent tablet. Correction: 40–80 mEq in 3–4 divided doses K-Lyte/Cl (potassium chloride) Effervescent tablet. Correction: 40–80 mEq in 3–4 divided doses K-Dur (potassium chloride) Effervescent tablet. Correction: 40–80 mEq in 3–4 divided doses Micro-K (potassium chloride) Effervescent tablet. Don’t give potassium if the patient suffers from renal insufficiency, renal failure, or Addison’s disease. Do not give potassium if the patient has hyper- kalemia, severe dehydration, acidosis, or takes potassium-sparing diuretics. Sodium Sodium is the major cation in extracellular fluid found in tissue spaces and ves- sels. Sodium plays an important role in the regeneration and transmission of nerve impulses and affects water distribution inside and outside cells. When it shifts into the cell, depolarization (contraction) occurs; when it shifts out of the cell, potas- sium goes back into the cell and repolarization (relaxation) occurs. The kidneys regulate the sodium balance by retaining urine when the sodium concentration is low and excreting urine when the sodium concentration is high. Most excess sodium is excreted in urine although sodium also leaves the patient as perspira- tion and in feces. The serum sodium level, which is the ratio of sodium to water, is the indicator of the sodium level in a patient’s body. A patient’s serum sodium level moves out of the normal range when the patient is retaining too much or too little water, has a high or low concentrations of sodium, or a combination of both. A patient is hypernatremic when there is a high concen- tration of sodium and hyponatremic when there is a low concentration of sodium. Hypernatremia Hypernatremia occurs when the patient’s serum sodium is greater than 145 mEq/L. This happens for one of two reasons: The patient’s sodium concentration has increased while the volume of water remains unchanged or the patient’s water volume has decreased while the sodium concentration remains unchanged. Regardless of what happened, the patient experiences hyperosmolality, which is a higher-than-normal concentration of sodium. This causes water to shift out of cells and into extracellular space resulting in cellular dehydration. However, a patient whose consciousness is impaired or who cannot swallow, such as a frail elderly patient, is at risk for hypernatremia. These are: • Agitation • Restlessness • Weakness • Seizures • Twitching • Coma • Intense thirst • Dry swollen tongue • Edematous (swollen) extremities The nurse should educate the patient to: • Avoid foods rich in sodium such as canned foods, lunch meats, ham, pork, pickles, potato chips, and pretzels. Hyponatremia Hyponatremia occurs when the patient’s serum sodium is less than 135 mEq/L. There are two reasons why this happens: the patient has increased the volume of water while the sodium concentration remains normal or the patient losses sodium while the water volume remains normal.