By U. Marius. James Madison University. 2018.
Think of three people you know personally buy inderal 40 mg otc, preferably of different ages buy inderal 40mg amex, professions generic 40mg inderal overnight delivery, or cultures. What about each of these individu- Which of these skills do you personally pos- als causes you to respect his/her human dig- sess and which do you need to develop in nity? Describe what the following words mean to you and how they apply to your use of the nursing process: a. Follow three different nurses on their daily rounds of patients, noticing how they relate b. Does their attitude say “drop dead,” “you mean nothing to me,” or “I care about you”? Brieﬂy explain how the following considera- tions are relevant to the successful use of crit- ical thinking competencies: 9. Nurses skilled in developing caring relationships often need to direct the conver- a. Develop four opening statements/questions designed to elicit information from a patient that you b. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Horvath is scheduled to learn how to perform wound care for her daughter at home but has missed every planned teaching session thus far. Assess your personal blend of the skills nurses vath works the evening shift and has a babysit- need: cognitive, technical, interpersonal, and ter stay with her children from immediately ethical/legal. What skills do you need to develop to meet the needs of those entrusted to your care? How might the nurse use blended nursing skills to respond to this patient situation? How might the school of nursing use the nursing process to address one or more of these problems? Do you as a nursing student have an obligation to address the health prob- lems you encounter? What intellectual, technical, interpersonal, How did you reach your ﬁnal decision? Relate and/or ethical/legal competencies are most the method you used in your life to the mod- likely to bring about the desired outcome? How might this knowledge help you to understand your responses to patients with different personal- ity traits? Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Which of the following sources of patient data is usually the primary and best source? Smith is admitted to the hospital with patient are known as: complaints of left-sided weakness and difﬁculty a. Brain scan shows evidence of a clot in the nurse–patient interview does the nurse gather middle cerebral artery. Which of the following nurse–patient ted to the hospital with complaints of positioning facilitates an easy exchange of difﬁculty urinating, bloody urine, and burning information? Focusing on altered patterns of elimination their chairs are at right angles to each common in the elderly other, 1 foot apart. If the patient is in bed, the nurse sits in a patient’s sexual history chair placed at a 45-degree angle to the bed. If the patient is in bed, the nurse stands at validate data on the patient’s record the side of the bed. Nursing assessments duplicate medical becomes very tired, but there are still questions assessments. Jones if she objects to your database for problem solving and care interviewing her husband to obtain the planning. Anderson, age 50, is admitted to your focus of Gordon’s functional health patterns unit with the diagnosis of scleroderma. Elimination, activity, sleep, and sexuality occur during the preparatory phase of the are components of the assessment and data nursing interview? The nurse assesses the patient’s comfort hands before signing a consent for surgery. A patient feels nauseated after eating his reading current and past records and reports. A patient complains of being cold and describe the unique focus of nursing requests an extra blanket. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition.
This is reflected in a very large volume of distribution emergency situations as discussed above cheap inderal 80 mg online, or orally if rapid (approximately 5000L) generic 40mg inderal with mastercard. It is only slowly eliminated via the liver generic inderal 40 mg with amex, with a t1/2 of Mechanism of action 28–45 days. In common with other cal- can cause severe bradycardia if used with β-adrenoceptor cium antagonists, it relaxes the smooth muscle of peripheral antagonists or verapamil. This reduces the ventricular response in atrial fibrillation and Sotalol has uses similar to amiodarone, but a different spec- flutter, and abolishes most re-entry nodal tachycardias. Mechanism of action Adverse effects and contraindications Sotalol is unique among β-adrenoceptor antagonists in 1. Gastrointestinal tract: About one-third of patients blocking activity of sotalol contraindicates its use in patients experience constipation, although this can usually be with obstructive airways disease, unstable heart failure, prevented or managed successfully with advice about peripheral vascular disease or heart block. Other adverse effects: Headache, dizziness and facial Diuretics predispose to torsades de pointes by causing elec- flushing are related to vasodilatation (compare with trolyte disturbance (hypokalaemia/hypomagnesaemia). These include class Ia anti-dysrhythmic drugs metallic taste in the mouth are uncommon. Histamine H1-antagonists (terfenadine, with β-adrenoceptor antagonists, which occurs especially astemizole) should be avoided for the same reason. In this setting it is given tically in patients with regular broad complex tachycardia intravenously over five minutes. This results in accumulation of intracellular smooth muscle by an A1 effect, especially in asthmatics. It 2 Na , which indirectly increases the intracellular Ca relaxes vascular smooth muscle, stimulates nociceptive afferent 2 content via Na /Ca exchange and intracellular neurones in the heart and inhibits platelet aggregation via 2 2 Ca storage. Slowing of the ventricular rate results from several Adverse effects and contraindications mechanisms, particularly increased vagal activity: Chest pain, flushing, shortness of breath, dizziness and nau- • delayed conduction through the atrioventricular node sea are common but short-lived. Chest pain can be alarming if and bundle of His; the patient is not warned of its benign nature before the drug • increased cardiac output due to the positive inotropic is administered. The cellular mechanism of this effect is the ventricular rate during atrial fibrillation may be acceler- not known. The circulatory effects of a bolus therapeutic dose of adenosine last for 20–30 Mechanism of action seconds, although effects on the airways in asthmatics persist for longer. Acetylcholine released by the vagus nerve acts on muscarinic receptors in atrial and cardiac conducting tissues. This increases K permeability, thereby shortening the cardiac Drug interactions action potential and slowing the rate of increase of pacemaker Dipyridamole blocks cellular adenosine uptake and potenti- potentials and cardiac rate. Theophylline blocks adenosine receptors and of acetylcholine at muscarinic receptors, and it thereby coun- inhibits its action. Adverse effects and contraindications Use Parasympathetic blockade by atropine produces widespread effects, including reduced salivation, lachrymation and sweat- The main use of digoxin is to control the ventricular rate (and ing, decreased secretions in the gut and respiratory tract, hence improve cardiac output) in patients with atrial fibrilla- tachycardia, urinary retention in men, constipation, pupillary tion. Digoxin is usually given orally, but if this is impossible, or dilatation and ciliary paralysis. It is contraindicated in if a rapid effect is needed, it can be given intravenously. Atropine can cause the t1/2 is approximately one to two days in patients with nor- central nervous system effects, including hallucinations. This is acceptable in many settings, but if clinical circum- Pharmacokinetics stances are more urgent, a therapeutic plasma concentration Although atropine is completely absorbed after oral adminis- can be achieved more rapidly by administering a loading dose. Its use may ‘buy time’ during which other meas- ures to lower the plasma potassium concentration (e. In addition, calcium chloride is used in patients Use with hypocalcaemia, but these usually present with tetany Although not usually classed as an ‘anti-dysrhythmic’ drug (it rather than with cardiac dysrhythmia. It may be useful for treat- is, of course, powerfully pro-dysrhythmogenic in healthy ing patients who have received an overdose of Ca2 -antago- individuals), adrenaline (also called epinephrine) is used in nists such as verapamil or diltiazem. For these Mechanism of action indications it is administered intravenously (or sometimes 2 Ca is a divalent cation. Divalent cations are involved in directly into the heart or down an endotracheal tube, as dis- maintaining the stability of the membrane potential in cussed in the above section on cardiac arrest). The outer aspects of cell uses other than in cardiac arrest, being essential for the treat- membranes contain fixed negative charges that influence the ment of anaphylactic shock (see Chapter 50) and useful in electric field in the membrane, and hence the state of acti- combination with local anaesthetics to reduce the rate of 2 vation of voltage-dependent ion channels (Na and Ca ) in removal from the injection site (see Chapter 24). Divalent cations bind to the outer membrane, neutralizing the negative charges and in effect hyperpolariz- Mechanism of action ing the membrane. Conversely, if the extracellular concentra- tion of Ca2 falls, Ca2 dissociates from the membrane, Adrenaline is a potent and non-selective agonist at both α- and β-adrenoceptors. Adverse effects Adrenaline is powerfully pro-dysrhythmogenic and increases Drug interactions the work of the heart (and hence its oxygen requirement).
In line with this generic 40 mg inderal with visa, Holland and Holahan (2003) explored the relationship between social support purchase genuine inderal on-line, coping and positive adaptation to breast cancer in 56 women discount inderal online american express. The results showed that higher levels of perceived social support and approach coping strategies were related to positive adjustment. Psychology has also been involved in treating the nausea and vomiting experienced by cancer patients. Cancer patients are often oﬀered chemotherapy as a treatment for their cancer, which can cause anticipatory nausea, vomiting and anxiety. Respondent conditioning and visual imagery, relaxation, hypnosis and desensitization have been shown to decrease nausea and anxiety in cancer patients. The quality of life of cancer patients may also be improved through altered body image counselling, particularly following the loss of a breast and more generally in dealing with the grief at loss of various parts of the body. Research also suggests that quality of life may also be improved using cognitive adaptation strategies. Taylor (1983) used such strategies to improve patients’ self-worth, their ability to be close to others, and the improvement in the meaningfulness of their lives. Such methods have been suggested to involve self- transcendence and this has again been related to improvement in well-being and decrease in illness-related distresses. Simonton and Simonton (1975) are well known for applying psychosocial factors and interventions for improving the quality of life of cancer patients using a whole-person approach. This involves the following processes: (1) relaxation, which aims to decrease muscle tension and therefore decrease pain; (2) mental imagery, whereby cancer patients are encouraged to focus on something positive (this aims to develop a belief in the ability to recover, therefore decreasing pain, tension and fear); and (3) exercise programmes, which aim to increase the sense of well-being. In 1975, Simonton and Simonton encouraged a positive attitude towards treatment using whole-person approach among 152 cancer patients for 18 months, and argued that this intervention predicted a good response of treatment and reduced side-eﬀects. This involves encouraging cancer patients to examine the personal meaning of their cancer and what they can do to cope with it (see Focus on research 14. Psychological factors in longevity The ﬁnal question about the role of psychology in cancer is its relationship to longevity; do psychosocial factors inﬂuence longevity? Using semi-structured interviews, they deﬁned three types of responders: those with ‘ﬁghting spirit’, those who showed denial of the implications of their disease and those who showed a hopeless/helpless response. The authors reported that the groups who showed either ‘ﬁghting spirit’ or ‘denial’ had a longer disease-free interval than the other group. In addition, at a further 15-year follow-up, both a ﬁghting spirit and denial approach also predicted longevity. At baseline the authors did not measure several important physiological prognostic indicators, such as lymph node involvement, as these measures were not available at the time. These physiological factors may have contributed to both the disease-free interval and the survival of the patients. Clinical data, measures of hopelessness, life changes and measures of aﬀect were collected at baseline from 49 Israeli women diagnosed with breast cancer. The life events and diﬃculties occurring during the disease-free interval were recorded in 50 women who had developed their ﬁrst recurrence of breast cancer and 50 women who were in remission. The two subject groups were matched for the main physical and pathological factors believed to be associated with prognosis and for the socio-demographic variables believed to be related to life events and diﬃculties. The results showed that life events rated as severe were related to ﬁrst recurrence of breast cancer. However, the study was cross-sectional in nature, which has implications for determining causality. Background Evidence suggests that a substantial minority of cancer patients show psychological ill-health, particularly in terms of depression and anxiety. As a result, a number of psycho- therapeutic procedures have been developed to improve cancer patients’ emotional well- being. However, evaluating the eﬀectiveness of such procedures raises several ethical and methodological problems, and these are addressed by Greer et al. These are: (1) the ethical considerations of having a control group (can patients suﬀering from psychological distress not be given therapy? Altogether, 153 subjects completed the baseline and eight-week measures and 137 completed all measures. Measures Subjects completed the following measures at baseline (before randomiza- tion), at eight weeks and four months follow-up: s The Hospital Anxiety and Depression scale. Therapy involved approximately eight one-hour weekly sessions with individual patients and their spouses (if appropriate). However, many patients in the present study did not attend all these sessions and several received additional sessions throughout the four months. The therapy focused on the personal meaning of the cancer for the patient, examined their coping strategies and emphasized the current problems deﬁned jointly by the therapist and the patient. Personality/coping style and longevity In 1991, Eysenck and Grossarth-Maticek reported a study whereby they selected ‘at- risk’ individuals who were healthy (the controls) and another group of individuals (the experimental group) who showed conﬂict-avoiding and emotion-suppression type per- sonality (a type C/cancer-prone personality). The experimental group received cognitive behavioural therapy in an attempt to change how they dealt with stress.
It has also been used for contraception inderal 40mg line, irregular or painful periods purchase inderal 80mg with visa, and infertility buy discount inderal 80 mg on-line. Niu (Cocos nucifera) is familiar to us in imagination at least as the coconut palm that is the most common coastal tree of Fiji and other South Pacific islands. The nut itself is crushed for its oil and the liquid inside used as a ‘milk’ drink or the starting material for an alcoholic drink known as ‘palm toddy’. Coconut oil is used alone as a massage oil and is also incorporated into ointments with other ingredients. Used as massage oil, it is said to relieve the aches and pains of rheumatism, pregnancy and exercise-induced over- exertion of muscles. Its emollient properties, when used either alone or with other ingredients, are promoted in many different cosmetic preparations. Coconut milk is used to treat mothers whose breast milk is too yellow and is recommended to be drunk frequently and in large quantities by people with blackwater fever (other examples of similia similibus perhaps? Wabosucu (Mikania micrantha) is known colloquially as ‘mile a minute’ because of the speed at which this creeping plant can grow. The juice of the leaves is a popular remedy for cuts and bruises; crushed leaves relieve the pain of wasp and other insect stings, and a poultice of leaves is used to treat boils, especially those that are located in the armpits. Yaqona, kava (Piper methysticum), is cultivated as both a garden and commercial plant in Fiji. Its use as a mild, sedative narcotic in ceremonial occasions, including the treatment of mate ni vanua, has already been mentioned but it is also used medicinally for a wide range of everyday condi- tions such as coughs and colds, headaches and sore throats, as well as for more unpleasant conditions such as filariasis. Present day: kava – a case study Kava has been used in Fiji and other Pacific islands for generations and had not excited any controversy until its sedative and mild anxiolytic properties were recognised by westerners who began using kava products provided by herbal medicine companies. A number of spontaneously reported cases of liver damage associated with kava use were reported in several European countries from the late 1990s,11 the upshot being that the German Federal 282 | Traditional medicine Institute for Drugs and Medical Devices banned its use in that country. Regulatory authorities in other countries were less confident of a link between kava and liver disorders. New Zealand, for example, accepted the advice of its expert advisers and did not withdraw kava from general sale. Although the debate has not yet ended, the picture that is emerging is of a twofold problem with kava’s non-traditional compared with traditional use. Kava use in Pacific countries such as Fiji generally follows well-established procedures in which the root of the plant is powdered and extracted with water and the resulting beverage drunk. The kava products used in non-traditional societies were often prepared from the leaves and stem peelings of the kava plant,13 and the resulting extracts ingested by people who might also be using other medi- cines that were themselves potentially hepatotoxic. The sedative activity of kava appears to be related to its kavalactones, most of which are concentrated in its roots. The hepatotoxicity that has been demonstrated is confined to extracts prepared from the leaves and stem peelings of the plants, which contain the alkaloid, pipermethystine. The whole episode is a cautionary tale of what can go wrong when tradi- tional usage of a medicinally active plant is extrapolated (and exploited) beyond its boundaries by people who are unaware that, although some infor- mation may not be written down, the way in which certain products are used has not been arrived at by chance but by long-established observation and experience. Samoa The practice of medicine in Samoa, similar to that in the other countries discussed in this chapter, appears to have been little documented before the arrival of the European settlers in the nineteenth century. There were no written records from before that time and what was recorded by the very Traditional medicines in the Pacific | 283 earliest settlers makes little reference to medicinal plants. What does seem clear, however, is the fact that, before the arrival of these Europeans, the health of the Samoan population was reasonably good, and similar to that of Fijian, Aboriginal and Maori populations. The health problems that they did experi- ence were largely the result of the way in which they lived and the climate of Samoa, which is hot and humid – a breeding ground for fungal and other infections as well as numerous biting insects. Families lived in large units, in close proximity to each other, on a diet that, although quite varied, was defi- cient in many vitamins and other essential foodstuffs. Skin problems were thus very common as were various respiratory and gastrointestinal ailments. Those problems that had an obvious external cause were treated physically where possible or with herbal medicines. Those problems that were internal and/or had no obvious cause were thought to be the due to the displeasure of the gods (atua) or spirits of ancestors (aitu) and had to be treated by spiritual means, through the intercession of the spiritual healer (taulaitu). Western (or Palagi, foreign) diseases, the Samoans noted, could sometimes be treated with Palagi herbal medicines so it was after this time that Samoan plants were investigated more intensively by the local population for their ability to treat both Samoan and Palagi diseases. After a flurry of such investigations in the late nineteenth and early twentieth centuries, the situation settled into what it remains effectively today, with both Samoan and western medicine coexisting in relative harmony and Samoan people choosing to use local medicine for Samoan sicknesses and western ones for Palagi problems. Samoans believe that good health is dependent on a balance of three worlds: natural, social and spiritual. When these are out of balance, sickness ensues, the treatment depending on which of the three worlds is most out of line. If the condition is one that will respond to Samoan treatment, the patient or their family may use one of their own folk medicines or seek out a traditional healer (fofo).