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Do the math: How many pulses has your ticker clocked if the average heart keeps up a pace of 72 beats per minute discount citalopram 40 mg visa, 100 buy citalopram 10mg free shipping,000 per day, or roughly 36 million per year? Moving to the Beat of a Pump Also called the cardiovascular system, the circulatory system includes the heart, all blood vessels, and the blood that moves endlessly through it all (see Figure 10-1). It’s what’s referred to as a closed double system; the term “closed” is used for three reasons: because the blood is contained in the heart and its vessels; because the vessels specifically target the blood to the tissues; and because the heart critically regulates blood flow to the tissues. The system is called “double” because there are two distinct circuits and cavities within the heart separated by a wall of muscle called the septum. The double circuits are the following: The pulmonary circuit carries blood to and from the lungs for gaseous exchange. Centered in the right side of the heart, this circuit receives blood saturated with carbon dioxide from the veins and pumps it through the pulmonary artery (or trunk) to capillaries in the lungs, where the carbon dioxide departs the system. That same blood, freshly loaded with oxygen, then returns to the left side of the heart through the pulmonary veins where it enters the second circuit. The systemic circuit uses the oxygen-rich blood to maintain a constant internal environ- ment around the body’s tissues. From the left side of the heart, the blood moves through the aorta to a variety of systemic arteries for distribution throughout the body. Head & arms Jugular vein Carotid artery Right lung Left lung Aorta Pulmonary vein Pulmonary artery Descending aorta Hepatic artery Inferior vena cava Liver Mesenteric artery Hepatic portal vein Digestive tract Renal vein Renal artery Figure 10-1: The circula- Kidneys tory system Iliac vein Iliac artery is a closed double system. Trunk & legs Although cutely depicted in popular culture as uniformly curvaceous, the heart actu- ally looks more like a blunt, muscular cone (roughly the size of a fist) resting on the diaphragm. A fluid-filled, fibrous sac called the pericardium (or heart sac) wraps loosely around the package; it’s attached to the large blood vessels emerging from the heart but not to the heart itself. The sternum (breastbone) and third to sixth costal cartilages of the ribs provide protection in front of (ventrally to) the heart. Two-thirds of the heart lies to the left of the body’s center, with its apex (cone) pointed down and to the left. At less than 5 inches long and a bit more than 3 inches wide, an adult human heart weighs around 10 ounces — a couple ounces shy of a can of soda. On the outside lies the epicardium (or visceral pericardium), which is composed of fibroelastic connective tissue dappled with adipose tissue (fat) that fills exter- nal grooves called sulci (the singular is sulcus). The larger coronary vessels and nerves are found in the adipose tissue that fills the sulci. Beneath the epicardium lies the myocardium, which is composed of layers and bundles of cardiac muscle tissue. The endocardium, the heart’s interior lining, is composed of simple squamous endothelial cells. Epi– is the Greek term for “upon” or “on” whereas endo– comes from the Greek endon mean- ing “within. The pericardium is made up of two parts — a tough inelastic sac called the fibrous peri- cardium on the outside and a serous (or lubricated) membrane nearer the heart called the parietal pericardium. Between the serous layers of the epicardium and the parietal pericardium is the small pericardial space and its tiny amount of lubricating pericardial fluid. This watery substance prevents irritation during systole (contraction of the heart) and diastole (relaxation of the heart). Yet the proper anatomical terms for their positions refer to the atria as being “superior” (above) and the ventricles “inferior” (below). The atria Sometimes referred to as “receiving chambers” because they receive blood returning to the heart through the veins, each atrium has two parts: a principal cavity with a smooth interior surface and an auricle, a smaller, dog-ear-shaped pouch with muscular ridges inside called pectinate muscles, or musculi pectinati, that resemble the teeth of a comb. The right atrium appears slightly larger than the left and has somewhat thinner walls than the left. Its principal cavity, the sinus venarum cavarum, is between the two vena cavae and the atrioventricular (between an atrium and a ventricle) openings. The point where the right atrium’s auricle joins with its principal cavity is marked externally by the sulcus terminalis and internally by the crista terminalis. Openings into the right atrium include the following: The superior vena cava, which has no valve and returns blood from the head, thorax, and upper extremities and directs it toward the atrioventricular opening The inferior vena cava, which returns blood from the trunk and lower extremities and directs it toward the fossa ovalis in the interatrial septum, which also has no valve The coronary sinus, which opens between the inferior vena cava and the atrio- ventricular opening, returns blood from the heart, and is covered by the ineffec- tive Thebesian valve An atrioventricular opening covered by the tricuspid valve Chapter 10: Spreading the Love: The Circulatory System 167 The fossa ovalis is an oval depression in the interatrial septum that corresponds to the foramen ovale of the fetal heart. If the foramen ovale does not close at birth, it causes a condition known as “blue baby. The ventricles The heart’s ventricles are sometimes called the pumping chambers because it’s their job to receive blood from the atria and pump it back to the lungs and out into the body’s network of arteries. More force is needed to move the blood great distances, so the myocardium of the ventricles is thicker than that of either atrium, and the myocardium of the left ventricle is thicker than that of the right. The right ventricle only has to move blood to the lungs, so its myocardium is only one- third as thick as that of its neighbor to the left. Roughly triangular in shape, the right ventricle occupies much of the sternocostal (front) surface of the heart and forms the conus arteriosus where it joins the pulmonary artery, or trunk. The right ventricle extends downward toward where the heart rests against the diaphragm. A circular opening into the pulmonary trunk is covered by the pulmonary semilunar valve, so- called because of its three crescent-shaped cusps.

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It is expensive 20mg citalopram overnight delivery, although spectrum of activity against Gram-positive buy cheap citalopram 10mg on-line, Gram-negative and when used against Gram-negative organisms that would other- anaerobic organisms. It is β-lactamase stable and is used for treat- wise necessitate use of an aminoglycoside, this cost is partly ing severe infections of the lung and abdomen, and in patients offset by savings from the lack of need for plasma concentra- with septicaemia, where the source of the organism is unknown. Meropenem is similar to imipenem, but is stable to renal dehy- Of the third-generation cephalosporins, ceftazidime, cef- dropeptidase I and therefore can be given without cilastatin. Imipenem is generally well tolerated, but seizures, myoclonus, confusion, nausea and vomiting, hypersensitivity, positive Adverse effects Coombs’ test, taste disturbances and thrombophlebitis have all About 10% of patients who are allergic to penicillins are also been reported. Some first-generation cephalosporins and can be used to treat central nervous system infection. Some of the third- Pharmacokinetics generation drugs are associated with bleeding due to increased Imipenem is filtered and metabolized in the kidney by dehy- prothrombin times, which is reversible with vitamin K. Imipenem is given intravenously as an infusion in three or four divided daily doses. They are powerful bactericidal agents that are active Aztreonam is primarily active against aerobic Gram-negative against many Gram-negative organisms and some Gram- organisms and is an alternative to an aminoglycoside. Gentamicin is widely used and has a Chloramphenicol inhibits bacterial ribosome function by broad spectrum, but is ineffective against anaerobes, many inhibiting the 50S ribosomal peptidyl transferase, thereby pre- streptococci and pneumococci. Amikacin is more effective than gentamicin for Adverse effects pseudomonal infections and is occasionally effective against These include: organisms resistant to gentamicin. Topical gentamicin or tobramycin anaemia occurs unpredictably with an incidence of eye drops are used to treat eye infections. Chloramphenicol accumulates in neonates (especially if Adverse effects premature) due to reduced glucuronidation in the immature liver (see Chapter 10). Therapeutic monitoring is performed by measuring plasma concentrations before dosing Pharmacokinetics (trough) and at ‘peak’ levels (usually at an arbitrary one hour Chloramphenicol is well absorbed following oral administra- after dosing). Eighth nerve damage is potentially catastrophic tion and can also be given by the intramuscular and intra- and is often irreversible. Drug interactions Pharmacokinetics Chloramphenicol inhibits the metabolism of warfarin, phenytoin and theophylline. Aminoglycosides are poorly absorbed from the gut and are given by intramuscular or intravenous injection. Distinctively, they are effective reduction and/or an increased dose interval is required. Uses include respiratory infections (including Mycoplasma pneumoniae, psittacosis and Legionnaires’ disease), whooping cough, Campylobacter enteritis and non-specific urethritis. It is useful for skin infections, such as low- Chloramphenicol has a broad spectrum of activity and pene- grade cellulitis and infected acne, and is acceptable for patients trates tissues exceptionally well. It is bacteriostatic, but is with an infective exacerbation of chronic bronchitis. It is most extremely effective against streptococci, staphylococci, commonly administered by mouth four times daily, although H. Nausea, vomiting, diarrhoea and abdominal cramps are the most common adverse effects reported, related to Pharmacokinetics direct pharmacological actions rather than allergy. Cholestatic Tetracyclines are well absorbed orally when fasting, but their jaundice has been reported following prolonged use. They undergo Intravenous administration frequently causes local pain and elimination by both the liver and the kidney. The shorter-acting drugs are given four times daily and the longer-acting ones once daily. Doxycycline is Erythromycin inhibits cytochrome P450 and causes accumu- given once daily, can be taken with food and is not contraindi- lation of theophylline, warfarin and terfenadine. Uses Azithromycin and clarithromycin are more expensive than erythromycin, but cause fewer gastro-intestinal side effects. Fusidic acid is combined with other drugs to treat staphylo- coccal infections, including penicillin-resistant strains. Gram-positive and Gram-negative organisms and, in addition organisms such as Rickettsia, Chlamydia and Mycoplasma. They Adverse effects are used in atypical pneumonias and chlamydial and rick- Adverse effects are rare, but include cholestatic jaundice. Pharmacokinetics They are not used routinely for staphylococcal or streptococ- When administered either orally or intravenously, its half-life cal infections because of the development of resistance. It is Mechanism of action eliminated by a combination of hepatic metabolism and renal Vancomycin inhibits bacterial cell wall synthesis. Drug interactions Adverse effects Metronidazole interacts with alcohol because it inhibits alde- These include: hyde dehydrogenase and consequently causes a disulfiram- • hearing loss; like reaction. Sulphonamides and trimethoprim inhibit the production of folic acid at different sites of its synthetic pathway and are synergistic in vitro.

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The psychotic person has difficulty thinking on the abstract level and may use literal transla- tions concerning aspects of the environment discount 40 mg citalopram overnight delivery. Circumstantiality refers to a psychotic person’s delay in reaching the point of a communication because of unnecessary and tedious details discount citalopram 20mg visa. Tangentiality differs from circumstantiality in that the psychotic person never really gets to the point of the communication. The individual with psychosis may persis- tently repeat the same word or idea in response to different questions. The psychotic person feels threatened and believes others intend harm or persecution toward him or her in some way. All events within the environment are referred by the psychotic person to himself or herself. The psychotic individual believes certain objects or people have control over his or her behavior. Hallucinations are false sensory percep- tions that may involve any of the five senses. Auditory and visual hallucinations are most common, although olfactory, tactile, and gustatory hallucinations can occur. The psychotic person becomes preoccupied with religious ideas, a defense mechanism thought to be used in an attempt to provide stability and structure to dis- organized thoughts and behaviors. Common Nursing Diagnoses and Interventions for Individuals with Schizophrenia and Other Psychotic Disorders (Interventions are applicable to various health-care settings, such as inpatient and partial hospitalization, community outpatient clinic, home health, and private practice. Within [a specified time], client will recognize signs of increasing anxiety and agitation and report to staff for assis- tance with intervention. Client will not harm self or others Long-term Goal Client will not harm self or others. Maintain low level of stimuli in client’s environment (low lighting, few people, simple decor, low noise level). Do this while carrying out routine activities so as to avoid creating suspiciousness in the individual. Close observation is necessary so that intervention can occur if required to ensure client’s (and others’) safety. Remove all dangerous objects from client’s environment so that in his or her agitated, confused state client may not use them to harm self or others. Try to redirect the violent behavior with physical outlets for the client’s anxiety (e. Have sufficient staff available to indicate a show of strength to client if it becomes necessary. This shows the client evidence of control over the situation and provides some physical security for staff. The avenue of the “least restrictive alternative” must be selected when planning interventions for a psychiatric client. If client is not calmed by “talk ing down” or by medication, use of mechanical restraints may be necessary. The physician must physician reissue a new order for restraints every 4 hours for adults and every 1 to 2 hours for children and adolescents. Observe the client in restraints every 15 minutes (or ac- cording to institutional policy). Ensure that circulation to extremities is not compromised (check temperature, color, pulses). Continuous one-to-one monitoring may be necessary for the client who is highly agitated or for whom there is a high risk of self- or accidental injury. As agitation decreases, assess client’s readiness for restraint removal or reduction. Possible Etiologies (“related to”) [Lack of trust] [Panic level of anxiety] [Regression to earlier level of development] [Delusional thinking] [Past experiences of difficulty in interactions with others] [Repressed fears] Unaccepted social behavior Schizophrenia and Other Psychotic Disorders ● 113 Defining Characteristics (“evidenced by”) [Staying alone in room] Uncommunicative, withdrawn, no eye contact [mutism, autism] Sad, dull affect [Lying on bed in fetal position with back to door] [Inappropriate or immature interests and activities for develop- mental age or stage] Preoccupation with own thoughts; repetitive, meaningless actions [Approaching staff for interaction, then refusing to respond to staff’s acknowledgment] Expression of feelings of rejection or of aloneness imposed by others Goals/Objectives Short-term Goal Client will willingly attend therapy activities accompanied by trusted staff member within 1 week. Long-term Goal Client will voluntarily spend time with other clients and staff members in group activities. Be with the client to offer support during group activities that may be frightening or difficult for him or her. Antipsychotic medications help to reduce psychotic symp- toms in some individuals, thereby facilitating interactions with others. Discuss with client the signs of increasing anxiety and techniques to interrupt the response (e. Maladaptive behaviors such as withdrawal and suspiciousness are manifested during times of increased anxiety. Give recognition and positive reinforcement for client’s vol- untary interactions with others. Positive reinforcement en- hances self-esteem and encourages repetition of acceptable behaviors. Possible Etiologies (“related to”) [Inability to trust] [Panic level of anxiety] [Personal vulnerability] [Low self-esteem] [Inadequate support systems] [Negative role model] [Repressed fears] [Possible hereditary factor] [Dysfunctional family system] Defining Characteristics (“evidenced by”) [Suspiciousness of others, resulting in: • Alteration in societal participation • Inability to meet basic needs • Inappropriate use of defense mechanisms] Goals/Objectives Short-term Goal Client will develop trust in at least one staff member within 1 week.

Work order 20mg citalopram visa, pleasure (recreation) and rest (restoration/sleep) should be balanced; watching television is a positive pastime if enjoyed (recreation) buy citalopram 10 mg visa, but a negative one if the viewer simply cannot be bothered to do something else. Effective time management enables nurses to work well while enjoying a full social life. Time out 3 Think back over the past week; note down how you have spent your time, for example: What are my overall feelings about the past week? The absence of all stress is not desirable, but achieving eustress without distress can be difficult. Stress is a complex individual reaction to stressors, with both physiological and psychological manifestations. When stressors exceed individual coping abilities, whether through prolonged exposure to, or intensity of, stressors, distressed begins; unresolved distress may progress to burn-out. Therefore, recognising the signs of stress in ourselves and Intensive care nursing 438 others is a necessary foundation for managing distress. Coping mechanisms may be negative (attempting to alter oneself, which is usually harmful) or positive (attempting to alter stressors). Farrington (1997) provides constructive ways to recognise and manage stress from a wider nursing perspective. Of the many popular books on assertion, Harris (1970) provides a simple self-help text while Dickson (1982) is especially thought provoking. Specify: (a) behaviours (adaptive/maladaptive), emotions (positive/negative) and thoughts (b) verbal comments (c) typical coping mechanisms (effective/ineffective, beneficial/ harmful). Chapter 47 Complementary therapies Introduction The recent growth of interest in complementary therapies is reflected in their increasing use in nursing and healthcare. The literature varies between introductory and anecdotal texts to substantive studies. The placebo effect is also discussed, before concluding with practical application and professional perspectives. Although discussed under separate headings, the use of various complementary therapies may be mixed, just as orthodox medicine may use combination therapy; thus essential oils may be used for massage, with benefits potentially being gained from both the massage and the oil itself. While research studies need to specify causal relationships, for clinical practice the end results to patients is (from utilitarian perspectives) more important than precisely how results are achieved. Concepts and terminology The term ‘complementary therapy’ is increasingly replacing ‘alternative therapy’. Both supporters and opponents of complementary therapies have used ‘alternative’, usually to try and devalue the other approach. This text follows Rankin-Box (1988) in using the term ‘complementary’ rather than ‘alternative’. Many complementary therapies are derived from traditional Chinese medicine, and conflicts can occur from the differing cultural contexts and translation. Yin and Yang, which are popularly and often over-simplistically assimilated into Western culture, involve balances between the various kinds of energy necessary for health (Downey 1995)—this carries similar connotations to orthodox medicine’s concept of ‘homeostasis’. In Chinese medicine, Ki (Qi or Chi), the universal energy which links people to their environment, is dispersed through twelve main channels (meridians) that connect the internal organs to the skin (Downey 1995). Intensive care nursing 440 Orthodox medicine Many complementary therapies are very old; reflexology is depicted in pyramids of c. Since knowledge of the therapies has been mainly transmitted through oral traditions and folklore, the lack of regulation led some practices into disrepute, while the Cartesian focus on atoms largely replaced European folklore medicine with an ‘orthodox’ (and increasingly regulated) medical profession. Orthodox medicine has adopted some of the tried and tested remedies, such as foxglove (digitalis— digoxin) for dropsy (oedema) and willow bark (aspirin) for analgesia, so that, refined and analysed, ‘orthodox medicine’ has preserved elements of herbal medicine. Orthodox medicine’s pursuit of diagnosing anatomically specific problems led to targeting specific problems with specific drugs (e. Complementary therapies focus attention on the whole person, and recognise the complex interactions contributing to disease (literally, dis-ease). Such holistic and humanist perspectives make complementary therapies attractive to many nurses; the absence of regulation (compared with orthodox medicine) enables nurses to initiate complementary therapies. The resurgence of interest in complementary therapies therefore parallels the growth of the nursing profession’s autonomy and advocacy of therapeutic nursing. Until recently, the knowledge bases of most complementary therapies was largely limited to anecdotes and unsupported assertions. Complementary therapies are often sought when orthodox medicine fails to resolve chronic problems, although some people seek interventions purely for pleasure (e. Therapeutic touch This intervention, conceptualised into nursing by Krieger (1975), develops the traditional laying-on of hands, and is included here mainly because its name can create confusion. Neither the laying-on of hands nor Krieger’s Therapeutic Touch involve skin-to-skin contact. Building on Martha Rogers’ philosophy that humans are made up of energy, and that humans and their environments are continuously, simultaneously and mutually exchanging energy with each other (Sayre-Adams 1994), Therapeutic Touch attempts to touch the energy or force field of the person. Any intervention that increases qualitative staff-patient interaction is potentially beneficial. Qualitative touch (skin- to-skin contact) is much underused by nurses, and can significantly reduce sensory imbalance (see Chapter 3): touch can be therapeutic. Labelling Krieger’s intervention Complementary therapies 441 ‘Therapeutic Touch’ may imply that other nursing touch is not therapeutic—an erroneous presumption.

In Australia the use of acupunc- ture by doctors has increased greatly since the 1984 introduction of a Medicare rebate for acupuncture buy citalopram 40 mg otc. Cost-effectiveness studies of acupuncture Cost-effectiveness studies of acupuncture have been mainly restricted to the treatment of pain 10mg citalopram amex. This Traditional Chinese medicine | 149 result was robust to sensitivity analysis. The provision of the treatments represents an additional healthcare cost in four out of the five studies considered. The authors acknowledged that estimates of cost-effectiveness may be less favourable in situations for which the complementary treatment is offered routinely rather than in the novel situation of a clinical trial. Most states (27) allow herbal medicine within the scope of acupuncture practice; only a few states (10) require the super- vision of a physician for the almost 11 000 practising non-physician acupuncturists. The number of acupuncturists is rapidly growing and is projected to quadruple by 2015. Acupressure relieves muscular tension, facilitating blood flow and therefore distributing more nutrients and oxygen throughout the body, as well as removing waste prod- ucts. The technique involves repeatedly pressing the acupuncture points for 3–5 seconds and then releasing the pressure. It is believed that the prac- titioner’s qi helps to strengthen the weakened qi of the patient. Thus it is important that the practitioner maintains a healthy body so that his or her qi is stronger than that of the recipient. Acupressure has been used to relieve mental tension, for tired and strained eyes, headaches, menstrual cramps and arthritis, as well as to promote general healthcare. Areas of scar tissue, boils, blis- ters, rashes and varicose veins should also be avoided. Certain pressure points should be avoided during pregnancy and in patients with hyper- or hypotension. Shiatsu This is a deeply relaxing therapy originating in Japan that provides stimula- tion by using the fingers and palm of the hand to apply pressure and gentle stretches to the meridians. It consists of a whole body treatment, as it is believed that a disorder in one area can have effects elsewhere on the body. It is similar to both Traditional Chinese medicine | 151 acupuncture and acupressure in its effects but uses a glowing wick instead of needles or fingertips as the source of stimulation for the acupoints. Tradi- tionally moxa is the dried leaves of Artemisia vulgaris and Artemesia argyi and other species of mugwort, made into various forms including: • punk – loose moxa, rather like green cotton-wool • moxa rolls – similar to cigars in appearance • moxa cones. Another method is for a small moxa cone to be placed on the blunt end of an acupuncture needle while it is in place. It is lit at its apex and burnt down until the patient is able to feel the heat; it is then removed. Chinese herbal medicine In the west it is quite normal to equate the word ‘herbal’ with something that grows in the garden. Certainly most Chinese herbal remedies are made from plant material, but others are of mineral or animal origin, e. In China and other Asian countries the practice is still wide- spread, but it has been largely discontinued elsewhere after action by regula- tory authorities with enthusiasm that may occasionally be misplaced. The famous highly aromatic salve marketed around the world known as Tiger Balm was once the subject of a dawn raid of Chinese herbalists by police in Manchester. They thought that they had uncovered the illegal use of parts from a protected wild animal. There were a few red faces when it was realised that the title merely referred to the nickname of the brand owner! History China’s greatest materia medica (Pen Ts’ao) was published by Li Shizhen in 1578. Secret recipes (also known as ‘prepared medicines’) were the equivalent of modern patent medicines. By the time of the Ming dynasty (1368–1644) more than 60 000 formulae had been recorded in the 1406 book entitled Formulas of Universal Benefit (Pu Ji Fang). In recent years many of these formulae have passed into public usage, but there may be as many as 5000 licensed patent medicines still circulating in China. The most famous factory is at the Tong Ren Tang pharmacy in Beijing, which has been operated by the same family since the late seventeenth century. These are: • cooling • diaphoresis • elimination • emesis • mediation • purging • tonification • warming. Traditional Chinese medicine | 153 Categorisation of Chinese herbs Chinese herbs may be categorised according to: • the four natures • the five tastes • the meridians. The herbs are ascribed qualities ranging from cold (extreme yin), cool, neutral to warm and hot (extreme yang), and are often used in combination according to the deficiencies or excesses of these qualities in the patient.

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Give an example of an interview question you could use to assess self-concept in the Patient goal: following areas order citalopram 20mg. A battered woman feels her situation is hopeless and believes she deserves to be b buy cheap citalopram 20mg. Role performance: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A 67-year-old woman complains that she feels she can no longer have a sexual rela- no longer has the patience to babysit for tionship with her husband. There are many factors that influence the self- concept of patients, including developmental c. Give three examples of how nurses can help resources, history of success or failure, patients maintain a sense of self-worth. Once you’ve identified these factors, write a nursing diagnosis for each patient and b. Describe nursing strategies to develop self- concept influence the relationship you estab- esteem that you might use to meet the needs lish with patients and colleagues? An 88-year-old woman, newly admitted to Use the following expanded scenario from a nursing home, says she has lost all sense Chapter 41 in your textbook to answer the of self (Self-Identity Disturbance): questions below. A 75-year-old man with crippling arthritis to complications resulting from poor glucose tells you he no longer recognizes himself control. One morning, he states, “I feel like when he looks in the mirror (Body Image damaged goods. What interventions might the nurse employ a stroke that has paralyzed his right side to try to resolve Mr. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. What would be a successful outcome for All I hear the girls talking about is boys, and I Mr. What intellectual, technical, interpersonal, admits that in the past, once she set a goal and/or ethical/legal competencies are most for herself, she was always able to achieve likely to bring about the desired outcome? Although she has withdrawn from her parents and teachers, she admits that she does know adults she can trust who have been a big sup- port to her in the past. Identify pertinent patient data by placing a single underline beneath the objective data in the case study and a double underline beneath the subjective data. Pretend you are performing a nursing but at 5 feet 3 inches and 150 pounds, she is assessment of this patient after the plan of overweight. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. For the purposes of this exercise, develop the one patient goal that demonstrates a direct resolution of the patient problem identified in the nursing diagnosis. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Which of the following statements concern- Circle the letter that corresponds to the best ing interactions with basic human needs is answer for each question. As a person strives to meet basic human that takes place as a result of a response to a needs at each level, stress can serve as stressor? Stress affects all people in their attain- anisms is which of the following systems? Autonomic likely suffering from which of the following stressors on basic human needs? Which of the following reactions would be considered anxiety due to a psychological d. You respond to an approaching examination living, and it increases alertness and percep- with a rapidly beating heart and shaking tual fields. Which of the following phrases best on specific detail, causing all behavior to be illustrates the panic level of anxiety? Narrow perception field learn, concentrates only on the present sit- uation, and often experiences feelings of 11. 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.

Foods high in vitamin C include fresh tomatoes purchase citalopram 20mg with visa, broccoli order 40mg citalopram with amex, citrus fruits, strawberries, cauliflower, cantaloupe, cabbage, and green peppers. Foods to avoid: L • Alcohol hampers immune function; has negative effects on your liver, kidneys, heart, and muscles; and may interact with your medications. These drugs can also stop the absorption of nutrients such as vitamins B6, C, and D, zinc, and potassium and interfere with cells’ ability to use them. In addition, corticosteroids can cause loss of muscle protein, change the body’s ability to handle blood sugar (glucose), and increase fat deposits and sodium retention. In order to counteract the nutrition-zapping effects of corticosteroids, eat a healthful diet and take a daily multivitamin and mineral supplement. Regu- lar exercise improves heart and lung function, helps reduce stress, and gives you more energy. Weight-bearing activities such as walking also help to improve bone strength and ward off osteoporosis. Smoking causes lung and heart damage, and those with lupus are already at risk of these problems. Complementary Supplements Antioxidants: Help to quench free radicals, which are generated by inflammation. Many people with lupus have low levels of antioxidants, such as beta-carotene and vitamin C. These antioxidants are essential for good health, immune function, and disease protection. Antioxidants may play a protective role against lupus complication such as joint, muscle, and organ damage. Those with lupus who are taking corti- costeroids are at significant risk of osteoporosis. Supplementing with calcium and vitamin D can help protect against bone loss, plus vitamin D levels have been found to be lower in those with lupus and this vitamin is essential for immune function. Look for a product that also contains magnesium and zinc, which are also essential for bone health. Celadrin: A patented blend of fatty acids that reduces inflammation and pain, lubricates joints, and promotes healing. Flaxseed oil: Some preliminary research suggests that flaxseed might help prevent or treat lupus nephritis. Moducare: A combination of beta-sitoserol and beta-sitosterolin, which help to balance/ correct immune function. Studies show that Mo- ducare is helpful for reducing pain and inflammation associated with rheumatoid arthritis. If you are taking medications to manage your lupus, consult with your doctor and pharmacist before you start taking any new herbal or other supplements to avoid any potential interactions. Avoid soy, alfalfa, mushrooms, beans, alcohol, saturated and trans fats, sugar, and caffeine. The macula is part of the retina, which is located on the inside back wall of the eyeball and is responsible for central vision. Deterioration of the macula results in blurring and loss of central vision, which worsens over time, leading to blindness. Macular degeneration is the leading cause of visual loss in people over 60 years and the second leading cause of blindness (after cataracts) in those over 65. There are two forms of macular degeneration: Dry: This is the most common form and is responsible for 90 percent of cases. It occurs when the macula breaks down and thins over time due to aging, free radical damage, and lack of blood and oxygen to the macula. Cellular debris accumulates under the retina and central vision slowly deteriorates over time. Wet: Also known as hemorrhagic macular degeneration, this is less common but more serious, as it develops suddenly and progresses fast. It occurs when blood vessels grow under the macula, pushing against it and leaking fluid, which causes scarring of the macula and permanent damage to central vision. Early detection and intervention can help to reduce visual loss from macular degen- eration. It is possible to slow down the progression and prevent macular degeneration with lifestyle measures and supplements. These procedures prevent further dam- age to the macula and further visual loss, but they do not restore vision that is lost. Research has shown that antioxidant supplements can prevent worsening of this condition and further vision loss.