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Part V: Mission Control: All Systems Go 252 Musculocutaneous Cervical nerves nerve (8 pairs) Phrenic nerve Thoracic nerves (12 pairs) Radial nerve Median nerve Lumbar nerves (5 pairs) Ulnar nerve Femoral nerve Sacral nerves (5 pairs) Sciatic nerve Internal saphenous nerve Figure 15-4: Anterior tibial nerve The spinal nerves plus Musculocutaneous nerve branching plexus nerves dilantin 100 mg low price symptoms 7 days after conception. Wolters Kluwer Health — Lippincott Williams &Wilkins Receptors in skin Pin Sensory neuron Muscle (effector) Figure 15-5: Motor neuron A reflex Cell body Internuncial neuron arc — Dorsal root ganglion Cell body of motor neuron responding Gray matter to pain order 100 mg dilantin medications for migraines. Wolters Kluwer Health — Lippincott Williams &Wilkins After a spinal nerve leaves the spinal column generic dilantin 100 mg free shipping translational medicine, it divides into two small branches discount dilantin 100mg overnight delivery symptoms lactose intolerance. The posterior, or dorsal ramus, goes along the back of the body to supply a specific seg- ment of the skin, bones, joints, and longitudinal muscles of the back. The ventral, or anterior ramus, is larger than the dorsal ramus and supplies the anterior and lateral regions of the trunk and limbs. Chapter 15: Feeling Jumpy: The Nervous System 253 Groups of spinal nerves interconnect to form an extensive network called a plexus (Latin for “braid”), each of which connects through the anterior ramus, including the cervical plexus of the neck, brachial plexus of the arms, and lumbosacral plexus of the lower back (including the body’s largest nerve, the sciatic nerve). Instead, the anterior ramus directly supplies the inter- costal muscles (literally “between the ribs”) and the skin of the region. Thoracic Keep Breathing: The Autonomic Nervous System Just as the name implies, the autonomic nervous system functions automatically. Divided into the sympathetic and parasympathetic systems, it activates the involuntary smooth and cardiac muscles and glands to serve such vital systems that function auto- matically as the digestive tract, circulatory system, respiratory, urinary, and endocrine systems. Autonomic functions are under the control of the hypothalamus, cerebral cortex, and medulla oblongata. The sympathetic system, which is responsible for the body’s involuntary fight-or-flight response to stress, is defined by the autonomic fibers that exit the thoracic and lumbar segments of the spinal cord. The parasympathetic system is defined by the autonomic fibers that either exit the brainstem via the cranial nerves or exit the sacral segments of the spinal cord. The sympathetic and parasympathetic systems oppose each other in function, helping to maintain homeostasis, or balanced activity in the body systems. The sympathetic system dilates the eye’s pupil, but the parasympathetic system contracts it again. The sympathetic system quickens and strengthens the heart while the parasympathetic slows the heart’s action. The sympathetic system contracts blood vessels in the skin so more blood goes to muscles for a fight-or-flight reaction to stress, and the parasympathetic system dilates the blood vessels when the stress concludes. Part V: Mission Control: All Systems Go 254 As shown in Figure 15-6, a pair of sympathetic trunks lies to the right and left of the spinal cord and is composed of a series of ganglia that form nodular cords extending from the base of the skull to the front of the coccyx (tailbone). Sympathetic nerves origi- nate as a short preganglionic neuron with its cell body inside the lateral horn of the gray matter of the spinal cord from the first thoracic to the third lumbar. Axons of these nerves then pass through the ventral root of the spinal nerve, leaving it through a branch of the spinal nerve called the white rami (named for their white myelin sheaths), which connect to one of the two chains of ganglia in the trunks. Parasympathetic nerves consist of long preganglionic fibers that synapse in a terminal ganglion near or within the organ or tissue that’s being innervated. Generally speaking, the parasympathetic system acts in opposition to the sympathetic system. Eye and lacrimal gland Parotid, submandibular and sublingual salivary glands Heart Trachea and Sweat lung glands Stomach and Smooth muscle Pancreas in blood vessels and intestines Adrenal gland and kidney Large intestine Figure 15-6: The sympa- thetic nerv- ous system. Wolters Kluwer Health — Lippincott Williams &Wilkins See whether any of the following practice questions touch a nerve: 66. Is separate anatomically and functionally from the cranial nerves Chapter 15: Feeling Jumpy: The Nervous System 255 67. It has two parts: the parasympathetic that controls all normal functions, and the sympathetic that carries out the same functions. It has two divisions that are antagonistic to each other, meaning that one counteracts the effects of the other one. Medulla oblongata Coming To Your Senses The nervous system must have some way to perceive its environment in order to gen- erate appropriate responses. Sense receptors are those numerous organs that respond to stimuli — like increased temperature, bitter tastes, and sharp points — by generating a nerve impulse. While there are millions of general sense receptors found throughout the body that can convey touch, pain, and physical contact, there are far fewer of the special sense receptors — those located in the head — that really bring meaning to your world. Sense receptors are classified by the stimuli they receive, as follows: Exteroceptors: Receive stimuli from the external environment. These are sen- sory nerve terminals, such as those in the skin and mucous membranes, that are stimulated by the immediate external environment. These can be any of the sensory nerve terminals located in and transmitting impulses from the viscera. They’re sensory nerve terminals chiefly found in muscles, joints, and tendons that give information concerning movements and position of the body. Teleceptors: Sensory nerve terminals stimulated by emanations from distant objects. Part V: Mission Control: All Systems Go 256 Eyes Although there are many romantic notions about eyes, the truth is that an eyeball is simply a hollow sphere bounded by a trilayer wall and filled with a gelatinous fluid called, oddly enough, vitreous humor (see Figure 15-7). The sclera provides mechanical support, protection, and a base for attachment of eye muscles, and it assists in the focusing process. An intermediate, or vascular, coat called the uvea provides blood and lymphatic fluids to the eye, regulates light, and also secretes and reabsorbs aqueous humor, a thin watery liquid that fills the anterior chamber of the eyeball in front of the iris. A pigmented coat has three layers: the iris, containing blood vessels, pigment cells, and smooth muscle fibers to control the pupil’s diameter; the ciliary body, which is attached to the periphery of the iris; and the choroid, a thin, dark brown, vascular layer lining most of the sclera on the back and sides of the eye. The choroid contains arteries, veins, and capillaries that supply the retina with nutrients, and it also contains pigment cells to absorb light and prevent reflection and blurring. The retina is part of an internal nervous layer that connects with the optic nerve. The nervous tissue layers along the inner back of the eye contain rods and cones (types of neurons that analyze visual input). The rods are dim light receptors whereas the cones detect bright light and construct form, structure, and color. The retina has an optic disc, which is essentially a blind spot incapable of producing an image. Located behind the pupil and iris, the lens is held in place by liga- ments attached to the ciliary muscles. When the ciliary muscles contract, the shape of the lens changes, altering the visual focus. This process of accommodation allows the eye to see objects both at a distance and close up. The palpebrae (eyelids) extend from the edges of the eye orbit, into which roughly five-sixths of the eyeball is recessed. Eyelids come together at medial and lateral angles of the eye that are called the canthi. In the medial angle of the eye is a pink region called the caruncula, or caruncle. A mucous membrane called the conjunctiva covers the inner surface of each eyelid and the anterior surface of the eye. Up top and to the side of the orbital cavities are lacrimal glands that secrete tears that are carried through a series of lacrimal ducts to the conjunctiva of the upper eyelid. Ears Human ears — otherwise called vestibulocochlear organs — are more than just organs of hearing. Here are the three divisions of the ear: The external ear includes the auricle, or pinna, which is the folded, rounded appendage made of cartilage and skin.

Appetite regulation A genetic predisposition may also be related to appetite control cheap 100 mg dilantin mastercard treatment zenker diverticulum. Over recent years researchers have attempted to identify the gene generic dilantin 100 mg visa medications zovirax, or collection of genes generic dilantin 100mg fast delivery chi infra treatment, responsible for obesity purchase dilantin 100mg on-line medicine vs medication. 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. For example, a study of middle-aged male joggers who ran approximately 65km per week, suggested that increased calorie intake was related to increased exercise with the joggers eating more than the sedentary control group (Blair et al. However, another study of military cadets reported that decreased food intake was related to increased exercise (Edholm et al. Much research has also been carried out on rats, which shows a more consistent relationship between increased exercise and decreased food intake. However, the extent to which such results can be generalized to humans is questionable. For example, 10 minutes of sleeping uses up to 16 kcals, standing uses 19 kcals, running uses 142 kcals, walking downstairs uses 88 kcals and walking upstairs uses 229 kcals (Brownell 1989). In addition, the amount of calories used increases with the individual’s body weight. However, the number of calories exercise burns up is relatively few com- pared with those in an average meal. However, only intense and prolonged exercise appears to have an effect on metabolic rate. There appears to be an association between population decreases in activity and increases in obesity. In addition, prospective data support this association and highlight lower levels of activity as an important risk factor. Further, cross-sectional data indicate that the obese appear to exercise less than the non-obese. It is possible that an unidentified third factor may be creating this association, and it is also debatable whether exercise has a role in reducing food intake and promoting energy expenditure. However, exercise may have psychological effects, which could benefit the obese either in terms of promoting weight loss or simply by making them feel better about themselves (see Chapter 7 for the effects of exercise on mood). Eating behaviour In an alternative approach to understanding the causes of obesity, research has exam- ined eating behaviour. Research has asked ‘Are changes in food intake associated with changes in obesity? The results from this data- base illustrate that, although overall calorie consumption increased between 1950 and 1970, since 1970 there has been a distinct decrease in the amount we eat (see Figure 15. Prentice and Jebb (1995) examined the association between changes in food intake in terms of energy intake and fat intake and changes in obesity. Their results indicated no obvious association between the increase in obesity and the changes in food intake (see Figure 15. Therefore, using population data there appears to be no relationship between changes in food intake and changes in obesity. Throughout the 1960s and 1970s theories of eating behaviour emphasized the role of food intake in predicting weight. Original studies of obesity were based on the assumption that the obese ate for different reasons than people of normal weight (Ferster et al. Schachter’s externality theory suggested that, although all people were responsive to environmental stimuli such as the sight, taste and smell of food, and that such stimuli might cause overeating, the obese were highly and sometimes uncontrollably responsive to external cues. It was argued that normal weight individuals mainly ate as a response to internal cues (e. Within this per- spective, research examined the eating behaviour and eating style of the obese and non- obese in response to external cues such as the time of day, the sight of food, the taste of food and the number and salience of food cues (e. Research exploring the amount eaten by the obese has either focused on the amount consumed per se or on the type of food consumed. Because it was believed that the obese ate for different reasons than the non-obese it was also believed that they ate more.

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But we should more apt to adhere to the elicitation routine buy cheap dilantin 100 mg on-line treatment centers for depression, look- bear in mind that the prayers which are effective— ing forward to it and enjoying it cheap 100 mg dilantin visa symptoms 13dpo. Affirmative no matter whose prayers they may be—are effective beliefs of any kind brought forth remembered well- because they embody certain universal principles which generic 100mg dilantin free shipping treatment venous stasis, ness order 100mg dilantin fast delivery medications narcolepsy, receiving top-down, nerve-cell-firing patterns when understood, can be consciously used. In their support there is ample solid depletion of normal gastric juices, lessened ability scientific evidence that directed, highly specific to fight infection, protein or potassium deficiency, imagery can bring about changes in the body. Under certain conditions, such as in a tem- meaning to hold fast, the ingestion of fluids, partic- perate climate and with reduced physical activity, ularly water, during a period when no solid food is an individual may survive on water for approxi- taken. Fasting is largely considered a body-purifica- mately two months, but without food or water, tion or cleansing process in alternative and com- death may occur in approximately 10 days. In Ayurvedic medicine, purpose of weight loss, conventional practitioners effective fasting requires that one take into account often recommend eliminating a meal per day or his or her dosha, or body type. Unsupervised body type should not fast for more than three days and prolonged fasting may be fatal, and, as a rule, because a longer fast may cause anxiety (a “vatic children should not fast. Fasting has particular value in the event of weight-loss and detoxification fasting is available fever, cold, arthritis, or constipation. Fruit and vegetable mineral or combination remedy that fights fever, juices, lemon water with honey or salt, and herbal such as Ferrum phos 6x. Aspirin, acetaminophen, teas taken every two hours may provide a cleans- and other conventional drugs, known as antipyret- ing but not depleting fast. In Ayurvedic medicine, (low-fat, high-fiber) is often less stressful and as ghee, made from boiled, strained, unsalted butter, is effective as fasting. Most experts sug- Israeli born in Russia who, after suffering a severe feng shui 45 knee injury, replaced his previous ways of physically tionship and impact on human life. Considered an moving with more efficient habits that proved environmental science, traditional Chinese feng healthier and more efficient. Also a martial artist and shui (a combination of the Chinese words for wind athlete, Feldenkrais said, “Each one of us speaks, and water) is employed in many aspects of life moves, thinks, and feels in a different way, each including nutrition, medicine, exercise, the arts, according to the image of himself that he has built and interior and exterior design. In order to change our mode of system, feng shui and its variations acclimate to action, we must change the image of ourselves that most cultures and societal requirements because of we carry within us. He (ch’i; life force or energy), and creation of a balance believed that if physical movement (including between yin and yang forces (positive and negative, breathing) became impaired, psychological and even or the universal opposites, such as Sun-Moon and other physical problems would result. Touted as cold-heat) are among the goals of feng shui prac- effective for stress-related problems, chronic pain, tices. The position of win- (stroke), cerebral palsy, and other ailments, the dows, doors, utilities (particularly water-related, Feldenkrais method of bodywork consists of two including sinks, toilets, and appliances); furniture, components: Awareness Through Movement and cabinets, architectural details, and materials; and Functional Integration, both terms registered service accessories, plants and living creatures, colors, marks of the Feldenkrais Guild [P. Awareness Through Movement involves and trees; Chinese astrology and numerology; and gentle, nonaerobic motions, such as sitting and location are all factors taken into account in feng standing, along with specific movements in 45- shui, which attempts to enhance well-being, har- minute to one-hour sessions once a week for four to ness good ch’i, or counteract negative conditions or six weeks. Feldenkrais practitioners Bagua map, an entire floor plan with each area and perform Functional Integration—gentle manipula- direction (north, south, east, and west) designated tion of muscles and joints not exceeding one’s nor- as a symbol of human life—health, family, children, mal range of motion—on an individual who is love and marriage, wealth, work, knowledge, help- standing, sitting, or lying down. The use of an of adverse effects of this therapy, which also provides indoor water fountain, for example, is thought to supportive conditioning for athletes, dancers, and enhance wealth and beneficial energy and richness others who wish to improve their flexibility, balance, of life. Feldenkrais is rooted in practicality and the interplay of ele- training is popular among physical therapists, but a ments and may be adapted to individual problems medical or health background is not necessary to and needs. The tank holds approxi- Five Elements Air (or metal), water, ether, fire, mately 10 inches of skin-temperature water mixed and earth, which represent individual and environ- with Epsom salts to make it five times denser and mental energy and constitution in various Asian, more buoyant than seawater. According The Five Element concept is based on the belief to an article by Barbara Ritacco in the October that all people have a connection to and interper- 2002 issue of Options (West Paterson, N. In the Tantric tradition (one of the restriction of external stimuli in the float tank. This Indian schools of thought), for example, air is sym- triggers relaxation response by inhibiting the bolized by a sphere and represents locomotion, fire release of stress-related chemicals such as cortisol. In (Other benefits include) an accelerated learning Ayurveda and traditional Chinese medicine, the process (due to the Theta State) and a loosening of Five Elements relate to body types and constitu- muscles. Flotation therapy helps treat asthma, tions, chakras (centers of energy down the midline digestive tract conditions, cardiovascular condi- of the body from the crown to the base of the tions, psychological and emotional conditions, spine), internal organs, and spiritual approaches addictions, and chronic pain conditions. Also in Ayurveda the Five Ele- therapy is often combined with guided imagery ments involve taste testing, that is, a method to and music therapy. The article goes on to say there determine how different foods and herbs affect are no adverse effects of flotation therapy, and each person. For instance, Ayurvedic practitioners famous advocates include Carl Lewis (in prepara- believe that an excessive intake of bitter foods and tion for the 1988 Seoul Olympics), the Dallas Cow- medicinal herbs may intensify the elements of air boys since 1981, the Australian Institute of Sport and ether and cause one to become disoriented. The “Hot” foods are said to intensify the fire element average length of a float is one hour, which costs and are not recommended for fiery, hot-tempered, approximately $45 to $75 per hour. Medicinal herbs flower remedies Also known as “soul therapy,” and foods and therapeutic activities such as yoga the use of flower essences to treat various physical correspond to the Five Elements. Flower essence remedies The Five Elements also play a role in feng shui, are made throughout the world, including Eng- the Chinese art of placement, in terms of fire, land, the United States (California), India, Aus- metal, wood, water, and earth. Among the ment, as in one’s personal biopsychosocial intake, literature on flower essence remedies are Flower each element must be represented in balance with Essence Repertory, by Patricia Kaminski and Richard the others for an optimal sense of well-being. Hundreds of foods are believed to help counteract the symptoms and folk medicine A term coined in 1878 referring to processes of hundreds of ailments. Food therapy the traditional medicine of a particular culture as also includes a multitude of diets and dietary practiced by physicians and nonprofessional health restrictions or specifications according to individual providers. One of the best-known diseases that requires extensive use of foods and herbs as remedies for a a highly specified diet is diabetes. Food therapy multitude of ailments, many of which have been complements herbal therapy, the use of vitamins adopted into the Western mainstream as alterna- and mineral supplements, and bodywork. He went on to develop theo- ries on dream interpretation, repression, sexual fomentations, herbal In Ayurvedic medicine deviation, guilt, the unconscious, psychosomatic warm, moist applications that are infused or pain, and many other groundbreaking psychody- treated with herbs. Heal- dation of the mind-body philosophy related to var- ing foods have always been known to humankind. In A Practical Guide to Vibrational Medicine as treatment for respiratory disorders such as aller- (New York: Quill/HarperCollins Publishers, 2000, gies and asthma, infections, aging (Arabs of the p. We must learn to walk that fine eties, such as pomelo, are reported to improve cir- line between understanding the meaning of our culation and prevent breast cancer. Among lives on the physical plane while still paying atten- common foods considered both nourishment and tion to our spiritual roots in the multidimensional remedy are papaya (for excess stomach acidity); worlds that underlie and energize physical energy. G galactagogue A substance or agent that stimu- Gattefossé, René-Maurice The French chemist lates the secretion of milk. After he Galen, Claudius Greek physician and writer burned his hand while working in his family’s per- (129–ca. Gatte- sance and are still considered pivotal in medical fossé the idea to explore curative properties of history. One of Galen’s ideas was that light and in terms of “I am,” which refer to the whole person. He is also believed to have said, “He cures son (1881–1959) in the 1930s immigrated to the most in whom most are confident,” referring to a United States and developed nutritional treatments mind-body influence on healing and the relation- for diabetes, migraines, tuberculosis, and cancer. Born in Wongrowitz, Germany, and considered a humanitarian physician, Gerson treated Dr. Albert Schweitzer for diabetes and other prob- designating herbs that are sweet-tasting, such as lems, believed that a low-salt vegan diet; additional gan mao ling, prescribed for the initial symptoms of fruit and vegetable juices; various supplements a cold. His meth- Indian nationalist, nonviolent movement against ods proved successful for patients in various stages the British and known as father of his country of melanoma; survival rates studied in 153 of Ger- (1869–1948) who championed the integration of son’s cancer patients were higher than those of mind, body, and spirit. For example, he believed patients receiving conventional treatment for exercise was as necessary to the quality of life as melanoma. Gerson’s daughter, Charlotte, and her air, water, and food and that lack of exercise staff continue his work at The Gerson Institute, in affected the mind as well. For “Footwork” developed by Avi Grinberg that example, raw adrenal glandular is used to stimu- attempts to prevent pain and alleviate chronic pain late the adrenal glands and help in the treatment of by teaching practitioners and laypeople to discern chronic fatigue syndrome, arthritis, diabetes, infec- the steps along the process of a physical or emo- tions, and ulcers. Other essential glandulars include tional crisis and use the techniques of Footwork to raw brain, raw female complex, raw heart, raw counteract them.

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Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care order dilantin 100mg line medicine go down, 7th Edition purchase dilantin 100 mg line treatment urinary tract infection. I used to think my sleep habits were bad at school dilantin 100mg otc treatment myasthenia gravis, but this is a Read the following patient care study and use hundred times worse because there never your nursing process skills to answer the seems to be time to crash order dilantin 100 mg fast delivery symptoms vaginitis. Identify pertinent patient data by placing a nurse, has been in her new position as a criti- single underline beneath the objective data in cal care staff nurse in a large tertiary-care med- the case study and a double underline beneath ical center for 3 months. Complete the Nursing Process Worksheet on of time for other things I want to do, but I’m page 223 to develop a three-part diagnostic not so sure anymore,” she says. Write down the patient and personal nursing it seems I’m always tired and all I think about strengths you hope to draw on as you assist all day long is how soon I can get back to bed. Worst of all, when I do finally get into bed, I often can’t fall asleep, especially if things have Patient strengths: been busy at work and someone ‘went bad. At that time, she “bounced into work” looking fresh each morning, and her features were always animated. Pretend that you are performing a nursing the “brightness” that was so characteristic assessment of this patient after the plan of of her earlier is strikingly absent. 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. Somatic pain endings that are involved in fast-conducting, acute, well-localized pain include which of c. The highest level of integration of sensory which of the following facts about pain? A patient who recently underwent amputation patient to see whether the pain is manu- of a leg complains of pain in the amputated factured or psychogenic before starting part. The pain cannot exist because the leg has istence and nature of her pain, and pain been amputated. Encourage the use of nondrug complemen- tary therapies as adjuncts to the medical 7. Increase and decrease the serum level of without any preparation can be explained by the analgesic as needed. Which of the following groups of opioids are produced at neural synapses at various points d. A patient complains of severe pain following does not mean the pain is a result of an a mastectomy. Your patient is experiencing acute pain but cannot vocalize this pain, which of the following the amputation of a limb. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. After sedating a patient, you assess that he is frequently drowsy and drifts off during con- c. What number on the sedation that sends additional pain stimuli to the scale would best describe your patient’s seda- central nervous system. Which of the following are accurate Multiple Response Questions descriptors of the gate control theory? Which of the following are characteristics of tatory pain stimuli away from the brain. Which of the following statements accurately be processed by the nervous system at any describe the nature of the pain experience? Patients are able to describe chronic pain through the nervous system, cells in the because it is generally localized. Pain that is resistant to therapy is referred person’s interpretation of the pain. Pain in people whose tissue injury is of a stimulus that causes the subject to rec- nonprogressive or healed is termed chronic ognize pain. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Pain that is resistant to therapy and per- sists despite a variety of interventions c. A patient who experiences acute pain following a noxious stimulus is experiencing 6. Pain that is diffuse or scattered and orig- inates in tendons, ligaments, bones, pain. Superficial pain that usually involves the localized following abdominal surgery is most skin or subcutaneous tissue likely experiencing pain. A person who experiences a “head rush” from eating ice cream too fast is experiencing originates in body organs, the thorax,. Pain that is perceived in an area distant arm following a myocardial infarction is from its point of origin experiencing pain. Somatic pain Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A noninvasive alternative technique infarction that involves electrical stimulation of 13. Pain associated with a knee injury large-diameter fibers to inhibit the trans- mission of painful impulses carried over 14. Pain associated with a gash in the skin subconscious condition by means of suggestion 17. Pain associated with ulcers signal to help the patient learn by trial Match the term for nonpharmacologic pain and error to control the supposedly relief listed in Part A with its definition listed involuntary body mechanisms that may in Part B. Hypnosis iologic, and affective responses to pain that you might observe in these patients: g. Involves using one’s hands to consciously cesarean birth 2 days ago and is using her direct an energy exchange from the prac- call light to request something for her inci- titioner to the patient sional pain. Involves four elements: assuming a com- history of degenerative joint disease and fortable position with the body in good tells you this is a “bad morning” for his alignment, being in quiet surroundings, joints: “I think the weather must be repeating certain words, and adopting a affecting my arthritis. Requires the patient to focus attention on something other than the pain Situation C: 23. An example of mind–body interaction Situation D: used to decrease pain that involves one or all of the senses and focusing on a mental picture Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Give an example of how the following factors the threshold of pain has been reached and may influence a patient’s pain experience. List two experiences you have had with pain an example of each from your own experience management for patients. Which pain control measures were most effective, and what could you have done differently to b. Intractable pain: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Describe how you would respond to a patient who tells you the following about his/her pain experience.

Various tilting and turning beds have been developed for spinal injury units (Waterlow 1995) discount dilantin 100 mg overnight delivery 5 asa medications. Kinetic therapy can assist ventilation (see Chapter 27) dilantin 100mg line medications gout, and also prevent pressure sores; it enables rotation through 124° purchase dilantin 100 mg without prescription medications names, but hard mattresses and pressure from straps can often cause cheap 100mg dilantin visa medicine 257, rather than heal, sores (Dobson et al. Fluidized silicone beds have proved popular in many units, although difficulties in maintaining upright positions are frequently identified by nurses. The beds are useful for patients with burns (Waterlow 1995) or large exposed wounds as they enable drainage of exudate; this can prevent the need for traumatic dressings. With the choice of commercial aids available, improvised aids are best avoided in view of the increasing levels of litigation and the professional individual accountability of nurses. For example, latex gloves filled with water can easily be overfilled (Waterlow 1995), thus exerting excessive (unmonitored) pressure on a single concave point and exposing patients’ heels to greater pressure than if left on hospital mattresses. Although talc dries perspiration and masks odours, so providing comfort and reducing the risk of breakdown from dampness, some patients are allergic to it. Waterlow recommends gel, head and elbow pads and 30° tilts for pillows (Waterlow 1995). Skincare 109 Cost Pressure sores increase ■ human suffering ■ recovery time (1,000 kcal may be needed each day to replace exudate protein loss and promote healing) ■ mortality ■ financial costs (prolonged stay, additional treatments, litigation). The cost of treating just one severe pressure sore can be £40,000 (Waterlow 1995). Tingle (1997a) cites costs ranging between £4,500 and £12,500 in recent cases where pressures sores contributed to mortality, but no records exist of nursing pressure area assessment. Necrotising fasciitis Necrotising fasciitis, an extension of cellulitis, is caused by aerobic and anaerobic soft tissue infection (Neal 1994). Necrotising fasciitis usually follows minor trauma or surgery (Neal 1994), beginning as cellulitis unresponsive to antibiotics. Tissue necrosis causes gas production (hydrogen, methane, hydrogen sulphide, nitrogen) and putrid discharge (Neal 1994)—although purely streptococcal infections have no odour (Neal 1994). The smell (and grey colour) of rotting flesh, distressing enough for staff, will probably cause profound anxiety to patients and visitors. Air fresheners can help mask the smell, although chemicals should not be allowed to enter exposed wounds. Gross swelling of flesh (oedematous) may make patients almost unrecognisable so that visitors need to be carefully prepared. Early stages of the disease are acutely painful (Neal 1994), but with progressive destruction of superficial nerve endings the later stages are often painless (Lipman 1997). The culture of guilt surrounding pressure sores is unhelpful to everyone; despite good nursing, sores will occur, and so nurses should assess and minimise risk factors in order to reduce the incidence. Further reading General nursing journals frequently carry articles on skincare; some journals specialise in the topic; regular library scans can identify new material. Following up at least one article on the assessment scale used by your unit can identify its strengths and limitations. Waterlow (1995) is also worth reading, although it is now rather dated and also shows the expected bias for the author’s own scale. Clinical scenario Gorgina Okra was admitted to intensive care following a cholecystectomy for postoperative respiratory management. She has an abdominal wound drain (T-tube) with large absorbent wound dressing, urinary catheter and oral endotracheal tube. List Mrs Okra’s intrinsic and extrinsic risk factors for developing pressure sore; include sources and likely sites. Using some of the published or adapted pressure risk assessment tools with Mrs Okra, analyse her potential for developing skin damage. Q3 Appraise the benefits and limitations of using a pressure relieving static mattress Skincare 111 to those of a low air loss bed with Mrs Okra. Which would be best for her immediate care, longer-term recovery and prevention of skin pressure points? To achieve optimal results for staff, child and family, adult intensive care nurses should develop their knowledge and become familiar with specific equipment associated with caring for critically ill children. After describing the initial assessment, the effects of critical illness on major body systems are identified, and the implications for nursing care are drawn. Children are different Caring for critically ill children requires nurses who are more familiar with nursing adults to adapt their skills and knowledge. Children differ from adults in several important ways: physically, psychologically and emotionally they are immature. Because of this many illnesses and their complications are more likely to occur in children. Immature respiratory and cardiovascular systems provide less reserve function so that children often deteriorate more rapidly. Children have higher metabolic rates, resulting in ■ higher cardiac index ■ greater gas exchange ■ higher fluid intake per kilogram ■ greater calorie intake per kilogram. Any nurse caring for critically ill children should recognise signs of organ dysfunction and failure, and respond appropriately when deterioration occurs. Responsiveness Normal healthy infants make good eye contact, orientate to familiar faces and are visually attracted to bright colours. As illness progresses, all extremities may become flaccid and the child unresponsive. Children’s’ pulse and respiratory rates normally increase during stress and decrease during sleep (Table 13. Family, play, education and maintenance of routine become central considerations when nursing children. The way families respond to this disruption may drastically affect the sick child. In order to meet the needs of each family, these should be individually assessed by the nurse (Hazinski 1992). When children are admitted to intensive care, family members often feel frustrated about not being able to contribute to the child’s care and treatment. Allowing parents to remain with children and to help with care helps them to cope with this stressful situation, as well as providing the child with familiar and trusted people. Since parents know their children best, they should be allowed to participate in the care team; Cox (1992) emphasises the importance of partnership in care. Nurses can support families both by involving them in care and helping them to maintain home routine. As the family’s confidence grows, they may wish to take over more aspects of the child’s care. Although many of the effects on children are similar to those on adults, there are some important physiological differences. Neurological Evaluation of children’s level of consciousness is based largely on alertness, response to environment and parents, level of activity and their cry. Neurological evaluation resembles that of an adult (see Chapter 22), but with infants some reflexes (e. The immature respiratory system differs not only in size and anatomical position but, with growth of the thorax, lung mechanisms are altered. Many anatomical differences affect respiratory care: ■ Infants are obligatory nose breathers, with a longer epiglottis which may need to be lifted by a straight blade during intubation. Endotracheal tubes should allow a small leak while achieving adequate pulmonary inflation pressures. Paediatric artificial airways may quickly become obstructed by mucous, therefore humidification with an appropriate system is vital (Tibballs 1997). Artificial ventilation for children is similar to adults, but with less margin for error (Betit et al. Children below 10 kg are usually ventilated with pressure control cycles; volume cycles are used for larger children. Pressure control ventilation reduces barotrauma in the immature lungs of smaller children and compensates for the airleak from uncuffed tubes.

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While the (R) and (S)-system can be used to describe the absolute stereochemistry of amino acids generic dilantin 100 mg with visa treatment zinc poisoning, conventionally the D and L-system is more popular for amino acids generic 100 mg dilantin with amex medications given for adhd. A protein is made up of one or more polypeptide chains cheap dilantin 100 mg without prescription medicine norco, each of which consists of amino acids 100mg dilantin for sale symptoms detached retina. Instead of writing out complex formulae, sequences of amino acids are commonly written using the three- or one-letter codes e. The ends of a peptide are labelled as the amino end or amino terminus, and the carboxy end or carboxy terminus. It is the structure of the R group (side chain) that determines the identity of an amino acid and its special properties. The side chain (R group), depending on the functional groups, can be aliphatic, aromatic, acidic, basic, hydroxylic, sulphur containing or amidic (containing amide group). However, proline has an unusual ring structure, where the side chain is bonded at its terminus to the main chain nitrogen. For amino acids, a zwitterionic structure is possible because the basic amino group can accept a proton and the acidic carboxylic group can donate a proton. However, many higher animals are deficient in their ability to synthesize all of the amino acids they need for their proteins. Human beings also must include in their diet adequate amounts of eight different amino acids, which they cannot synthesize in their body. The eight essential amino acids are valine, leucine, isoleucine, phenylalanine, tryptophan, threonine, methionine and lysine. Sometimes, arginine and histidine are also included in the category of essential amino acids. Several amino acids can be classified as glucogenic and ketogenic because of their degradation products. Amino acids that are converted to glucose or glycogen are called glucogenic amino acids. Alanine, arginine, asparagine, cysteine, glutamine, glycine, histidine, hydroxyproline, methionine, proline, serine and valine are glucogenic amino acids. Amino acids that give rise to ketone bodies (acetylCoA or acetoacetyl- CoA, neither of which can bring about net glucose production) are called ketogenic amino acids. However, the liver is the major site of metabolism of nitrogenous compounds in the body. Digestion of dietary proteins produces amino acids, which are absorbed through epithelial cells and enter the blood. In our bodies, amino acids are used for the synthesis of proteins and other nitrogen-containing compounds, or they are oxidized to produce energy. Cellular proteins, hormones (thyroxine, epinephrine and insulin), neuro- transmitters, creatine phosphate, the haem of haemoglobin, cytochrome, melanin (skin pigment) and nucleic acid bases (purine and pyrimidine) are examples of amino-acid-derived nitrogen-containing biologically important group of compounds found in humans. The high melting points and greater water solubility than in ether are saltlike characteristics, not the characteristics of uncharged organic molecules. Water is the best solvent for most amino acids because it solvates ionic groups much as it solvates the ions of a salt. A large dipole moment is characteristic of zwitterionic compounds that contain great deal of separated charge. The pKa values for amino acids are also typical of zwitterionic forms of neutral molecules. The process that separates proteins according to their isoelectric point is called isoelectric focusing. At a pH below the pI proteins carry a net positive charge, whereas above the pI they carry a net negative charge. Appling this principle, gel electrophoretic methods have been developed to separate proteins. If the pH of the buffer is above the pI of the protein being run, the protein will migrate to the positive pole (negative charge is attracted to a positive pole). Similarly, if the pH of the buffer is below the pI of the protein being run, the protein will migrate to the negative pole of the gel (positive charge is attracted to the negative pole). If the protein is run with a buffer pH that is equal to the pI, it will not migrate at all. A drug’s pharmacological activity is inherently related to its chemical struc- ture. Various functional groups present in the drug molecules are involved in the drug–receptor binding or interaction. For example, drugs containing hydroxyl or amino groups tend to be involved in hydrogen bonding with the receptor. The activity can be a pharmacological response, binding, toxicity or any other quantifiable event. These essential functional groups for the pharmacological activities are called pharmacophores. A number of approved drugs have also been forced to be withdrawn from the market beacuse of toxicities. For example, in 2004, Merck’s arthritis drug Vioxx was withdrawn owing to severe cardiovascular side-effects, and the Parke-Davis and Warner-Lambert antidiabetic drug troglitazone (Rezulin) was withdrawn from the market in 2000 after it was found to cause severe liver toxicity. The drug industries expend considerable time and effort trying to avoid or minimize toxic effects by identifying and altering the functional groups responsible for toxic effects. A change in functional groups leading to toxicty can be demonstrated by paracetamol toxicity. The sulpha drugs and the penicillin group of antibacterial agents can be the ideal examples for demonstrating the importance of functional groups in drug actions and effectiveness. In Chapter 6, you will also see how a small change in the functional group(s) of steroidal molecules can render remarkable changes in their pharmacological and hormonal functions. In addition, the following structural features have to be present in sulpha drugs for the optimum antibacterial activity. As result, it does not have any in vitro antibacterial activity, but in vivo Prontosil is converted via reduction of the ÀÀNÀÀÀÀNÀÀ linkage to its active metabolite sulphanilamide. They are generally more water soluble, and thus better absorbed and retained better, i. Penicillin G, the parent of all these antibiotics, was first isolated from a fungal species, Penicillium notatum. Since the discovery of this antibiotic, several modifications have been introduced to the parent structure in order to enhance the activity, increase the acid resistance, facilitate bioavailability 4. Penicillin G is rather a complex molecule, and possesses various types of functional group, e. All penicillins are susceptible to attack in acidic solution via intramole- cular attack of the amide carbonyl oxygen on the b-lactam carbonyl, leading to the complete destruction of the b-lactam ring, and thus the antibacterial activity. Similarly, penicillins are unstable in basic solution because of b- lactam ring opening by free basic nucleophiles. Thus, for the antibacterial activity, the stability of the b-lactam functional group in penicillins is of paramount importance. For example, the amino group of amoxicillin and ampicillin makes these molecules acid stable. For example, the amino group in amoxicillin gives the molecule polarity, and makes it effective against both Gram-positive and Gram-negative bacteria. A bulky group directly adjacent to the amide carbonyl will prevent the penicillin from entering the active site of penicillin-destroying enzymes, e. For example, methicillin has a bulky group directly adjacent to the amide carbonyl, and is b-lactamase resistance.

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