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By H. Larson. Eastern Oregon University.

Damage to the optic nerve occurs slowly and is painless buy dutas 0.5 mg visa hair loss in men 80s costumes, so visual loss may occur without symptoms cheap dutas 0.5mg free shipping hair loss in men going. This can result from a narrow drainage angle that you are born with discount dutas 0.5mg overnight delivery hair loss in menopause symptoms, or as a result of aging generic dutas 0.5mg on line hair loss in men xosbextliyi. Childhood glaucoma is an inherited form of the disease that is similar to open-angle glaucoma. There may not be any symptoms initially, but it leads to blindness if left untreated. Congenital glaucoma appears soon after birth and causes noticeable signs, including tearing, light sensitivity, and cloudiness of the cornea. In the early stages, if there is no damage to the optic nerve, your doctor may just G recommend more frequent exams to monitor any changes. If you have glau- coma, minimize coffee, pop, tea, and other caffeinated beverages. Top Recommended Supplements Note: Supplements may be used in conjunction with prescribed therapies under doctor’s supervision. G Ginkgo biloba: One study found that ginkgo can improve vision in those with glaucoma. Magnesium: Preliminary research suggests it may improve vision in those with glaucoma. Uric acid is a substance created by the breakdown of foods containing high amounts of purines, a component of protein found in organ meat, seafood, and fish. However, some people produce high amounts or are not able to eliminate it properly, leading to a buildup in the blood and the formation of uric acid crystals in the joints. Gout was once known as the “disease of kings” due to its association with consumption of rich foods and alcohol. They reduce pain and inflammation and work within 12–24 hours, but may cause side effects, including upset stomach, bleeding stomach, and ringing in the ears. Use only when absolutely necessary—the lowest dose for the short- est period of time. One of the oldest remedies for a gout attack is colchicine, which is derived from the herb autumn crocus. It can also be used for prevention, but is limited by unpleas- ant side effects, such as severe diarrhea and upset stomach. There are a number of drug interactions with allopurinol, so check with your phar- macist before taking new medications. However, certain lifestyle changes and nutritional supplements may help ease symptoms of an attack and prevent recurrences. Dietary Recommendations Foods to include: • Cherries (fresh, canned, or juice) help to reduce uric acid levels. Foods to avoid: • Organ meats (heart), sardines, herring, mackerel, mussels, and sweetbreads contain very high amounts of purines, which can substantially increase uric acid levels. However, if you have heart or kidney disease and are on fluid restriction, consult your doctor before changing fluid intake. Avoid foods highest in purines during an acute attack, and gradually resume eating these foods once symptoms disappear. Lifestyle Suggestions • Acupuncture helps to relieve pain and inflammation and promote relaxation. Avoid rapid weight loss or fast- G ing as this can raise uric acid levels and aggravate gout. Top Recommended Supplements Celadrin: Reduces joint pain and inflammation and also helps improve joint mobility. Higher amounts (4 g and higher) have been used to relieve an attack, but this should be done only under the supervision of a health care professional. Complementary Supplements Bromelain: An enzyme that helps reduce inflammation during an attack. Quercetin: A flavonoid that in preliminary studies was found to help prevent gout attacks. Eat gout-fighting foods such as cherries, berries, and pineapple; drink plenty of water. If left untreated, gum disease can lead to periodontitis, a very serious infection that destroys the soft tissue and bone that support your teeth, leading to tooth loss. Chronic periodontitis is very serious as it can lead to other health problems such as high blood sugar and increased risk of heart attack and stroke. In pregnant women it can affect the health of the un- born child and lead to premature babies. There are many factors that affect gum health such as smoking, heredity, and immune function. The disease starts with the formation of plaque on the teeth when starches and sugars in food interact with bacteria in the mouth, creating a sticky film on the teeth. Brushing and flossing help to reduce plaque formation, but it reforms quickly and any that is missed and stays on the teeth longer than two or three days can harden under the gum line into tartar. It cannot be eliminated G by brushing or flossing; only professional cleaning can eliminate this substance. In time this inflamma- tion causes pockets to develop between the gums and teeth that fill with more plaque, tartar, and bacteria. Over time the pockets become deeper and more bacteria accumu- late under the gum tissue, leading to loss of bone and tissue, and even tooth loss. With proper oral hygiene, regular dental cleaning, and a healthy diet and lifestyle, gum disease can be prevented. The sooner you seek care, the better your chances of reversing damage and preventing more serious problems. Tobacco use damages the immune system and creates a favourable environment for bacterial growth. Chewing tobacco and exposure to second-hand smoke can also increase risk of gum disease. If you have early-stage gum disease, your dentist may ask you to come in more frequently. Profes- sional cleaning and scaling can remove tartar and bacteria that can’t be accomplished with brushing or flossing. Root planing can be done to smooth the root surface and discourage further accumulation of tartar. For advanced periodontitis, you may be referred to a gum specialist called a peri- odontist, who can offer various treatments such as flap surgery (to reduce pockets), soft tissue or bone grafts, and tissue-regeneration procedures. Citrus, berries, peppers, and cantaloupe are good sources of vitamin C, which is used in the synthesis of collagen. Foods to avoid: • Refined, starchy carbohydrates (white bread/rice/pasta) and sugars (candy, sweets) stick on the teeth and lead to plaque and tartar formation. Lifestyle Suggestions • Brush your teeth after meals and at bedtime and floss daily. Replace your brush every three to four months or even more often if the bristles are worn down. Electric toothbrushes are very effective and may be helpful especially for those with arthritis or problems with dexterity. Use gentle pressure; the tips of the brush do the cleaning, so it isn’t necessary to use force.

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The patient and family shall accept need for experiencing anticipatory loss and use this knowl- help as appropriate and use available resources buy 0.5 mg dutas visa hair loss in men 70s fashion. In favor of: It is a beneficent and compassionate nurse must develop a trusting relationship with the act purchase 0.5 mg dutas mastercard hair loss cure 54. Malic vocalizes her fears for her will feel a subtle pressure to conform in order to baby and herself and lists the benefits of grief relieve the economic and emotional burdens counseling purchase dutas 0.5 mg line hair loss miracle cure. Comfort measures only: Nurses should be ships discount dutas 0.5mg on-line hair loss in men 80s clothes, even in times of great crisis related to antici- familiar with the forms used to indicate patient patory loss preferences about end-of-life care. The goal of a Ethical/Legal: commitment to safety and quality, comfort measures only order is to indicate that strong sense of responsibility and accountability, the goal of treatment is a comfortable, dignified and strong advocacy skills death and that further life-sustaining measures 4. Grief counseling, information on premature babies Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Although both LeRoy grieving process: denial, isolation, depression, and Michael “did the bathhouse scene” in the early anger, guilt, fear, rejection. Help Michael under- 1980s and had multiple unprotected sexual encoun- stand LeRoy’s grief and need to move in and out ters, they have been in a monogamous relationship of each stage at his own pace. He is enrolled in still denying that he is experiencing any difficulty a hospice program. LeRoy has been very supportive dealing with Michael’s impending death; appears of Michael throughout the different phases of his ill- fearful of even discussing this subject. He also says that he is “acting with Michael and desire to be present and support- strangely;” he seems emotionally withdrawn and ive is a powerful motivator for getting him to unusually uncommunicative. When the hos- Personal strengths: Knowledge about stages of grief pice nurse calls to arrange a meeting with LeRoy, and grief work; strong interpersonal skills; teaching LeRoy informs him that he is “managing quite and counseling skills well, thank you,” and that he has no concerns or 4. Nursing Process Worksheet He noted that he finally had a long talk with Health Problem: Anticipatory grieving Michael and can see that he hasn’t been able to Etiology: Inability to allow himself to think about deal with his dying in a conscious manner at all: “I what his life will be like without his life partner; guess I just kept hoping that if I didn’t think about history of using denial as a coping mechanism it, it wouldn’t happen. He also sion of stages of grieving and grief work, and says that he is “acting strangely” and that he seems appointment made for follow-up. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A stimulus, an agent, act, or other influence capa- meals could be prepared to stimulate taste; flowers, ble of initiating a response by the nervous system cards, and pictures could be displayed to stimulate b. Know the danger signals that indicate serious translate the impulse into a sensation. Visual: Read different types of books to the is at high risk for sensory deprivation. Olfactory: Have child identify different odors; patient who is confused cannot process prepare enticing meals and savor the aromas. Perceptual responses: Inaccurate perception of with different foods with varying colors, tastes, sights, sounds, tastes, smells, and body shapes, and textures; introduce finger foods position; poor coordination and equilibrium; into diet. Tactile: Use games and sports to increase body from daydreams to hallucinations contact with child; demonstrate affection by b. Cognitive responses: Inability to control the hugging, holding child in lap, and so on. Developmental considerations: The adult may memory, problem solving, and task performance experience the need to compensate for the loss c. Emotional responses: Inappropriate emotional of one type of stimulation by increasing other responses: apathy, anxiety, fear, anger, belliger- sources of sensory stimuli. Cultural care deprivation is a lack of culturally reception of sensory stimuli; medications that assistive, supportive, or facilitative acts (e. Infant: Soothing sounds, rocking, holding and sensory stimulation if the type of stimulation changing position, changing patterns of light present is developmentally appropriate. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Objective data are underlined; subjective data are in patients include confused patients and patients boldface. Assess the George Gibson, an 81-year-old, married, African patient’s abilities to transmit, perceive, and American man, reluctantly reports, after much prod- react to stimuli during everyday interactions. More and more, people just seem to be by name, and speak in a normal tone of voice. Hearing-impaired patients: Avoid excessive seated on the edge of his chair and bends toward noise, avoid excessive cleaning of ears, and you when you speak to him. Unconscious patients: Be careful of what is said room whenever people come to visit because he is in the patient’s presence, assume the person embarrassed by his inability to hear. Nursing Process Worksheet Health Problem: Sensory/perceptual alteration: Sample Answers auditory 1. What nursing interventions might be appropriate Etiology: Reluctance to accept that he has an for Mr. Therefore, attempts to deny hearing loss and attributes the nursing plan of care should include sensory problem to others who are “mumbling”; has greatly stimulation for Mr. The nurse reduced opportunities for conversation; has not should also investigate if hearing aids would help sought help until now Mr. The nurse should Expected Outcome: After medical evaluation of hear- assess both Mr. Pirolla and his wife to see how they ing loss and treatment, patient demonstrates better are coping with the changes in their social environ- coping skills by increasing amount of time he ment. The nurse should Nursing Interventions: incorporate knowledge of the guidelines for a. Explain that hearing loss often accompanies communicating both with persons with reduced aging and that a medical evaluation is important vision and hearing when developing a teaching to provide proper treatment. What would be a successful outcome for this tion skills and preventing social isolation. Pirolla states that he is adapting to hearing aid has enabled patient to comprehend his condition and receiving new sensory most one-to-one conversations, but ability to hear stimulation from his environment. What intellectual, technical, interpersonal, and/or gate possibility of learning to lip-read. No longer ethical/legal competencies are most likely to bring avoids company, especially if it is only one or two about the desired outcome? Patient strengths: Healthy until now; wife is support- and how the body responds, including sensoristasis ive; previous history of strong interactional skills and adaptation; ability to integrate knowledge of Personal strengths: Recognize significance of sensory alterations, including factors contributing sensory/perceptual alterations; able to distinguish to disturbed sensory perceptions changes in perceptual abilities normally related to Interpersonal: demonstration of the ability to aging from those indicating treatable medical prob- empathize and communicate with patients with lems; able to establish trusting relationship with sensory deficits and interact effectively with older patients patients and their caregivers. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Diabetes: Some men may be candidates for a revealed a partial sensorineural loss that was distort- penile prosthesis; pharmacologic management of ing his perception of certain frequencies; partially erectile dysfunction may be indicated. Cardiovascular disease: Teach gradual close to speaker, but in a one-to-one conversation, resumption of sexual activity, comfortable posi- his responses demonstrate his ability to correctly tion for affected partner. Loss of body part: Teach acceptance of body reports that he still has great difficulty listening in image. Spinal cord injury: Promote stimulation of other “more like his old self” when one or two friends erogenous zones. Female: The breasts of the woman swell and nip- ples become erect; vaginal lubricant seeps out of b c a d e body; upper two thirds of vagina expand; clitoris enlarges and emerges slightly from clitoral hood; 2. Male: Erection of the penis caused by increased c d e b a f congestion with blood; scrotum noticeably ele- vates, thickens, and enlarges. Chronic pain: Teach altered or modified deferens, and rectum; most often accompanied positions for coitus.

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This theory has been supported by some evidence of the relationship between negative mood and drinking behaviour (Violanti et al dutas 0.5 mg with mastercard hair loss in men valentine. Further- more generic dutas 0.5 mg line hair loss diabetes, it has been suggested that medical students’ lifestyle and the occurrence of problem drinking may be related to the stress they experience (Wolf and Kissling 1984) cheap dutas 0.5mg without a prescription hair loss young women. In one study discount 0.5mg dutas overnight delivery hair loss in men rain, this theory was tested experimentally and the health-related behaviours of medical students were evaluated both before and during a stressful examination period. The results showed that the students reported a deterioration in mood in terms of anx- iety and depression and changes in their behaviour in terms of decreases in exercise and food intake (Ogden and Mtandabari 1997). The authors concluded that acute exposure to stress resulted in negative changes in those behaviours that had only a minimal influence on the students’ ability to perform satisfactorily. Obviously chronic stress may have more damaging effects on longer-term changes in behaviour. Eating Diet can influence health either through changes in body weight or via the over or under consumption of specific dietary components (see Chapter 6). Most research has focused on the individual difference model and has examined whether either naturally occurring stress or laboratory- induced stress causes changes in eating in specific individuals. Therefore, gender, weight and levels of dieting (see Chapter 6) seem to be important predictors of a link between stress and eating. Their results showed a direct associ- ation between increased daily hassles and increased snacking but showed no differences according to either gender or dieting. Such inconsistencies in the literature have been described by Stone and Brownell (1994) as the ‘stress eating paradox’ to describe how at times stress causes overeating and in others it causes undereating without any clear pattern emerging. Exercise Exercise has been linked to health in term of its impact on body weight and via its beneficial effects on coronary heart disease (see Chapter 7). Accidents Accidents are a very common and rarely studied cause of injury or mortality. Research has also examined the effects of stress on accidents and correlational research suggests that individuals who experience high levels of stress show a greater tendency to perform behaviours that increase their chances of becoming injured (Wiebe and McCallum 1986). Further, Johnson (1986) has also suggested that stress increases accidents at home, at work and in the car. If this is the case then the stress following illness also has implications for the health of individuals. Such stress may influence individuals’ behaviour in terms of their likelihood to seek help, their compliance with interventions and medical recommendations, and also adopting healthy lifestyles. Therefore, stress may cause behaviour changes, which are related to the health status of the individual. Research indicates that stress causes physiological changes that have implications for promoting both the onset of illness and its progression. Stress and illness onset and progression Stress causes changes in both sympathetic activation (e. Sympathetic activation: The prolonged production of adrenalin and noradrenalin can result in: s blood clot formation; s increased blood pressure; s increased heart rate; s irregular heart beats; s fat deposits; s plaque formation; and s immuno suppression. These changes may increase the chances of heart disease, kidney disease and leave the body open to infection. These changes may increase the chances of infection, psychiatric problems and losses in memory and concentration. These physiological changes can be further understood in terms of Johnston’s chronic and acute model of the stress illness link (Johnston 2002). This results in ongoing wear and tear and the slower process of atherosclerosis and damage to the cardiovascular system. Acute stress operates primarily through changes in sympathetic activation with changes in heart rate and blood pressure. This can contribute to atherosclerosis and kidney disease but is also related to sudden changes such as heart attacks. So far the behavioural and physiological pathways have been presented as separate and discrete. Stress may cause changes in behaviours such as smoking and diet which impact upon health by changing the individual’s physiology. Likewise, stress may cause physiological changes such as raised blood pressure but this is often most apparent in those that also exhibit particularly unhealthy behaviours (Johnston 1989). Therefore, in reality, stress is linked to illness via a complex interaction between behavioural and physiological factors. Further, Johnston (1989) argued that these factors are multi- plicative, indicating that the more factors that are changed by stress the greater the chance that stress will lead to illness. To some extent this is due to the role of variables such as coping, control, personality and social support which are described in detail later on. However, research indicates that this variability is also due to individual differences in stress reactivity, stress recovery, the allostatic load and stress resistance. Stress reactivity Some individuals show a stronger physiological response to stress than others which is known as their level of ‘cardiovascular reactivity’ or ‘stress reactivity’. This means that when given the same level of stressor and regardless of their self perceived stress some people show greater sympathetic activation than others (e. Research suggests that greater stress reactivity may make people more susceptible to stress-related illnesses. For example, individuals with both hypertension and heart disease have higher levels of stress reactivity (e. However, these studies used a cross sectional design which raises the problem of causality. The results showed that stress and illness were not linked in the children with low reactivity but that those with higher reactivity showed more illness if they had experienced more stress. Everson and col- leagues (1997) also assessed baseline stress reactivity and explored cardiac health using echo cardiography at follow-up. The results showed that higher stress reactivity at base- line was predictive of arteriol deterioration after four years. In addition, stress reactivity has been suggested as the physiological mechanism behind the impact of coronary prone behaviours on the heart (Harbin 1989; Suarez et al. This doesn’t mean that individuals who show greater responses to stress are more likely to become ill. However, some people recover more quickly than others and some research indicates that this rate of recovery may relate to a susceptibility to stress-related illness. This is reflected in Seyle’s (1956) notion of ‘exhaustion’ and the general wear and tear caused by stress. Some research has focused particularly on changes in cortisol production suggesting that slower recovery from raised cortisol levels could be related to immune function and a susceptibility to infection and illness (e. Allostatic load McEwan and Stellar (1993) described the concept ‘allostatic load’ to reflect the wear and tear on the body which accumulates over time after exposure to repeated or chronic stress. They argued that the body’s physiological systems constantly fluctuate as the individual responds and recovers from stress, a state of allostasis, and that as time progresses recovery is less and less complete and the body is left increasingly depleted. Therefore if exposed to a new stressor the person is more likely to become ill if their allostatic load is quite high. Stress resistance To reflect the observation that not all individuals react to stressors in the same way, researchers developed the concept of stress resistance to emphasize how some people remain healthy even stressors occur (e. Stress resistance includes adaptive coping strategies, certain personality characteristic and social support. This perspective provides a scientific basis for the ‘mind over matter’, ‘think yourself well’ and ‘positive thinking, positive health’ approaches to life. The immune system The role of the immune system is to distinguish between the body and its invaders and to attack and protect the body from anything that is considered foreign.

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