By O. Jaroll. Mount Holyoke College. 2018.
A nurse explores with a patient the Match the type of spiritual distress listed in importance of learning to accept Part A with the appropriate example listed in himself zithromax 100mg otc, even with his faults zithromax 500 mg with mastercard. A Roman Catholic college student stops her relationship with her family and going to Mass on Sundays and moves in identify the origin of negative beliefs with her boyfriend; she tells you purchase zithromax 250 mg on line, “I really about people discount 100mg zithromax visa. A woman cannot accept the death of her newborn and says buy zithromax 250mg with visa, “How long will it hurt 1. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A family who insists on care deemed med- ically futile for a terminally ill patient b. Christian Scientist parents of a child need- ing an appendectomy who refuse to sign a consent form for surgery: b. Give two examples of practices associated with healthcare that may have religious signiﬁcance to a patient. As a source of strength and healing: statement you might use to assess a patient for the following types of spiritual distress. Give an example of how the following factors may inﬂuence a person’s spirituality. Life events: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. She tells you she these beliefs inﬂuence the way you carry on believes God has abandoned her and her your daily routine in life? In what Suggest a nursing diagnosis for this patient ways might they affect the way you react to and develop a nursing care plan that includes patients of different faiths? Scenario: Margot Zeuner, a 75-year-old woman, is taking care of her 80-year-old hus- 11. Develop a prayer expressing a patient’s needs band with advanced Alzheimer’s disease, who that could be used for a patient facing was just discharged from the hospital and surgery. When visited at home, she says, “I really miss going to church and seeing everyone. How might the nurse use blended nursing skills to provide holistic, competent nursing b. What intellectual, technical, interpersonal, and/or ethical/legal competencies are most likely to bring about the desired outcome? What resources might be helpful for you to pray with them for their child’s recov- Mrs. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. I guess there’s a whole lot more to Read the following patient care study and use life, and maybe this was my invitation to sort your nursing process skills to answer the out my priorities. Identify pertinent patient data by placing a Scenario: Jeffrey Stein, a 31-year-old attorney, single underline beneath the objective data in is in a step-down unit following his transfer the patient care study and a double underline from the cardiac care unit, where he was beneath the subjective data. During his second night in the strengths you hope to draw upon as you assist step-down unit, he is unable to sleep and tells this patient to better health. Pretend that you are performing a nursing I celebrate the holidays, but that’s about all. If assessment of this patient after the plan of there is a God, I wonder what He thinks about care is implemented. 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. Nursing is respecting individual differences Prioritization Questions through unconditional acceptance, ensuring 1. Promoting health: The nurse prepares the patient for tests, explaining each test thoroughly to the 2. Cognitive skills: A nurse selects nursing the technology to give safe, individualized interventions to promote wound healing.
These essential functional groups for the pharmacological activities are called pharmacophores 100mg zithromax overnight delivery. A number of approved drugs have also been forced to be withdrawn from the market beacuse of toxicities purchase 250 mg zithromax with amex. For example zithromax 100 mg line, in 2004 buy discount zithromax 250mg on line, Merck’s arthritis drug Vioxx was withdrawn owing to severe cardiovascular side-effects purchase zithromax 250mg with visa, 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. For example, the enzymatic breakdown of the analgesic acet- aminophen (paracetamol), where the aromatic nature and the hydroxyl functionality in paracetamol are lost, yields N-acetyl-p-benzoquinone imine, a hepatotoxic agent. Paracetamol can cause liver damage and even liver failure, especially when combined with alcohol. Similarly, many drug molecules are susceptible to oxidation because of certain oxidizable func- tional groups, e. Like any other proteins in the gastrointestinal tract, insulin is reduced to its amino acid components, and the activity is totally lost. Many drugs having oleﬁnic double bonds exhibit trans–cis isomerism in the presence of light. Similarly, because of the presence of certain functional groups or the chemical structure, a drug can be sensitive to heat. Addition reactions Addition means two systems Alkenes, alkynes, aldehydes combine to a single entity. Elimination reactions Elimination refers to the loss Alcohols, alkyl halides and of water, hydrogen halide or alkyl dihalides. Substitution reactions Substitution implies that one Alkyl halides, alcohols, group replaces the other. Alkene, alkyne, aldehydes, ketones, alkyl halides, nitriles, carboxylic acid and its derivatives, and benzene and its derivatives. Pericyclic reactions Concerted reaction that takes Conjugated dienes and place as a result of a cyclic a,b-unsaturated carbonyl rearrangement of electrons. So their chemistry is very different from the chemistry of even-electron and electron-deﬁcient species, e.
The authors suggested that the results from this study provide insights into the development of successful national campaigns to promote exercise behaviour that involve a minimal and cheap intervention and argued for an emphasis on unsupervised individual exercising discount 100mg zithromax mastercard. Other factors that appear to play a role in developing successful exercise programmes are the use of behavioural contracts generic zithromax 250 mg otc, whereby the individual signs a contract with an instructor agreeing to participate in a programme for a set period of time (e zithromax 500 mg amex. Oldridge and Jones 1983) and the use of instructor praise and feedback and ﬂexible goal-setting by the subject (e purchase 500 mg zithromax overnight delivery. These factors involve supervised exercise and suggest that individualized exercise programmes may not be the only form of intervention purchase zithromax 500mg mastercard. The social/political climate therefore has implications for predicting and promoting exercise. However, even if councils provide the facilities and government programmes are established, individuals have to make decisions about whether or not to par- ticipate. Research has, therefore, also examined the individual predictors of exercise behaviour. Individual predictors of exercise Dishman and colleagues (Dishman 1982; Dishman and Gettman 1980) carried out a series of studies to examine the best individual predictors of exercise and suggested that these factors can be deﬁned as either non-modiﬁable or modiﬁable. Non-modiﬁable predictors of exercise Dishman (1982) reported that non-modiﬁable factors such as age, education, smoking, ease of access to facilities, body fat/weight and self-motivation were good predictors of exercise. The results of a prospective study indicated that the best predictors of exercise behaviour were low body fat, low weight and high self-motivation (Dishman and Gettman 1980). However, whether factors such as access to facilities and self-motivation should be regarded as non-modiﬁable is problematic. They described the proﬁle of an active individual as younger, better educated, more aﬄuent and more likely to be male. However, it is possible that other individuals (less aﬄuent/less educated) may be more active at work. Several studies indicate that blacks are less active than whites, that black women are especially less active and that these diﬀerences persist even when income and education are controlled (e. The role of attitudes and beliefs Research has examined the role of attitudes and beliefs in predicting exercise. Cross-sectional research examines the relationships between variables that co-occur, whereas prospective research attempts to predict future behaviour. Cross-sectional research This type of research indicates a role for the following beliefs and attitudes: s Perceived social beneﬁts of exercise. Research examining the predictors of exercise behaviour consistently suggests that the main factors motivating exercise are the beliefs that it is enjoyable and provides social contact. In a cross-sectional study examining the diﬀerences in attitude between joggers and non-joggers, the non- joggers reported beliefs that exercise required too much discipline, too much time, they did not believe in the positive eﬀects of jogging and reported a lower belief that signiﬁcant others valued regular jogging (Riddle 1980). In support of this, the non- joggers in the study by Riddle (1980) also reported a lower value on good health than the joggers. Exercisers have also been shown to diﬀer from non-exercisers in their beliefs about the beneﬁts of exercise. For example, a study of older women (aged 60–89 years) indicated that exercisers reported a higher rating for the health value of exercise, reported greater enjoyment of exercise, rated their discomfort from exer- cise as lower and perceived exercise programmes to be more easily available than non-exercisers (Paxton et al. They developed a questionnaire entitled the ‘Temptation to not exercise scale’ which measured two forms of barriers ‘aﬀect’ and ‘competing demands’. The answers include ‘when I am angry’ and ‘when I am satisﬁed’ to reﬂect ‘aﬀect’ and ‘when I feel lazy’ and ‘when I am busy’ to reﬂect competing interests. The authors argue that such temptations are central to understanding exercise uptake and should be used alongside the stages of change model. Prospective research This has examined which factors predict the uptake of exercise. It has often been carried out in the context of the development of exercise programmes and studies of adherence to these programmes. The results indicated that exercise self-eﬃcacy, attitudes to exercise and health knowledge were the best pre- dictors. They concluded that having realistic aims and an understanding of the possible outcomes of a brief exercise programme were predictive of adherence to the programme.
Necrotising fasciitis Necrotising fasciitis cheap 250 mg zithromax, an extension of cellulitis zithromax 500mg cheap, is caused by aerobic and anaerobic soft tissue infection (Neal 1994) zithromax 250mg generic. Necrotising fasciitis usually follows minor trauma or surgery (Neal 1994) order zithromax 250 mg with amex, beginning as cellulitis unresponsive to antibiotics zithromax 100mg online. 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.
Sleep Disorders: Problems in Sleeping  According to a recent poll (National Sleep Foundation discount 500mg zithromax otc, 2009) order zithromax 100 mg otc, about one-fourth of American adults say they get a good night‘s sleep only a few nights a month or less generic zithromax 250 mg online. These people are suffering from a sleep disorder known asinsomnia buy zithromax 250mg with amex, defined as persistent difficulty falling or staying asleep generic zithromax 500 mg fast delivery. Most cases of insomnia are temporary, lasting from a few days to several weeks, but in some cases insomnia can last for years. Insomnia can result from physical disorders such as pain due to injury or illness, or from psychological problems such as stress, financial worries, or relationship difficulties. Changes in sleep patterns, such as jet lag, changes in work shift, or even the movement to or from daylight savings time can produce insomnia. Sometimes the sleep that the insomniac does get is disturbed and nonrestorative, and the lack of quality sleep produces impairment of functioning during the day. Ironically, the problem may be compounded by people’s anxiety over insomnia itself: Their fear of being unable to sleep may wind up keeping them awake. Barbiturates, benzodiazepines, and other sedatives are frequently marketed and prescribed as sleep aids, but they may interrupt the natural stages of the sleep cycle, and in the end are likely to do more harm than good. Most practitioners of sleep medicine today recommend making environmental and scheduling changes first, followed by therapy for underlying problems, with pharmacological remedies used only as a last resort. Another common sleep problem is sleep apnea, a sleep disorder characterized by pauses in breathing that last at least 10 seconds during sleep(Morgenthaler, Kagramanov, Hanak, &  Decker, 2006). In addition to preventing restorative sleep, sleep apnea can also cause high  blood pressure and may raise the risk of stroke and heart attack (Yaggi et al. Most sleep apnea is caused by an obstruction of the walls of the throat that occurs when we fall asleep. It is most common in obese or older individuals who have lost muscle tone and is particularly common in men. Sleep apnea caused by obstructions is usually treated with an air machine that uses a mask to create a continuous pressure that prevents the airway from Attributed to Charles Stangor Saylor. If all other treatments have failed, sleep apnea may be treated with surgery to open the airway. Narcolepsy is a disorder characterized by extreme daytime sleepiness with frequent episodes of “nodding off. It is estimated that at least 200,000 Americans suffer from narcolepsy, although only about a quarter of these people  have been diagnosed (National Heart, Lung, and Blood Institute, 2008). Narcolepsy is in part the result of genetics—people who suffer from the disease lack  neurotransmitters that are important in keeping us alert (Taheri, Zeitzer, & Mignot, 2002) — and is also the result of a lack of deep sleep. Narcolepsy can be treated with stimulants, such as amphetamines, to counteract the daytime sleepiness, or with antidepressants to treat a presumed underlying depression. However, since these drugs further disrupt already-abnormal sleep cycles, these approaches may, in the long run, make the problem worse. Many sufferers find relief by taking a number of planned short naps during the day, and some individuals may find it easier to work in jobs that allow them to sleep during the day and work at night. Other sleep disorders occur when cognitive or motor processes that should be turned off or reduced in magnitude during sleep operate at higher than normal levels (Mahowald & Schenck,  2000). One example is somnamulism(sleepwalking), in which the person leaves the bed and moves around while still asleep. Sleepwalking is more common in childhood, with the most frequent occurrences around the age of 12 years. In extreme cases, sleep terrors may result in bodily harm or property damage as the sufferer moves about abruptly. Up to 3% of adults suffer from sleep terrors, which typically  occur in sleep stage N3 (Mahowald & Schenck, 2000). Other sleep disorders include bruxism, in which the sufferer grinds his teeth during sleep; restless legs syndrome, in which the sufferer reports an itching, burning, or otherwise uncomfortable feeling in his legs, usually exacerbated when resting or asleep; and periodic limb movement disorder, which involves sudden involuntary movement of limbs. The latter can cause sleep disruption and injury for both the sufferer and bed partner. As their actions may injure themselves or their sleeping partners, this disorder, thought to be neurological in nature, is normally treated with hypnosis and medications. The Heavy Costs of Not Sleeping Our preferred sleep times and our sleep requirements vary throughout our life cycle. Newborns tend to sleep between 16 and 18 hours per day, preschoolers tend to sleep between 10 and 12 hours per day, school-aged children and teenagers usually prefer at least 9 hours of sleep per night, and most adults say that they require 7 to 8 hours per night (Mercer, Merritt, & Cowell,  1998; National Sleep Foundation, 2008).
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