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By N. Yussuf. Southern Oregon University.

Referred pain can be transmitted to a cutaneous site capable of comparing the strength of excitatory different from where it originated because afferent and inhibitory signals entering this region to neurons enter the spinal cord at the same level as the determine which impulses will travel toward cutaneous site to which the pain has been referred buy lasix 40mg with amex. When too much information arrives Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins discount lasix 40mg visa. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Answers will vary with the student’s experiences believed to interrupt the signal, closing the gate. Acute pain: Generally rapid in onset, varying in suspects a plot to trick him/her into feeling better, intensity from mild to severe, and lasting from a the patient is unlikely to respect or appreciate the brief period up to 6 months (e. A patient with a cognitive impairment: Many interferes with normal functioning (e. Intractable pain: Pain that is resistant to therapy nurses must rely on their own careful assess- and persists despite a variety of interventions ments, their empathetic qualities, and the 6. Culture: In one culture, it may be acceptable to pain if a verbal patient usually reports this express pain vocally, whereas in another event as painful. Ethnicity: An Italian man may respond to pain expressions, body positions, crying, and physio- with cries, moans, complaints, and so on, logic responses. Communication with parents whereas an Irish man may be calm and unemo- or guardians is vital for accurate pain tional about his pain. Religious beliefs: In some religions, pain is limit their independence; boredom, loneliness, viewed as suffering and as a means of purifica- and depression may affect an older person’s per- tion to make up for individual or community ception of pain and willingness to report it. Anxiety and other stressors: Fear of the unknown may compound anxiety and aggravate pain. Potter’s symptoms are in pain or when the medication isn’t work- and pain history to determine what pharmaceutical ing anymore. What would be a successful outcome for this with cancer pain and other severe types of pain patient? What intellectual, technical, interpersonal, and/or tions and conscientiously assess any side effects. Duration of pain: “For how long have you been Intellectual: knowledge of the pain experience, pain experiencing this pain? Quantity and intensity of pain: “How frequently experience, such as stress and fatigue do you get these attacks? On a scale of 1 to 10, Interpersonal: ability to communicate and interact how would you rate the intensity of this pain? Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Several nurses have expressed great Multiple Response Questions frustration caring for Tabitha because they find it 1. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Nitrogen balance is a comparison between catabo- the decrease in growth is dramatic. Mobility, lism and anabolism and can be measured by com- autonomy, and coordination increase, as do paring nitrogen intake and nitrogen excretion. This age group When catabolism and anabolism are occurring at develops an attitude toward food. Appetite the same rate, as in healthy adults, the body is in a decreases and becomes erratic. Weight consciousness becomes bonds are broken, carbons can bind with addi- compulsive in 1 of 100 teenage girls and results tional hydrogen atoms. Smoking, alcohol abuse, and long-term use of support growth and maintain maternal homeo- certain medications stasis, particularly during the second and third c. Nutritional and physical activity and loss of lean body needs per unit of body weight are greater than mass, energy expenditure decreases. Carbohydrates Supply energy (4 cal/g); also spares protein, 50%–60% helps burn fat efficiently, and prevents ketosis b. Proteins Maintain body tissues; support new tissue 10%–20% growth; component of body framework c. Fats Important component of cell membranes; Saturated 10% synthesis of bile acids; precursor of steroid Unsaturated 35% hormones and vitamin D; most concentrated source of energy (9 cal/g); aids in absorption of fat-soluble vitamins; provides insulation, structure, and body temperature control. Water Essential for all biochemical reactions; participates 2,000–3,000 mL/day in many biochemical reactions; helps regulate body temperature, helps lubricate body joints; needed for adequate mucous secretions Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Anorexia nervosa: Characterized by denial of room temperature, such as clear liquids plus appetite and bizarre eating patterns; may result milk, plain frozen desserts, pasteurized eggs, in extremely dangerous amount of weight loss; cereal gruels; high-calorie, high-protein supple- can be fatal.

More ins in the colon or gastrointestinal tract discount 100 mg lasix fast delivery, and information is available at www buy discount lasix 40 mg on line. Face, lips, nail, and eye evaluations are Transcendental Meditation Practiced by 5 mil- also used in Ayurvedic diagnostic measures. Tonics may be served hot or people around the world have learned Transcen- cold, depending upon the ingredients, which may dental Meditation (160,000 in Britain), and the include honey, various juices, cloves, cinnamon, first published research on this technique appeared herbs, hot mustard powder, turmeric, cilantro, in 1970. It allows stress and tired- replace the services of a doctor in any way and ness to be released in a natural way, resulting in always advise people to follow the recommenda- greater energy, clarity, and enjoyment of life. As potential a result, more than 500 research and review papers • Reduction of stress covering a wide variety of physiological, psycho- logical, and sociological effects have been written. After Tran- • Improvement in the environment and creation scendental Meditation, individuals report feeling of world peace refreshed physically and mentally. The mind is • Reduction of hospital admissions and doctor visits calmer and more alert, thinking is clearer, and • Reduction of medical expenditure energy levels are increased. Those with busy schedules • Reduction of atherosclerosis (hardening of the note that Transcendental Meditation produces arteries) increased efficiency in activity; time is used more • Promotion of more positive health habits effectively. When mental and physical well-being • Decrease in cigarette, alcohol, and drug abuse are enhanced, personal relationships also improve; such improvement is a commonly reported and Maharishi’s Vedic Approach to Health is the name valued benefit of Transcendental Meditation. Instruction involves a standard seven-step changes have also been observed during Transcen- course given by qualified teachers who have dental Meditation. Taken together, these studies undergone an extensive and systematic training clearly distinguish the physiological characteristics of program, ensuring high professional standards Transcendental Meditation from those of sleep or worldwide. The most important contribution technique and recommend it to their patients, in a of Transcendental Meditation to health would number of cases the National Health Service has appear to be in primary prevention. Research in the paid for instruction in Transcendental Meditation United States examined health care utilization over when it has been recommended by a doctor. Tran- five consecutive years among 2000 people practicing scendental Meditation has many applications in the Transcendental Meditation, as compared to control field of health and supports the highest ideals of groups (from a total sample of 600,000) who were Transcendental Meditation 153 closely comparable with regard to age, gender, occu- Further analysis showed that Transcendental Med- pation, and health benefits. Over the five-year itation produced significant reductions in systolic period the Transcendental Meditation participants and diastolic blood pressure for men and women in consistently had fewer than half the number of doc- both high- and low-risk groups on six measures of tor visits and days in hospital when compared to hypertension risk: psychosocial stress, obesity, alco- controls. Of considerable interest was the fact that hol use, physical inactivity, dietary sodium-potas- the Transcendental Meditation group showed rela- sium ratio, and a composite measure of these risk tively little increase in need for health care with factors. Nonpharmacological methods are now rec- increasing age, whereas the opposite trend was ognized as crucial to therapy for hypertension, clearly seen in controls, as would usually be especially in patients below 60 years. Hospital admission rates for medical and the United States Joint National Committee on the surgical conditions were 60–70 percent lower in the Detection, Evaluation, and Treatment of High Transcendental Meditation group, with reductions Blood Pressure has recommended that nonphar- in all 17 disease categories studied. For example, macological, behavioral approaches “should be numbers of hospital admissions were 87 percent used both as definitive intervention and as an lower for diseases of the heart and blood vessels, 55 adjunct to pharmacologic therapy and should be percent lower for tumors, 73 percent lower for res- considered for all antihypertensive therapy. These findings include reduc- • Produces rapid, clinically significant blood pres- tions in high blood pressure; elevated cholesterol sure reductions levels; cigarette smoking, alcohol consumption, • Is distinctly more effective than other medita- and drug abuse; overweight; cardiovascular reac- tion and relaxation procedures tivity to stress; physiological and psychological • Is continued by a high proportion of subjects (in stress levels; and anxiety, depression, and hostility. Randomized con- in a wide range of populations trolled trials have found that Transcendental Medi- • Is effective in reducing high blood pressure both tation is significantly more effective in reducing when used as sole treatment and when used mild high blood pressure than any of the following: concurrently with medication a relaxation technique (progressive muscular relax- • Reduces high blood pressure in “real-life” envi- ation), a pseudomeditation procedure (which ronments outside the clinic attempted to imitate the Transcendental Meditation technique), or a “usual care” program consisting of • Is free of harmful side effects or adverse reactions advice on weight loss, salt restriction, exercise, and • Reduces other cardiovascular risk factors and reduced alcohol intake. Furthermore, Transcendental Meditation was more effective in after three years, all those who had learned Tran- reducing anxiety than other techniques (including scendental Meditation were still alive, in contrast progressive muscular relaxation, methods claimed to significantly lower survival rates for the other to induce a Relaxation Response, and other forms three groups and for the remaining inhabitants of of meditation). Meditation remained highly significant when only Individual health affects the collective health of the strongest and most rigorous studies were a society. A controlled, randomized study conducted at Harvard University found that elderly individuals tridoshas In Ayurvedic medicine the three body who learned Transcendental Meditation showed or constitutional types known as vata, pitta, and significantly greater improvements in a variety of kapha (Sanskrit terms). The doshas reveal many age-related aspects of mental and physical health characteristics and tendencies of an individual, and well-being than subjects taught other tech- who may be a combination of two or all the doshas. Those who Vata relates to the elements ether and air, pitta rep- learned a relaxation procedure that attempted to resents fire, and kapha corresponds to water and imitate Transcendental Meditation showed no earth. Most subjects prac- type and symptoms, Ayurvedic practitioners are ticing Transcendental Meditation rated their tech- able to diagnose illness or predisposition to illness. Various uses of urine may be of drinking, injecting, or externally applying one’s found in the following sources: the German ency- own urine as a treatment for certain ailments or as clopedia Johann Heinrich Zedler’s Grossen Vollstandi- a way of promoting health. Also called amaroli, gen Universallexikon of 1747; The Water of Life, by urine therapy is part of the yoga and tantra tradition John W. Armstrong (Saffron Walden, England: and is said to cleanse the body of impurities and Health Science Press, first edition 1944, 1990); encourage spiritual growth. Karlekar (Bombay, India: some claim are treatable with urine therapy are Shree Gajanan Book Depot Prakashan, 1969); Mir- asthma, flu, tuberculosis, toothache, allergies, heart acles of Urine Therapy, by Dr. Mithal (New disease, dysentery, edema, eye irritation, fatigue, Delhi, India: Pankaj Publications, 1978); Urine fever, smallpox, infertility, hepatitis, Kaposi’s sar- Therapy; Self-Healing through Intrinsic Medicine, by Dr. Color, odor, amount, others who espouse urine therapy say urine is ster- clarity, and other characteristics are observed while ile, has antiseptic properties, and contains harmless tests for acidity, alkalinity, toxins, microorganisms, and nourishing components, as opposed to its being proteins, and other measurements are performed a toxic end or waste product of digestion. Its avail- by adding a sample of urine to certain chemicals or ability and lack of cost are also factors enthusiasts substances and obtaining results.

This process is demon- A major concentration of nursing activity is to as- strated in the exemplar study reported here lasix 40 mg without prescription. Given the priority of this notion generic lasix 40 mg online, Roy fo- three categories to assess the potential of research cused efforts on further conceptual and empirical findings for use in practice: Category 1—high po- work to understand this human ability and nursing tential for implementation based on positive find- practice based on that understanding. This review Drawing from knowledge in the neurosciences, her showed the breadth and depth of the Roy model’s early theory development and research on the use in nursing research in qualitative and quantita- model, and her observations in neuroscience nurs- tive research and in instrument development stud- ing practice, Roy proposed a nursing model for ies, using populations of individuals and groups (of cognitive processing (Roy, 1988b, 2001). Cognitive all ages, both in health and in illness, and in all areas processes in human adaptation are described as fol- of nursing practice). A review of the next five years lows: input processes (arousal and attention, sensa- of research, including 57 identified studies, is un- tion and perception), central processes (coding, derway, along with a critique, examples, and rec- concept formation, memory, language), output ommendations for the use of instruments to processes (planning and motor responses), and measure concepts of the Roy Adaptation Model emotion. Through these cognitive processes, adap- (visit the Roy Adaptation Association Web site at: tive responses occur. Taylor (1983), in a study of cancer patients, pro- posed a related theory of cognitive adaptation. Finally, Factor 5, knowing and relat- adaptation, in which individuals make cognitive ing, had eight items whose loadings ranged from. This version of In developing a new instrument, Roy sought to the scale was used in the research exemplar de- address issues in the measurement of coping as scribed in this chapter. The items retained were in- identified by Aldwin (1994) and Schwarzer & clusive of the inferred coping strategies, and the Schwarzer (1996). Further, it was important to have categories were derived from the nursing model for a tool that is useful for nursing assessment and in- cognitive processing. Based on the cognator subsystem of the was based on both the strong theoretical-empirical grand theory, Roy developed a middle-range theory basis for its development and the review by content of Coping and Adaptation Processing (Roy & experts. At that time, Roy gies within these categories were generated by pa- termed these five factors (1) cognitive processing of tient interviews and nursing care plans based on the self-perception, (2) clear focus and method, (3) Roy model, as well as by deductively derived cate- knowing awareness, (4) sensory regulation, and (5) gories of information processing, with related pa- selective focus. The scores on this version of the tient observations to identify related strategies. It serves to sig- The psychometric properties were established nal needs for cognitive efforts, to help the person to with a data set that included 349 subjects from non- attend, and to interfere with cognition. Examples of probability purposive samples from national mail- items were “keep in touch with emotions,” “put ing lists of patient support groups for persons with things into perspective,” “rechannel feelings,” and long-term neurologic deficits. It involves Thai patients with acute illnesses from three hospi- systematic thinking. Factor 1, resourceful and be viewed in part as a process in which people clas- focused, contained 10 items with factor loadings sify the problem, organize information to accom- ranging from. Factor 2, physical and fixed, had 14 risks of their efforts to their self-structure (Das, items with factor loadings from. Factor 3, alert process requires knowledge of the adaptation en- processing, had nine items with loadings from. Lecky (1961) proposed the Theory ing awareness involves retrieving information from of Self-consistency to conceptualize a person as a one’s mind and recognizing what has worked for holistic and consistent structure. It can be viewed as a self- Self-consistency Theory is that people are moti- regulating process (Carver & Scheier, 1991). The vated to act in a way that is congruent with their overall function of such cognitive processing is to sense of self and thereby maintain intactness when minimize discrepancies between a desirable sense facing potentially challenging situations. It includes tain self-consistency in the transaction between the cognitive input processing of receiving, analyzing, person and the environment (Elliot, 1986, 1988; storing, memory, successive processing, and Lecky, 1961; Rogers, 1961; Roy & Roberts, 1981), arousal-attention (Roy, 1988b, 2001). Example one initiates cognitive and emotional responses items were “gather information,”“recall past strate- (Roy & Andrews, 1991). Examples of items in- clude “try to maintain balance,” “change physical activity,” “picture actions,” and “share concerns to maintain health. Klarkowska, 1987; Ahan and Zhan, 1994) report Some examples of items were “useful to focus,” that older persons with greater self-consistency had “tend not to blame self,”“get away by self,” and “put more positive levels of well-being. Internal con- changes in aging than did those who had less con- sistency reliability of these five subscales ranged sistency of self-perceptions. Their find- individual has two subareas: the physical self and ings suggested that the older people who had a the personal self. The physical self includes two stability of self-concept coped well in stressful en- components: body sensation and body image; and counters. Therefore, the critical task for older the personal self has three components: selfconsis- tency, self-ideal, and moral-ethical-spiritual self. The critical task for older people is to Conceptual Development maintain self-consistency by transcending internal and external losses in the aging Self-consistency was introduced during the devel- process. These authors noted that people strive to maintain a consistent people is to maintain self-consistency by transcend- self-organization and thus avoid disequilibrium ing internal and external losses in the aging process. An example of a reverse-scored item Roy & Andrews, 1991; Wylie, 1989), Zhan devel- was: “I feel mixed up about what I am really like. Therefore, self-perception and self- a score range from 51 to 104, a mean total score of evaluation are consciously available and can be 85. High social within human development are the physical anxiety leads to less self-consistency (Elliot, 1986).

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