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Antibiotics destroy both the good and bad bacteria order amitriptyline 10 mg otc depression nightmares, which can dis- turb the balance of your normal ﬂora in your intestine buy 25mg amitriptyline amex definition of depression in history, leading to overgrowth or potentially dangerous bacteria amitriptyline 50 mg otc depression test calm clinic, such as Clostridium difﬁcile, which can cause very serious diarrhea and requires medical treatment. If lactose intolerance is causing the diarrhea, you will be advised to avoid dairy products or to take lactase (enzyme needed to digest lactose) when eating dairy. There are over-the-counter anti-diarrheal medications, such as Imodium (loper- amide), which can help to slow the diarrhea. However, these drugs should not be used if you have infectious diarrhea as they can prevent your body from eliminating D the offending organism. One study of 41 infants with diarrhea found that carob powder (at a dose of 1 g per kilogram per day) signiﬁcantly improved resolution of diarrhea as compared to placebo. Teas containing chamomile or blackberry, blueberry, or red raspberry leaves can be helpful in alleviating diarrhea because these herbs contain tannins, which have astringent properties. As you start to feel better, eat foods that are nutritious and easy to digest, such as bananas, brown rice, and pota- toes. When your bowel movements have normalized, add more ﬁbre-rich foods back into your diet. Foods to avoid: • Caffeine, alcohol, and spicy foods (hot peppers) are too stimulating to the digestive tract. Fruit juices (especially apple and pear) are high in sugar and should be minimized until you have recovered. Signs of dehydration include excessive thirst, dry mouth or skin, little urination, severe weakness, dizziness or lightheadedness, or dark urine. Signs of dehydration in infants include dry mouth, crying without tears, unusual sleepiness, sunken eyes or cheeks, and skin that doesn’t ﬂatten if pinched and released. Top Recommended Supplements D Multivitamin and mineral complex: Persistent diarrhea can lead to deﬁciencies of vari- ous vitamins and minerals, and taking a multivitamin can help prevent deﬁciencies. Certain nutrients (such as folic acid and zinc) can promote healing of the intestine. Speak to your pharmacist or health adviser for a recommendation as products vary depending on age, activity level, lifestyle, and gender. Probiotics: Regular use of these beneﬁcial bacteria can help prevent traveller’s diarrhea and also help treat infectious diarrhea. Over 13 clinical studies have shown that probiotics can reduce the severity and duration of diarrhea and help prevent it from occurring. Look for a product that provides at least one billion live cells per dosage and is stable at room temperature, such as Kyo-Dophilus. To prevent antibiotic-induced diar- rhea, take your probiotic when you start your antibiotic and for at least two weeks after the antibiotic is ﬁnished. Complementary Supplements Brewer’s yeast: Some research has shown that this supplement can help relieve infectious diarrhea, particularly when caused by Clostridium difﬁcile (associated with antibiotic use). Goldenseal: Has antibiotic properties and contains a chemical called berebine, which pre- vents infectious bacteria from attaching to the gut and blocks the action of toxins produced by bacteria. To reduce your risk, avoid tap water and ice cubes and drink only bottled water and beverages; avoid raw fruits and vegetables unless you can peel them yourself; avoid raw or undercooked meats; use bottled water to brush your teeth; and keep your mouth closed while showering. Tak- ing a probiotic (friendly bacteria) every day while away can also help reduce the risk 208 of traveller’s diarrhea. These beneﬁcial bacteria (such as lactobacilli and biﬁdobacteria) normally live in the colon and inhibit the overgrowth of disease-causing bacteria. See your doctor if diarrhea persists beyond ﬁve days or if you develop dehydration. Diverticula usually develop when weak places in your colon give way under pressure, causing the formation of pouches, which can protrude through the colon wall. These pouches rarely cause problems, so people often don’t realize that they have them. However, if the diverticula become infected (diverticulitis), this can cause abdominal pain, fever, nausea, and change in bowel habits. It is possible to prevent diverticular disease by eating a high-ﬁbre diet and avoid- ing constipation. If diverticulitis occurs, it can cause: • Abdominal pain (severe and sudden onset) • Constipation or diarrhea • Fever, nausea, vomiting • Rectal bleeding Note: Complications of diverticulitis include blockage in the colon and abscess or ﬁstula formation. If a pouch ruptures, the waste material can spill into the abdominal cavity, leading to peritonitis, which is a serious medical problem that needs immediate attention. Prior to the 1900s when reﬁning of grains started, diverticular disease was rare in North America. A high-ﬁbre diet can reduce your risk of diverticular disease and also help prevent ﬂare-ups in those who already have it. For those with mild symptoms, dietary changes and antibiotics for the infection may be all that is needed. During a ﬂare-up, your doctor will advise a temporary low-ﬁbre diet to allow the colon to heal. Surgery is a last resort, but may be necessary for those with bowel obstruction or severely damaged intestine. Foods to avoid: • Fast foods and processed foods contain chemicals that can damage intestinal health. In the past, those with diverticular disease were told to avoid nuts or seeds, but there is no evidence that these foods trigger ﬂare-ups, so they can be enjoyed as part of a healthy diet. Avoid holding it in as that can create dry, hard stools that are hard to pass, increasing colon pressure. Top Recommended Supplements Fibre: Helps prevent constipation and improve bowel function. One study of glucomannan, a water-soluble dietary ﬁbre derived from konjac root, found that it reduced symptoms of diverticular disease. Probiotics: Beneﬁcial bacteria help to reduce the risk of gut infection and also aid digestion and nutrient absorption. Dosage: Take one to three capsules daily of a product that provides at least one billion live cells. Include healthy fats (ﬁsh and ﬂaxseed) and fermented milk products (yogurt and keﬁr) in your diet. Ear infections, known medi- cally as Otitis Media, are a non-contagious infection of the middle ear, just behind the eardrum. If the middle ear becomes inﬂamed from the infection, ﬂuid builds up behind the eardrum, creat- ing a breeding ground for infection. These infections can also occur when there is swelling or problems with the eustachian tubes (the tubes that connect the middle ear to inner nose). In chil- dren, the eustachian tubes are narrower and shorter, making it easier for ﬂuid to get E trapped in the middle ear during an infection.
H completely closed purchase amitriptyline canada depression scale, and the Te pulp chamber has a periodontal membrane has a trapezoidal form purchase amitriptyline with amex depression symptoms guilt. With appropriate consideration purchase genuine amitriptyline anxiety 2 days after drinking, though, one can use actual teeth from recently deceased or archaeological material. Records of young children (less than about ten years of age) were examined from the Boston area. Tis is a simplifcation of the sixteen-grade scheme developed by Gleiser and Hunt50 and of the nineteen-grade scheme constructed by Fanning. In practice, these graphs proved time-consuming and inefective (but they are commonly reproduced in the literature). Harris and Buck “reverse engineered” these graphs to provide the data in a more usable format (Tables 13. Te data age estimation from oral and dental structures 275 were derived from the cross-sectional study of children attending a dental school in Tennessee for routine dental care (Tables 13. An exception would seem to be dysmorphic teeth, including microform and pegged teeth, where the formative status is ques- tionable. In Westernized settings, where the subject may have been exposed to chemotherapy or irradiation during growth, one needs to be alert to abnor- mal crown-root forms. Te simplest suggestion for combining the individual tooth age estimates is to average across all scorable teeth. Te third molar is notorious in this regard, with unusually high variability, and it is omitted from some scoring systems. Just the mandibular teeth are used because of their greater clarity on radio- graphs (whereas several maxillary teeth are obscured by the complex bony architecture), and because there is considerable statistical redundancy among the teeth in the two arches. Likewise, teeth from just the lef (or from the clearer, better preserved) side are used because of the duplication of informa- tion between sides. Tere are four steps in the Demirjian system: (1) the extent of crown-root development of the seven teeth is scored (Figure 13. Several researchers have computerized this sequence of events to minimize the arithmetic. Stages: initiation (i), coalescence (co), cusp outline complete (co), complete (c), clef (cl). Te solution is to produce group-appropriate norms that accurately refect the target group’s tempo of growth. Demirjian refected that the statistical information among the seven tooth types was largely redundant since the teeth were developing synchronously. Afer this, the variable third molar is the only tooth that has not yet completed root formation. Focus then turns to age estimation based upon the aging and, ofentimes, degenerative processes associated with adulthood, or to techniques that look at histological, bio- chemical, or special changes in teeth. Tis is the wearing down of the occlusal sur- face, predominantly from grit in the diet (ignoring hyperfunctional issues in individuals with bruxism). Te major issues that Gustafson did not deal with are (1) the virtual absence of grit in the modern, Westernized diet, so rates of wear can be inconsequential, and con- versely, (2) that rates of wear difer widely depending on the group 282 Forensic dentistry under study. Destruction of the gingival, periodontal, and alveolar tissues may develop due to pathogens—acute infectious diseases. Tese ofen rapid destruc- tive processes have to be distinguished from “continued eruption,” in which teeth continue to erupt, albeit slowly, throughout much of life. In contempo- rary peoples, with trivial wear, the efect is simply to increase lower face height. Te slow age-progressive deposition of second- ary dentin diminishes and ultimately occludes the pulp chamber. Precision is required if teeth are sectioned so as to fnd and preserve the maximum dimensions of the pulp chamber. Te measurements include comparisons of pulp and root length, pulp and tooth length, tooth and root length, and pulp and root widths at three defned levels. Recent attention has focused on cementum annulations—the deposition of a new layer of cementum onto roots in a manner analogous to the growth of tree age estimation from oral and dental structures 283 rings. Tis method might be of some use when the tooth cannot be used to count annulations, though one needs to control for diferences among tooth types. Researchers have also found systematic diferences when using impacted teeth (cementum is thicker92) or periodontally involved teeth (cementum is thicker109). More accurately, the incidence of resorption is somewhat more common in older-aged groups in cross-sectional studies. Root transparency is due to the age-progressive occlusion of dentin tubules leading to sclerotic dentin. Tis change can occur in the crown and root of a tooth, but changes in the crown are in consequence to attrition, trauma, caries, and other noxious stimuli. He assumed that all six of the parameters could be visually graded on a four-step scale. Tis assumed that (1) these four (unequally spaced) ordinal stages informatively refect the trait distributions; (2) all six parameters are equally efective at estimating age, so they can just be added together; (3) the rates of change are equivalent among all of the param- eters, so they can just be added together; and (4) the imprecision (variability of true and predicted ages) is the same for all parameters, so the variances can be assumed to be equal. Gustafson’s scoring method also assumes that the six pieces of age information are statistically independent, which is far from true. Tese various shortcomings were overcome in subsequent studies using multiple linear regression methods and similar statistical techniques that more appropriately account for the nature of the data. But, rather than pursuing his collective mix of six dental changes, most researchers have elaborated on the scientifc bases of one or another of these processes. Te procedure is destructive in that the tooth has to be extracted, sectioned, and polished before measurement. Root transparency develops due to pro- gressive sclerosing of the tubules, frst at the root apex, then advancing coro- nally. Aging causes the refractive indexes to converge, making the dentin transparent to transmitted light. Changes may be seen as early as the later teens, though typically starting in adulthood. Tey also suggest that the rate of sclerosis difers among populations (possibly due to dietary diferences), and that the rate may not be linear throughout adulthood (possibly slowing in older adults). Tese authors found that at least 55% of their age estimates deviated by more than fve years. Diferences in the alternating light and dark bands are due to their diferent crystal orientations. Interestingly, the annuli show evidence of certain life history events that negatively infuence calcium deposition, such as pregnancies, and renal and skeletal disease. A few specimens exhibited doubling, where there were about twice as many lines as anticipated from the person’s known age. Tese authors made several observations: (1) archaeological specimens tend to have fainter annulations (and should be decalcifed more gently), (2) cementum deposition may be afected by periodontal disease, (3) a few teeth possess no cementum annulations, (4) accuracy of the method diminishes with the person’s age, which is common to most aging techniques, and (5) population diferences need to be studied.
Nap frequently during the day to make up person to remain awake for long periods for the lost sleep at night order amitriptyline paypal depression definition economic. Respirations are irregular and sometimes She is scheduled for an exploratory laparotomy interspersed with apnea trusted 25 mg amitriptyline mood disorder episodes. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care order amitriptyline 75 mg mastercard depressive reaction symptoms, 7th Edition. An average of 5 to 7 hours of sleep is gener- he/she could not sleep during the night. Which of the following statements accurately describe factors that affect sleep patterns? Which of the following describe the inﬂuences breathing between snoring intervals. Patients with restless arm syndrome cannot lie still and experience unpleasant crawling a. Place the following stages of a sleep cycle in interventions for patients experiencing insom- the order in which they would normally occur. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Which two systems in the brainstem are quality of sleep believed to work together to control the cyclic nature of sleep? Marked muscle contraction that results in the jerking of one or both legs during sleep 2. Match the sleep disorder listed in Part A with its appropriate deﬁnition listed in Part B. Constitutes about 5% of sleep Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. List the average amount of sleep required for True False the following age groups. Older adults: time, he/she will return to sleep again by starting at the point in the cycle where 3. Exercise that occurs within a 2-hour interval before normal bedtime stimulates sleep. The administration of a larger mid-afternoon dose of asthma medication may prevent i. True False Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Maher, age 28, consumes four in a sleep history when a sleep disturbance is alcoholic drinks when watching television noted. After eliminating the alcohol from her diet, she complains of waking after a short period and not being able to fall back to sleep. Eichorn, age 45, has two teenage sons conﬁrm that a patient is getting sufﬁcient rest who are often out late at night. She cannot to provide energy for the day’s activities or val- get to sleep until they are both home idate the existence of a sleep disturbance that safely, and even then she continues to is decreasing the quantity or quality of sleep. Describe how you would prepare a restful environment for a home healthcare patient b. List three measures a nurse can take to help falling asleep, but the noise of the hospital alleviate a patient’s sleep problem. Loper, a 74-year-old patient in a long- ask a patient to assess for the following sleep term care facility, is bored during the day factors. Quality of sleep: that he is sleepy all the time but cannot sleep when he lies down after work. Number and duration of naps: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Interview several friends or relatives to ﬁnd out what they do to prepare for a restful night’s sleep. Nature of a sleep disturbance: man who has recently been admitted to a long-term care facility. Onset of a disturbance: don’t fall asleep until after midnight and then I’m up twice to go to the bathroom and have a lot of trouble falling back to sleep. Causes of a disturbance: ter has mentioned to the nurse that her father spends a lot of time napping during the day. What intellectual, technical, interpersonal, factors on the ward that would contribute to a and/or ethical/legal competencies are most patient’s sleep deﬁcit. Develop a sleep teaching tool that explains the typical sleep patterns and requirements for patients of all ages (infants to older adults). What resources might be helpful for Include common factors that disrupt sleep pat- terns, total amount of sleep required, and pos- Mr. Interview individuals who have tried your interventions and evaluate the like- lihood that your teaching tool will resolve sleep problems. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. I used to think my sleep habits were bad at school, 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. 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.
A phi- and levels of abstraction of nursing theories purchase amitriptyline no prescription depression symptoms while on antidepressants, they losophy comprises statements of enduring values are also sometimes described by the content or and beliefs held by members of the discipline generic amitriptyline 10mg with amex depression young adults. Types of Nursing Theory Philosophical statements are practical guides for examining issues and clarifying priorities of the Nursing theories have been organized into cate- discipline purchase cheap amitriptyline on line anxiety 9 code. George (2001) sets forth cate- to examine compatibility among personal, profes- gories of theories according to the orientation of sional, organizational, and societal beliefs and the theorist: nursing problems, interactions, gen- values. Conceptual models are sets of general concepts and Meleis (1997) describes types of nursing theory propositions that provide perspectives on the based on their levels of abstraction and goal orien- major concepts of the metaparadigm, such as per- tation. Barnum (1998) divides theories into those son, health and well-being, and the environment. Types of nursing theories generally in- beliefs, as in philosophical statements and prefer- clude grand theory, middle-range theory, and ences for practice and research approaches. Conceptual models are less abstract Grand theories have the broadest scope and present than the metaparadigm and more abstract than general concepts and propositions. Theories at this theories, offering guidance (not distinct direction) level may both reﬂect and provide insights useful to nursing endeavors. Conceptual models may also for practice but are not designed for empirical test- be called “conceptual frameworks” or “systems. This limits the use of grand theories for direct- ing, explaining, and predicting nursing in particular situations. In general, nursing theory describes and explains Development of grand theories resulted from the phenomena of interest to nursing in a system- the deliberate effort of committed scholars who atic way in order to provide understanding for use have engaged in thoughtful reﬂection on nursing in nursing practice and research. Although there is debate about which nursing theories are grand in scope, the fol- Nursing practice theory has the most limited scope lowing are usually considered to be at this level: and level of abstraction and is developed for use Leininger’s Theory of Culture Care Diversity and within a specific range of nursing situations. Universality, Newman’s Theory of Health as Theories developed at this level have a more direct Expanding Consciousness, Rogers’ Science of impact on nursing practice than do theories that Unitary Human Beings, Orem’s Self-Care Deﬁcit are more abstract. Nursing practice theories pro- Nursing Theory, and Parse’s Theory of Human vide frameworks for nursing interventions and pre- Becoming. These theories are presented in the third dict outcomes and the impact of nursing practice. At the same time, nursing questions, actions, and procedures may be described or developed as nurs- ing practice theories. Practice theories theories that are both broad enough to be useful in should also reﬂect concepts and propositions of complex situations and appropriate for empirical more abstract levels of nursing theory. Nursing scholars proposed using this level veloped at this level is also termed prescriptive the- of theory because of the difﬁculty in testing grand ory (Dickoff, James, & Wiedenbach, 1968; Crowley, theory (Jacox, 1974). Middle-range theories are 1968), situation-speciﬁc theory (Meleis, 1997), and more narrow in scope than grand theories and offer micro theory (Chinn & Kramer, 2004). The depth and sitions at a lower level of abstraction and hold great complexity of nursing practice may be fully appre- promise for increasing theory-based research and ciated as nursing phenomena and relations among nursing practice strategies. Benner (1984) demon- ports of nurses’ experiences of developing and using middle-range theory. A wide range of nursing The day-to-day experience of nurses is a practice situations and nursing issues are being ad- major source of nursing practice theory. The methods used for developing middle-range theories are many and represent some of the most exciting work being strated that dialogue with expert nurses in practice published in nursing today. Many of these new the- is fruitful for discovery and development of prac- ories are built on content from related disciplines tice theory. Research ﬁndings on various nursing and are brought into nursing practice and research problems offer data to develop nursing practice (Lenz, Suppe, Gift, Pugh, & Milligan, 1995; Polk, theories as nursing engages in research-based de- 1997; Eakes, Burke, & Hainsworth, 1998). Nursing practice ature also offers middle-range nursing theories that theory has been articulated using multiple ways of are directly related to grand theories of nursing knowing through reflective practice (Johns & (Olson & Hanchett, 1997; Ducharme, Ricard, Freshwater, 1998). The process includes quiet re- Duquette, Levesque, & Lachance, 1998; Dunn, ﬂection on practice, remembering and noting fea- 2004). Reports of nursing theory developed at this tures of nursing situations, attending to one’s own level include implications for instrument develop- feelings, reevaluating the experience, and integrat- ment, theory testing through research, and nursing ing new knowing with other experience (Gray & practice strategies. These have particular rele- Nursing theories address the phenomena of inter- vance for nursing and illustrate the need for est to nursing, including the focus of nursing; the nursing theory. The attributes of King and person, group, or population nursed; the nurse; the Brownell are used as a framework to address the relationship of nurse and nursed; and the hoped- need of the discipline for nursing theory. Based on strongly the attributes is described next, from the perspec- tive of the nursing discipline. Theories are patterns that guide the think- Expression of Human Imagination ing about, being, and doing of nursing. Nursing theory is dependent on the imagination and questioning of nurses in practice and on their held values and beliefs about nursing, and within creativity to bring ideas of nursing theory into contexts of various worldviews, theories are pat- practice. In order to remain dynamic and useful, terns that guide the thinking about, being, and our discipline requires openness to new ideas and doing of nursing. They provide structure for devel- innovative approaches that grow out of members’ oping, evaluating, and using nursing scholarship reﬂections and insights. Nursing theories either implicitly Domain or explicitly direct all avenues of nursing, including A discipline of knowledge and professional practice nursing education and administration. Nursing must be clearly deﬁned by statements of the do- theories provide concepts and designs that deﬁne main—the theoretical and practical boundaries the place of nursing in health and illness care. The domain of nurs- Through theories, nurses are offered perspectives ing includes the phenomena of interest, problems for relating with professionals from other disci- to be addressed, main content and methods used, plines who join with nurses to provide human serv- and roles required of the discipline’s members ices. The processes and prac- At the same time, theories must provide structure tices claimed by members of the discipline commu- and substance to ground the practice and scholar- nity grow out of these domain statements. Nursing ship of nursing and also be ﬂexible and dynamic to theories containing descriptions of nursing’s do- keep pace with the growth and changes in the dis- main may incorporate a statement of the disci- cipline and practice of nursing. The focus may be set in statements about human, social, and ecological concerns addressed by nursing. Later, Donaldson and Crowley (1978) stated that a disci- The discipline of nursing is a community pline has a special way of viewing phenomena and of scholars, including nurses in all venues, a distinct perspective that deﬁnes the work of the where nursing occurs. The call for clarity of focus continues in the current environment of nursing practice (Parse, 1997). This enhances auton- developed over centuries to communicate the na- omy, and accountability and responsibility are de- ture and development of nursing. The domain of nursing is also other forums on every aspect of nursing and for called the “metaparadigm of nursing,” as described nurses of all interests occur frequently throughout in the previous section of this chapter. Nursing the- Syntactical and Conceptual Structures ories form the bases for many of the major contri- Syntactical and conceptual structures are essential butions to the literature, conferences, societies, and to the discipline and are inherent in each of the other communication networks of the nursing dis- nursing theories. This struc- The tradition and history of the nursing discipline ture is grounded in the metaparadigm and is evident in study of nursing theories that have philosophies of nursing. There is recognition that relates concepts within nursing theories, and it is theories most useful today often have threads of from this structure that we learn what is and what connection with theoretical developments of past is not nursing. For example, many theorists have acknowl- nurses and other professionals understand the tal- edged the inﬂuence of Florence Nightingale and ents, skills, and abilities that must be developed have acclaimed her leadership in inﬂuencing nurs- within the community. In addition, nursing has a rich scriptions of data needed from research as well as heritage of practice. Nursing’s practical experience evidence required to demonstrate the impact of and knowledge have been shared, transformed into nursing practice.
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