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That is because each person perceives health in relation to personal expectations and values the concept of health must allow for his individual variability bisoprolol 5mg with visa blood pressure medication migraines. Health is a dynamic state in which the person is constantly adapting to changes in the internal and external environments bisoprolol 10mg sale blood pressure medication zestril. For example buy bisoprolol 5mg overnight delivery blood pressure medication names starting with m, a person may see himself/herself as healthy while experiencing a respiratory infection. Wellness Wellness is a life – style aimed at achieving physical, emotional, intellectual, spiritual and environmental well being. The use of wellness measures can increase stamina, energy and self – esteem, then enhance quality of life. Wellness can be thought of a balance of the physical, emotional, psychological, social and spiritual aspects of a 5 Community Health Nursing person’s life. Wellness behaviors are those that promote healthy functioning and help prevent illness. These include, for example, stress management, nutritional awareness, and physical fitness. Clinical Model (Dunn, 1961) In this model, health is interpreted as the absence of signs and symptoms of disease or injury; thus the opposite of health is disease. Dunn defined, in this model, “health as a relatively passive state of freedom from illness, and a condition of relative homeostasis. Many health care providers focus on the belief of signs and symptoms of disease and conclude that when these are no longer present, the person is healthy. This model may not take into consideration person’s health beliefs or person life styles. Host –Agent – Environment Model (Leavell, 1965) This model helps to identify the cause of an illness. In this model: Host: Refers to the person (or group) who may be at risk for or susceptible to an illness. Agent: is any factor (internal or external) that can lead to illness by its presence. Environment: refers to those factors (physical, social, economic, emotional, spiritual) that may create the likelihood or the predisposition for the person to develop disease. In this model health and illness depends on the interaction of these three factors. Factors that influence persons belief’s: Personal expectation in relation to health and illness Earlier experience with illness or health Age and development state. Health beliefs are person’s ideas, convictions and attitudes about health and illness. They may be based on factual information, misinformation, commonsense or myths, or reality or false expectations. Health beliefs usually influence health behavior this influence can be positive or negative. Seriousness • Structuralvariable (knowledge Perceivedbarriersto (severity)ofdisease aboutth e disease,prior preventive action ‘x’ contactwith th edisease etc. L ikelih oodoftaking Perceivedth reatofdisease “X” recommendedpreventive h ealth action. Cues to A ction M assmediacampaignsadvice from oth ersreminderpostcardfrom ph ysicianordentist. Second component (Modifying Factors) • Individual’s perception of the seriousness of the illness. This perception is influenced and modified by demographic and socio-psychological variables, perceived threat of the illness and cues to action. The preventive action may include: Lifestyle modification/change, increased adherence to medical therapies or search for medical advice or treatment. High – Level Wellness Model (Dunn, 1961) According to Dunn (1961), health recognized as an ongoing process toward the person’s highest potential functioning. Dunn described high level wellness as the experience of the person alive with the glow of good health, alive to the tips of their fingers with energy to burn, tingling with vitality – at times like this the world is a glorious place. Holistic Health Model Holism is seen as a “new” model of health, but actually it is not new at all. Holism has been a major theme in the humanities, western political tradition and major religions throughout history. Holism is a different approach to health is that acknowledges and respects the interaction of a person’s mind, body and spirit within the environment. Holism is derived from the Greek holos (whole), was first used by South African philosopher Jan Christian Smuts (1926) in Holism and Evolution. Smuts viewed holism as antidote to the automistic approach of contemporary science. An automistic approach takes things apart, examining the person piece by piece in an attempt to understand the larger picture by examining the smaller molecule or atom. Holism is based on the belief that people (or even their parts) cannot be fully understood if examined solely in pieces apart from their environment. Below figure illustrates, the organism and the system in which it lives are seen as greater than and different from the sum of their parts. Health and illness Rather than focusing on curing illnesses, community based nursing care focuses on promoting health and preventing illness. This holistic philosophy therefore differs greatly from that of the acute care setting. Improvement of health is not seen as an outcome of the amount and type of medical services or the size of the hospital. Care provided in acute care setting is usually directed at resolving immediate health problems. In the community, care focuses on maximizing individual potential for 13 Community Health Nursing self-care regardless of any injury or illness. Where health is the essence of care, the client’s ability to function becomes the primary concern. Health protection strategies relate to environmental or regulatory measures that confer protection on large population groups. Preventive services include counseling, screening, immunization, or chemoprophylactic interventions for individuals in clinical settings. Prevention is conceptualized on three levels: • Primary prevention level • Secondary prevention level • Tertiary prevention level 1. Health – illness continuum the wellness illness continuum (Travis and Ryan 1988) is a visual comparison of high – level wellness and traditional medicine’s view of wellness. Someone with wellness – oriented goals wants to more beyond the neutral 14 Community Health Nursing point (more absence of disease) to the right (toward high – level wellness). This person evaluates the current conduct of his/her life, learns about the available options, and grows toward self – actualization by tying out of these options in the search of high level wellness. Community health Practice It is part of the larger public health effort that is concerned with preserving and promoting the health of specific populations and communities. Community health practice incorporates six basic elements: Promotion of health • It includes all efforts that seek to move people closer to optimal well-being or higher level of wellness. Prevention of health problems (refer to unit three for the details) Treatment of disorders • It focuses on the illness end of continuum and is the remedial aspects of community health practice.
Mydriatic atropine substitutes cheap bisoprolol 10mg free shipping arrhythmia untreated, this group of drugs have shorter duration of action than atropine and are used locally in the eye; drugs included: Homatropine purchase 10mg bisoprolol fast delivery blood pressure zoloft, Eucatropine etc buy bisoprolol 5mg overnight delivery arteria sa. Antiseccretory antispasmodic atropine substitutes: Effective more localized to the Gl. Antiparkinsonian atropine substitute: drugs like Benztropine, Trihexyphenidyl 4. Catecholamines have a direct action on sympathetic effectors cells through interactions with receptor sites on the cell membrane. The group includes adrenaline, noradrenaline, dopamine, isoprenaline, and dobutamine. They may directly act on the receptors or may indirectly release the physiologic catecholamines e. Indirect mode of action: their actions are dependent on the release of endogenous catecholamines. Blood Vessels and Blood pressure: constriction of blood vessels in the skin and mucous membranes 42 Dilatation of skeletal muscle vessels Adrenaline increases systolic and decreases diastolic blood pressure at low doses but increases both at higher doses Noradrenaline increases both systolic and diastolic blood pressure 2. Bladder: relaxation of detrusor muscle; contraction of sphincter and trigone muscle 3. Eye: mydriasis; reduction of intraocular pressure in normal and glacucomatous eyes 4. Respiration: Bronchodilatation; relief of congestion; mild stimulation of respiration 5. Metabolic: Increased hepatic glycogenolysis; decreased peripheral glucose intake; increased free fatty acids in the blood (lipolysis) 6. Skeletal muscle: facilitation of neuromuscular transmission and vasodilatation Drugs Acting on the Adrenergic Receptor Subtypes α1 α2 β1 β2 Agonist Phenylephrine Clonidine Dobutamine Salbutamol Methoxamine Oxymetazoline Isoproterenol Terbutaline Terbutaline Isoetharine Antagonist Prazosin Yohimbine Propranolol Propranolol Phentolamine Phentolamine Pindolol Pindolol Phenoxybenzamine Phenoxybenzamine Atenolol Butoxamine Metoprolol Timolol Timolol Adrenaline stimulates all the four receptor subtypes. Noradrenaline stimulates both alpha receptors and beta1 but has very poor affinity for beta2 receptors. It is therefore ineffective when given orally and should be given intramuscularly or subcutaneous. Intravenous injection is highly dangerous and is likely to precipitate ventricular fibrillation. The drug may how ever, be given by nebulizer for inhalation when its relaxing effect on the bronchi is desired or it may be applied topically to mucus membranes to produce vasoconstriction. Because of the extensive metabolism of the drug in liver, little is excreted unchanged in the urine. Pharmacodynamics Adrenaline directly stimulates all the adrenergic receptors both and brings about effects of sympathetic nerve stimulation. Its action may be divided in to two, depending on the type of receptor stimulated. The α effects consist of vasoconstriction in skin and viscera, mydriasis, platelet aggregation and some increase in blood glucose. The ß effects consists of increased contractility and rate of heart with a decreased refractory period (ß1), vasodilatation in muscles and coronary vessels (ß2), bronchial relaxation (ß2) uterine relaxation (ß2), hyperglycemia, lactic acidemia and increased circulating free fatty acids. Pharmacokinetics Like adrenaline, noradrenaline is ineffective orally so it has to be given intravenously with caution. It is not given subcutaneous or intramuscularly because of its strong vasoconstrictor effect producing necrosis and sloughing. The metabolism is similar to adrenaline; only a little is excreted unchanged in urine. Pharmacodynamics Nor adrenaline is a predominantly α receptor agonist with relatively less β agonist action when compared to adrenaline. Adverse effects include: Anxiety, headache, bradycardia are common side effects Severe Hypertension in sensitive individuals Extravasation of the drug causes necrosis and sloughing. These are the other catecholamines which have similar properties to adrenaline and noradrenaline. These drugs have advantage over the others because they are 45 more selective in their action so that they have fewer side effects than adrenaline and nor adrenaline. It has a good distribution through out the body and is resistant to hydrolysis by the liver enzymes. Because of its stability to metabolism it has long duration of action than the catecholamines. This effect is partly by a direct action on the receptors and partly indirectly by releasing noradrenaline from its tissue stores the effect of the drug to various organs and systems is similar to that of adrenaline. Nocturnal enuresis Side effects the side effects are similar to those of adrenaline; but in addition it may produce insomnia and retention of urine. Based on their selectivity to specific receptors the rest of the catecholamines, are classified but it is very difficult to exhaust all the drugs. More over their effect and pharmacology is discussed where they are clinically indicated. Drugs blocking theβ Adrenergic receptor these drugs prevent the response of effectors organs to adrenaline, noradrenaline and other sympathomimetic amines whether released in the body or injected. Circulating catecholamines are antagonized more readily than are the effects of sympathetic nerve stimulation. The drugs act by competing with the catechoamines for α or β receptors on the effectors organs. Irreversible antagonists tightly bind to the receptor so that their effects may persist long after the drug has been cleared from the plasma e. Hence, postural hypotension and reflex tachycardia are common during the use of these drugs. It has high affinity for alpha1 receptor and relatively low affinity for the alpha2 receptor. Prazosin leads to relaxation of both arterial and venous smooth muscles due to the blockage of alpha1 receptors. Drugs blocking all the β receptor effects of adrenaline (non-selective beta blockers) e. Drugs blocking mainly the β1 effects (those on the heart) with less effect on the bronchi and blood vessels (beta1-selective blockers), e. Pharmacokinetics Propranolol is almost completely absorbed following oral administration. How ever, the liver, leaving only 1/3 rd of the dose to reach the systemic circulations, metabolizes most of the administered dose. Cardiovascular system • Bradycardia • Reduces force of contraction • Reduces blood pressure 2. However, the problem of cardiovascular disorders is also increasing in developing countries including Ethiopia.
The meninges that form the protective covering around the spinal cord also extend up and around the brain to enclose it completely proven 5mg bisoprolol blood pressure iphone. Fluid fills the subarachnoid spaces between the pia mater and arachnoid in the brain and spinal cord purchase bisoprolol with a visa arrhythmia grand rounds. These illustrations can also help you visualize the location of the ventricles if you remember that these large spaces lie deep inside the brain and that there are two lateral ventricles cheap bisoprolol amex arteria yahoo. One 145 Human Anatomy and Physiology lies inside the right half of the cerebrum (the largest part of the human brain), and the other lies inside the left half of the cerbrum. It forms continually from fluid filtering out of the blood in a network of brain capillaries known as the choroid plexus and into the ventricles. It moves from the fourth ventricle into the small, tube like central canal of the cord and out into the subarachnoid spaces. Then it moves leisurely down and around the cord and up and around the brain (in the subarachnoid spaces of their meninges) and returns to the blood (in the veins of the brain). Lippincot Company) 147 Human Anatomy and Physiology Figure 7-3 Reflex arc showing the pathway of impulses and a cross section of the spinal cord (Source: Carola, R. Cerebrum Observe in Figure 7-5 the location and relative sizes of the medulla, pons, cerebellum, and cerebrum. Immediately superior to the medulla lies the pons and superior to that the midbrain. It lies just inside the cranial cavity superior to the large hole in the occipital bone called the foramen magnum. Like the spinal cord, the medulla consists of gray and white matter, but their arrangement differs in the two organs. In the medulla, bits of gray matter mix closely and intricately with white matter to form the reticular formation (reticular means "netlike"). In the spinal cord, gray and white matter does not intermingle; gray matter forms the interior core of the cord, and white matter surrounds it. The pons and midbrain, like the medulla, consist of white matter and scattered bits of gray matter. Sensory fibers conduct impulses up from the cord to other parts of the brain, and motor fibers conduct impulses down from the brain to the cord. The cardiac, respiratory, and vasomotor centers (collectively called the vital centers) are located in the medulla. Impulses from these centers control heartbeat, respirations, and blood vessel diameter (which is important in regulating blood pressure). Diencephalon the diencephalon is a small but important part of the brain located between the midbrain inferiorly and the cerebrum superiorly. The posterior pituitary gland, the stalk that attaches it to the undersurface of the brain, and areas of gray matter located in the sidewalls of a fluid-filled space called the third ventricle are extensions of the hypothalamus. Measured by 150 Human Anatomy and Physiology size, it is one of the least significant parts of the brain, but measured its contribution to healthy survival; it is one of the most important brain structures. Impulses from neurons whose dendrites and cell bodies lie in the hypothalamus are conducted by their axons to neurons located in the spinal cord, and many of these impulses are then relayed to muscles and glands all over the body. Among the vital functions that it helps control are the heartbeat, constriction and dilation of blood vessels, and contractions of the stomach and intestines. Some neurons in the hypothalamus function in a surprising way; they make the hormones that the posterior pituitary gland secretes into the blood. Their axons secrete chemicals called releasing hormones into the blood, which then carries them to the anterior pituitary gland. Releasing hormones, as their name suggests, control the release of certain anterior pituitary hormones. Thus the hypothalamus indirectly helps control the functioning of every cell in the body. Therefore a marked elevation in body temperature in the absence of disease frequently characterizes injuries or other abnormalities of the hypothalamus. In addition, this important center is involved in functions such as the regulation of water balance; sleep cycles, and the control of appetite and many emotions involved in pleasure, fear, anger, sexual arousal, and pain. Just superior to the hypothalamus is a dumbbell shaped section or largely gray matter called the thalamus. The thin center section of the thalamus passes from left to right through the third ventricle. The thalamus is composed chiefly of dendrites and cell bodies of neurons that have axons extending up to the sensory areas of the cerebrum. Its neurons relay impulses to the cerebral cortex from the sense organ of the body. Almost all sensations are accompanied by a feeling of some degree of pleasantness or unpleasantness. The way that these pleasant and unpleasant feelings are produced is unknown except that they seem to be associated with the arrival of sensory impulses in thalamus. It plays a part in the so -called arousal or alerting 152 Human Anatomy and Physiology mechanism. It contains important nuclei such as medial geniculate which is responsible for auditory sense and lateral geniculate which is responsible for vision. In the cerebellum, gray matter composes the outer layer, and white matter composes the bulk of the interior. Most of our knowledge about cerebellar functions has come from observing patients who have some sort of disease of the cerebellum and from animals who have had the cerebellum removed. From such observations, we know that the cerebellum plays an essential part in the production of normal movements. A patient who has a tumor of the cerebellum frequently loses balance and may topple over and reel like a drunken person when walking. Frequent complaints about being clumsy and unable to even drive a nail or draw a straight line are typical. With the loss of normal cerbellar functioning, the ability to make precise movements is lost. The general functions of the cerebellum, then, are to produce smooth coordinated movements, maintain equilibrium, and sustain normal postures. If you were to look at the outer surface of the cerebrum, the first features you would notice might be its many ridges and grooves. The deepest sulci are called fissures; the longitudinal fissure divides the cerebrum into right and left halves or hemispheres. These halves are almost separate structures except for their lower midportions, which are connected by a structure called the corpus callosum(Figure 7 5). Two deep sulci subdivide each cerebral hemisphere into four major lobes and each lobe into numerous convolutions. The lobes are named for the bones that lie over them: the frontal lobe, the parietal lobe, the temporal lobe, and the occipital lobe. A thin layer of gray matter, made up of neuron dendrites and cell bodies, composes the surface of the cerebrum. White matter made up of bundles of neuronal fibers (tracts), composes most of the interior of the cerebrum.
Organogenesis in humans is in the first 60 days after fertilization buy bisoprolol 10 mg mastercard blood pressure quadriplegic, unfortunately at a time when a woman may be or female) should be protected from exposure if they are going unaware of her condition generic 10mg bisoprolol mastercard blood pressure scale. As one might expect buy cheap bisoprolol 5 mg on-line heart attack 5 year survival rate, the periods of chemicals on the fetus are more likely to be cancer, organ organogenesis vary between species (F12. This is a problem in Standard teratology testing protocols now demand that the occupational health, with a workforce that is 45% female, a pregnant test animal be exposed to the agent between days 6 large percentage of which in child-bearing years. Parents (male and 15 (for mouse and rat) and between days 6 and 18 (for the rabbit), thus covering the major span of organogenesis. Number of Days after Conception Species Implantation Organogenesis Parturition Human 6-7 20-56 260-280 Monkey 9-15 20-45 164-168 Rabbit 7-8 8-16. Nausea and vomiting tend to peak between the 8 and 12 week of pregnancy, the crest sensitivity of fetal tissues. In the standard teratological study protocol, pregnant females are exposed to three levels plus control from day 6 to day 15 (mice and rats) or from day 6 to 18 (rabbits). Specific malformations associated with a chemical exposure will occur in a particular species at the critical periods corresponding to appearance and development of cellular structures (F12. The time course of malformation probability in a specific organ system can follow different unfoldings, as shown in F12. In “A”, the foundation of an organ system is put into place, leading to a sudden rise in malformation susceptibility. Curve “B” reflects malformation rates corresponding to the exponential phase of organ development. When more than one cell population is involved in an organ, the curve can be multi-phasic (“C”). While animal experiments can be controlled closely, epidemiological investigations of teratogens in humans require an association between exposure and a "congenital" defect. In the case of thalidomide, the number of phocomelia cases was orders of magnitude increased from the previously known incidence rate of this rare birth defect. But most chemicals induce birth defects at a low rate, the risk ratio or 2 odds ratio usually being below 2. With so many confounding factors in epidemiological studies, it is difficult to obtain the tight associations needed to identify culprit chemicals in full confidence. When testing for teratogenicity, it is often convenient to use models that develop rapidly and that are convenient to observe. In the zebra fish, the first structures, such as the trunk muscles and the head, begin to form 10 hours after fertilization. The larvae hatch and start to swim when they are just a little more than 48 hours old. By day 5, the yolk is largely consumed and the embryo has been transformed into an independent organism. This can be studied by the classical methods of tissues have special properties relevant not only to toxicity but toxicokinetics (F12. Toxicity on Fertilization-Migration There are many factors that can affect conception (T12. Fertilization occurs when the ovum meets the upward migrating sperm in the region of the ampulla of the Fallopian tube. To penetrate the layers of the oocyte (the thick acellular zona pellucida and several layers of granulosa cells), the spermatozoon must have matured, becoming highly motile and fertile, and achieved capacitation (changes in the sperm surface and chemical changes within). The first, the acrosome reaction, results in a series of fusions between specific membranes, with the release of hydrolytic enzymes capable of penetrating the oocyte granulosa cells, digesting them. A two compartment toxicokinetic model adapted to explore the activated motility, provides the extra flagellar activity to thrust disposition of a xenobiotic during pregnancy. This data is interesting in that some occurs during a period of 4 to 5 days during which time the prenatal periods for humans correspond to postnatal exposure cells double, double again and again from 1 cell to 2 cells to 4 43 time windows for animals. This rapidly dividing cell mass is susceptible to Since the fetus and placenta temporarily become chemical attack and may die at later stages following supplementary organs in the female, compartmentalization is implantation. This will result in spontaneous abortion during 12-15 the 1st to 2nd months of gestation. If concentrations in human males have already been inversely exposed before the age of 10, their sperm is feeble and associated with sperm count and motility. When exposed as adults, 35 33 Phthalates are also associated with low birth weight. It appears that phthalates are more delicate, environmental pollution may can amplify the body’s response to allergy-causing 20 contribute to the observed decrease in male births. It is expected to be Epididymis is a cordlike structure on the posterior edge of the testes where replaced by epsilon-caprolactone. Teratogenicity Examples (Hermann Loser, University Children’s Clinic, Munster, Germany) 12. Corpus Callosum difference 25% Eye problems between normal (top) and alcohol 16% Bent crooked little finger exposed infants (bottom). Alcohol 30% Pigeon Chest 7% Concave chest prevents cells guided by L1 from 7% Cleft palate adhering to each other. A single 44% Spinal dimple episode of alcohol exposure 12% Hernia lasting 4 hours is enough to kill 35% Hair growth on back of neck groups of cells by interfering with 12. Exposure to alcohol also Women who smoke reach menopause sooner than non diminishes the size of the corpus smokers, possibly because their supply of eggs is smaller. In mice, weekly administration of benzo(a)pyrene and 7,12 There have also been indications dimethyl-benz(a)anthracene over 3 weeks in doses representing in rat studies that alcohol consumption in mothers can increase one pack of cigarettes per day caused offspring to have one 22 third fewer eggs. If exposed during both periods, two-thirds of the Thalidomide, originally developed as a sedative in 1957, was 32 widely used, particularly in England and Germany, to stem eggs were missing. Women who complain of headaches or Thalidomide focused attention on breathing problems associated with chemical-induced birth defects and led regulatory agencies to exposure to organic chemicals such as phenol, xylene, acetone introduce specific protocols to test for organ-specific and trichloroethylene are much more likely to have premature teratogenicity. Given before or after a crucial time period (days 24-36 of gestation), thalidomide has little effect, but during that 12 day time span, when limb buds develop, the drug halts further 12. Postnatal growth in fetuses exposed to high levels (100 dB) of continuous sound is slower in exposed than in controls. In rats, exposure to pulsed noise for 7 hours induced serious retardation of embryo growth (F12. Marmoset (normal at left) and Thalidomide-exposed between days 38 and 52 (at right). Thalidomide is approved since 1998 to treat the male and female reproductive tracts. Thalidomide-affected babies continue to be born in developing countries where it is used for the treatment of leprosy. A prominent anti-angiogenesis effect may explain its teratogenicity (developing bones need extra capillaries) as well as its effect in multiple myeloma (squelching new blood vessel formation should starve cancer in the bone marrow). It was believed at the time and female reproduction, breast development and cancer, that insufficient amounts of estrogen led to miscarriage. Stress to studies to alter prostate gland size, mothers reprograms a baby’s physiology, making it and shift the onset of sexual susceptible to high blood pressure later in life.