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Almost 90% occur on the left side since the liver protects and prevents herniation of abdominal organs through right-sided defects discount emsam 5mg overnight delivery anxiety symptoms full list. Typically purchase 5mg emsam with visa anxiety symptoms numbness in face, patients are tachypneic and have absent breath sounds and dullness to percussion of the chest sec- ondary to the accumulation of blood. The contusion usually manifests itself within min- utes of the initial injury, is usually localized to a segment or a lobe, is usually apparent on the initial chest radiograph, and tends to last 48 to 72 hours. Soft signs include diminished ankle-brachial indices, asymmetri- cally absent or weak distal pulse, history of moderate hemorrhage or wound close to a major artery, and a peripheral nerve deficit. Emergent surgery is generally necessary when there are hard signs of vascular injury. When severe ischemia is present, the repair must be completed within 6 to 8 hours to prevent irreversible muscle ischemia and loss of limb function. In the presence of hard signs without evidence of ischemia, some surgeons may prefer to first perform angiography to better define the injury. However, when there is evidence of limb ischemia, the patient should undergo exploration and repair immediately. Although compartment syndrome can occur with blunt and penetrating extremity trauma, it is more common in crush injuries or fractures with marked swelling. It may be required, but should be performed in conjunction with and after the establishment of arterial blood flow. Herniation can occur within minutes or up to days after a trau- matic brain injury. Once the signs of herniation are present, mortality approaches 100% without rapid reversal or temporizing measures. Uncal herniation is the most common clinically significant form of traumatic herniation and is often associated with traumatic extracranial bleeding. The classic signs and symptoms are caused by compression of the ipsilateral uncus of the temporal lobe. As herniation progresses, compression of the ipsilateral oculomotor nerve eventually causes ipsilateral pupillary dila- tion and nonreactivity. It can lead to hypovolemic shock and can significantly reduce vital capacity if it is not recognized. Hemorrhage from injured lung parenchyma is the most common cause of hemothorax, but this tends to be self-limiting unless there is a major laceration to the parenchyma. A hemothorax is treated with chest thoracostomy (chest tube) that is generally placed in the fourth or fifth intercostal space at the anterior or midaxillary line, over the superior portion of the rib. The tube should be directed superior and posterior to allow it to drain blood from the dependent portions of the chest. Indications for thoracotomy include: • Initial chest tube drainage of 1000 to 1500 cc of blood (a and b). In general, if the patient remains hemodynamically unstable after 40 cc/kg of crystal- loid administration (approximately 2-3 L), then a blood transfusion should be started. Fully cross-matched blood is preferable; however, this is generally not available in the early resuscitation period. Therefore, type- specific blood (type O, Rh-negative or type O, Rh-positive) is a safe alternative and is usually ready within 5 to 15 minutes. Type O, Rh-negative blood is typically reserved for women in their childbearing years to prevent Rh sensitization. Type O, Rh-positive blood can be given to all men and women beyond their childbearing years. Epinephrine is used if the patient is in cardiopulmonary arrest and no longer has a pulse. If the patient remains hypotensive despite resuscitation, then definitive measures need to take place, such as an exploratory laparo- tomy to stop the hemorrhage. It is important to focus the primary examination on the patient and evaluate the fetus in the secondary examination. Cardiotocographic observation of the viable fetus is recommended for a minimum of 4 hours to detect any intrauterine pathology. The minimum should be extended to 24 hours if, at any time during the first 4 hours, there are more than three uterine contractions per hour, persistent uterine tenderness, a non-reassuring fetal monitor strip, vaginal bleeding, rupture of the membranes, or any serious maternal injury is present.

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Elimination: Do you have any problems with brief period of constriction buy emsam 5mg otc anxiety symptoms ear ringing, these same blood incontinence? Have you ever used any briefs or vessels dilate and capillary permeability pads for incontinence problems? Appearance: Assess for the approximation of components to leak out into the area that is wound edges discount 5mg emsam free shipping anxiety love, color of the wound and surround- injured, forming a liquid called exudate. Wound drainage: Assess the amount, color, White blood cells, predominantly leukocytes odor, and consistency of wound drainage. About Drainage can be assessed on the wound, the 24 hours after the injury, macrophages enter dressings, in drainage bottles or reservoirs, or the wound area and remain for an extended under the patient. They not only ingest debris, but is constant; pain may indicate delayed healing also release growth factors that are necessary or an infection. These growth factors also attract and whether enough tensile strength has devel- fibroblasts that help to fill in the wound, oped to hold the wound edges together during which is necessary for the next stage of heal- healing. Provide physical, psychological, and aesthetic pain, heat, redness, and swelling at the site of comfort; remove necrotic tissue; prevent, eliminate, the injury. Proliferative phase: Begins about day 2 or 3 up moist wound environment; protect the wound to 2 to 3 weeks. New tissue is built to fill the from further injury; and protect the skin surround- wound space (action of fibroblasts). R red protect: Red wounds are in the prolif- that stretches through the clot, a thin layer of erative stage of healing and are the color of nor- epithelial cells forms across the wound, and mal granulation. Granulation tissue gentle cleansing, using moist dressings, apply- forms the foundation for scar tissue. Maturation phase: Begins about 3 weeks after changing the dressing only when necessary. Y yellow cleanse: Yellow wounds are char- gen is remodeled, new collagen is deposited, acterized by oozing from the tissue covering and avascular collagen tissue becomes a flat, the wound, often accompanied by purulent thin white line. The patient will participate in the prescribed herent, hydrogel, or other absorptive dressings; treatment regimen to promote wound healing. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The eschar obese may slow wound healing because fatty tissue must be débrided before the wound can heal by is more difficult to suture, is more prone to using sharp, mechanical, chemical, or autolytic infection, and takes longer to heal. Hot water bags or bottles: Relatively inexpensive turning and positioning schedules, as well as the and easy to use; may leak, burn, or make the use of appropriate support surfaces (tissue load patient uncomfortable from their weight management surfaces) and reposition him at least b. Aquathermia pad: Commonly used in further injury or alteration in skin integrity, healthcare agencies for various problems promoting physical and emotional comfort, and including back pain, muscle spasms, facilitating coping. Heat lamps: Provide dry heat to increase circu- hygiene, diet, positioning, and turning in bed. Bentz will manifest intact Assess skin exposed to the heat every 5 skin free of skin irritations, infections, and wounds. Heat cradles: A heat cradle is a metal half-circle ethical/legal competencies are most likely to bring frame that encloses the body part to be treated about the desired outcome? Precautions should be taken to pre- Intellectual: knowledge of the phases of wound vent burning. Hot packs: Commercial hot packs provide a spec- Technical: ability to correctly use the products, pro- ified amount of dry heat for a specific period. Warm moist compresses: Used to promote treat pressure ulcers and other skin alterations circulation and reduce edema. Must be changed Interpersonal: ability to establish trusting frequently and covered with a heating agent. Sitz baths: Patient is placed in a tub filled with their caregivers in a plan to prevent or treat sufficient water to reach the umbilicus; the legs pressure ulcers and other skin alterations and feet remain out of the water. Objective data are underlined; subjective data are in medication to a locally infected area. Chijioke noticed during the patient’s bath that the skin of her coccyx, heels, and elbows Sample Answers was reddened. What nursing intervention would be appropriate to prevent skin irritation and the development of pres- when pressure was relieved in these areas.

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In addition generic 5mg emsam free shipping anxiety synonyms, the terms illustrate how difficult it is to define one term without using another with the risk that the definitions become tautologies emsam 5mg generic anxiety symptoms in children facts for families. Questions about the causes of an addiction can be answered according to the different theoretical perspectives that have been developed over the past 300 years to explain and predict addictions, including the moral model, the 1st disease concept, the 2nd disease concept and the social learning theory. These different theories and how they relate to attitudes to different substances will now be examined. However, parallels can be seen between changes in theoretical perspective over the past 300 years and contemporary attitudes. The seventeenth century and the moral model of addictions During the seventeenth century, alcohol was generally held in high esteem by society. It was regarded as safer than water, nutritious and the innkeeper was valued as a central figure in the community. In addition, at this time humans were considered to be separate from Nature, in terms of possessing a soul and a will and being responsible for their own behaviour. Animals’ behaviour was seen as resulting from biological drives, whereas the behaviour of humans was seen to be a result of their own free choice. Accordingly, alcohol consumption was considered an acceptable behaviour, but excessive alcohol use was regarded as a result of free choice and personal responsibility. Alcoholism was therefore seen as a behaviour that deserved punishment, not treatment; alcoholics were regarded as choosing to behave excessively. This perspective is similar to the arguments espoused by Thomas Szasz in the 1960s concerning the treatment versus punishment of mentally ill individuals and his distinction between being ‘mad’ or ‘bad’. Szasz (1961) suggested that to label someone ‘mad’ and to treat them, removed the central facet of humanity, namely personal responsibility. He suggested that holding individuals responsible for their behaviour gave them back their sense of responsibility even if this resulted in them being seen as ‘bad’. Similarly, the moral model of addictions considered alcoholics to have chosen to behave excessively and therefore deserving of punishment (acknowledging their responsibility) not treatment (denying them their responsibility). The temperance movement was developed and spread the word about the evils of drink. Alcohol was regarded as a powerful and destructive substance and alcoholics were regarded as its victims. This was the earliest form of a biomedical approach to addiction and regarded alcoholism as an illness. Alcohol was seen as an addictive substance, and alcoholics were viewed as passively succumbing to its influence. The 1st disease concept regarded the substance as the problem and called for the treatment of excessive drinkers. The twentieth century and the 2nd disease concept Attitudes towards addiction changed again at the beginning of the twentieth century. In parallel, attitudes towards human behaviour were changing and a more liberal laissez-faire attitude became dominant. The 2nd disease model of addiction was developed, which no longer saw the substance as the problem but pointed the finger at those individuals who became addicted. Within this perspective, the small minority of those who consumed alcohol to excess were seen as having a problem, but for the rest of society alcohol consumption returned to a position of an acceptable social habit. This perspective legitimized the sale of alcohol, recognized the resulting government benefits and emphasized the treatment of addicted individuals. Alcoholism was regarded as an illness developed by certain individuals who therefore needed support and treatment. The 1970s and onwards – social learning theory Over the past few years attitudes towards addictions have changed again. With the development of behaviourism, learning theory and a belief that behaviour was shaped by an interaction with both the environment and other individuals, the belief that excessive behaviour and addictions were illnesses began to be challenged. Since the 1970s, behaviours such as smoking, drinking and drug-taking have been increasingly described within the context of all other behaviours. In the same way that theories of aggression shifted from a biological cause (aggression as an instinct) to social causes (aggression as a response to the environment/upbringing), addictions were also seen as learned behaviours. Within this perspective, the term addictive behaviour replaced addictions and such behaviours were regarded as a consequence of learning processes. This shift challenged the concepts of addictions, addict, illness and disease, however the theories still emphasized treatment. Although the development of social learning theory highlighted some of the problems with the 2nd disease concept of addictions, both these perspectives still remain, and will now be examined in greater detail.

Her first each for Nursing Theories and Nursing Practice 1st book emsam 5 mg otc anxiety symptoms in 8 year old, The Dynamic Nurse-Patient Relationship: edition generic emsam 5mg on-line anxiety 5 weeks pregnant. To the extent possible, content written by Function, Process and Principles (1961), was based each of the identified authors is used. For a wealth on her research and blended nursing practice, of additional information on these nurses, scholars, psychiatric–mental health nursing, and nursing ed- researchers, thinkers, writers, practitioners, and ed- ucation. It was published when she was director ucators, please consult the reference and bibliogra- of the graduate program in mental health and phy sections at the end of this chapter. She received a bachelor of arts degree from tative and inductive, using naturalistic inquiry Wellesley College in 1922. As a consultant at McLean Hospital in Johns Hopkins School of Nursing in 1925 (Nickel, Belmont, Massachusetts, Orlando continued to Gesse, & MacLaren, 1992. After completing a study nursing practice and developed a training master of arts at Columbia Univeristy in 1934, she program and nursing service department based on became a professional writer for the American her theory. With two opment of prescriptive theory (Dickoff, James & of her brothers serving in the armed forces during Wiedenbach, 1968). Even after her retirement in World War I and in anticipation of a critical short- 1966, she and her lifelong friend Caroline Falls of- age of nurses, Virginia Henderson entered the Army fered informal seminars in Miami, always remind- School of Nursing at Walter Reed Army Hospital. It ing students and faculty of the need for clarity of was there that she began to question the regimen- purpose, based on reality. She even continued to talization of patient care and the concept of nurs- use her gift for writing to transcribe books for the ing as ancillary to medicine (Henderson, 1991). Her pioneer work in the area of “series of almost unrelated procedures, beginning identifying and structuring nursing knowledge has with an unoccupied bed and progressing to aspira- provided the foundation for nursing scholarship tion of body cavities” (Henderson, 1991, p. Henderson admired Goodrich’s intel- Introducing the Theories lectual abilities and stated: “Whenever she visited our unit, she lifted our sights above techniques Virginia Henderson, sometimes known as the and routine” (Henderson, 1991, p. Henderson modern day Florence Nightingale, developed the credited Goodrich with inspiring her with the definition of nursing that is most well known inter- “ethical significance of nursing” (Henderson, 1991, nationally. Ida Jean Orlando was perhaps the ence forever influenced her ethical understanding first nurse to use qualitative research methods and of nursing and her appreciation of the importance was the first to articulate nursing concepts based on and complexity of the nurse-patient relationship. Each of these She continued to explore the nature of nursing nurses helped us focus on the patient, instead of on as her student experiences exposed her to different the tasks to be done, and to plan care to meet needs ways of being in relationship with patients and of the person. For instance, a pediatric experience caring based on the perspective of the individual as a student at Boston Floating Hospital introduced being cared for—through observing, communicat- Henderson to patient-centered care in which ing, designing, and reporting. Each was concerned nurses were assigned to patients instead of tasks, with the unique aspects of nursing practice and and warm nurse-patient relationships were encour- scholoarship and with the essential question of, aged (Henderson, 1991). She enjoyed the less formal vis- Initial work on Wiedenbach’s prescriptive theory is iting nurse approach to patient care and became presented in her article in the American Journal skeptical of the ability of hospital regimes to alter of Nursing (1963) and her book, Meeting the patients’ unhealthy ways of living upon returning Realities in Clinical Teaching (1969). She entered Teachers tion of prescriptive theory is that:“Account must be College at Columbia University, earning her bac- calaureate degree in 1932 and her master’s degree “Account must be taken of the motivating in 1934. She continued at Teachers College as an in- factors that influence the nurse not only in structor and associate professor of nursing for the doing what she does but also in doing it next 20 years. Henderson wrote about nursing the way she lived it: focusing on what taken of the motivating factors that influence the nurses do, how nurses function, and on nursing’s nurse not only in doing what she does but also in unique role in health care. Her works are beauti- doing it the way she does it with the realities that fully written in jargon-free, everyday language. The nurse’s central purpose in nursing is the • The Recipient, or the patient receiving this nurse’s professional commitment. For Wiedenbach, action or on whose behalf the action is the central purpose in nursing is to motivate the taken; individual and/or facilitate his efforts to over- • The Framework, comprised of situational fac- come the obstacles that may interfere with his tors that affect the nurse’s ability to achieve ability to respond capably to the demands made nursing results; of him by the realities in his situation • The Goal, or the end to be attained through (Wiedenbach, 1970, p. She emphasized that nursing activity on behalf of the patient; the nurse’s goals are grounded in the nurse’s • The Means, the actions and devices through philosophy, that “those beliefs and values that which the nurse is enabled to reach the shape her attitude toward life, toward fellow goal. She rec- in whatever setting they are found for the purpose of ognized that nurses have different values and avoiding, relieving, diminishing or curing the indi- various commitments to nursing and that to vidual’s sense of helplessness. Following is an overview of the major nurse to undergo this experience and be “willing components of Orlando’s work. The nursing process includes identifying needs nursing for examination and discussion when of patients, responses of the nurse, and nursing appropriate” (Wiedenbach, 1970, p. The prescription indicates the broad general ac- practiced by Orlando, is not the linear model tion that the nurse deems appropriate to fulfill- often taught today, but is more reflexive and ment of her central purpose. The nurse will have circular and occurs during encounters with thought through the kind of results to be sought patients. Understanding the meaning of patient behavior accepting accountability for what she does and is influenced by the nurse’s perceptions, for the outcomes of her action.