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By I. Berek. Pontifical University. 2018.

Too many investigations may reinforce her belief in her illness and false-positive findings do occur and may exacerbate her anxieties buy pilex 60 caps with amex prostate cancer metastasis to bone. However purchase 60 caps pilex visa prostate cancer 1-10 scale, if the patient could not be simply reassured it might be appropri- ate to proceed with an exercise stress test or a thallium scan to look for areas of reversible ischaemia on exercise or other stress. A coronary arteriogram would not be appropriate without other information to indicate a higher degree of risk of coronary artery disease. History A 30-year-old woman is brought up to the emergency department at 2 pm by her hus- band. She has a history suggestive of depression since the birth of her son 3 months earlier. She has been having some counselling since that time but has not been on any medication. The previ- ous evening about 10 pm she told her husband that she was going to take some pills and locked herself in the bathroom. Two hours later he persuaded her to come out and she said that she had not taken anything. They went to bed but he has brought her up now because she has complained of a little nausea and he is worried that she might have taken something when she was in the bathroom. The only tablets in the house were aspirin, paracetamol and temazepam which he takes occasionally for insomnia. Her pulse is 76/min, blood pressure is 124/78 mmHg and respiratory rate is 16/min. There is some mild abdom- inal tenderness in the upper abdomen but nothing else abnormal to find. Aspirin and temazepam would be likely to produce more symptoms in less than 14 h if they have been taken in significant quantity. However, the salicylate level should certainly be measured; in this case it was not raised. In the absence of drowsiness at this time, it is not necessary to consider temazepam any further. Paracetamol overdose causes hepatic and renal damage, and can lead to death from acute liver failure. The severity of paracetamol poisoning is dose related with a dose of 15 g being serious in most patients. Patients with pre-existing liver disease and those with a high alcohol intake may be susceptible to smaller overdoses. It is often the first test to become abnormal when there is liver damage from paracetamol overdose. There are few symptoms in the first 24 h except perhaps nausea, vomiting and abdominal dis- comfort. Acute liver failure may develop between days 3 and 5, and renal failure occurs in about 25 per cent of patients with severe hepatic damage. The earlier this is used the better but it is certainly still worth- while 16 h after the ingestion. In this case a level of paracetamol of 64 mg/L confirmed that treatment was appropriate and that the risk of severe liver damage was high. Further advice can always be obtained by ringing one of the national poisons information ser- vices. The electrolyte, renal and liver function tests and the clotting studies should be monitored carefully over the first few days, and referral to a liver unit considered if there is marked liver dysfunction. Patients with fulminant hepatic failure are considered for urgent liver transplantation. The other areas that need to be addressed in this case are the mental state and the safety and care of the son and any other children. She should be seen by a psychiatrist or other appropriately trained health worker. The question of any possible risk to the baby should be evaluated before she returns home. On direct questioning she states that she has lost 8 kg in weight over the past year although she says her appetite is good. This is a disorder usually of teenagers or young adults char- acterized by severe weight loss, a disorder of body image (the patient perceiving themself as being fat despite being objectively thin) and amenorrhoea (or, in men loss of libido or potency). Often sufferers from this condition work in a profession where personal image is very important, e. Some patients exhibit the bulimic behaviour of recurrent bouts of overeating and self-induced vomiting. The skin is dry with growth of lanugo hair over the neck, cheeks and limbs as in this woman. Severe physical complications include proximal myopathy, cardiomyopathy and peripheral neuropathy. A number of interrelated mechanisms cause the metabolic alkalosis in this patient. The vom- iting causes a net loss of hydrogen and chloride ions, causing alkalosis and hypochloraemia.

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Some The Sunrise Enabler was developed with the nurse researchers have studied care with limited idea to “let the sun enter the researcher’s mind” and variables or in regard to medical symptoms and discover largely unknown care factors of cultures pilex 60caps sale man healthcom pay bill pay bill. Discovering the totality of living Generally purchase 60 caps pilex fast delivery prostate 600 side effects, a wealth of new and unexpected nursing with a caring ethos in a culture has provided a care knowledge is discovered that has never been wealth of new knowledge about clients’ lifeworld known and used in present-day nursing and med- and care. This characteristic helps nurse re- searchers to discover what exists, or has the poten- Current Status of the Theory tial to be known and used for human caring and health practices. What exists and does not exist is Currently, the theory of culture care diversity and important to discover, as is the potential for future universality is being studied and used in many discoveries. Some theories deal only with abstract schools of nursing within the United States and phenomena, but this theory has both abstract and other countries (Leininger & McFarland, 2002). The theory has grown in recognition and value for Sixth, the theory of culture care is a synthesized several reasons. First, the theory is the only nursing concept; integrated with the ethnonursing method, theory that focuses explicitly and in depth on it has already provided a wealth of many new in- discovering the meaning, uses, and patterns of sights, knowledge areas, and valuable ways to work culture care within and between specific cultures. Thus, it has greatly expanded nurses’ are the new knowledge holdings that support the knowledge about care so essential for nurses to new discipline of transcultural nursing. Third, the theory has the “gold nuggets” to change or transform health a “built-in” and tailor-made ethnonursing nursing care to realize therapeutic outcomes for different research method that helps to realize the theory cultures. It is different from ethnography and other been reported in the Journal of Transcultural research methods. The ethnonursing method is a Nursing and other transcultural nursing books and qualitative method and is valuable in discover- journals since 1980. They substantiate the theory ing largely covert, complex, and generally hidden (Leininger, 1991, 1995, 1997a, 1997b). It was Seventh, the theory and its research findings are the first specific research method designed so that stimulating nursing faculty and clinicians to use the theory and method fit together. This has culture specific care appropriate and safe for cul- brought forth a wealth of new data. Thus, transcultural nursing knowledge is to data methods were not helpful to find hidden be used in clinical and community settings. Nursing administrators in service and academia Fourth, the theory of culture care is the only the- need to be active change leaders to use transcultural ory that searches for comprehensive and holistic nursing findings. Nursing faculty members need to care data relying on social structure, worldview, promote and teach ways to be effective with cul- and multiple factors in a culture in order to get a tures (Leininger, 1998). The theory is being used a lot to trism and racial biases and prejudices are being re- do culturalogical–health care assessments. Many nurses transcultural nursing concepts, findings, policies, also like to discover the differences and similarities and standards of care are being developed and used among cultures as it expands their worldviews and from findings (Leininger, 1991). Interdisciplinary deepens their appreciation of human beings of di- health personnel are finding the theory and trans- verse cultures. Learning to become immersed in a cultural nursing concepts and are finding help in culture has been a major benefit. This has been the most rewarding benefit of be used in any culture and at any time and with the theory. The consumer also likes the ethno- the theory slightly to fit their major and unique in- nursing method as they can “tell their story” and terest and goals of their discipline. Several disci- guide health researchers to discover the truths plines, including dentistry, medicine, social work, about their culture. Informants speak of being and pharmacy, are now using the culturally con- more comfortable with researchers. The goal for United States government and several theory encourages the researcher or clinician to dis- states. The concept is growing in use and will be- cover culture from the people and to let them be in come a global force. In general, the theory of culture care is a theory Tenth, nurse researchers who have been pre- of global interest and significance as we continue to pared in transcultural nursing and have used the understand cultures and their care needs and prac- theory and method commonly say things like, “I tices worldwide. It is the only theory that makes principles, theory, and findings must become fully sense to help cultures. They grow in ideas and enjoy incorporated into professional areas of teaching, discovering new knowledge of the lifeways of peo- practice, consultation, and research. Unques- Eleventh, nurses who have used the theory and tionably, the theory will continue to grow in rele- findings over time often speak of how much they vance and use as our world becomes more intensely have learned about themselves and about new cul- multicultural. Nurses dis- will be expected in the near future to function com- cover their ethnocentric tendencies as well as petently with diverse cultures. The findings are helpful to reduce with many transcultural nursing concepts, princi- cultural biases and prejudices that influence quality ples, and research findings, will be used. This was the first research method de- of Leininger’s signed to study a nursing theory and related nurs- ing phenomena. The method facilitates the discovery of people care knowledge and culturally Theory of based care related to the theory. Leininger has Leininger has defined the ethnonursing re- Culture Care search method as “a qualitative research method using naturalistic, open discovery, and largely inductively derived emic modes Diversity and and processes with diverse strategies, tech- niques, and enabling tools to document, describe, understand, and interpret the Universality people’s meanings, experience, symbols, and other related aspects bearing on Marilyn R. Qualitative Paradigm and Quantitative Paradigm The purpose of the second part of Chapter 20 is In order to understand the qualitative ethnonurs- twofold.

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Drowsiness; dizziness * Ensure that client does not operate dangerous machin- ery or participate in activities that require alertness discount 60caps pilex free shipping prostate cancer causes. Hypotension; bradycardia * Take vital signs just before initiation of therapy and before daily administration of the medication buy pilex 60caps with visa anti-androgen hormone therapy for prostate cancer. Constipation * Encourage increased fluid (if not contraindicated) and fiber in the diet. Drowsiness; dizziness * Ensure that client does not operate dangerous machin- ery or participate in activities that require alertness. Dry mouth; constipation * Provide sugarless candy or gum, ice, and frequent sips of water. Provide foods high in fiber; encourage physical activity and fluid if not contraindicated. Observe for the appear- ance of symptoms of polydipsia, polyuria, polyphagia, and weakness at any time during therapy. The physician will administer orders for tapering the drug when therapy is to be discontinued. Increase by 20 to 50 mg every 3 to 4 days until effective dose is reached, usually 200 to 400 mg/ day. Increase gradually over several days (up to 400 mg every 4 to 6 hours in severe cases). Hospitalized patients with schizophrenia: 8 to 16 mg 2 to 4 times a day, not to exceed 64 mg/day. Gradually increase dosage by small increments over 2 or 3 days to 50 to 75 mg/day. Once effective response has been achieved, may reduce gradually to determine the minimum maintenance dose. Increase gradually until therapeutic effect has been achieved or maximum dose of 3 mg/kg/day has been reached. Usual optimum dosage range: 15 to 20 mg/day, although a few may require 40 mg/day or more. Other effects may be due to an- tagonism of histamine H1 receptors and alpha1-adrenergic receptors. Antipsychotic Agents ● 483 Contraindications and Precautions: Loxapine ● Contraindicated in: hypersensitivity; comatose or severe drug-induced depressed states; clients with blood dyscrasias; hepatic, renal, or cardiac insufficiency; severe hypotension or hypertension; children, pregnancy, and lactation (safety not established) ● Use cautiously in: patients with epilepsy or history of sei- zures; glaucoma; urinary retention; respiratory insufficiency; prostatic hypertrophy; elderly patients with dementia-related psychosis (black box warning). Orally dis- integrating tablets only: Phenylketonuria (orally disintegrating tablets contain aspartame) ● Use cautiously in: hepatic insufficiency, elderly clients (reduce dosage), pregnancy and children (safety not established), car- diovascular or cerebrovascular disease, history of glaucoma, history of seizures, history of attempted suicide, prostatic hypertrophy, diabetes or risk factors for diabetes, narrow an- gle glaucoma, history of paralytic ileus; elderly patients with dementia-related psychosis (black box warning). Quetiapine ● Contraindicated in: hypersensitivity; lactation ● Use cautiously in: cardiovascular or cerebrovascular dis- ease; dehydration or hypovolemia (increased risk of hypoten- sion); hepatic impairment; hypothyroidism; history of suicide attempt; pregnancy or children (safety not established); patients with diabetes or risk factors for diabetes; elderly pa- tients with dementia-related psychosis (black box warning). Concomitant use with lorazepam (and possibly other benzodiazepines) may result in respiratory depres- sion, stupor, hypotension, and/or respiratory or cardiac arrest. Increased hypotension fl u o x e t i n e , rifampin), with antihypertensive agents. Olanzapine Fluvoxamine, Carbamazepine, Decreased effects of levodopa fl u o x e t i n e omeprazole, and dopamine agonists. Quetiapine Cimetidine; Phenytoin, Decreased effects of levodopa ketoconazole, thioridazine and dopamine agonists. Increase dosage fairly rapidly over the first 7 to 10 days until symptoms are controlled. Dosage should be maintained at the lowest level effective for controlling symptoms. May increase dosage by 25 to 50 mg/day over a period of 2 weeks to a target dose of 300 to 450 mg/day. If required, make additional increases in increments of 100 mg not more than once or twice weekly to a maximum dosage of 900 mg/day in 3 divided doses. The mean and median doses are approximately 600 mg/day for schizophrenia and 300 mg/day for reducing recurrent suicidal behavior. If for a 6-month period the counts remain within the acceptable level for the biweekly period, counts may then be monitored every 4 weeks there- after. May increase in increments of 1 to 2 mg/day at intervals of 24 hours to a recommended dose of 4 to 8 mg/day. After clinical assessment, dose increases may be made at intervals of more than 5 days. May increase dosage by intervals of at least 2 days up to a dosage of 80 mg 2 times a day. Adjust dosage on the basis of toleration and efficacy within the range of 40 to 80 mg 2 times a day. Maintenance dosage: 10 to 30 mg/day (maintain at lowest effective dose for symptom remission).

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Finally order pilex 60 caps visa androgen hormone in birth control pills, you see how to keep track of both your moods and the thoughts that accompany distressing feelings discount pilex 60caps fast delivery androgen hormone structure. Chapter 1 Sor ting Ou t Signs of Anxiet y and Depression In This Chapter Figuring out how depression and anxiety affect you Finding your personal starting point Knowing when to get more help veryone feels sad or worried from time to time. And most people have shed a tear or two watching a sad movie or a news story about a poignant tragedy. But when sadness fills most of your days or worries saturate your mind, that’s not so normal. Anxiety and depression can affect how you think, behave, feel, and relate to others. The discussion and quizzes in this chapter help you figure out how depression and anxiety affect your life. Don’t freak out if the quizzes in this chapter reveal that you have a few symptoms of anxiety or depression. If your symptoms are numerous and severe or your life seems out of control, you should consult your primary care physician or a mental health professional. These quizzes aren’t meant to replace trained mental health professionals — they’re the only people who can really diagnose your problem. Dwelling on Dismal and Worried Thoughts If you were able to listen in on the thoughts that reverberate through a depressed person’s head, you might hear “I’m a failure,” “My future looks bleak,” “Things just keep on getting worse,” or “I regret so many things in my life. The very darkest thoughts usually lead to depression, whereas anxiety usually stems from thoughts about being judged or hurt. Take the quiz in Worksheet 1-1 to determine if your thoughts reflect a problem with anxiety or depression. Although these thoughts can occur to someone who’s either depressed or anxious (or both), the odd-numbered items are most indicative of depression, and the even-numbered items reflect anxious thinking. However, the more items you endorse, the more you have cause for concern; specifically, if you check more than eight or ten items, you should think seriously about addressing your condition. At the same time, if you very strongly believe in any of these items, you just may have too much anxiety or depression. If you have any thoughts of suicide or utter hopelessness, you should consult your primary care physician or a mental health professional immediately. Chapter 1: Sorting Out Signs of Anxiety and Depression 11 Walking in Quicksand: Apprehensive and Blue Behavior If you were to follow a depressed or anxious person around, you might see some behavioral signs of their emotional turmoil. That’s because depression and anxiety on the inside affect what people do on the outside. For example, a depressed person may look tired, move slowly, or withdraw from friends and family; an anxious person may avoid socializing or have a trembling voice. Take the quiz in Worksheet 1-2 to see if your behavior indicates a problem with anxiety and/or depression. I feel compelled to repeat actions (such as hand washing, checking locks, arrang- ing things in a certain way, and so on). Even-numbered items are most consistent with anxiety, and odd-numbered items largely indicate depression. And, of course, like many people, you may have symptoms of both types of problems. In fact, some people primar- ily suffer from changes in appetite, sleep, energy, or pain while reporting few problematic thoughts or behaviors. These symptoms directly affect your body, but they’re not as easily observed by other people as the behavioral signs covered in the preceding section. Part I: Analyzing Angst and Preparing a Plan 12 Take The Sad, Stressed Sensations Quiz in Worksheet 1-3 to see if your body is trying to tell you something about your emotional state. The symptoms in this quiz can also result from various physical illnesses, drugs in your medicine cabinet, or even your three-cup coffee fix in the morning. Be sure to consult your primary care physician if you’re experiencing any of the symptoms in The Sad, Stressed Sensations Quiz. It’s always a good idea to have a checkup once a year and more frequently if you experience noticeable changes in your body. Although physical sensations overlap in anxiety and depression, even-numbered items in the quiz above are most consistent with anxiety, and the odd-numbered items usually plague those with depression. Reflecting upon Relationships When you’re feeling down or distressed for any length of time, odds are that your relation- ships with those around you will take a hit. Although you may think that your depression or anxiety affects only you, it impacts your friends, family, lovers, co-workers, and acquaintances. Take the quiz in Worksheet 1-4 to see if your emotions are causing trouble with your rela- tionships.

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