By W. Umbrak. Amherst College.
Patients who have migraines experience intense purchase 20 mg crestor mastercard foods to lower cholesterol and diabetes, throbbing 5mg crestor otc cholesterol treatment guidelines, headache pain which is often accompanied by nausea, photophobia (sensitivity to light), phono- phobia (sensitivity to sound), and temporary disability. Migraines are sometimes preceded by an aura such as a breeze, odor, a beam of light, or a spectrum of colors. Migraines can occur on one side of the head (unilateral) and the pain is frequently reported as pulsating or throbbing. These are blood-vessel constrictors and dilators (see Chapter 26), antiseizure drugs (dis- cussed later in this chapter), antidepressants (discussed later in this chapter), beta-blockers (see Chapter 26), and analgesics (see Chapter 16). Patients are given a selected combination of these medications to prevent migraines. The prescriber determines the most effective combination for each patient based on the patient’s response to these medications. Commonly prescribed medications to prevent migraines are amitriptyline, divaproex sodium, propranol, timolol, topiramate, bupropion, cyproheptadine, diltiazem, doxepin, fluvoxamine, ibuprofen, imipramine, and methysergide. A list of drugs utilized in the treatment of migrane headaches is provided in the Appendix. With increased doses, the patient experiences a hypnotic effect causing the patient to fall asleep. Such is the case of the ultra-short-acting barbiturate thiopental sodium (Pentothal) that produces anesthesia. Sedative-hypnotics and barbituates were first used to reduce tension and anx- iety. Over-the-counter sleep medications such as diphenhydramine con- tain an antihistamine not barbiturates to achieve sedation. Short-acting sedative-hypnotics are ideal for patients who need assistance falling asleep but who must awaken early without experiencing a lingering aftereffect from the medication. The use of sedative-hypnotics for sleep (hypnotic) should be short term or there is a chance that the patient could become dependent on the medication or develop a tolerance. Patients who take high doses of sedative-hypnotics over long periods must gradually discontinue the medication rather than abruptly stopping the drug which can cause withdrawal symptoms. Sedative-hypnotics should not be administered to patients who have severe respiratory disorders or who are pregnant. Before a patient is prescribed a sedative-hypnotic to aid with sleep, the patient should try non-pharmacological methods that promote sleep such as: • Arise at a specific hour in the morning. Barbiturates are clas- sified by duration of action referred to as ultrashort-acting, short-acting, inter- mediate acting, and long-acting. Ultrashort-acting barbiturates such as thiopental sodium (Pentothal) is a com- monly used anesthetic. Secobarbital (Seconal) and pentobarbital (Nembutal) are short-acting barbiturates that induce sleep. For longer periods of sleep, patients are prescribed intermediate acting such as amobarbital (Amytal), aprobarbital (Alurate) and bubatabarbital (Butisol). Phenobarbital and mephobarbital are long-acting barbiturates used for controlling epileptic seizures. Anesthetic agents were introduced in surgery in the early 1800s in the form of nitrous oxide (laughing gas), which continues to be used today for dental pro- cedures. Ether is a highly flammable liquid with a pun- gent odor that causes nausea and vomiting and is seldom used today. General anesthetics are used for general surgery, cardiac surgery, neuro- surgery, and pediatric surgery. A general anesthetic can consist of one medication or a combination of med- ications—called balanced anesthesia—depending on the patient’s age, weight, medical history, general health, and allergies. The night before the surgery, the patient is given a hypnotic to assist with a good night’s sleep. On the day of the surgery, premedication may be given to the patient about one hour before surgery. A short-acting barbiturate such as thiopental sodium (Pentothal) is then administered in the operating room to induce anes- thesia. Depending on the nature of the operation, the patient may also receive a muscle relaxant. The patient experiences four stages of anesthesia, some of which are not observable because they occur rapidly. These stages are: Stage one: analgesia The patient experiences analgesia (a loss of pain sensation) but remains con- scious and can carry on a conversation. This stage is typically bypassed by administering a barbiturate such as sodium pentothal before the anesthesia. Stage four: medullary paralysis Breathing and other vital functions cease to function because the respiratory cen- ter (medulla oblongata) is paralyzed. These properties make it especially useful in developing countries and during warfare medical treatment. Ketamine is frequently used in pediatric patients because anesthesia and analgesia can be achieved with an intramus- cular injection.
Furthermore 5 mg crestor sale cholesterol test while breastfeeding, because the effects of the benzodiazepines are very similar to those of alcohol cheap crestor 5mg otc cholesterol and eggs, they are very dangerous when combined with it. Antipsychotic Medications Until the middle of the 20th century, schizophrenia was inevitably accompanied by the presence of positive symptoms, including bizarre, disruptive, and potentially dangerous behavior. As a result, schizophrenics were locked in asylums to protect them from themselves and to protect society from them. In the 1950s, a drug called chlorpromazine (Thorazine) was discovered that could reduce many of the positive symptoms of schizophrenia. Antipsychotic drugs (neuroleptics) are drugs that treat the symptoms of schizophrenia and related psychotic disorders. Today there are many antipsychotics, including Thorazine, Haldol, Clozaril, Risperdal, and Zyprexa. Some of these drugs treat the positive symptoms of schizophrenia, and some treat both the positive, negative, and cognitive symptoms. The discovery of chlorpromazine and its use in clinics has been described as the single greatest advance in psychiatric care, because it has dramatically improved the prognosis of patients in psychiatric hospitals worldwide. Using antipsychotic medications has allowed hundreds of thousands of people to move out of asylums into individual households or community mental health centers, and in many cases to live near-normal lives. Despite their effectiveness, antipsychotics have some negative side effects, including restlessness, muscle spasms, dizziness, and blurred vision. In addition, their long-term use can cause permanent neurological damage, a condition called tardive dyskinesia that causes uncontrollable muscle  movements, usually in the mouth area (National Institute of Mental Health, 2008). Newer antipsychotics treat more symptoms with fewer side effects than older medications do (Casey,  1996). Direct Brain Intervention Therapies In cases of severe disorder it may be desirable to directly influence brain activity through electrical activation of the brain or through brain surgery. When it was first developed, the procedure involved strapping the patient to a table before the electricity was administered. The patient was knocked out by the shock, went into severe convulsions, and awoke later, usually without any memory of what had happened. The patient is first given muscle relaxants and a general anesthesia, and precisely calculated electrical currents are used to achieve the most benefit with the fewest possible risks. Still other biomedical therapies are being developed for people with severe depression that persists over years. One approach involves implanting a device in the chest that stimulates the vagus nerve, a major nerve that descends from the brain stem toward the heart (Corcoran,  Thomas, Phillips, & O‘Keane, 2006; Nemeroff et al. When the vagus nerve is stimulated by the device, it activates brain structures that are less active in severely depressed people. Psychosurgery, that is, surgery that removes or destroys brain tissue in the hope of improving disorder, is reserved for the most severe cases. Developed in 1935 by Nobel Prize winner Egas Moniz to treat severe phobias and anxiety, the procedure destroys the connections between the prefrontal cortex and the rest of the brain. The procedure— which was never validated scientifically—left many patients in worse condition than before, subjecting the already suffering patients and their families to further heartbreak (Valenstein,  1986). Perhaps the most notable failure was the lobotomy performed on Rosemary Kennedy, the sister of President John F. There are very few centers that still conduct psychosurgery today, and when such surgeries are performed they are much more limited in nature and calledcingulotomy (Dougherty et al. The ability to more accurately image and localize brain structures using modern neuroimaging techniques suggests that new, more accurate, and more beneficial developments in  psychosurgery may soon be available (Sachdev & Chen, 2009). They do not cure schizophrenia, but they help reduce the positive, negative, and cognitive symptoms, making it easier to live with the disease. The drugs are effective but have severe side effects including dependence and withdrawal symptoms. Would you take an antidepressant or antianxiety medication if you were feeling depressed or anxious? Autonomic and behavioral effects of dextroamphetamine and placebo in normal and hyperactive prepubertal boys. Journal of the American Academy of Child & Adolescent Psychiatry, 35(11), 1460–1469. The antidepressant quandary—Considering suicide risk when treating adolescent depression. Effect size of lithium, divalproex sodium, and carbamazepine in children and adolescents with bipolar disorder. Discontinuation of benzodiazepine treatment: Efficacy of cognitive-behavioral therapy for patients with panic disorder.
A 39-year-old alcoholic woman is no longer is generally experienced at about 15 years interested in having sex with her partner order crestor 10 mg with visa cholesterol test strips. In the ovaries buy generic crestor 10 mg on line oxidized cholesterol definition, in a typical 28-day cycle, the describe common sexual orientations? In the luteal phase, the leftover empty folli- sexual fulﬁllment with a person of the cle ﬁlls with a yellow pigment and is then opposite gender. At day 28 of the menstrual cycle, menses sexual fulﬁllment with a person of the same begin as a result of the uterus shedding the gender. A bisexual is a person of a certain biologic gender with the feelings of the opposite 4. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The diaphragm is a dome-shaped device describe alternative forms of sexual expression? Pedophilia is a term used to describe the practice of adults gaining sexual fulﬁllment 1. Celibacy involves the use of inanimate yellow pigment and is then called the cor- objects to stimulate ejaculation. If fertilization does not occur, the corpus in which a man consistently reaches luteum begins to disintegrate. Retarded ejaculation refers to the man’s inability to ejaculate into the vagina, or delayed intravaginal ejaculation. Dyspareunia is a condition in which the which they occur in the sexual response vaginal opening closes tightly and prevents cycle. There is a heightened feeling of physical or pain characterized by burning, stinging, pleasure followed by overwhelming release irritation, or rawness of the female genitalia and involuntary contraction of the genitals. Continuous abstinence depends on and intensiﬁes; the woman’s clitoris retracts charting a woman’s fertility pattern. Pregnancy cannot occur with coitus interruptus because sperm is kept out of the vagina. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. One who experiences sexual fulﬁllment exhibits and experiences maleness or femaleness with a person of the opposite gender physically, emotionally, and mentally. Diabetes: contraceptive consisting of six capsules placed under the skin of the woman’s upper arm. Cardiovascular disease: daily circulating levels of ethinyl estradiol and norelgestromin to prevent conception. Person of a certain biologic gender with the feelings of the opposite sex Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. List three general categories of patients who in the following phases of the sexual response should have a sexual history recorded by the cycle. List three interview questions a nurse may use during a sexual history when assessing a male b. Complete the following table, listing the advantages and disadvantages associated with Male: contraceptive methods. Sterilization Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Write down the interview questions you would use to obtain a sexual history from the following patients. An 18-year-old female victim of date rape who is brought to the emergency room for testing and treatment 2. What intellectual, technical, interpersonal, practices and/or ethical/legal competencies are most d. A 5-year-old girl who presents with soreness likely to bring about the desired outcome? A sexually active teenager complains of a Read the following patient care study and use burning sensation during urination. He has a history really insistent that each of her sons should of diabetes and hypertension and is receiving respect women and that intercourse was some- numerous medications as treatment. During a thing you saved until you were ready to get routine visit to his primary care physician, Mr.