By G. Gambal. Wentworth Institute of Technology. 2018.

Which of the following conditions is most likely the etiology of this patient’s symptoms? He is currently on an oxygen face mask and was admin- istered one nebulized treatment of a β2-agonist by the paramedics buy danazol 200mg without prescription xeloda menopause. Upon chest auscultation proven 200 mg danazol women's health center in grants pass or, there are minimal wheezes localized over bilateral lower lung fields. Which of the following medications, in addition to a rescue β2-agonist inhaler, should be pre- scribed for outpatient use? Upon physical examination, the patient has clear breath sounds bilaterally and no signs of trauma. Given this clinical presentation, what initial antibiotic coverage is most appropriate for this patient? The patient is endotracheally intubated, given a 2-L bolus of normal saline, and started on antibiotics. You see a friend that accompanied the patient to the hospital and ask him some questions. What is the most likely organism that is responsible for the patient’s presentation? Upon physical examination, there are decreased breath sounds on the right as compared to the left. A chest radiograph indicates blunting of the right costophrenic angle with a fluid line. Given this patient’s history, which of the following most likely describes his effusion? Upon physical examination, the patient appears to be in mild distress with audible wheezing. She is able to speak in partial sen- tences and states that she occasionally uses an inhaler. Given this patient’s history and physical examination, which of the following measures should be taken next? If pharyngeal or laryngeal structures become involved, or there is significant tongue swelling, the patient may begin to compromise their airway and emergent intubation or surgical cricothyroidotomy needs to be performed. All patients need to be on a monitor and should receive supplemental oxygen despite normal oxygen saturation. Heparin is the first-line therapy in this patient and should be administered promptly. Warfarin initially causes a temporary hypercoagulable state because the anticoagulants, protein C and S (inhibited by warfarin), have shorter half-lives compared with the procoagulant vitamin K–dependent proteins that warfarin also inhibits. Classically, it presents with a productive cough with currant jelly sputum, fever, general malaise, and an overall toxic appearance. A dense lobar infiltrate with a bulging fissure appearance on a chest radiograph is often described. Streptococcus pneumoniae (a) is the most common etiology in community- acquired pneumonia among adults. Mycoplasma pneumoniae (c) is a common cause of community-acquired pneumonia in patients under the age of 40. Legionella pneumophila (d) is an intracellular organism that lives in aquatic environments and is not transmitted from person to person.

Place the following steps for digital removal and the anal valve on the figure below and of stool in the order in which they would write the appropriate body part on the lines normally occur: provided order 200 mg danazol fast delivery breast cancer karyotype. Work the finger around and into the hard- ened mass to break it up and then remove pieces of it discount 200 mg danazol otc breast cancer treatment options. Instruct the patient to bear down if possible while extracting feces to ease in removal. Place the patient in a side-lying position and place a bedpan on the bed for deposit- ing removed feces. This helps to avoid discomfort as well as irritation, which can injure intes- tinal mucosa. Lubricate the forefinger generously to reduce irritation of the rectum and insert the finger gently into the anal canal. The presence of the finger added to the mass tends to cause discomfort for the patient if the work is not done slowly and gently. Have a second person assist with the proce- dure to reassure and comfort the patient while the first person breaks up the mass. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Indicate the type of stool that figures below by writing your answers on the would be expected with each ostomy. Sigmoidoscopy hollow body organ using a long flexible tube containing glass fibers that transmit e. Lower gastrointestinal examination of an image that can be viewed Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The visual examination of the lining of Match the term in Part A with its definition the distal sigmoid colon, the rectum, and listed in Part B. Barium sulfate is instilled into the large intestine through a rectal tube inserted b. The patient drinks barium sulfate, which coats the esophagus, stomach, and small j. The passage of excessively liquid and tion to test for pH or blood in the stool unformed stools Match the type of enema in Part A with its use 17. Used to lubricate the stool and intestinal listed in Part A with the illustration in Part B. Esophagus rectum and provide relief from gaseous distention Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Give an example of how the following factors might affect a patient’s bowel elimination. Developmental considerations: patient complaining of painful defecation due to hard, dry stools.

The presence of any groups larger than H changes the stability by increasing the steric strain buy cheap danazol 100mg on line women's reproductive health issues and controversies, especially if these groups are present in axial positions cheap danazol 100mg free shipping pregnancy timeline. Because of axial and equatorial positions in the chair conformation of cyclohexane, one might expect to see two isomeric forms of a monosub- stituted cyclohexane. However, in reality, only one monosubstituted form exists, because cyclohexane rings are conformationally mobile at room temperature. Different chair conformations interconvert, resulting in the exchange of axial and equatorial positions. During ring-flip, the middle four carbon atoms remain in place, while the two ends are folded in opposite directions. As a result, an axial substituent in one chair form of cyclohexane becomes an equatorial substituent in the ring-flipped chair form, and vice versa. Before we look into the details of various configurational isomers, we need to understand the concept of chirality. For example, our left and right hands are mirror images of each other, and cannot be superimposed on each other. X X W C* Y W C z z z Chiral carbon Achiral carbon Four different groups/atoms present At least two same groups/atoms (Z) present When there are two or more atoms/groups that are the same, the carbon is called achiral. Ifa molecule can be divided by a plane into two equal halves that are mirror images of each other, the plane is a plane of symmetry, and the molecule is 3. If you rotate the mirror image through 180 , it is identical to the original structure. Cl Cl Br H H Br H H Mirror image Achiral molecule Superimposable mirror image Enantiomers The Greek word enantio means ‘opposite’. A chiral mole- cule and its mirror image are called enantiomers or an enantiomeric pair. The actual arrangement or orientation (in space) of atoms/groups attached to the chiral carbon (stereogenic centre or stereocentre) is called the configuration of a compound. However, they differ in their activities with plane polarized light, which gives rise to optical isomerism, and also in their pharmacological actions. Drawing a chiral molecule (enantiomer) On a plane paper, chiral molecules can be drawn using wedge bonds. There are also a few other methods that use horizontal bonds representing bonds pointing out of the paper and vertical bonds pointing into the paper. If we looked ‘end-on’ at light as it travels, we would see it oscillates in all directions. When a beam of ordinary light is passed through a polarizer, the polarizer interacts with the electrical vector in such a way that the light emerging from it oscillates in one direction or plane. Light oscillates in all directions The plane of oscillation in plane-polarized light When plane-polarized light passes through a solution of an enantiomer, the plane of light rotates. If the rotation is in a clockwise direction, the enantiomer is said to be dextrorotatory and is given the (þ) sign in front of its name. Anticlockwise rotation gives an enantiomer which is known as levorotatory and is given the sign (À) in front of its name. A solution of optically active molecule (enantiomer) is placed in a sample tube, plane-polarized light is passed through the tube and a rotation of the polarization plane takes place. By rotating the analyser until the light passes through it, the new plane of polarization can be found, and the extent of rotation that has taken place can be measured. Polarizer Light source Observer Ordinary Plane-polarized light Sample tube containing unpolarized light a solution of optically Analyser active compound (Can be rotated) Enantiomers are optically active, and are called optical isomers, with one being (þ) and the other (À). A mixture of enantiomers with the same amount of each is called a racemic mixture.

Sources of food contamination Food may acquire their micro-organism from various sources and the following are the important sources trusted danazol 100mg women's health magazine uk back issues. Sewage - Gastrointestinal pathogens 50mg danazol free shipping breast cancer markers, coliforms, Enterococci of untreated domestic sewage could be source of contamination of raw plant foods. Soil - Soil is a very rich environment in microbes and is a major source of contamination of food. Nutrient found in foods • Organisms obtain their energy for carrying their metabolic activity mainly from the food. Hydrogen ion concentration (pH) • The optimum pH for many microorganisms is near the neutral point of pH 7. This is one of the reasons why fungi are usually associated with acid foods especially fruits. Oxidation reduction potential (O – R) • Organisms can be classified into aerobic and anaerobic based on their oxygen requirements. There fore, the reducing and oxidizing power of the food influences the type of organism that growth on it. Growth inhibitors: - These are chemicals such as sodium chloride (NaCl), Nitrate, Nitrite, Sulphur dioxide and hypochlorites that are added to foods to the growth of certain organisms. Water acitivity (aW) 344 • No microbial activity can occur unless water is available. This means that aW x 100 indicates the equilibrium relative humidity, which the particular food would produce if enclosed in a sealed container at a constant temperature. The lowest aW values permitting growth of spoilage organisms are - Normal bacteria 0. Microorganism of importance in food bacteriology Micro-organisms of interest in food bacteriology are: (i) Indicator organism(s):- 345 ƒ An indicator organism or group of organisms is/are one whose numbers in a product reflects the success or failure of good manufacturing practices. Differentiation of faecal from non faecal coliform:- ƒ In many laboratories differentiation of faecal coliforms from non faecal coliform is considered of limited value in determining the suitability of water or food for human consumption, as contamination with either type renders water or food potentially dangerous and unsafe from a sanitary stand point. However, differentiation may be advantageous under some conditions where the identity of specific members of the group present may indicate the source of pollution. The most most common microorganisms includes salmonella tyhimurrium, entropathogenicE. The most common microorganism in this group are clostridium botulinium,staphylococcus and toxigenic fungi eg. The spoilage microorganisms include bacteria, yeasts and modlds that cause undesirable changes of the appearance, odour, texture or taste of the food. They are commonly grouped according to their type of activity or according to theiri growth reguirements. Are those organisms capable of growing relatively rapidly at commercial refrigeration temperatures with out reference to optimum temperature for growth. Species of Pseudomans, Achromobacter, flavobacterium and Alcahigenes are examples of Psychrophilic bacteria. Many psychrophilic bacteria when present in large numbers can cause a variety of off flavoirs as well as defects in foods. The presence of large number of psychrophilic bacteria in refrigerated foods such as dairy products, meat, poultry and sea food may reflect growth of initial population during storage and /or massive contamination at some point prior to or during refrigerated storage. Thermoduric organisms are those organisms which will survive so significant measure of heat treatment 350. The thermophilic organisms not only survive the heat treatment but also grow at the elevated temperature. Thermoduric bacteria are important with regard to milk and milk products as they may survive pastourisation temperature The genera Micrococcus, Streptococcus primary the entrococci, Lactobacillus, Bacillus and Clostridium are recognized as containing some species which will qualify as thermoduric.

This is an inflammatory skin reaction that is also known as delayed hypersensitivity danazol 50 mg generic the women's health big book of exercises. Summary A drug has a physiochemical action with the physiological process of the body resulting in a pharmaceutical response cheap danazol 50 mg mastercard xenoestrogens menopause. Drugs replace a missing element such as a hormone, interrupts a physiological process or stimulates a physiological process to occur. In addition to a therapeutic effect, drugs may have side effects that can be desirable or undesirable. The first dose is called a loading dose or priming dose and consists of a large concentration of the drug. Subsequent doses are called maintenance doses and consist of a normal concen- tration of the drug. Drug activity is divided into the pharmaceutic phase, pharmacokinetic phase; and the pharmacodynamic phase. The pharmaceutic phase is the disintegration and dissolution of a drug taken orally. The pharmacokinetic phase is the mecha- nism used to absorb, distribute, and eliminate a drug. The pharmacodynamics is a drug’s effect on the physiology of the cell and the mechanism that causes the pharmaceutical response. Depending on the drug, binding either initiates a physiological response by the cell or blocks a cell’s physiological response. A low ther- apeutic index means a drug has a narrow margin of safety requiring that that the drug’s peak level and trough levels be closely monitored. A high therapeutic index means a drug has a broad margin of safety and does not require frequent monitoring of the patient and the serum drug level. Now that you have a good understanding of the theory of how drugs work, in the next chapter we’ll turn our attention to the practical aspect of pharmacology and see how pharmacology is used in the nursing process. The ingredient in a drug that causes a physiological response is called (a) D-fill. The method in which a drug is absorbed by flowing from a high concen- tration to a low concentration is called: (a) active diffusion. Primary loading is the first measured quantity of drug that is eliminated from the body. A drug that causes a nonspecific physiological response is called a(n) (a) agonist. The voice simply becomes more insistent until you have no choice but to open your eyes. This is to determine if the medication is having an effect or if the patient is experi- encing an undesirable side effect. In cases where the patient is being treated with a narrow spectrum antibiotic, blood may be drawn to determine if the antibiotic is working on the infection. Administering medication, evaluating the patient’s response, and determining if the drug is working as planned are pharmacology activities that are part of the nursing process. This chapter takes a look at the nursing process as it relates to giving medications. During the assessment step, the nurse is gather- ing subjective and objective data from the patient that will later be used to arrive at a nursing diagnosis.

Nerve fibres Pain is sensed by nociceptors which exist throughout almost all body tissue buy danazol 100 mg low cost menstrual yoga, especially the skin danazol 200mg low cost breast cancer event ideas. A fibres are large; their thick myelin sheaths enable rapid conduction—up to 20 m/s (Grubb 1998). A- delta fibres are found mainly in skin, skeletal muscle and joints, producing sharp and well-localised impulses and defensive motor reflex withdrawal (Melzack & Wall 1988). C fibres transmit dull, poorly localised, deep and prolonged pain signals, resulting in guarded movements and immobility. Sharp impulses from the fast A-delta fibres are superseded by slower, dull and prolonged impulses from C fibres. Pain may be described in these or other terms, and descriptions may indicate the sources of pain (e. Pain management 63 Gate control theory Ancient associations of pain with the heart bequeathed linguistic concepts and images (e. Descartes’ description of direct pain pathways to the brain, although now recognised as grossly oversimplistic, influenced many subsequent theories. While pain mechanisms remain unproven, Melzack and Wall’s ‘gate control’ theory is widely accepted. Hopes that neuropeptide endorphins (endogenous morphines) would achieve better pain control than exogenous narcotics have been disappointed (McCaffery & Beebe 1994). Psychology The perception of signals received is influenced by various psychological factors, including culture anticipation (past experience, fear, misinterpretation) distraction. The word ‘pain’ derives from the Latin poena (punishment) (Schofield 1994), and the perception of pain as retribution may be partly a psychological coping mechanism, but it also encourages stoic attitudes of endurance that can be physiologically harmful. Cultures can also influence whether, when and how it is acceptable to admit to pain. Distraction may help people cope with pain (Puntillo 1988) by blocking the gate with other impulses and stimulating serotonin release. Stereotypes While recognising cultural influences (especially when pain is denied), stereotyping people is unhelpful and dehumanising; the examples below illustrate some of the dangers. Men are expected to tolerate more pain than women (McCaffery & Beebe 1994), and so are less likely to report it (Puntillo & Weiss 1994), but in fact pain tolerance is similar between the genders (Phillips 1997). Pain management 65 Children used to receive little analgesia, even though pain pathways are intact by 30 weeks gestation (Tatman & Ralston 1997); misconceptions may still prevent children receiving adequate analgesia (see Table 7. Even if pain impulses were comparable, pain experiences are unique to each individual necessitating individual assessment, which should be a nursing priority (Doverty 1994). Assessing pain Pain assessment, together with nursing knowledge and attitudes, is fraught with problems. Compared with patients’ own assessments, nurses consistently underestimate pain (Seers 1987; Ferguson et al. Since it is impossible to judge what others are experiencing, it is better to give too much analgesia rather than too little (McCaffery & Beebe 1994). Verbal assessment may be influenced by a nurse’s choice of words and so ‘hurt’, ‘discomfort’, ‘ache’ and ‘soreness’ may identify discomforts that would be denied as ‘painful’ (McCaffery & Beebe 1994). Pharmacological interventions Although the actions of drugs are often complex, including significant psychological/placebo components, analgesics can be divided between those with peripheral actions (e. Observe for skeletal muscle response (a) body movement immobility purposeless or inaccurate body movements protective movements include withdrawal reflex rhythmic movements (b) facial expression: clenched teeth wrinkled forehead biting of lower lip widely opened or tightly shut eyes 2. Autonomic nervous system response (a) sympathetic nervous system activation: increased pulse increased respiration increased diastolic and systolic blood pressure cold perspiration pallor dilated pupils nausea muscle tension (b) parasympathetic activation in some visceral pain low blood pressure slow pulse 3. Verbal report of pain Pain management 67 Questions to elicit from the patient location of pain intensity of pain (scale 1–10) onset and duration precipatating and aggravating factors nature of pain (i.

Parsons & Shils danazol 100 mg with mastercard breast cancer 49er hats, 1951; Rapoport buy generic danazol 50 mg line women's health clinic brighton, 1968; and Von We define the person (behavioral system) as being Bertalanffy, 1968) were all sources for her model. In homeorrhesis, the system stabi- the sustenal imperatives (Grubbs, 1980; Holaday, lizes around a trajectory rather than a set point. A toddler placed in a body cast may show motor lags when the cast is removed but soon shows age- Wholeness and Order appropriate motor skills. An adult newly diagnosed The developmental analogy of wholeness and order with asthma who does not receive proper education is continuity and identity. Given the behavioral sys- until a year after diagnosis can successfully incor- tem’s potential for plasticity, a basic feature of the porate the material into her daily activities. These system is that both continuity and change can exist are examples of homeorhetic processes or self- across the life span. Instead, the issue should be cast in with illness, he or she is subject to biopsychosocial terms of determining patterns of interactions perturbations. The nurse, according to Johnson among levels of the behavioral system that may (1980, 1990), acts as the external regulator and promote continuity for a particular subsystem at a monitors patient response, looking for successful given point in time. If behavioral system balance tinuity is in the relationship of the parts rather than returns, there is no need for intervention. Johnson (1990) noted that at nurse intervenes to help the patient restore behav- the psychological level, attachment (affiliative) and ioral system balance. It is hoped that the patient dependency are examples of important specific be- matures and with additional hospitalizations the haviors that change over time while the representa- previous patterns of response have been assimilated tion (meaning) may remain the same. Adaptation is defined as balance, this pattern of dependence to independ- change that permits the behavioral system to main- ence may be repeated as the behavioral system en- tain its set points best in new situations. To the ex- gages in new situations during the course of a tent that the behavioral system cannot assimilate lifetime. The nurse acts to provide con- respond to contextual changes by either a homeo- ditions or resources essential to help the accommo- static or homeorhetic process. Systems have a set dation process, may impose regulatory or control point (like a thermostat) that they try to maintain mechanisms to stimulate or reinforce certain be- by altering internal conditions to compensate for haviors, or may attempt to repair structural com- changes in external conditions. A behavioral system is embedded in an tion of ability or effort are behavioral homeostatic environment, but it is capable of operating inde- processes we use to interpret activities so they are pendently of environmental constraints through the consistent with our mental organization. Hierarchic Interaction The combination of systems theory and develop- Each behavioral system exists in a context of hier- ment identifies “nursing’s unique social mission archical relationships and environmental relation- and our special realm of original responsibility in ships. Hierarchies, or a pattern of Next, we review the model as a behavioral system relying on particular subsystems, lead to a degree of within an environment. A disruption or failure will not destroy the Person whole system but leads instead to a decomposition to the next level of stability. Johnson conceptualized a nursing client as a behav- The judgment that a discontinuity has occurred ioral system. The behavioral system is orderly, is typically based on a lack of correlation between repetitive, and organized with interrelated and in- assessments at two points of time. For example, terdependent biological and behavioral subsys- one’s lifestyle prior to surgery is not a good fit post- tems. These discontinuities can provide op- subsystems that interrelate to form the behavioral portunities for reorganization and development. Dialectical Contradiction The client is seen as a collection of behav- ioral subsystems that interrelate to form The last core principle is the motivational force for the behavioral system.