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B. Silas. University of Massachusetts at Amherst.

Waterlow recommends gel 5mg zebeta mastercard, head and elbow pads and 30° tilts for pillows (Waterlow 1995) zebeta 5mg mastercard. Skincare 109 Cost Pressure sores increase ■ human suffering ■ recovery time (1 order zebeta 10 mg,000 kcal may be needed each day to replace exudate protein loss and promote healing) ■ mortality ■ financial costs (prolonged stay, additional treatments, litigation). The cost of treating just one severe pressure sore can be £40,000 (Waterlow 1995). Tingle (1997a) cites costs ranging between £4,500 and £12,500 in recent cases where pressures sores contributed to mortality, but no records exist of nursing pressure area assessment. Necrotising fasciitis Necrotising fasciitis, an extension of cellulitis, is caused by aerobic and anaerobic soft tissue infection (Neal 1994). Necrotising fasciitis usually follows minor trauma or surgery (Neal 1994), beginning as cellulitis unresponsive to antibiotics. Tissue necrosis causes gas production (hydrogen, methane, hydrogen sulphide, nitrogen) and putrid discharge (Neal 1994)—although purely streptococcal infections have no odour (Neal 1994). The smell (and grey colour) of rotting flesh, distressing enough for staff, will probably cause profound anxiety to patients and visitors. Air fresheners can help mask the smell, although chemicals should not be allowed to enter exposed wounds. Gross swelling of flesh (oedematous) may make patients almost unrecognisable so that visitors need to be carefully prepared. Early stages of the disease are acutely painful (Neal 1994), but with progressive destruction of superficial nerve endings the later stages are often painless (Lipman 1997). The culture of guilt surrounding pressure sores is unhelpful to everyone; despite good nursing, sores will occur, and so nurses should assess and minimise risk factors in order to reduce the incidence. Further reading General nursing journals frequently carry articles on skincare; some journals specialise in the topic; regular library scans can identify new material. Following up at least one article on the assessment scale used by your unit can identify its strengths and limitations. Waterlow (1995) is also worth reading, although it is now rather dated and also shows the expected bias for the author’s own scale. Clinical scenario Gorgina Okra was admitted to intensive care following a cholecystectomy for postoperative respiratory management. She has an abdominal wound drain (T-tube) with large absorbent wound dressing, urinary catheter and oral endotracheal tube. List Mrs Okra’s intrinsic and extrinsic risk factors for developing pressure sore; include sources and likely sites. Using some of the published or adapted pressure risk assessment tools with Mrs Okra, analyse her potential for developing skin damage. Q3 Appraise the benefits and limitations of using a pressure relieving static mattress Skincare 111 to those of a low air loss bed with Mrs Okra. Which would be best for her immediate care, longer-term recovery and prevention of skin pressure points? To achieve optimal results for staff, child and family, adult intensive care nurses should develop their knowledge and become familiar with specific equipment associated with caring for critically ill children. After describing the initial assessment, the effects of critical illness on major body systems are identified, and the implications for nursing care are drawn. Children are different Caring for critically ill children requires nurses who are more familiar with nursing adults to adapt their skills and knowledge. Children differ from adults in several important ways: physically, psychologically and emotionally they are immature. Because of this many illnesses and their complications are more likely to occur in children. Immature respiratory and cardiovascular systems provide less reserve function so that children often deteriorate more rapidly. Children have higher metabolic rates, resulting in ■ higher cardiac index ■ greater gas exchange ■ higher fluid intake per kilogram ■ greater calorie intake per kilogram. Any nurse caring for critically ill children should recognise signs of organ dysfunction and failure, and respond appropriately when deterioration occurs. Responsiveness Normal healthy infants make good eye contact, orientate to familiar faces and are visually attracted to bright colours. As illness progresses, all extremities may become flaccid and the child unresponsive. Children’s’ pulse and respiratory rates normally increase during stress and decrease during sleep (Table 13. Family, play, education and maintenance of routine become central considerations when nursing children. The way families respond to this disruption may drastically affect the sick child. In order to meet the needs of each family, these should be individually assessed by the nurse (Hazinski 1992).

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Once the standard conjunct therapy with sedation buy cheap zebeta 10 mg on-line, the use of paralysing agents (also called muscle relaxants) showed a similar reversal between the three studies cited at the start of this chapter buy zebeta 10 mg overnight delivery. The routine use of paralysing agents fell from nearly all units in Merriman’s 1981 study to only 16 per cent regularly using it by 1987 (Bion & Ledingham 1987) order zebeta 10 mg fast delivery, with little change (15 per Intensive care nursing 58 cent) by Reeve and Wallace’s 1991 study. The reasons for reduced use of paralysis reflect those for reduced use of chemical sedatives. If adequately sedated, neuromuscular blockade does not further reduce oxygen consumption or energy expenditure (Sheridan et al. Paralysing agents should only be given where there are specific therapeutic indications, such as hyperpyrexia (see Chapter 8) and intracranial hypertension (see Chapter 22). Where patients are receiving paralysing agents, these will need to be stopped to assess sedation. With paralysing agents normally being given for therapeutic benefits (to prevent aggravating intracranial hypertension), the removal of paralysis for sedation assessment may cause undesirable physiological effects. When paralysing agents are being used, frequency of assessment should therefore be a multidisciplinary team decision, with paralysing agents being stopped for no longer than is pharmacologically necessary. Similarly, the use of paralysing agents should be assessed to ensure full therapeutic benefit (other than when sedation is being assessed). Paralysis is usually tested by absence of reflexes, such as electrical nerve stimulation. A relatively low (unpainful) voltage is usually sufficient to stimulate nerve reflexes; users can benefit by trying out such tests on themselves so that they know what they are inflicting on their patients. Implications for practice ■ the sedation needs of each patient should be individually assessed by the multidisciplinary team to meet each patient’s need, evaluating • humanitarian needs • therapeutic benefits • side effects (e. However, side effects can cause problems such as cardiovascular depression, while deep coma inhibits orientation and compliance with requests, as well as removing patient autonomy. How far, if at all, this should be compounded by chemical sedation is a question of balancing benefits and burdens. These issues cut across professional boundaries and plans for sedation should be agreed by nurses and doctors, using the advice of pharmacists and other appropriate disciplines. Although chemical sedatives are prescribed by doctors, they are (normally) given by nurses, and so the professional accountablity of each nurse ensures that patients receive adequate (but not excessive) sedation. The use of paralysing agents has declined; where they are used, there are usually specific therapeutic indications. Further reading Sedation has been widely studied and written about in both nursing and medical journals. Monger (1995) provides a thought- provoking article well worth reading, but it should be read critically. Readers are also advised to follow up source articles and any subsequent studies on the scoring system used on their unit identified above. Clinical scenario Joanna Tomlinson is 38 years old and was on holiday with her family when their hired car became involved in a tragic road traffic accident. She was sedated with a continuous intravenous infusion of midazolam (1 mg/ml) in order to facilitate ventilation and other treatments. The midazolam infusion was administered at titrated rate of between 2 and 4 ml/h for 10 days. Evaluate any potentially longer-term effects and outline some nursing strategies which can minimise these. Chapter 7 Pain management Fundamental knowledge Nerve pathways—sympathetic, parasympathetic, motor, sensory Spinal nerves Stress response (see Chapter 3) Introduction Much literature on pain management focuses on pharmacology. Specific information on individual drugs (indications, contraindications, usual doses, preparation, benefits and adverse effects) can be found in the manufacturer’s data sheets and pharmacopaedias (e. British National Formulary), both of which should be available in all clinical areas. Individual nursing assessments may identify ways to minimise discomfort—information which should be shared with colleagues (verbally, nursing records). Pain should be controlled for humanitarian reasons, but pain also initiates all the detrimental physiological effects of stress response (see Chapter 3), while reluctance to breathe deeply (if self-ventilating) contributes to atelectasis (Puntillo & Weiss 1994). How the stimuli are perceived by the cerebral cortex determines whether pain exists and, if so, its type and intensity (‘quality’). Pain is therefore necessarily individual to each sufferer, a complex interaction between physiology and psychology. The individuality of pain experiences underlies McCaffery’s widely quoted definition: ‘pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does’ (McCaffery & Beebe 1994:15). However some patients may deny pain, even if experiencing it (possibly due to social expectations—‘stiff upper lip’). McCaffery and Beebe (1994) add that nurses should not accept denial of pain, but explore reasons for that denial.

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Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: Impact of alcohol deterrents on outcome cheap 5 mg zebeta. Why rational emotive behavior therapy is the most comprehensive and effective form of behavior therapy generic 5 mg zebeta fast delivery. Clinical management of depression order zebeta 5mg without prescription, hopelessness, and suicidality in patients with bipolar disorder. Classify the different types of drugs used in the treatment of mental disorders and explain how they each work to reduce disorder. Critically evaluate direct brain intervention methods that may be used by doctors to treat patients who do not respond to drug or other therapy. Like other medical problems, psychological disorders may in some cases be treated biologically. Biomedical therapies are treatments designed to reduce psychological disorder by influencing the action of the central nervous system. Drug Therapies Psychologists understand that an appropriate balance of neurotransmitters in the brain is necessary for mental health. If there is a proper balance of chemicals, then the person‘s mental health will be acceptable, but psychological disorder will result if there is a chemical imbalance. The use of these drugs is rapidly increasing, and drug therapy is now the most common approach to treatment of most psychological disorders. Unlike some medical therapies that can be targeted toward specific symptoms, current psychological drug therapies are not so specific; they don‘t change particular behaviors or thought processes, and they don‘t really solve psychological disorders. However, although they cannot “cure‖ disorder, drug therapies are nevertheless useful therapeutic approaches, particularly when combined with psychological therapy, in treating a variety of psychological disorders. The best drug combination for the individual patient is usually found through trial and [1] error (Biedermann & Fleischhacker, 2009). Short-acting forms of the drugs are taken as pills and last between 4 and 12 hours, but some of the drugs are also available in long-acting forms (skin patches) that can be worn on the hip and last up to 12 hours. Additionally, the best drug and best dosage varies from child to child, so it may take some time to find the correct combination. It may seem surprising to you that a disorder that involves hyperactivity is treated with a psychostimulant, a drug that normally increases activity. When large doses of stimulants are taken, they increase activity, but in smaller doses the same stimulants improve attention and decrease motor activity (Zahn, Rapoport, & Thompson, [3] 1980). The most common side effects of psychostimulants in children include decreased appetite, weight loss, sleeping problems, and irritability as the effect of the medication tapers off. Stimulant medications may also be associated with a slightly reduced growth rate in children, although in most cases growth isn‘t permanently affected (Spencer, Biederman, Harding, & [4] O‘Donnell, 1996). Although they are used primarily in the treatment of depression, they are also effective for patients who suffer from anxiety, phobias, and obsessive-compulsive disorders. Antidepressants work by influencing the production and reuptake of neurotransmitters that relate to emotion, including serotonin, norepinephrine, and dopamine. These medications work by increasing the amount of serotonin, norepinephrine, and dopamine at the synapses, but they also have severe side effects including potential increases in blood pressure and the need to follow particular diets. These medications also work by blocking the reuptake of neurotransmitters, including serotonin, norepinephrine, and dopamine. Treatment is more complicated for these patients, often involving a combination of antipsychotics and antidepressants along with mood stabilizing medications (McElroy & Keck, [7] 2000). Another drug, Depakote, has also proven very effective, and some bipolar patients may do better with it than [8] with lithium (Kowatch et al. People who take lithium must have regular blood tests to be sure that the levels of the drug are in the appropriate range. Potential negative side effects of lithium are loss of coordination, slurred speech, frequent urination, and excessive thirst. Though side effects often cause patients to stop taking their medication, it is important that treatment be continuous, rather than intermittent. Antianxiety Medications Antianxiety medications are drugs that help relieve fear or anxiety. These drugs, which are prescribed millions of times a year, include Ativan, Valium, and Xanax. The benzodiazepines act within a few minutes to treat mild anxiety disorders but also have major side effects. They are addictive, frequently leading to tolerance, and they can cause drowsiness, dizziness, and unpleasant withdrawal symptoms including [9] relapses into increased anxiety (Otto et al. Furthermore, because the effects of the benzodiazepines are very similar to those of alcohol, they are very dangerous when combined with it.

The is a group of data elements a designated diagnosis discount zebeta 5 mg without prescription, which includes that represent core items of a comprehensive expected outcomes order zebeta 5 mg free shipping, interventions to be assessment for an adult home care patient and performed order 10mg zebeta, and the sequence and timing form the basis for measuring patient outcomes of these interventions. The nurse summarizes a patient’s reason staff gather definitive information on a for treatment, significant findings, resident’s strengths and needs and address procedures performed and treatment these in an individualized plan of care. A nurse who communicates oral, written, or audiotaped patient data to the nurse replacing 4. The nurse uses this form to record a him/her on the next shift is giving a(n) patient’s pulse, respiratory rate, blood report. The nurse documents routine aspects of anything out of the ordinary that results in, or care that promote goal achievement, has the potential to result in, harm to a safety, and well-being. A(n) is a meeting of nurses to from the nursing history and physical discuss some aspect of a patient’s care. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Briefly explain the following purposes of the homebound and still needs nursing care. List four areas of nursing care data that, accord- ing to the Joint Commission, must be perma- nently integrated into the patient record. Reports to family members and significant reporting a significant change in a patient’s others: condition to other healthcare professionals by telephone. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Complete the chart below listing the purpose, advantages, and disadvantages of the various methods of documentation. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. He will be going home with his wife, She no longer recognizes her daughter, who who is a nurse, and they require discharge was taking care of her. What should be the focus of discharge teach- her mother physically to prevent falls. Think about the information the team will need to provide safe, quality care for this patient. What types of data should the admitting nurse record, and what system of documentation is most likely to bring the information to the attention of everyone 2. How would you go about scheduling a consul- tation for a male amputee who needs physical therapy? Write a brief summary of the patient’s condition and how you would pre- sent his case to the referred agency. Make an appointment to interview the risk and/or ethical/legal competencies are most manager of a healthcare system. Use the following expanded scenario from Chapter 17 in your textbook to answer the questions below. Scenario: Philippe Baron, age 52, is being dis- charged from the outpatient surgery department Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The human process of growth and development living and growing are based on learning, and is the result of which two interrelated factors? Which of the following theorists listed the unconscious mind, the id, the ego, and the 6. A child who learns that he must sit quietly superego as the primary aspects of the psycho- during story hour in kindergarten, thereby analytic theory? Which of Freud’s stages of development marks the transition to adult sexuality during 7. Latency stage with an understanding of reversibility, relations between numbers, and loss of b. Formal operational stage biologic processes is credited to which of the following theorists? An increased incidence of teenage ing and deductive reasoning occurs during pregnancy can be linked to substance which of the following stages of development? Which of the following are components of Freud’s theory of psychoanalytic development? Which of the following concepts are Multiple Response Questions components of Erikson’s theory of psychosocial development? Growth and development are differentiated describe the developmental stages and and integrated. Within each developmental level, certain external control as the child learns to con- milestones can be identified. Few adults ever reach stage 6 of the the effects of environment and nutrition devel- postconventional level. Substance abuse by a pregnant woman expectations, and societal values are increases the risk for congenital anomalies adopted. Failure to thrive cannot be linked to punishment and obedience orientation, emotional deprivation.

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