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Pristiq

By O. Chris. Gettysburg College.

Both theoretical expressions had their associated reasons purchase 100mg pristiq amex, individuals’ self-care agency is beginning in understandings of their formulators unequal in its development or operability for meet- about the reasons why individuals need and can ing their existent and changing therapeutic self- be helped through nursing cheap pristiq 100mg without prescription. The real or potential existence of such a health- It is posited that in valid general theories of nurs- related deficit relationship between the care demand ing discount 50 mg pristiq visa, the named nursing-specific conceptualizations and power of agency is the reason why individuals are the human points of reference that reveal the require nursing care. For example, in Self-Care planation that both internal and external condi- Deficit Nursing Theory, individuals throughout tions arising from or associated with health states their life cycles are viewed as having a continuing of individuals can bring about action limitation of demand for engagement in self-care and in care of individuals to engage in care of self (for example, self; the constituent action components of the de- lack of knowledge or developed skills, or lack of en- mand together are named the “therapeutic self-care ergy) (Orem, 1995). Individuals also are viewed as having erational powers of self-care agency and the kinds the human power (named “self-care agency”) to de- and frequencies of deliberate actions to be per- velop and exercise capabilities necessary for them to formed to know and meet individuals’ therapeutic know and meet the components of their therapeu- self-care demands in time and place frames of tic self-care demands. This human power with its place frames of reference (that is, their self-care constituent capabilities and disposition is named agency), are not adequate because of health state or “nursing agency. The identification and development of the components of their own therapeutic self-care de- power of nurses to design and produce nursing care mands and the therapeutic self-care demands of for others are essential elements in any valid general their dependents. The investigation of this power of mature and maturing human beings in self-care and the capabilities and conditions for its exercise and dependent-care by observing their actions in are critical components of nursing science. The societal-contractual system legit- degrees of development and operability of self-care imizes the interpersonal relationships of nurses agency, and in estimating persons’ potential for reg- and persons seeking nursing and their next of kin ulation of the exercise or development of their or their legitimate guardians. Nurses’ capabilities ex- system is constituted from series and sequences of tend to appropriately helping individuals with interaction and communication among legitimate health-associated self-care deficits to know and parties necessary for the design and production meet with appropriate assistance the components of nursing in time-place frames of reference. The of their therapeutic self-care demands and to regu- professional-technological nursing system is the late the exercise and development of their powers system of action productive of nursing. These outcomes of nursing are pendent upon the initial and continuing produc- contributory to the life, health, and well-being of tion of an effective interpersonal system. Outcomes, of Comprehensive general theories of nursing ad- course, are related to the reasons why individuals dress what nurses do, why they do what they do, require nursing care. A Self-Care Deficit Nursing Theory, as it has been valid general theory of nursing thus sets forth nurs- developed, builds from expressed insights about the ing’s professional-technological features specific to powers and properties of persons who need nurs- the production of nursing. A general theory of ing care and those who produce it, to the nature nursing that addresses nursing’s professional- and constitution of those properties, to the details technological features provides points of articula- of the structure of the processes of providing nurs- tion with interpersonal features of nursing and sets ing care for individuals, and to the processes for the standards for safe, effective interpersonal sys- providing nursing care in multiperson situations, tems. These features also point to the legitimacy including family and community (Orem, 1995). In the initial and later stages nature of nursing systems within the frame of Self- of development of this general theory of nursing, Care Deficit Nursing Theory, see the Nursing developers formally recognized that nursing is a Development Conference Group’s (1979) develop- triad of interrelated action systems: a professional- ment of a “triad of systems. Consider, Nursing students should be helped to under- for example, the conceptual element of self-care stand and recognize in concrete nursing practice agency in the Self-Care Deficit Nursing Theory. Theoretical stood as the human power to deliberate about, nursing science differentiates content that is specif- make decisions about, and deliberately engage in ically interpersonal from professional-technological result-producing actions or refrain from doing so. However, the power of self-care may not endure or be legitimate throughout nurs- agency is necessarily attributed to human beings ing practice situations. Individual human beings are human beings as self-care agents fits within the viewed as having the status of object subject to view of human beings as persons. Within the Inability of individuals to surmount physical frame of reference of Self-Care Deficit Nursing forces, such as wind or forces of gravity, can Theory, persons who deliberate about and engage arise from both the individual and prevailing in self-care are referred to as “self-care agents” and environmental conditions. All other views are subsumed by the person acteristic properties of human beings specified in view. The person view also is the view essential to the conceptual elements of general nursing models understanding nursing as a triad of action systems. Orem interpersonal contacts with individuals under nurs- (1995) and the Nursing Development Conference ing care and with their family and friends. Group (1979) suggest five broad views of human The person-as-agent view is the essential opera- beings that are necessary for developing under- tional view in understanding nursing. If there is standing of the conceptual constructs of Self-Care nursing, nursing agency is developed and opera- Deficit Nursing Theory and for understanding the tional. If there is self-care on the part of individu- interpersonal and societal aspects of nursing sys- als, self-care agency is developed and operational. The five views are summarized as follows: The agent view incorporates not only discrete de- liberate actions to achieve foreseen results and the The view of person. Individual human beings are structure of processes to do so, but also the powers viewed as embodied persons with inherent and capabilities of persons who are the agents or rights that become sustained public rights who actors. The internal structure, the constitution, and live in coexistence with other persons. A mature the nature of the powers of nursing agency and self- human being “is at once a self and a person with care agency are content elements of nursing sci- a distinctive I and me... The structure of the processes of designing viable rights and able to possess changes and and producing nursing and self-care is also nursing pluralities without endangering his [or her] science content. Individual human beings are tial in understanding the nature of interpersonal viewed as persons who can bring about condi- systems of interaction and communication be- tions that do not presently exist in humans or in tween nurses and persons who seek and receive their environmental situations by deliberately nursing. The age and developmental state, culture, acting using valid means or technologies to and experiences of persons receiving nursing care bring about foreseen and desired results. The beings are viewed as persons who use symbols ability of nurses to be with and communicate effec- to stand for things and attach meaning to them, tively with persons receiving care and with their to formulate and express ideas, and to com- families incorporates the use of meaningful lan- municate ideas and information to others guage and other forms of communication, knowl- through language and other means of commu- edge of appropriate social-cultural practices, nication. Individuals are viewed as uni- what persons receiving care are endeavoring to tary living beings who grow and develop ex- communicate. Nurses also has been a handicap in nurses’ communications may need to help individuals under nursing care to about nursing to the public as well as to persons take these views about themselves.

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The practices within each town were paired according to socio-demographic characteristics and were randomly designated as either the intervention or the com- parison practice cheap pristiq 100 mg with visa. Intervention practices were then randomly allocated either to a further comparison group or to an intervention group pristiq 100mg mastercard. This provided both an internal and external comparison with the subjects receiving the intervention discount pristiq 100mg visa. All intervention practices received screening, but only the intervention group of these practices received lifestyle counselling and follow-up within the one-year period. The screening process involved an appointment with a trained research nurse, who asked about demographic, lifestyle and medical factors and measured height, weight, carbon monoxide, blood pressure, blood glucose and blood cholesterol. The subjects in the intervention group also received lifestyle counselling and repeated follow-up. The counselling used a client-centred family approach and involved an assessment of the patients’ risk status, educational input and a booklet for the subject to document their personally negotiated lifestyle changes. All subjects were then offered follow-up every 1, 2, 3, 4, 6 or 12 months, depending on their risk status. Outcome was measured at the follow-up in terms of changes in the main risk factors for coronary heart disease and the Dundee risk score, which is dependent on serum cholesterol concentration, systolic blood pressure, and previous and current smoking behaviour. Outcome was compared within the intervention practices, between the intervention practice and the internal comparison practice, and between the inter- vention practice and practices in the external comparison group. The results showed a 16 per cent reduction in overall risk score in the intervention practices at one year, a 4 per cent reduction in smoking, a small reduction in systolic (7 mmHg) and diastolic (3 mmHg) blood pressure and marginal reductions in weight (1 kg) and cholesterol concentrations (0. In addition, the greatest changes in risk status were reported in subjects with the highest risk levels. Although this intensive screening and intervention did result in changes in risk for coronary heart disease in the correct direction, Wood et al. The authors also concluded that the government sponsored health promotion clinics ‘would probably have achieved considerably less and possibly no change at all’ (Wood et al. All subjects received an initial health check and the intervention group received an additional follow-up health check after one year (further results were also collected for subjects over a four- year period). The health checks involved the nurse recording information about personal and family history of heart disease, stroke, hypertension, diabetes and cancer. Informa- tion about smoking history, alcohol consumption and habitual diet, height, weight, serum cholesterol concentration and blood pressure was also recorded. The nurses were also instructed to counsel patients about risk factors and to negotiate priorities and targets for risk reduction. The re-examination was briefer than the original health check but it involved re-measurement of the same profile and lifestyle factors. The authors concluded that using health checks to reduce smoking may be ineffective as the effectiveness of health information may be diluted if the health check attempts to change too many risk factors at once. They suggested that the reduction in blood pressure was probably due to an accommodation effect, suggesting that the health checks were ineffective. Both of the above studies suggested that screening and minimal interventions are not cost-effective, as the possible benefits are not worthy of the amount of time and money needed to implement the programmes. The effects of screening on the psychological state of the individual The third problem with screening concerns its impact on the individual’s psychological state. The debates Early evaluations of screening included an assessment of screening outcome in terms of the patients’ understanding and recall of their diagnosis, not in terms of possible negative consequences (Sibinga and Friedman 1971; Reynolds et al. Recent dis- cussions of the effects of screening, however, have increasingly emphasized negative consequences. McCormick (1989), in a discussion of the consequences of screening, suggested that ‘false positive smears in healthy women cause distress and anxiety that may never be fully allayed’ (McCormick 1989: 208). Skrabanek (1988) specifically expressed an awareness of the negative consequences of screening in his statement that ‘the hazards of screening are undisputed: they include false positives leading to unnecessary investigations and treatments, with resulting iatrogenic morbidity both physical and psychological’ (Skrabanek 1988: 1156). He was supported by Marteau (1989), who commented that ‘a positive result in any screening test is invariably received with negative feelings’. The research: the psychological impact of screening The negative sequelae of screening have been described as ‘the intangible costs’ (Kinlay 1988) but research suggests that they are indeed experienced by the individuals involved. These psychological sequelae can be a result of the various different stages of the screening process: 1 The receipt of a screening invitation. Research indicates that sending out invita- tions to enter into a screening programme may not only influence an individual’s behaviour, but also their psychological state. Their results showed that 55 per cent reported feeling worried although 93 per cent were pleased. However, when asked in retrospect 30 per cent said that they had become anxious after receiving the letter of invitation.

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Nursing Process Worksheet Prioritization Questions Health Problem: Constipation 1 discount 50mg pristiq with visa. Etiology: New medication buy pristiq 100 mg on-line, deficient fiber and fluid e b f a g c h d intake purchase 100 mg pristiq with amex, and insufficient exercise Signs and Symptoms: Change in bowel habits from one soft, formed stool daily to one or two hard 2. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Lower airway: The lower airway comprises the After: Observe patient for changes in respirations; trachea, right and left mainstem bronchus, seg- chest x-ray. The inhalation of cigarette smoke increases airway major functions are conduction of air, mucocil- resistance, reduces ciliary action, increases mucus iary clearance, and production of pulmonary production, causes thickening of the alveolar–cap- surfactant. According to Boyle’s law, the volume of a gas at a thicken and lose their elasticity. Pressure in the lungs is lower than to make each breath deep enough to move the atmospheric pressure; this condition facilitates the bottom ribs. Incomplete lung expansion or lung collapse breath and observes the results of his/her efforts (atelectasis) prevents pressure changes and as they register on the spirometer as the patient exchange of gases by diffusion in the lungs. Abdominal breathing: The patient places one ing of the alveolar–capillary membrane makes hand on the stomach and the other on the diffusion more difficult. The solubility and molecular weight of the slowly in through the nose, letting the gases are factors in diffusion. Most oxygen (97%) is carried in the body by red One hand should be pressing inward and blood cells in the form of oxyhemoglobin. The be repeated for 1 minute, followed by a chest wall is so thin that the ribs, sternum, and 2-minute rest. Place “No Smoking” signs in conspicuous places neous fat is deposited on the chest wall, so in the patient’s room. Check to see that electric equipment is in good preschool child’s eustachian tubes, bronchi, working order. Avoid wearing and using synthetic fabrics, than in an infant, so the number of routine which build up static electricity. Older adult: Bony landmarks are more promi- cular tube of plastic or rubber inserted into the nent; kyphosis contributes to appearance of back of the pharynx through the mouth or nose leaning forward; barrel chest deformity may in a spontaneously breathing patient; used to result; senile emphysema may be present; power keep the tongue clear of the airway and to per- of respiratory and abdominal muscles is reduced. Endotracheal tube: Polyvinylchloride tube that one’s hands on the patient’s posterior thorax at is inserted through the nose or mouth into the the level of the 10th rib, with both thumbs trachea, using a laryngoscope as guide; used to almost touching the vertebrae. While patient administer oxygen by mechanical ventilator, to takes a few deep breaths, the nurse’s thumbs suction secretions easily, or to bypass upper air- should move 5 to 8 cm symmetrically at maxi- way obstructions mal inspiration. The curved tracheostomy tube palm’s surface on each side of the patient’s is inserted into this opening to replace an endo- chest wall, avoiding bony areas; the nurse tracheal tube, provide a method to mechanically should detect equal vibrations as the patient ventilate the patient, bypass an upper airway says a multisyllable word. B: Breathing: If the victim does not start to deviation from normal color, pulse, and respira- breathe spontaneously after the airway is tory rates to physician. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. If the victim Intellectual: knowledge of developmental variables has no pulse, artificial circulation must be affecting respiratory function started with breathing. The nurse is responsible for collecting the baseline necessary to diagnose and treat respiratory problems data before the examination. Pain medication Ethical/Legal: knowledge of patients’ and families’ should be administered before the test if rights related to refusal of care requested. Objective data are underlined; subjective data are in procedure, the nurse should observe the patient boldface. A chest x-ray is usually Toni is a 14-year-old girl who is in the adolescent done to verify the absence of complications. Help the patient assume a position that allows chart reveals that on several occasions when her free movement of the diaphragm and expansion mother was visiting, she began hyperventilating of the chest wall to promote ease of respiration. Keep the patient’s secretions thin by asking the ing for breath on these occasions, she nevertheless patient to drink 2 to 3 quarts of clear fluids daily. Perform cupping on the patient’s lungs to the midst of a divorce and that it hasn’t been easy loosen pulmonary secretions. Use vibration to help loosen respiratory rough time at school, and I guess I’ve been too secretions. McIntyre’s chart for ratory rate and rhythm (not to exceed 24) during advance directives or a living will and if one is not her mother’s visits. A counselor could be called in to facilitate the its probable cause, and its effect on her lifestyle. Demonstrate consciously controlled breathing should take into consideration age-related changes and encourage her to use it during periods of that may be increasing Ms. What would be a successful outcome for this patient and maintain eye contact during conver- patient? If fear is the cause of her anxiety, encourage her to of, and signs, an advance directive to direct her express concerns. What intellectual, technical, interpersonal, and/or with the patient the possibility of developing effec- ethical/legal competencies are most likely to bring tive coping skills with professional counseling.

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