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Because you are legally responsible for medications admin- istered discount extra super levitra 100mg amex, what would you do? Interview several nurses about their experiences with errors and what contributes to them order extra super levitra 100 mg fast delivery. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Lemke, age 42, is scheduled for elective Circle the letter that corresponds to the best hernia surgery. Lemke be administered by injecting a local anesthetic predisposed because of his use of antibiotics? When preparing a patient who has diabetes mellitus for surgery, the nurse should be 2. When obtaining a consent form from a aware of which of the following potential patient scheduled to undergo surgery, the surgical risks associated with this disease? The responsibility for securing informed cal risks related to obesity should be considered consent from the patient lies with the when performing an assessment for this nurse. When preparing this patient for infection surgery, the nurse should consider which of b. Alterations in fluid and electrolyte balance the following surgical risks associated with c. Place the patient in a flat position with legs pain control, the nurse should consider elevated 45 degrees. Place the patient in the Trendelenburg or patient should ask for the medication “shock” position. The nurse is responsible for ordering and physical preparation for a patient undergoing administering pain medications. To prevent postoperative complications, which of the following measures should be 13. The patient should be instructed to avoid pulmonary and oral secretions and prevent coughing if possible to minimize damage laryngospasm? The patient should not be turned in bed used in minimally invasive surgery of the until the incision is no longer painful. Keep him cool and uncovered to prevent Which of the following conditions would elevated temperature. Thrombophlebitis Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The underlying disease process and its nat- ural course Multiple Response Questions d. Explanation of the risks involved and how Circle the letters that correspond to the best often they occur answers for each question. Which of the following actions would be per- binding and cannot be withdrawn formed in the postoperative phase of the peri- f. Which of the following examples of surgery necessitating careful monitoring of fluid would be classified as surgical procedures and electrolyte status and input and based on purpose? Older adults have an increased gastric pH and require monitoring of nutritional b. Which of the following statements accurately through which of the following methods? Endocrine diseases increase the risk for must be provided to a patient to obtain hyperglycemia after surgery. The name and qualifications of the nurse hemorrhage and hypovolemic shock after providing perioperative care surgery. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Encourage the patient to use incentive describe the effects the patient’s medications spirometry 10 times each waking hour for may have on surgical risk? Diuretics may cause respiratory depression patient deep breathing in the order in which from anesthesia. Ask the patient to exhale gently and may cause cardiovascular collapse in long- completely. Which of the following are significant abnor- mal findings related to presurgical screening e. Ask the patient to exhale as completely as possible through the mouth with lips b.

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Therefore cheap 100mg extra super levitra otc, the nurse needs to de- velop a medication plan to help the patient manage the medication schedule order 100mg extra super levitra with mastercard. These influences include the patient’s belief about health such as: • What healthcare can do for the patient • The patient’s susceptibility to disease • The benefits of taking steps to prevent disease • What makes a patient seek healthcare • What makes a patient follow healthcare guidelines For example, a patient who is a coal miner may believe that all coal miners will eventually have lung cancer. Another patient may avoid taking pain medication for fear that they might become addicted. For example, although garlic does lower blood pressure, taking garlic as an herbal cure might be dangerous if the patient is also taking antihypertensive medication because the patient’s blood pressure could be lowered too much. Herbal reme- dies are preferred by some cultures over traditional Western medicine and some patients continue herbal treatment even when a mild illness progresses to a crit- ical level. A patient may refuse any treatment because of the sole belief in the healing power of prayer. Healthcare providers must be nonjudgmental and tolerate alternative beliefs in healthcare even if those beliefs are harmful to the patient. When con- fronted with cultural differences that can result in an adverse effect to the patient, healthcare providers can educate the patient about the benefits of medications and treatment and the risk that the patient is exposed to by not following rec- ommended treatment. This information is sometimes best given while the health- care provider is assessing the patient. The nurse should be careful to remain nonjudgmental about the patient’s decisions. Cultural beliefs can also influence who makes healthcare decisions for the family. However, in some cultures, although the female is responsible for providing and obtaining care, the oldest male is seen as the head of the family and the authority figure for making overall decisions such as when to access healthcare. The way the patient communicates with healthcare providers is greatly influ- enced by individual culture. Here are factors to consider when communicating with a patient: • Eye contact might not be appropriate. Always address the patient formally until the patient gives permission to be addressed informally. Other- wise, the patient may be unable to comply with the appropriate medication schedule. In some cultures, patients don’t want anyone standing or sitting too close and they feel uncomfortable if someone touches them. The elderly are revered in some cultures and the family goes to great lengths to care for them. In other cultures, the family leaves the elderly to die peacefully without interference. As you’ll recall from Chapter 2, pharmaco- genetics is the study of the influence genetics have on a drug response. For example children with Reyes Syndrome, which is a liver disease, cannot metab- olize aspirin because of a genetic defect. Likewise, a genetic factor in African-Americans makes them less responsive to beta-blocking agents used in cardiac and antihypertensive medications. Asians have a genetic factor that causes undesirable side effects when given the typical dose of benzodiazepines (diazepam [Valium]) alprazolam [Xanax], tricyclic anti- depressants, atropine, and propranol [Inderal]. Waste products are excreted into the amniotic fluid and then absorbed by the mother or swallowed by the fetus. Alcohol, barbiturates, and narcotics—such as diphenhydramine (Benadryl), amobarbital (Amytal), diazepam (Valium), codeine, heroin, methadone, morphine, propoxyphene (Darvon)—that are used during pregnancy can lead to harmful effects on the newborn. This can result in hyperactivity, crying, irritability, seizures and even sudden death. When taken by the mother during the first trimester, some drugs have a ter- atogenic effect on the fetus resulting in fetal defects. This includes mutagenic (genetic mutation) or carcinogenic (causing cancer) effects. These drugs include Thalidomide, which causes abnormal limb development, and cocaine, which causes miscarriages, fetal hypoxia (lack of oxygen), low-birth-weight infants, tremors, strokes, increase in stillbirth rates, congenital heart disease, skull defects, and other malformations. Adverse side effects of the drug on the fetus can be avoided by carefully checking the Pregnancy Category of the medication before the medication is administered to a pregnant woman. Regardless of the Pregnancy Category of the drug, always carefully observe the pregnant patient after administering medication to assure that the patient doesn’t show any observable adverse response. Pediatrics Special care must be given when administering medication to pediatric patients because their organs are immature and they might have difficulty absorbing, distributing, and excreting the medication. However, because the mother has already metabolized and excreted the medica- tion, less than the original dose is passed into breast milk. These medications include amphetamines, bromocriptine, cocaine, cyclophos- phamide, cyclosporine, doxorubicin, ergotamine, gold salts, lithium, methotrex- ate, nicotine, and phenindione.

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A According to the Complementary Wellness Pro- marked improvement was found in 29 percent of fessional Association (http://www buy extra super levitra 100 mg overnight delivery. The association says that regular discount extra super levitra 100mg mastercard, systematic Acupuncture is reported to relieve blockage, pres- treatment usually gets the best results. Treatment sure, or other ill effects from the body’s 14 major three times each day for five to 10 minutes, or meridians, or energy channels. Rendered as qi or every two hours if necessary, reflects the concept ch’i (pronounced “chee”), the flow of this energy or that acupressure’s positive effects are cumulative— life force is essential to health. Given a new credi- one cannot overdose because the treatments are bility and acknowledgment by Western practition- safe. However, they are not recommended for ers, acupuncture studies suggest that the technique administration directly after a meal, and pregnant stimulates the release of the body’s natural, opiate- women should avoid pressure at certain points like substances called endorphins. Endorphins and plementary Health (Hamlyn, London, 2000), acu- enkephalins, also polypeptides that work as endor- pressure is similar to shiatsu, which means “finger phins do, are thought also to contribute to a feeling pressure” in Japanese, in that it is meant to trigger of well-being. It branches The author and physician Richard Gerber off from shiatsu, which includes massage, in that explained the 12-pathway acupuncture-meridian acupressure mostly employs thumb and fingertip system as “the body’s biocircuitry,” through which pressure on acupuncture points. In clinical studies, more than 1,000 acupoints carry the environmen- acupressure was successfully used to treat morning tal life energy ch’i. This type of ‘inher- study to exclude any with organic disease or infec- ited’ life energy is referred to as ancestral ch’i. The tion, and 142 workers with chronic lumbar pain second source of ch’i is absorbed (and produced) acupuncture 3 from the foods we eat. The third (and possibly the 1997, “acupuncture’s credibility as a viable medical most important) source of ch’i comes directly from treatment was bolstered by the U. Acupoints appear to function acupuncture needle is a safe and effective medical like tiny energy pores in the skin that absorb this instrument. They reasoned that these also seem to function like miniature electrical relay points acted as amplifiers to boost the minute elec- stations along a vast power line, helping to main- trical signals as they traveled along the body, and tain the flow of energy along each meridian,” Ger- that the insertion of a needle could interfere with ber wrote; that concept, he believes, requires “a that flow and thus block the stimulus of pain. Acupuncture is also reported to would preclude the use of acupuncture as a treat- have positive results in the treatment of addiction ment modality, and no known side effects, with the withdrawal and in the course of rehabilitation for exception of infection resulting from improperly stroke patients. Patients may request disposable nee- common cold, tonsillitis, eye inflammation, near- dles to eliminate the sterilization issue. For individ- sightedness, duodenal ulcer and other gastroin- uals who have a fear of needles, there are laser testinal disorders, trigeminal neuralgia, Ménière’s acupuncture, which uses laser beams instead of disease, tennis elbow, sciatica, rheumatoid condi- needles; ultrasound and light-therapy acupunc- tions, menstrual cramps, radiation illness and other ture, which use sound waves and light waves in types of environmental poisoning, and speech lieu of needles; and electroacupuncture, which aphasia may also be treated with acupuncture. Orga- placed top-down on an acupoint or any flat area nizations that set standards and certify practitioners such as the back, abdomen, or legs. The vacuum include the Accreditation Commission for created by the cups “sucks” the skin so that blood Acupuncture and Oriental Medicine and the rushes to the point and rebalances the flow of National Certification Commission for Acupunc- energy. A tiny gests that the typical gauge for effectiveness is 10 stick, roll, or cone-shaped amount of moxa, from sessions, and chronic pain relief should be experi- the herb mugwort, burns on the head of the nee- enced from acupuncture after six treatments. The moxa, conditions such as asthma may require months of which may also be used without needles but with acupuncture before a patient perceives relief. Auricular therapy, revived and improved in the “Many unconventional treatments have been 1960s by the French acupuncturist Dr. Herbert is a type of acupuncture that focuses exclusively on Benson in Timeless Healing (Scribner, New York, the ear for pain management and the treatment of 1996), “but their positive effects, if present and migraines, arthritis, and stomach ailments. When above those of remembered wellness, are still ques- Nogier treated patients with sciatica by cauterizing tionable. If its inher- part of their earlobes, he discovered after they ent healing effects were equivalent to those of reported relief that the technique dated back to proven scientific remedies, they would already have ancient Egypt. Also, while small acupuncture needles Beinfield, and her coauthor Efrem Korngold, also a may be used in the ear, electrotherapy, light ther- licensed acupuncturist and practitioner of osteo- apy, and small, magnetically charged ball bearings pathic manipulative medicine, wrote in Between (which can be taped over acupoints for long-term, Heaven and Earth: A Guide to Chinese Medicine (Bal- or semipermanent, therapy) may be preferred lantine Books, New York, 1991): “While neurolog- methods. Auricular therapists, popular in France, ical and hormonal hypotheses describe how say this type of acupuncture helps provide diagnos- acupuncture alleviates pain, they do not accurately tic information; is less invasive than regular explain its diverse therapeutic effects. The measurable electrical prop- immunoglobulins, gastrointestinal peristalsis, erties of acupuncture points allow practitioners to secretion of hydrochloric acid, and the production diagnose problems, and auricular therapy is said to of red and white blood cells. Acupuncture seems to relieve addictions, certain respiratory disorders, adjust all the physiological processes of the organ- labor pains, and pain related to terminal illnesses. The the United States are licensed, registered, or certi- central issue from the classical Chinese medical fied, and approximately 3000 medical doctors, both point of view is not why acupuncture works, but Alexander Technique 5 rather how and when to use it. The dynamic balance agni Ayurvedic term referring to the element of that Chinese medicine equates with health mani- fire, the central bodily fire, the digestive fire, or the fests as smooth and constant movement. In Chinese medicine, this logic is reversed, stress reduction developed by the Australian actor so that global changes in the whole organism result Frederick Matthias Alexander (1869–1955, born in in the disappearance of specific symptoms. In Tasmania), who believed that “every man, woman acupuncture ‘secondary’ effects are intended, all and child holds the possibility of physical perfection; part of one continuous process of change. According to the self-help author move or rest harmoniously, he taught, stressors such Stuart Wilde, there are four types of affirmations— as tension and emotional problems may become word, thought, feeling, and action—and there are worse or evolve into more serious health problems.

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The situation throughout the Austra- lian states is variable buy extra super levitra 100 mg overnight delivery, with intrastate differences relating to specific police staff; for example purchase extra super levitra 100 mg on line, plain clothes staff may use an Asp-type baton, whereas uniformed officers are equipped with straight or side-handled batons. Strikes are made from an officer’s strong (dominant) or weak (nondominant) side, and clearly the potential for injury varies with the baton mass and velocity at impact, the target area, and to how much of the surface area the force is applied. Although no body area is absolutely forbidden to strike, an officer must use a proportionate response to the situation he or she faces knowing the potential to injure. Although target areas are divided into low-, medium-, and high-risk areas, maintaining a distinction between them can be difficult because strikes are made in dynamic situations where an initial target area may change as the potential detainee moves. Target areas with a low injury potential are the areas of the common peroneal, femoral, and tibial nerves on the legs and those of the radial and median nerves on the arms. There is a low probability of permanent injury, with the main effects being seen as short-lived motor nerve dysfunction, as in a “dead leg” and bruising. The medium injury potential areas involve bones and joints, including the knees and ankles, wrist, elbow, hands, upper arms, and clavicle. In these cases fractures, dislocations, and more extensive soft tissue injuries would be expected. Finally, those areas with the highest risk of injury include the head, neck and throat, spine, kidneys, and solar plexus. The most common injury is bruising, and this is often in the pattern of so-called “tramline bruising,” where two parallel lines of bruising are sepa- rated by a paler area. This is not unique to a baton injury but reflects an injury caused by any cylindrical hard object. The absence of bruising or other find- 200 Page ings does not mean that a baton was not used because, for example, a degree of cushioning can occur from clothing. It is possible for a detainee to have signs but minimal symptoms or even be unaware of being struck. Fractures need to be considered where there are the traditional clinical signs of local pain, swelling, and loss of function. Considering the forces that can be applied when necessary, there is the potential for significant injury with bruising and rupture of internal organs, including the heart, liver, spleen, or kidneys or a head injury. The forensic physician should refer suspected cases for hospital review without delay, es- pecially if a confirmatory history for events is unavailable. Particular care is needed in those who are intoxicated because they are difficult to assess. Because they cannot be released them- selves, snips to cut them are always available at the same time. Although quick and easy to apply, they have no way of being locked in position, so they can tighten in an uncontrolled manner, resulting in direct compression injuries. At least two ties are used on each detainee; one is placed on each wrist and then interlocked with the other. These plastic constraints are used in preplanned operations, where numerous arrests are expected or in special- ized operations. Excessive force, either directly applied by the officer or from a detainee continuing to move, can result in strains to joints, such as the wrist, elbow, and shoulder. Officers in the United Kingdom are not trained in any neck holds because of the high risk of serious injury or death as a result of large blood vessel or airway compression. Fatalities can occur quickly, and if a detainee complains of such holds being used, the neck should be examined carefully. Petechial bruising should be looked for in the face, particularly in and around the eyes, on the cheeks, and behind the ears. It is common for clothing to be held in a struggle to restrain, which may tighten it around the neck. Linear bruising Medical Issues of Restraint 201 may be seen at the site of tightening, as well as petechial bruising on the neck and above on the face. Clearly, the tactical firearms units are often required in these situations, but there is an increasing trend to look for other “nonlethal” options, which will incapacitate with a lower risk of serious injury. In the United Kingdom, the investigation of firearm inci- dents under the auspices of the Police Complaints Authority with its attendant recommendations is a major influence when looking at developments in this area (7). Different countries use different restraint equipment, such as water cannon or the firing of different projectiles (e. They were first introduced in Northern Ireland in 1970; 125,000 rounds have been fired, and 17 fatalities have resulted, the last one occurring in 1989. With time, the delivery systems have improved, and this is reflected in the mortality figures. In June 2001, the L21A1 baton round was introduced to replace the “plastic bullet” in combina- tion with a new baton gun and optical sight (L104 baton gun). This gives much better accuracy, both decreasing the chances of dangerous inaccurate direct impacts and avoiding hitting unintended persons.

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