C. Aschnu. Allen University.
Help client recognize signs of escalating anxiety quality sotalol 40 mg, and explore ways client may intervene before behaviors become disabling order online sotalol. Assess for effectiveness buy sotalol 40mg without a prescription, and instruct client regarding possible adverse side effects. Client is able to verbalize behaviors that become evident when anxiety starts to rise, and takes appropriate action to interrupt progression of the condition. In the presence of an agreed-on, health-promoting or therapeutic plan, person’s or caregiver’s behavior is fully or partially nonadher- ent and may lead to clinically ineffective or partially ineffective outcomes. Possible Etiologies (“related to”) [Biochemical alteration] [Neurological alteration related to premature birth, fetal distress, precipitated or prolonged labor] [Negative temperament] [Dysfunctional family system] [Negative role models] [Retarded ego development] [Low frustration tolerance and short attention span] [Denial of problems] Deﬁning Characteristics (“evidenced by”) Behavior indicative of failure to adhere [to treatment regimen] [Inability to sit still long enough to complete a task] [Expression of opposition to requests for participation] [Refusal to follow directions or suggestions of treatment team] Goals/Objectives Short-term Goal Client will participate in and cooperate during therapeutic activities. Long-term Goal Client will complete assigned tasks willingly and independently or with a minimum of assistance. Interventions with Selected Rationales For the client with inattention and hyperactivity: 1. Provide an environment for task efforts that is as free of dis- tractions as possible. Client is highly distractible and is unable to perform in the presence of even minimal stimulation. Provide assistance on a one-to-one basis, beginning with simple, concrete instructions. Client lacks the ability to assimilate information that is complicated or has abstract meaning. Establish goals that allow client to complete a part of the task, rewarding completion of each step with a break for physical activity. Short-term goals are not so overwhelming to client with such a short attention span. Gradually decrease the amount of assistance given to task performance, while assuring client that assistance is still available if deemed necessary. This encourages client to per- form independently while providing a feeling of security with the presence of a trusted individual. Start with minimum expectations and increase as client begins to manifest evidence of compliance. Structure provides security, and one or two activities may not seem as over- whelming as the whole schedule of activities presented at one time. Establish a system of rewards for compliance with therapy and consequences for noncompliance. Posi- tive and negative reinforcements can contribute to desired changes in behavior. Convey acceptance of client separate from the undesirable behaviors being exhibited. Onset of the disorder can be as early as 2 years, but it occurs most commonly during childhood (around age 6 to 7 years). The symptoms usually diminish during adolescence and adulthood and, in some cases, disappear altogether by early adulthood. Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence ● 43 Predisposing Factors 1. Family studies have shown that Tourette’s dis- order is more common in relatives of individuals with the disorder than in the general population. It may be transmitted in an autosomal pattern intermediate between dominant and recessive (Sadock & Sadock, 2007). Altered levels of neurotransmitters and dysfunction in the area of the basal ganglia have been implicated in the etiology of Tourette’s disorder. The genetic predisposition to Tourette’s disorder may be reinforced by certain factors in the environ- ment, such as complications of pregnancy (e. The disorder may begin with a single motor tic, such as eye blinking, neck jerking, shoulder shrugging, facial grimacing, or coughing. Complex motor tics may follow and include touching, squat- ting, hopping, skipping, deep knee bends, retracing steps, and twirling when walking. Vocal tics include various words or sounds such as clicks, grunts, yelps, barks, sniffs, snorts, coughs; in about 10% of cases, a complex vocal tic involves uttering obscenities. Vocal tics may include repeating certain words or phrases out of context, repeating one’s own sounds or words (palilalia), or repeating what others say (echolalia). The movements and vocalizations are experienced as compul- sive and irresistible, but they can be suppressed for varying lengths of time. Tics are exacerbated by stress and attenuated during periods in which the individual becomes totally absorbed by an activity. Client will seek out staff or support person at any time if thoughts of harming self or others should occur. Recog- nition of behaviors that precede the onset of aggression may provide the opportunity to intervene before violence occurs. Provide hand coverings and other restraints that prevent client from self-mutilative behaviors. Excess energy is released through physical activities and a feeling of relaxation is induced. Children on this medica- tion must be monitored for adverse effects associated with most antipsychotic medications (see Chapter 28). Because of the potential for adverse effects, haloperidol should be reserved for children with severe symptoms or with symptoms that interfere with their ability to function. The response rate and side effect pro- ﬁle of pimozide are similar to those of haloperidol. It is used in the management of severe motor or vocal tics that have failed to respond to more conventional treatment. Clonidine is an antihyperten- sive medication, the efﬁcacy of which in the treatment of Tourette’s disorder has been mixed. Some physicians like it and use it as a drug of ﬁrst choice because of its rela- tive safety and few side effects. Atypical antipsychotics are less likely to cause extrapyramidal side effects than are the older antipsychotics (e. Risperidone, the most studied atypical antipsy- chotic in Tourette’s disorder, has been shown to re- duce symptoms by 21% to 61% compared with placebo (results that are similar to those of pimozide and cloni- dine) (Dion et al. Both olanzapine and ziprasi- done have demonstrated effectiveness in decreasing tic symptoms of Tourette’s disorder. Long-term Goal Client will be able to interact with staff and peers using age- appropriate, acceptable behaviors. Appropriate social behav- ior is often learned from the positive and negative feedback of peers. Role modeling of a respected individual is one of the strongest forms of learning. Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence ● 47 Outcome Criteria 1. Client seeks out staff or support person for social, as well as for therapeutic, interaction.
By 8/18/12 buy 40 mg sotalol overnight delivery, patient will learn three exercises designed to strengthen leg muscles purchase sotalol 40 mg without a prescription. In each case 40 mg sotalol overnight delivery, appropriate nursing action when evaluating a the goal is discontinued. Reinforce the plan of care when each of a goal after it has been achieved to expected outcome is achieved. Continue the plan of care if more time is by the Institute of Medicine’s Committee on needed to achieve the goals/outcomes. Care should include shared knowledge and will verbalize decreased anxiety about tak- the free ﬂow of information. Organize a task force to implement the a target weight gain of 8 lb (birthweight: change. After the data have been collected to deter- describe the process of quality assurance in mine patient outcome achievement, the nursing practice? The nurse writes a two-part evaluative state- nursing units to improve nursing care. Quality assurance programs enable the well the outcome was met, along with nursing profession to be accountable to patient data that support the decision. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. In the quality-by-inspection system, outcomes of nursing care or the process by mistakes are viewed not as being caused by which these outcomes were achieved, he/she a lack of motivation or effort, but rather as is conducting a(n). During the evaluation step of the nursing goals while the patient is receiving the process, based on the patient’s responses care to the plan of care, the nurse decides to , , or 4. The most important act of evaluation Match the measurement tool in Part A with its performed by nurses is evaluating appropriate example in Part B. The admission database will be care should be managed in speciﬁc diseases, completed on all patients within 24 problems, or situations. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The student will be able to name and describe steps of the nursing procedure by the end of the semester. Give an example of a variable that may inﬂu- that ensures the quality of the profession ence goal/outcome achievement in the follow- using quality by inspection or quality as ing areas. Give four examples of the type of evaluations nurses are involved in as members of the c. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Interview friends and family members who regimen, the patient says, “I take this one have experienced a stay in the hospital. Ask labeled ‘furosemide’ every day in the morning, them if they were aware of speciﬁc nursing along with this other one labeled ‘Lasix. How can you use this knowledge to help you develop the blended skills necessary to help patients achieve goals? Think of speciﬁc ways nurses can use evaluation to motivate patients to achieve healthy goals. Give an example of each of the following “Seven Crucial Conversations in Health Care” 3. What intellectual, technical, interpersonal, and brainstorm with a friend or the class to and/or ethical/legal competencies are most provide a recommendation for solving the likely to bring about the desired outcome? Mioshi Otsuki, an elderly woman with a history of heart failure being Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Source-oriented method Circle the letter that corresponds to the best answer for each question. Which of the following is a nurse’s best defense against allegations of negligence by a d. Student nurses are not granted access to using uniform deﬁnitions to create a common patient records. You and other nurses visit similar patients legal document that details the nurse’s individually at each patient’s bedside in interactions with the patient. You send or direct someone for action in a as a defense against nursing negligence speciﬁc nursing care problem. Omissions and errors in the nursing docu- written documentation of the effectiveness of mentation always affect patient care. Gray is receiving sufﬁcient relief from concise, legally prudent, and conﬁdential. Gray appears comfortable and is resting that pertains to patient care is considered adequately. Which of the following are potential proper to use dittos to decrease recording documentation errors that increase the risk time. The content includes descriptions of respiratory rate, blood pressure, and body situations that are out of the ordinary. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The use of sign-in sheets that contain or medical diagnoses is used that information about the reason for the incorporates many aspects of a patient and patient visit patient care. In charting by exception, only signiﬁcant conversation being overheard, provided ﬁndings or “exceptions” to these standards that the surroundings are appropriate and are documented. X-ray light boards that can be seen by documentation system that integrates the passersby, provided that patient x-rays are collaborative pathway and documentation not left unattended on them ﬂow sheets designed to match each day’s expected outcomes. Calling out names in the waiting room, provided that the reason for the patient 6. In a problem-oriented record, the entire healthcare team works together in identify- Hot Spot Question ing a master list of patient problems and contributes collaboratively to the plan of 1. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Medication record actions taken in response to the event, and discharge planning if appropriate. The is a group of data elements a designated diagnosis, which includes that represent core items of a comprehensive expected outcomes, interventions to be assessment for an adult home care patient and performed, 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.
Awards scientiﬁc information or sufﬁcient maturation of totaling $8 million each over ﬁve years were made the science purchase sotalol with amex. This is illustrated by our support of a study of mit us to develop innovative pilot projects in areas an approach advocated by Dr generic 40mg sotalol amex. Gonzalez treats cancer patients with dietary where possible buy sotalol with a visa, on studies involving minority and supplements, including pancreatic enzymes, mag- underserved populations. Preliminary data from nesium citrate, papaya extracts, vitamins, miner- this research will serve as the basis for more deﬁn- als, trace elements, and animal glandular products, itive clinical trials. Cancer patients for longing life expectancy for those suffering from whom a cure is not an option face not only death, pancreatic cancer. Given that conventional regi- but also the diminution of quality of life and mens for this type of cancer only moderately pro- intractable pain. Perhaps as many as 70 percent of long life, there is sufﬁcient argument from a public these cancer patients are seeking complementary health standpoint to evaluate the regimen in a and alternative therapies to expand their end-of- more rigorous fashion. A second trial will native remedies for centuries, little is known about examine safety and efﬁcacy of shark cartilage in how they work. Acupuncture for osteoarthritis pain—the range of motion, as well as the impact of lumbar National Institute of Arthritis and Muscu- spinal manipulation on posture. Despite the growing the research base through collaborative research body of literature that addresses the clinical effects and outreach to scientists and clinicians. More than one million tigators to join us in exploring how acupuncture people in the U. Potential areas of research include the basic in approximately 10 million treatment visits biology and biochemistry of acupuncture, its annually. Acupuncture is administered by a vari- effects at the cellular level, its effects upon body ety of health care providers ranging from conven- systems (such as the immune and nervous sys- tional physicians to Traditional Chinese Medicine tems), and genetic factors that correlate with practitioners. Currently, there is consider- has received an increasing amount of attention able use of acupuncture for the management of recently due to its effect on pain management. As illustrated by investigation include various forms of manual the effects of St. However, little reliable research-based data is ment and prevention of a number of conditions. John’s wort for depression, about the use of botanicals simultaneously with Ginkgo biloba for improved memory, and saw pal- over-the-counter and prescription drugs. For instance, recent increase our knowledge of the mechanisms of studies suggest that St. This been associated with beneﬁts such as preservation phenomenon has also been observed with certain of cardiovascular, skeletal, genitourinary, and cogni- oral contraceptives and drugs that prevent rejection tive health. Soybeans are known National Center for Complementary and Alternative Medicine 97 to be rich in naturally occurring compounds with the number of Americans suffering from asthma. This study would determine the safety and the most signiﬁcant limitation is the lack of stan- efﬁcacy of magnesium in different subpopulation dardized products worthy of in-depth study. However, tions, emphasizing the use of traditional and folk no conclusive studies have been conducted in medicine among immigrant populations and the humans. We will also con- ing, making awards at the institutional level, as tinue to create opportunities for minority scientists well as to individuals. It integrates or rejects approaches Research training is also an important component based on scientiﬁc evidence. For example, will help treat or prevent many of the diseases that willow tree bark is a remedy for arthritis. Not Native American healing practices Methods for unlike steam baths or saunas, sweat lodges and restoration of health based on the belief that phys- special teas that induce vomiting may be part of a ical and emotional well-being is interconnected healing regimen. Smudging—cleansing a place or with morality, spirituality, and harmonious rela- person with the smoke of sacred plants—is also tionships with the community and nature. There done to induce an altered state of consciousness are approximately 500 Native American Nations and sensitivity, making a person more receptive to (commonly called tribes), each with its own prac- the healing. Prayer is also a major component of tices and beliefs and some basic rituals and healing Native American healing practices. Another practice of Native American healing, Although Native American healers claim to symbolic healing rituals, can involve a shaman and have cured victims of heart disease, diabetes, thy- even entire communities. These ritual ceremonies roid problems, skin rashes, asthma, and cancer, as include chanting, singing, body painting, dancing, well as emotional and spiritual problems, there is exorcisms, sand paintings, and even the use of no scientiﬁc evidence to support these claims. Prac- mind-altering substances, such as peyote, to per- titioners of Native American healing believe illness suade the spirits to heal the sick person. The migration of tribes and ers also believe that birth defects and other heredi- contact with other tribes along trade routes tary conditions result from the parents’ immoral allowed for exchanges of information and tech- behavior. The tribes gathered many herbs from the attempt to restore balance and wholeness in an surrounding environment and sometimes traded individual in order to retrieve physical and spiritual over long distances. More than receptive to other Native American healing tech- 80 percent showed some benefit after a seven- to niques. Five years caused an illness, a Native American healer called a later, 50 of the original participants said they were shaman is often relied on for invoking spiritual cured of their diseases while another 41 said they healing powers to treat the person and appease the felt better. However, the family and friends of the sick person help invoke comparison group who received different treat- the spirits to participate in healing the sick person. More clinical studies One of the most common forms of Native Amer- are needed to confirm the benefits of the specific ican healing involves the use of herbal remedies, healing methods. The word naturopathy was stress through prayer, introspection, meditation, coined in America a century ago from the Greek and communal support. Discrepancies among “father of medicine,” Hippocrates, perhaps one of Nations, shamans, and types of ailments and indi- the world’s earliest naturopathic and homeopathic vidual considerations make it almost impossible to physicians. The concept of invoking nature’s heal- study Native American healing under accepted sci- ing power by using herbs, water, fasting, diet, and entiﬁc standards. Moreover, certain Native Ameri- other noninvasive, gentle treatments is now seeing cans conceal their practices and techniques because a renaissance, particularly in the United States. People with cancer and nutrition, botanicals, homeopathy, and other nat- other chronic conditions are advised to consult ural treatments. Naturopathic physicians also function scientiﬁc evidence it can cure cancer or any other within an integrated framework, for example, by disease, but the communal support provided by referring patients to appropriate conventional this approach to health care does offer the possibil- medical specialists. The result is a team-care approach that recognizes the need of the patient to naturopath A licensed naturopathic physician receive the best overall treatment most appropriate (N. During the 1920s a strong emphasis on disease prevention and opti- there were a number of naturopathic medical mization of wellness. In addition to a standard med- schools, thousands of naturopathic physicians, and ical curriculum, the N. A naturopathic physician takes rigorous clinically and economically) on high-tech and phar- professional board exams so that he or she may be maceutical treatments put naturopathic and other licensed by a state or jurisdiction as a primary care natural healing methods into a temporary decline. Both the American public and policy makers training and certification in acupuncture and are recognizing and contributing to the resurgence home birthing.