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By R. Cole. Keene State College.

Laya yoga is geared Ashtanga yoga developed by Beryl Bender toward overcoming selfishness and self-cen- Birch order rizact with american express, author of Power Yoga and Beyond Power teredness and developing the ability to cope with Yoga (New York: Simon & Schuster generic rizact 5mg on-line, 2000) cheap 5mg rizact with amex. Mantra yoga: Mantra, from the Sanskrit word ate of Syracuse University, Birch addresses the manas, or mind, focuses on the meditative word positive mind-body therapeutic effects of yoga, or prayer repeated for a length of time. The repetition of the word tal and physical toxins and to stretch and Japa, meaning “in the name of God,” may be strengthen muscles. Other common mantras are systems, the ultimate spiritual goal is the real- Om Namo Sivaya (to call upon the energy of ization of the Self or the recognition of the true Siva) and Om Nama Narayanaya (which calls Self as divine consciousness. Sivananda yoga: Sivananda yoga is a method address the seven charkas, or energy zones of geared toward balancing the intellect, heart, the body. The major ones are Lam, Vam, Ram, body, and mind that includes proper exercise Yam, Ham, Ksam, Bam (or Om). Office yoga: Office yoga practice is also called relaxation (savasana), proper diet (vegetarian), Desktop yoga because the stretches do not positive thinking (vedanta), and meditation require moving away from a chair or desk. Introduced to the United States of Incorporating ergonomics and working condi- America in 1957 by Swami Vishnu-devananda, tions that promote the well-being of office founder of the International Sivananda Yoga workers, office yoga offers stress relief from the Vedanta Centers, Sivananda yoga is based on daily business world routine and confinement the teachings of Swami Sivananda of Rishikesh, to the office. Svaroopa yoga: Svaroopa yoga is a method that Phoenix Rising yoga blends classical techniques includes gentle poses directed toward “core with contemporary mind-body psychology in opening,” or unraveling tensions all along the order to allow the release of physical and emo- spine, developed by Rama Berch, who founded tional tension. A Phoenix Rising session is a and directs the Master Yoga Foundation in La one-on-one, one-and-a-half-hour experience Jolla, California, and who has also directed the of assisted yoga postures, nondirective dia- yoga program for Dr. Berch discovered that many of yoga 171 her students “impose the pose upon their body resists aging. Few classes are available on this rather than unfolding it from within,” and method. Viniyoga: Viniyoga is a method incorporating dents experience the deeper effects she realized asana, pranayama, meditation, ritual, and prayer from Kundalini yoga. With the goal of opening for the higher purpose of enhancing an individ- the body and experiencing the transcendent ual’s ability to adapt. Desikachar, “Yoga Sutras,” Svaroopa focuses on alignment advocated treating each yoga student as an indi- and support and makes frequent use of chair vidual who wishes to reach particular goals in a poses to help release deep-muscle tension. Gary Each pose is based on integrated principles of Kraftsow, a yoga teacher since 1976, wrote Yoga asana, anatomy, and yoga philosophy. Tantra yoga: Tantra means expansion in San- Viniyoga (New York: Viking Penguin, 1999) and skrit; a Tantra yogi teaches ways to expand all Yoga for Transformation: Ancient Practices and levels of consciousness to realize the Supreme Teachings for Healing the Body, Mind, and Heart Reality (samadhi). Krishnamacharya and cre- awaken and balance male-female energy for ated a link with the Viniyoga tradition through the sake of inner peace and overcoming of per- his American Viniyoga Institute, which offers sonal limitations and subconscious blockages. White Lotus yoga: A nondogmatic approach Often considered a secret doctrine, the Tantra is developed by the husband-and-wife team also known as Gupta Vidya. Srinivasan said one Ganga White and Tracey Rich, White Lotus must acquire this knowledge not from books, yoga is dedicated to the development of the but from the practical Tantrikas, the Tantric whole human being. The tantric student must five yoga videos that highlight the practice of be “endowed with purity, faith, devotion, ded- partner yoga in 1978, and White is also the ication to Guru, dispassion, humility, courage, author of Double Yoga (New York: Penguin, cosmic love, truthfulness, non-covetousness, 1981). Tibetan yoga: A method of yoga little known in vigorous and consists of alignment, breath, and the West, Tibetan yoga is the name used by the basic yoga principles. White Lotus includes Buddhists to describe tantric meditation and the Flow Series, or Flow Yoga, which uses breathwork. In 1939 Peter Kelder published proper body alignment, attunement with Ancient Secret of the Fountain of Youth (New York: breath, focused attention, and the development Doubleday, 1998), which contains a series of of a balance of strength, flexibility, and postures called “The Five Rites of Rejuvena- endurance. Kilham’s book acre retreat in the Santa Ynez Mountains in explains five flowing movements that start Santa Barbara, California, offers weekend and with 10 to 12 repetitions and progress to 21, week-long yoga-immersion experiences as well with the purpose of restoring the spin of the as 16-day teacher-training programs. YogaDance: A combination of standing move- if the chakras are perfectly balanced, the body ments and yogic stretches developed by Jeff 172 yoga Hoffman, a native New Jersey yogi for 27 years, ardha matsayana (half-fish). Yoga therapy is the practice focuses on relaxation, breath, known to be beneficial as a preventive health self-observation, and individual awareness, and exercise regimen and as complementary according to Hoffman, whose website is www. Simple and common yoga asanas tism, anxiety, migraines, insomnia, nerve or (postures) include balasana (the child’s posture), muscle disease, menstrual problems and pre- paschimottanasana (posterior stretch), bhujan- menstrual syndrome, menopause symptoms, gasana (cobra), shalabhasana (locust), ardha mat- high blood pressure, heart disease, asthma, syendrasana (half-spinal twist), shavasana bronchitis, duodenal ulcer, hemorrhoids, dia- (corpse), sarvangasana (shoulder stand), and betes, obesity, and substance addictions. Z zanfu zhi qi The energy, or qi, of the body’s energetic zones for the treatment of a variety of organs, according to traditional Chinese medicine. After the laryngologist William Fitzger- ald, of Saint Francis Hospital in Connecticut, found zang fu The term for the internal organ systems that zone therapy with finger pressure applied to in traditional Chinese medicine. It aims to bodily reflexes (reflex points) and regions on the help relieve physical and mental symptoms, soles of the feet, which contain approximately improve the ability to deal with stress, and organize 7,200 nerve endings. When finger pressure is vibratory fields in order to promote a sense of applied to certain areas—the ball of the foot, rep- wholeness and well-being. Founded in 1991, the resenting the lungs and breast, for example—stim- Zero Balancing Association represents the integra- ulation and a healing effect are directed to the tion of Eastern views of energy with Western views lungs or breast. Ingham’s techniques brought forth of science and teaches how to use energy as a work- reflexology, as it is known today, as a form of ing tool in relation to body structure. More information is zong qi In Chinese traditional medicine energy, available by contacting www. Zukav, of California, became one Zikr The Sufi practice of remembrance that of the New Age movement’s intellectual explor- includes chanting, drumming, meditating, releas- ers with his vision that goes beyond physics and ing false impressions and delusions, and embracing science to the new mind-expanding theory of new dimensions of inner reality. Zukav is also the author zone therapy Originally, European technique of The Seat of the Soul (New York: Simon & Schus- that involves the stimulation of the body’s regional ter, 1989). As a result, many schools that taught prac- appear not to conform to standard medical prac- tices such as homeopathy were closed, homeopaths tice, or are not generally taught at accredited med- were shunned and stigmatized, and their therapies ical schools. The scope of alternative medicine is became the “alternatives” to the standards that broad, with widespread use among the American evolved after acceptance of the Flexner reports. In public of a long list of treatments and practices, contrast, Osteopathic schools like allopathic schools such as acupuncture, homeopathy, relaxation tech- developed rigorous standards and practices. Alternative Systems and Techniques Medicine, Murray and Rubel comment, “Many are well known, others are exotic and mysterious, and Most observers from outside the fields of alterna- some are dangerous. Many such therapies are and the medical profession might deal with the characterized by a charismatic leader or proponent, issues surrounding these unconventional measures and are driven by ideology; some spring from folk in health and healing. Among other acupuncturists, naturopaths, and homeopathic outcomes, the resulting changes in medical educa- therapists) and unregulated, particularly those tion led to the acceptance of the biological, disease- dealing in alternative nutritional therapy. The recuperative power of the human chicken soup for colds and honey and lemon tea body and the potential for certain stimuli to for sore throat. Most folk medicine is not done enhance this natural healing are central to many for personal enrichment and is noncommercial. Anecdotal testimonials are the main • A belief that personal experience and anecdote basis for the “success” of these modalities. Theories of Alternative Medicine blind studies, and found to be both safe and effective for the specific condition for which Mind-Body Interventions their use is proposed. Such trials should be spiritual well-being in persons and a feeling of conducted under the supervision of recognized wholeness even in the face of a disease process or entities such as the Food and Drug Administra- condition.

People can show both problem focused coping and emotional focused coping when facing a stressful event buy rizact in united states online. Problem focused coping: This involves attempts to take action to either reduce the demands of the stressor or to increase the resources available to manage it buy rizact uk. Examples of problem focused coping include devising a revision plan and sticking to it cheap 10mg rizact with amex, setting an agenda for a busy day, studying for extra qualifications to enable a career change and organizing counselling for a failing relationship. Emotion focused coping: This involves attempts to manage the emotions evoked by the stressful event. Examples of behavioural strategies include talking to friends about a problem, turning to drink or smoking more or getting distracted by shopping or watching a film. Examples of cognitive strategies include denying the importance of the problem and trying to think about the problem in a positive way. Several factors have been shown to influence which coping strategy is used: Type of problem: Work problems seem to evoke more problem focused coping whereas health and relationship problems tend to evoke emotion focused coping (Vitaliano et al. Age: Children tend to use more problem focused coping strategies whereas emotion focused strategies seems to develop in adolescence (Compas et al. Gender: It is generally believed that women use more emotion focused coping and that men are more problem focused. For example, Stone and Neale (1984) considered coping with daily events and reported that men were more likely to direct action than women. However, Folkman and Lazarus (1980) and Hamilton and Fagot (1988) found no gender differences. In contrast they use more emotion focused coping if the problem is perceived as being out of their control (Lazarus and Folkman 1987). Available resources: Coping is influenced by external resources such as time, money, education, children, family and education (Terry 1994). Poor resources may make people feel that the stressor is less controllable by them resulting in a tendency not to use problem focused coping. Measuring coping The different styles of coping have been operationalized in several measures which have described a range of specific coping strategies. The most commonly used measures are the Ways of Coping checklist (Folkman and Lazarus 1988) and Cope (Carver et al. The coping strategies described by these measures include the following: s Active coping (e. Some of these strategies are clearly problem focused coping such as active coping and planning. For example, positive reframing involves thinking about the problem in a different way as a means to alter the emotional response to it. Some strategies can also be considered approach coping such as using emotional support and planning whereas others reflect a more avoidance coping style such as denial and substance use. Therefore effective coping can be classified as that which reduces the stressor and minimizes the negative outcomes. In addition, recent research has shifted the emphasis away from just the absence of illness towards positive outcomes. Much research has addressed the impact of coping on the physiological and self-report dimensions of the stress response. Coping and the stress illness link: Some research indicates that coping styles may moderate the association between stress and illness. For some studies the outcome vari- able has been more psychological in its emphasis and has taken the form of well-being, psychological distress or adjustment. For example, Kneebone and Martin (2003) critic- ally reviewed the research exploring coping in carers of persons with dementia. They examined both cross-sectional and longitudinal studies and concluded that problem- solving and acceptance styles of coping seemed to be more effective at reducing stress and distress. In a similar vein, research exploring coping with rheumatoid arthritis sug- gests that active and problem-solving coping are associated with better outcomes whereas passive avoidant coping is associated with poorer outcomes (Manne and Zautra 1992; Young 1992; Newman et al. Similarly, research exploring stress and psoriasis shows that avoidant coping is least useful (e. For example, Holahan and Moos (1986) examined the relationship between the use of avoidance coping, stress and symptoms such as stomach-ache and headaches. The results after one year showed that of those who had experienced stress, those who used avoidance coping had more symptoms than those who use more approach coping strategies. Coping and positive outcomes: Over recent years there has been an increasing recognition that stressful events such as life events and illness may not only result in negative outcomes but may also lead to some positive changes in people lives. This phenomenon has been given a range of names including stress related growth (Park et al. This finds reflection in Taylor’s cognitive adaptation theory (Taylor 1983) and is in line with a new movement called ‘positive psychology’ (Seligman and Csikszentmihalyi 2000). Although a new field of study, research indicates that coping processes which involve finding meaning in the stressful event, positive reappraisal and problem focused coping are more associated with positive outcomes (Folkman and Moskowitz 2000). Coping is considered to moderate the stress/illness link and to impact upon the extent of the stressor. Much research has involved the description of the kinds of coping styles and strategies used by people and some studies suggest that some styles might be more effective than others. Initially, it was defined according to the number of friends that were available to the individual. However, this has been developed to include not only the number of friends supplying social support, but the satisfaction with this support (Sarason et al. Wills (1985) has defined several types of social support: s esteem support, whereby other people increase one’s own self-esteem; s informational support, whereby other people are available to offer advice; s social companionship, which involves support through activities; s instrumental support, which involves physical help. The term ‘social support’ is generally used to refer to the perceived comfort, caring, esteem or help one individual receives from others (e. A number of studies have examined whether social support influences the health status of the individual. Lynch (1977) reported that widowed, divorced or single individuals have higher mortality rates from heart disease than married people and suggested that heart disease and mortality are related to lower levels of social support. However, prob- lems with this study include the absence of a direct measure of social support and the implicit assumption that marriage is an effective source of social support. Berkman and Syme (1979) reported the results of a prospective study whereby they measured social support in 4700 men and women aged 30–69, whom they followed up for nine years. Research has also indicated that birth complications are lower in women who have high levels of social support, again suggesting a link between social support and health status (Oakley 1992). Research has also examined the effects of social support on immune functioning and consequently health. The unemployed group received either standard economic benefits only or received benefits as well as a psychosocial support programme. The results showed that those unemployed subjects who received the psychosocial support showed better immune functioning than the subjects who received benefits only. It would seem that social support reduced immuno- suppression, thus promoting health.

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Too many investigations may reinforce her belief in her illness and false-positive findings do occur and may exacerbate her anxieties discount rizact 10mg without prescription. However quality rizact 10mg, if the patient could not be simply reassured it might be appropri- ate to proceed with an exercise stress test or a thallium scan to look for areas of reversible ischaemia on exercise or other stress order rizact with a mastercard. A coronary arteriogram would not be appropriate without other information to indicate a higher degree of risk of coronary artery disease. History A 30-year-old woman is brought up to the emergency department at 2 pm by her hus- band. She has a history suggestive of depression since the birth of her son 3 months earlier. She has been having some counselling since that time but has not been on any medication. The previ- ous evening about 10 pm she told her husband that she was going to take some pills and locked herself in the bathroom. Two hours later he persuaded her to come out and she said that she had not taken anything. They went to bed but he has brought her up now because she has complained of a little nausea and he is worried that she might have taken something when she was in the bathroom. The only tablets in the house were aspirin, paracetamol and temazepam which he takes occasionally for insomnia. Her pulse is 76/min, blood pressure is 124/78 mmHg and respiratory rate is 16/min. There is some mild abdom- inal tenderness in the upper abdomen but nothing else abnormal to find. Aspirin and temazepam would be likely to produce more symptoms in less than 14 h if they have been taken in significant quantity. However, the salicylate level should certainly be measured; in this case it was not raised. In the absence of drowsiness at this time, it is not necessary to consider temazepam any further. Paracetamol overdose causes hepatic and renal damage, and can lead to death from acute liver failure. The severity of paracetamol poisoning is dose related with a dose of 15 g being serious in most patients. Patients with pre-existing liver disease and those with a high alcohol intake may be susceptible to smaller overdoses. It is often the first test to become abnormal when there is liver damage from paracetamol overdose. There are few symptoms in the first 24 h except perhaps nausea, vomiting and abdominal dis- comfort. Acute liver failure may develop between days 3 and 5, and renal failure occurs in about 25 per cent of patients with severe hepatic damage. The earlier this is used the better but it is certainly still worth- while 16 h after the ingestion. In this case a level of paracetamol of 64 mg/L confirmed that treatment was appropriate and that the risk of severe liver damage was high. Further advice can always be obtained by ringing one of the national poisons information ser- vices. The electrolyte, renal and liver function tests and the clotting studies should be monitored carefully over the first few days, and referral to a liver unit considered if there is marked liver dysfunction. Patients with fulminant hepatic failure are considered for urgent liver transplantation. The other areas that need to be addressed in this case are the mental state and the safety and care of the son and any other children. She should be seen by a psychiatrist or other appropriately trained health worker. The question of any possible risk to the baby should be evaluated before she returns home. On direct questioning she states that she has lost 8 kg in weight over the past year although she says her appetite is good. This is a disorder usually of teenagers or young adults char- acterized by severe weight loss, a disorder of body image (the patient perceiving themself as being fat despite being objectively thin) and amenorrhoea (or, in men loss of libido or potency). Often sufferers from this condition work in a profession where personal image is very important, e. Some patients exhibit the bulimic behaviour of recurrent bouts of overeating and self-induced vomiting. The skin is dry with growth of lanugo hair over the neck, cheeks and limbs as in this woman. Severe physical complications include proximal myopathy, cardiomyopathy and peripheral neuropathy. A number of interrelated mechanisms cause the metabolic alkalosis in this patient. The vom- iting causes a net loss of hydrogen and chloride ions, causing alkalosis and hypochloraemia. The loss of fluid by vomiting leads to a contracted plasma volume with consequent second- ary hyperaldosteronism to conserve sodium and water, but with renal loss of potassium, due to its secretion in preference to sodium and the fact that fewer hydrogen ions are available for secretion by the renal tubules. These events combine to give the typical picture of an alkalosis with low chloride and raised bicarbonate in the blood, and urine which contains excess potassium and very little chloride. This patient should be referred to a unit with a special interest in eating disorders. Other serious physical illnesses should be excluded with the appropriate investigations. Often such patients are admitted for several weeks in an attempt to make them gain weight. Supportive psychotherapy tackles the patient’s disordered perception of their body image. This developed suddenly a week previously after carrying a heavy suitcase at the airport. She has had increasing problems with back pain over the past 10 years, and her family have commented on how stooped her posture has become. She takes courses of oral corticosteroids, and use steroid inhalers on a regular basis. She has a moon-face, abdominal striae and a number of bruises on her arms and thighs. The loss of height is typical, and is usually noted more by others than the patient. This can occur spontaneously or in association with a recognized stress such as carrying a heavy load. Examination confirms loss of trunk height, thoracic kyphosis and proxim- ity of the ribs to the iliac crest. The differential diagnoses of osteoporosis • Multiple myeloma • Metastatic carcinoma, particularly from the prostate, breast, bronchus, thyroid and kidney • Osteomalacia • Hyperparathyroidism • Steroid therapy or Cushing’s syndrome This patient has several risk factors for osteoporosis. Thirdly she has been on oral and inhaled corticosteroids for her asthma for years.

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What would be a successful outcome for in the morning and maybe a glass of wine at Mr cheap 5 mg rizact visa. What intellectual buy cheap rizact 10 mg line, technical buy rizact amex, interpersonal, is a workaholic computer programmer and and/or ethical/legal competencies are most spends what little spare time she has watching likely to bring about the desired outcome? She reports tiring after walking one flight of stairs and says she avoids all forms of vigor- ous exercise. Identify pertinent patient data by placing a single underline beneath the objective data in the case study and a double underline beneath 4. Complete the Nursing Process Worksheet on page 261 to develop a three-part diagnostic statement and related plan of care for this patient. Read the following patient care study and use your nursing process skills to answer the Patient strengths: questions below. Elgaresta, age 54, a single Hispanic woman, is being followed by a cardi- ologist who monitors her arrhythmia. At this visit, she says to the nurse practi- tioner who works with the cardiologist: “Right after I started taking that medication, I got 4. Pretend that you are performing a nursing terribly constipated, and nothing seems to assessment of this patient after the plan of help. The nurse practitioner realizes that Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. For the purposes of this exercise, develop the one patient goal that demonstrates a direct resolution of the patient problem identified in the nursing diagnosis. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Dullness bronchioles that are the sites of gas exchange are known as which of the following? A patient who has difficulty breathing, increased respiratory and pulse rates, and d. A nurse suctioning a patient through a is generally preferred, despite its addictive tracheostomy tube should be careful not to quality? Cough syrup with codeine catheter because it would cause which of the following to occur? Suctioning of carbon dioxide ing should be placed in which of the follow- ing positions? The patient has no impairment of speaking lobes of the lungs, the nurse should place the function. Suctioning of the tracheostomy tube must and half on the side be done using sterile technique. Trendelenburg position emphysema, the nurse would probably hear which of the following sounds? The brain is sensitive to hypoxia and will sustain irreversible brain damage after how a. His nurse has taught him pursed-lip Circle the letters that correspond to the best breathing, which helps him in which of the answers for each question. Bronchioles Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Infants have a rounded chest wall in which the physiology of the lungs are accurate? Each lobe in the lung is further divided into would a nurse expect to find when performing lobules. When palpating the trachea, the nurse describe how respirations are controlled in the should note a slightly higher skin tempera- body? The medulla is stimulated by a decrease in tions from the patient’s repeated word the concentration of carbon dioxide and should be equal bilaterally in different areas hydrogen ions and by the decreased on the chest wall. Chemoreceptors in the aortic arch and pitched sound, should be heard over carotid bodies can shut down the medulla. Which of the following actions should a nurse rate and depth of ventilation to blow off perform when inserting an oropharyngeal air- carbon dioxide and hydrogen and increase way? The medulla sends an impulse down the 60 mm is appropriate for the average spinal cord to the respiratory muscles adult). The lungs contract in response to pressure changes in the intrapleural space and lungs. Position patient on his/her back with the head turned to one side, resting on the 4. Slide the airway across the tongue to the although the airways are comparatively back of the mouth and rotate it 180 degrees long, and aspiration is a potential problem. Which of the following actions would a nurse perform when correctly providing postural d. Respiratory activity is primarily abdominal to drain the apical sections of the upper in infants. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Place the patient in the Trendelenburg posi- Prioritization Questions tion to drain the right lobe of the lung. Carry out postural drainage two to four to use an incentive spirometer in the order in times a day for 20 to 30 minutes. Place the patient in a lying position, half and not to breathe through his or her nose. Medicate with ordered pain medication if and left, to drain the posterior sections of needed. Check position of gauge to determine with a pillow under the chest wall to drain progress and level attained. Which of the following statements describes about 10 times every hour, if possible, and the proper use of inhaled medications? Instruct the patient to remove lips from vate the device before and after inhaling. Place the following steps for inserting a dose of medications with each compression nasopharyngeal airway in the order in which of the canister. Remove the airway and place it in the other side effects whenever they are needed by naris at least every 24 hours; assess for skin the patient. The diet should consist of 40% to 55% car- resistance is met, stop and try inserting it bohydrates.

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