By C. Stejnar. Tuskegee University.
Nursing diagnoses or patient needs researchers to determine the most effective way c buy coversyl 4mg lowest price. Change-of-shift reports: Given by a primary review often provides the data needed by strate- nurse to the nurse replacing him/her or by the gic planners to identify needs and the means charge nurse to the nurse who assumes responsi- and strategies most likely to address these needs purchase coversyl 4mg otc. Telephone reports: Telephones can link about the clinical manifestations of health prob- healthcare professionals immediately and enable lems discount coversyl 8 mg with visa, effective treatment modalities, and factors nurses to receive and give critical information that affect patient goal achievement. Telephone orders: Policy must be followed regard- documents that may be entered into court ing telephone orders; they must be transcribed on proceedings as evidence and play an important an order sheet and co-signed by the physician role in implicating or absolving health within a set time. Reimbursement: Patient records are used to summary of a patient’s condition and care when demonstrate to payers that patients received the transferring or discharging patients. Historical document: Because the notations in Nurses must keep the patient’s family and signiﬁ- patient records are dated, they provide a chrono- cant others updated about the patient’s condition logic account of services provided. Incident reports: A tool used by healthcare agen- and state their relationship to the patient. Nurses should report concisely and accurately the out of the ordinary that results in or has the change in the patient’s condition and what has potential to result in harm to a patient, already been done in response to this change. Nurses should record concisely the time and date they lie outside the scope of independent nurs- of the call, what was said to the physician, and ing practice, they make referrals to other profes- the physician’s response. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Notations are entered chronologically, with most recent entry being nearest the front of the record. Disadvantages: Data are fragmented, making it difﬁcult to track problems chronologically with input from different groups of professionals. Advantages: Entire healthcare team works together in identifying a master list of patient problems and contributes collaboratively to plan of care. Advantages: It promotes continuity of care and saves time since there is no separate plan of care. Disadvantages: Nurses need to read all the nursing notes to determine problems and planned interventions before initiating care. A focus column is used that incorporates many aspects of a patient and patient care. Advantages: Holistic emphasis on the patient and patient’s priorities; ease of charting. Advantages: Decreased charting time, greater emphasis on signiﬁcant data, easy retrieval of signiﬁcant data, timely bedside charting, standardized assessment, greater communication, better tracking of important responses and lower costs. Collaborative pathway is part of a computerized system that integrates the collaborative pathway and documentation ﬂowsheets designed to match each day’s expected outcomes. Advantages: Reduced charting time by 40% and increased staff satisfaction with the amount of paperwork from 0–85%. Advantages: The nurse can call up the admission assessment tool and key in the patient data, develop the plan of care using computerized care plans, add new data to the patient data base, receive a work list showing treatments, procedures and medications, and document care immediately. Disadvantages: Policies should specify what type of patient information can be retrieved, by whom, and for what purpose (privacy). Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Baron’s medication administration and any follow-up appointments should be discussed and written in the discharge summary. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Latent stage Genital stage Eric Erikson Based on Freud, expanded to include Trust vs. Havighurst Living and growing are based on learning; Infancy and early childhood Developmental tasks person must continually learn to adjust to Middle childhood changing social conditions, developmental Adolescence tasks Young adulthood Middle adulthood Later maturity Jean Piaget Learning occurs as result of internal Sensorimotor stage Cognitive development organization of an event, which forms Preoperational stage a mental schemata and serves as a base for Concrete operational stage further schemata as one grows and develops. Formal operational stage Lawrence Kohlberg Levels closely follow Piaget’s; preconventional Preconventional level Moral development level, conventional level, postconventional Stage 1: punishment and level; moral development inﬂuenced by cultural obedience orientation effects on perceptions of justice or interpersonal Stage 2: instrumental relationships relativist orientation conventional level Stage 3: “good boy– good girl” orientation Stage 4: “law and order” orientation Postconventional level Stage 5: social contract, utilitarian orientation Stage 6: universal ethical principle orientation Carol Gilligan Conception of morality from female point of Level 1—selﬁshness Moral development view (ethic of care); selﬁshness, goodness, Level 2—goodness nonviolence; female: morality of response and Level 3—nonviolence care; male: morality of justice. James Fowler Theory of spiritual identity of humans; faith is Intuitive–projective faith Faith development reason one ﬁnds life worth living; six stages Mythical–literal faith of faith. Synthetic–conventional faith Individuative–reﬂective faith Conjunctive faith Universalizing faith Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Conventional level: This level is obtained when According to Havighurst, the developmental tasks person becomes concerned with identifying with of later adulthood include adjusting to decreasing signiﬁcant others and shows conformity to their physical strength and health, adjusting to retirement expectations. Example: A college student gets all and reduced income, and establishing physical A’s in college so his parents will think he is a living arrangements. Postconventional level: This level is associated of dependency on healthcare providers and his with moral judgment that is rational and inter- family. The nurse could then base the nursing plan nalized into one’s standards or values. Example: of care on interventions to foster feelings of A bank teller resists the urge to steal money from personal dignity and worth. Logan states that he is willing to participate in latency stage and will be experiencing increased his care plan and do everything in his power to interest in gender differences and conﬂict and adjust to his situation by accepting the assistance of resolution of that conﬂict with parent of same others when necessary sex. Erikson: The 6-year-old is becoming achievement ethical/legal competencies are most likely to bring oriented, and the acceptance of parents and about the desired outcome? Havighurst: The 6-year-old is ready to learn the mental theories to nurse care planning developmental tasks of developing physical Technical: ability to provide technical nursing assis- skills, wholesome attitudes toward self, getting tance to Mr. Logan as needed along with peers, sexual roles, conscience, moral- Interpersonal: ability to use therapeutic communi- ity, personal independence, and so on. An illness cation to meet the emotional and spiritual needs of could stall these processes. Piaget: The 6-year-old is in the preoperational Ethical/Legal: ability to advocate for the unmet stage, including increased language skills and developmental needs of Mr. Kohlberg: Moral development is inﬂuenced by Home healthcare services, community services, cultural effects on perceptions of justice in inter- support groups personal relationships. Moral development begins in early childhood and could be affected by a traumatic illness. A health problem of any family member can affect the Chart/Exhibit Questions remainder of the unit. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Age group—Physiologic characteristics and behaviors I—Is in oral stage (Freud); strives for immediate P—Motor abilities include skipping, throwing and gratiﬁcation of needs; strong sucking need. A—In Freud’s genital stage, libido reemerges in I—Brain grows to about half the adult size mature form.
When the food reaches the esophagus purchase 4mg coversyl mastercard, it is moved to the stomach and intestines with an involuntary move- ment called peristalsis coversyl 4 mg visa. The esophagus is a tube connecting the oral cavity to the stomach and is lined with mucous membranes that secrete mucus cheap 8mg coversyl amex. These are the superior (hyperpharyngeal) sphincter and the lower sphincter that prevents gastric juices from entering the esophagus (gastric reflux). The stomach is a hollow organ that holds between 1000 to 2000 mL of con- tents that takes about 2–3 hours to empty. These are the cardiac sphincter (located at the opening of the esophagus), and the pyloric sphincter (that connects the stomach to the head of the duodenum). The stomach has mucosal folds containing glands that secrete gastric juices used to break down food (digest) into its chemical elements. Mucus-Producing Cells Mucus-producing cells release mucus that protect the stomach lining from the gastric juices. The small intestine extends from the ileocecal valve at the stomach to the duo- denum. The cecum is attached to the duodenum, which is the site where most medication is absorbed. This results in the intestinal juices having a higher pH than the gastric juices in the stomach. Hormones, bile, and pancreatic enzymes trypsin, chymotrypsin, lipase, and amylase digest carbohydrates, pro- tein, and fat in preparation for absorption in the small intestine. The small intestine lead into the large intestine where undigested material from the small intestine is collected. The large intestine also absorbs water and secretes mucus while moving the undigested material—using peristaltic con- tractions—to the rectum where it is eliminated through defecation. Vomiting is sometimes preceded by nausea, which is a queasy sensation, although vomiting can occur without nausea. These include motion sickness, viral and bacte- rial infections, food intolerance, surgery, pregnancy, pain, shock, effects of selected drugs, radiation, and disturbances of the middle ear affecting equilibrium. These impulses are transmitted by the neurotransmitter dopamine to the vomiting center. Sensory impulses such as odor, smell, taste, and gastric mucosal irritation are transmitted directly to the vomiting center. When the vomiting center is stimulated, motor neurons respond causing con- traction of the diaphragm, the anterior abdominal muscles, and the stomach. The glottis closes, the abdominal wall moves upward, and the stomach contents are forced up the esophagus. Begin treatment with nonpharmacological measures such as drinking weak tea, flattened carbonated beverages, gelatin, Gatorade, and for children, Pedialyte. Nausea and vomiting that occur during the first trimester of pregnancy should be treated with nonpharmacologic remedies since amtimetics can cause possible harm to the fetus. If dehydration occurs because vomiting is severe, intravenous fluids may be needed to restore body fluid balance. Nonpre- scription antiemetics are purchased over-the-counter and used to prevent motion sickness. They must be taken 30 minutes before traveling and are not effective once vomiting occurs. Antihistamine antiemetics such as diphenhydrinate (Dramamine), meclizine hydrochloride (Antivert), and diphenhydramine hydrochloride (Benadryl) are over-the-counter medications that prevent nausea, vomiting, and dizziness (ver- tigo) caused by motion by inhibiting stimulation in the middle ear. Several over-the-counter drugs—such as bismuth subsalicylate (Pepto- Bismol)—act directly on the gastric mucosa to suppress vomiting. Do not give Pepto-Bismol to children who are vomiting who might be at risk for Reyes syndrome as it con- tains salicylates. Phosphorated carbodydrate solution (Emetrol), a hyperosmolar carbohydrate is also available over-the-counter. It decreases nausea and vomiting by changing the gastric pH or by decreasing smooth muscle contractions of the stomach. Prescription antiemetics act as antagonists to dopamine, histamine, serotonin, and acetylcholine. They are also used for the management of motion sickness and to treat allergic symptoms. Anticholinergics Anticholinergics are used to prevent and treat nausea, vomiting and motion sick- ness. They are also used to treat vertigo that is associated with vestibular system disease. It was introduced as an antihistamine with seda- tive side effects and can be used for motion sickness. Chlorpromazine (Thorazine) and prochlorperazine edisylate (Compazine) are tranquilizers used for both psychosis and vomiting. Lorazepam (Ativan) is the choice drug in this category and may be given with metoclopramide. Two serotonin antagonists—ondanestron (Zofran) and granisetron (Kytril)—are effective in suppressing chemotherapy-induced emesis. These include drowsi- ness, dry mouth, blurred vision, tachycardia, and constipation. These drugs should not be administered to glaucoma patients because they dilate the pupils (mydriasis). Side effects include mood changes, euphoria, drowsiness, dizziness, headaches, depersonalization, nightmares, con- fusion, incoordination, memory lapse, dry mouth, orthostatic hypotension, hyper- tension, and tachycardia. Benzquinamide appears to have antiemetic, antihistaminic, and anti- cholinergic effects. Side effects and adverse reactions of the miscellaneous antiemetics include drowsiness and anticholinergic symptoms such as dry mouth, increased heart rate, urine retention, constipation, and blurred vision. Benzquinamide should be used cautiously in clients with cardiac problems such as dysrhythmias. However, vomiting should not be induced if the toxin is a caustic substance such as ammonia, chlorine bleach, lye, toilet cleaners, or battery acid. In cases where vomiting is contraindicated, the patient should be adminis- tered activated charcoal, which is available in tablets, capsules, or suspension. Charcoal absorbs (detoxifies) ingested toxic substances, irritants, and intestinal gas. In cases where vomiting is desired, use one of two ways to expel a toxin: The nonpharmacological treatment is to induce vomiting by stimulating the gag reflex by placing a finger or a toothbrush in the back of the patient’s throat. Ipecac, available over the counter, should be purchased as a syrup—not a fluid extract. Ipecac should be taken with at least eight or more ounces of water or juice (do not use milk or carbonated beverages). Diarrhea can be mild (lasting one bowel movement) or severe (lasting several bowel movements).
Quieter cheap coversyl 8 mg with amex, meaningful noises may be noticed (parents sleeping through heavy traffic may waken with small noises from their children) cheap 8 mg coversyl mastercard. As the reticular activating system filters out progressively more cheap 8 mg coversyl overnight delivery, or receives progressively fewer/abnormal sensory stimuli, the cortex attempts to rationalise remaining stimuli, resulting in hallucinations and progressively disorganised behaviour. The reasons behind nursing actions may appear mysterious to many patients (relevance deprivation), and explanations can reduce anxiety and psychological (and so physical) pain (Hayward 1975). Patients often quickly forget so that nurses should not assume patients will remember rationales given previously. Ashworth (1980) describes one patient interpreting a monitor as fluorescent light displays in Piccadilly Circus. Alarms are deliberately irritating (to nurses) to ensure prompt response; patients’ responses vary (from fearing something is wrong to using alarms to control attention), but the purposes of alarms should be Sensory imbalance 19 explained to patients and families, and the parameters selected should balance safety against stress. Reticular activating system dysfunction may cause failure to filter out stimuli, bombarding the cortex with excessive, often meaningless, inputs. Sleep The purpose of sleep remains unclear; Canavan (1984) observes that some people sleep little without consequent impairment, alluding obscurely to one (unidentified) author’s suggestion that sleep is merely an instinct. Sleep patterns vary widely, most people sleeping 6–9 hours each night (Atkinson et al. Sleep cycles are controlled by the suprachiasmatic nucleus (‘biological clock’) in the hypothalamus, which regu-lates the preoptic nucleus (sleep-inducing centre). Precise mechanisms of sleep remain debated; theories of passive control by the reticular activating system have been largely discounted in favour of active inhibitory hormone control (Guyton & Hall 1997), especially by serotonin. Full sleep usually consists of 4–5 cycles, each lasting about 90 minutes (Hodgson 1991). Timings of stages vary between individuals and over Intensive care nursing 20 subsequent sleep cycles. McGonigal (1986) describes orthodox (non-rapid eye movement, slow-wave) sleep as having four stages (see Table 3. Whether orthodox sleep achieves emotional healing (Evans & French 1995), protein synthesis, physical restoration and leucocyte production (Krachman et al. The duration of stage 4 reduces steadily from birth, and often disappears altogether by about 60 years of age, contributing to poor sleep and muscle atrophy in older people. If woken during paradoxical sleep, the person returns to stages 1 and 2 orthodox sleep, thus being deprived of the later stages. Paradoxical sleep occupies about one-half of an infant’s sleep cycles, but by adulthood forms only about one-fifth of total sleep (Atkinson et al. Overnight paradoxical Sensory imbalance 21 sleep progressively replaces stage 4 orthodox sleep (Guyton & Hall 1997), providing mental restoration. Whenever possible, clustering nursing actions to minimise physical disturbance can help to ensure undisturbed stretches of 2 hours (one sleep cycle). Awareness of the need for sleep has increased, and lights are now usually dimmed overnight to maintain circadian rhythm, but commencing nursing activities early each morning (e. One of the most valuable nursing interventions at night is usually to allow patients to sleep. Family and close friends may also suffer sleep deprivation from prolonged overnight vigils (Hodgson 1991); nurses should encourage visitors to get adequate sleep. Daytime sleep Sleep patterns alter during the day, although generally the quality of daytime sleep is poorer than night sleep (Wood 1993). Since the length of stage 2 sleep increases during daytime, less daytime sleep provides less tissue recovery than night-time sleep (Turnock 1990). Although not usually identified in literature, nightwork may alter hormone and sleep patterns; individual assessment of patients’ normal patterns will help nurses to plan appropriate individualised care (e. Times and figures given here are ‘averages’, and should be treated as guides rather than absolutes. Since most nurses working night duties experience the ebb Intensive care nursing 22 stage, high-risk actions (such as extubation) should be avoided during this period when they and their colleagues are likely to be least efficient. The risk of myocardial infarctions and strokes is therefore increased between 6 a. Reduced peripheral circulation may cause ischaemia (‘night cramps’); assessment should identify whether patients normally suffer from night cramps, and what they do for relief. Circadian rhythm adapts to environments; dimming lights can mimic day/night cycles, but ‘dimmed’ lighting often exceeds levels most nurses would choose for their own bedrooms at night. Daylight, rather than artificial light, helps psychological wellbeing, so fluorescent lighting is a poor substitute for lack of windows. Drug benefits may be increased by coinciding with circadian rhythm (chronotherapy); leucocyte count peaks and bacterial reproduction ebb make once daily antibiotics most effective in the early morning. Noise Noise (undesired sound) is subjective: what is useful or enjoyable for one person can annoy others (e. However, ‘unnecessary noise is the most cruel absence of care which can be inflicted on either sick or well’ (Nightingale  1980:5); nurses should actively seek to reduce unnecessary noise. Even whispers usually cause 30 dB, enough to disturb sleep (Wood 1993), and exceeding the International Noise Council’s night-time limit of 20 dB. Conversation cannot be avoided, and appropriate conversation can benefit patients, but volume, tone and pitch of speech vary between individuals, and nurses coordinating care should ensure that both content and timing of conversation is appropriate. Sensory imbalance 23 Suction catheters (with vacuum running) under pillows places noise near patients’ ears; suction units are also usually near patients’ heads. An average quiet bedroom at home might measure 20–30 dB overnight (Krachman et al. Children have fewer coping mechanisms than adults (Bood 1996) and so may be more susceptible to disturbed sleep. Childrens’ normal circadian rhythm and psychological health may be helped by play, an essential need during prolonged admissions (Palmer 1996), but adult nurses are often less able than paediatric nurses to meet children’s play and other needs, and may have less access to play therapists. Post-discharge support may include: ■ follow-up clinics ■ discharge liaison nurses ■ inviting patients to return or telephone the unit While potentially easing psychological trauma, nurses should be confident that they have the knowledge and skills needed to provide adequate support, including providing psychologically ‘safe’ environments (confidentiality, privacy) and meeting local ethical requirements; unit managers should be able to guide staff on such issues. Implications for practice ■ sensory imbalance is a symptom of psychological pain, provoking a stress response; alleviating pain provides both humanitarian and physiological benefits, so should be fundamental to nursing assessment and care ■ monitors should be sited unobtrusively ■ facilitating sleep is usually the nurse’s most important role overnight ■ sleep is individual, so each patient’s normal sleep pattern should be assessed ■ whenever possible, planned care should include 4 sleep cycles, each lasting at least 90 minutes (patients remaining undisturbed during this time) ■ circadian rhythm can be facilitated through daylight, interesting views and, overnight, by dimming lights as much as is safely possible ■ relatives should be encouraged to participate in care, and encouraged to share news and use touch. Maintaining sensory balance helps to maintain psychological health and reduces complications from stress responses. Many factors contribute to sensory imbalance, including sleep deprivation (quality or quantity) and noise. Nurses should assess each individual patient’s needs; while safety and physiological needs of critically ill patients necessarily compromise psychological care, nurses can humanise even the most technological environments. Sensory imbalance 25 Further Reading Much has been written on sensory imbalance: West (1996) and Granberg et al. Detrimental physiological effects of stress are described by Torpy and Chrousos (1997). Clinical scenario Edward Creighton is a 20-year-old university student admitted with bacterial meningitis.
This internal nucleophilic addition introduces a new chiral centre into the molecule purchase coversyl 8mg mastercard. The carbon of the new centre is known as the anomeric carbon and the two new stereoisomers formed are referred to as anomers buy coversyl 8 mg mastercard. In this convention solid lines represent bonds above the plane of the ring whilst dotted lines are used to indicate bonds below the plane of the ring order coversyl 8mg fast delivery. Reproduced from G Thomas, Chemistry for Pharmacy and the Life Sciences including Pharmacology and Biomedical Science, 1996, by permis- sion of Prentice Hall, a Pearson Education Company In many cases pure a- and b-anomers may be obtained by using appropriate isolation techniques. For example, crystallization of D-glucose from ethanol yields a-D-glucose [a] þ112. However, in aqueous solution these cyclic structures can form equilibrium mixtures with the corresponding straight chain form (Figure 1. The change in optical rotation due to the conversion of either the pure a- or pure b-anomer of a monosaccharide into an equilibrium mixture of both forms in aqueous solution is known as mutarotation (Figure 1. The specific rotation of the aqueous equilib- rium mixture is þ52 All monosaccharides have a number of stereogenic centres. The configurations of these centres may be indicated by the use of the R/S nomenclature system. However, the historic system where the configurations of all the chiral centres are indicated by the stem name of the monosaccharide (Figure 1. In the D form this hydroxy group projects on the right of the carbon chain towards the observer whilst in the L form it projects on the left of the carbon chain towards the observer when the molecule is viewed with the unsaturated group at the top. These configurations are usually represented, on paper, by modified Fischer projections (Figure 1. The D and L forms of a monosaccharide have mirror image structures, that is, are enantiomers (Figure 1. The system is based on the relative positions of adjacent hydroxy groups with the carbonyl group being used as a reference point for the hydroxy groups. Epimers are compounds that have identical configurations except for one carbon atom. For example, both a-D-glucose and a-D-fructose react with phenylhydrazine to form the same osazone. This means that after a short time a basic aqueous solution of a monosaccharide will also contain a mixture of monosaccharides that will exhibit their character- istic chemical properties. For example, a solution of fructose will produce a silver mirror when treated with an ammoniacal solution of silver nitrate (Tol- len’s reagent). This is because under basic conditions fructose undergoes tauto- merism to glucose, whose structure contains an aldehyde group, which reduces Tollen’s reagent to metallic silver. The approximate concen- trations of the isomers present at equilibrium are given in the brackets 1. Commonly used trivial names are given in the brackets monosaccharides are based on a stem name indicating the number of carbon atoms, a prefix indicating the configuration of the hydroxy group and either the suffix -ose (aldoses) or -ulose (ketoses). Five membered ring monosacchar- ides have the stem name furanose whilst six membered ring compounds have the stem name pyranose together with the appropriate configurational prefixes indicating the stereochemistry of the anomers (Figure 1. Monosacchar- ides in which one of the hydroxy groups has been replaced by a hydrogen atom have the prefix deoxy- with the appropriate locant, except if it is at position 2, when no locant is given. These are compounds which consist of a carbohydrate residue, known generally as a glycone, bonded to a non-sugar residue, known generally as an aglycone, by a so called glycosidic link to the anomeric carbon of the glycone. Since the glycosidic link is formed to the anomeric carbon both a- and b-isomers of a glycoside are known. Each type of glycosidic link will exhibit the characteristics of the structure forming the link. For example, oxygen glycosidic links are effectively acetals and so undergo hydrolysis in aqueous solution. In systematic nomenclature the radical name of the aglycone preceeds the name of the glycone, which has the suffix -oside. The shaded parts of the structures are the aglycone sections Glycoproteins are glycosides that have a protein aglycone. The links between between monosaccharide residues of a polysaccharide molecule are usually referred to in terms of the type of the numbers of the carbon atoms forming the link and the stereochemistry of the anomeric pos- ition. For example, the glycosidic link formed in maltose is refered to as an a-1,4-link (Figure 1. The anomeric carbon atom of the second glucose residue can undergo mutarotation and so maltose will exist as two isomers in aqueous solution. The structures are normally drawn so that the oxygen atom forming the glycosidic link is above or below the plane of the ring system. This sometimes requires the structure of a residue to be turned around and/or over in order to obtain the correct alignment of the oxygen atom. Enzymes that catalyse the aque- ous hydrolysis of the glycosidic links of polysaccharides will only usually cata- lyse the cleavage of a link formed by a particular anomer or anomers. For example, an a-glucosidase catalyses the hydrolysis of glycosidic links formed by an a-glucose residue acting as a glycone in the polysaccharide chain. These names are based on the systematic names of the monosaccharides corresponding to the residues. How- ever, the suffix -osyl is used for a substituent residue joined through its anomeric carbon to the next residue in the chain and the suffix -oside is used for the last residue in the chain (Figure 1. In all cases the poly- saccharide section may have linear or branched chain structures, which often contain the derivatives of both monosaccharides and aminosugars (Figure 1. They occur as integral parts of the structures of specific tissues: the mureins, for example, (Figure 1. For example, heparin inhibits the clotting of blood whilst starch and glycogen (Figure 1. Adapted from G Thomas Medicinal Chemistry, an Introduction, 2000, John Wiley and Sons, Ltd. Both structures are based on chains of a-glucose residues joined by a-(1,4) glycosidic links in a similar manner to that found in amylose. In glycogen, these chains are branched every eight to 10 glucose residues, the branches being attached by a-(1,6) glycosidic links similar to those found in the amylopectins. This section discusses a selection of the classes of compound that are classified as lipids. However, not all classes of compound obtained by extraction with nonpolar solvents are classified as lipids. They occur as isolated molecules and are more commonly found as residues in other lipid structures. The fatty acids and residues that are commonly found are normally referred to by trivial names (Table 1. They usually have ‘straight chain structures’ with even numbers of between 14 and 22 carbon atoms inclu- sive.
Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care buy discount coversyl 8mg, 7th Edition coversyl 4mg fast delivery. Interview members of your family or several to some couples about using sperm from close friends generic 8mg coversyl with amex. Use the following expanded scenario from Rosemary tells the nurse in her pediatri- Chapter 13 in your textbook to answer the cian’s ofﬁce that she is concerned about questions below. Questioning reveals that problems with constipation and I’ve seen Rosemary has found herself yelling at Sarah some blood when I wipe myself after a bowel for minor disobedience and spanking her, movement. Prescott’s about Sarah’s striking physical resemblance father and an uncle both died in their early to the fertility specialist but attributed this 50s from colon cancer. What nursing diagnosis would be appropriate I see her now, I can’t help but see Dr. Rosemary express great remorse that Sarah, who is innocent, is bearing the brunt of something that is in no way her fault. With a partner or several classmates, write and/or ethical/legal competencies are most appropriate nursing diagnoses for the likely to bring about the desired outcome? She is overwrought and says she feels God is punishing her for an abortion she had when she was in college. She and her husband have been trying to have children for years and were counting on this pregnancy to come to term. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Identiﬁcation of factors causing undesirable success or failure response and preventing desired change d. Which of the following is a correctly written desired change goal for a patient who is scheduled to ambulate d. Over the next 24-hour period, the patient 50-year-old executive, is being discharged will walk the length of the hallway assisted from the hospital after undergoing coronary by the nurse. The nurse will help the patient ambulate strates an affective goal for this patient? Patient will become mobile within a demonstrate breathing techniques to 24-hour period. Which of the following patient sufﬁciently to reduce the cholesterol in his goals for Mr. Nursing interventions are a separate entity carry out necessary self-care behaviors at from the original goal/outcome. According to Maslow, which of the following ten and when the plan of care is reviewed. At least one of the outcomes should show a Multiple Response Questions direct resolution of the problem statement in the nursing diagnosis. The patient and family need not value the outcomes as long as they support the plan 1. Which of the following actions occur during strate injecting himself with insulin. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Conditions a restaurant for lunch, how to help a young cancer patient accept the loss of a limb, e. Which of the following goals are written planning that are critical to comprehensive correctly? The patient will know how to dress her “Pain related to delayed healing of surgical wound after receiving a demonstration. After attending an infant care class, the patient will correctly demonstrate the pro- cedure for bathing her newborn. By 4/5/12, the patient will demonstrate Outcomes Project, presents the ﬁrst compre- how to care for a colostomy. When a nurse writes a statement regarding a two coping measures to deal with stress. Which of the following accurately describe the supporting the statement, he/she is writing purposes of a plan of nursing care? It represents an effective philosophy of on clinical judgment and knowledge that a nursing and is intended to advance only nurse performs to enhance patient outcomes. When a nurse supplies education to an obese patient best and is recorded on the day the teenager regarding the fat content in food and patient presents for treatment and care, helps him choose a nutritious diet, he/she is according to agency policy. When a nurse administers physician- always a response to the individual charac- prescribed pain medication to a patient teristics and needs of the patient. A(n) is a set of steps (typically responsibilities for fulﬁlling the medical and embedded in a branching ﬂowchart) that interdisciplinary plan of care. It is separate from the discharge plan and clinician and is used to make a decision. When appropriate, it is compatible with directs the efforts of the nursing team as the the medical plan of care and that of the nurses work with patients to meet health goals. Ongoing, problem-solving care plan Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. By 3/30/12, patient will list three reasons and physical assessment to continue taking blood pressure medication. Used to keep the nursing plan up to worker familiar with the patient’s date community. The emphasis of this care plan is to oritized nursing diagnoses and identiﬁes clearly state expected patient outcomes appropriate patient goals and related and the speciﬁc times by which it is nursing care reasonable to achieve these outcomes. The emphasis of this type of care plan is and develops new diagnoses to individualize the plan to meet unique 19. This diagram of patient problems and and family interventions is used to organize data, 20. Involves teaching and counseling skills analyze data, and take a holistic view of to help the patient and family carry out the patient situation. Affective goals Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Nursing care related to the medical and ing interventions: interdisciplinary plan of care: d. List four considerations a nurse should employ when planning nursing care for each day. Explain how a formal plan of care beneﬁts that are written correctly, and on the line the nurse and patient. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. List six measures nurses should consider to correctly plan healthcare for a patient.