Lamictal

By W. Makas. Unity College.

Several applications have tar- theories have been developed from within King’s geted high-risk infants (Frey & Norris cheap 50mg lamictal amex medicine woman dr quinn, 1997; Norris Interacting Systems framework order 25 mg lamictal with visa medicine go down. Hanna (1993) investigated the effect of systems (the nursing staff and hospital environ- nurse-client interactions on oral-contraceptive ad- ment). Interestingly, these theory is their utility in encompassing complex set- studies considered personal systems (infants), in- tings and situations. Kenny (1990) also studied the 1988), and renal procedures (Hanucharurnkui role of the elderly in their care. Gender-specific work in- ied the “impact of information on the health be- cluded Sharts-Hopko’s (1995) use of concepts haviors of older adults” (p. Clearly, focus of care (client system) and/or focus of health these applications, and others, show how the problem (phenomenon of concern). The focus of complexity of King’s framework and midrange the- care, or interest, can be an individual (personal sys- ory increases its usefulness for nursing (refer to tem) or group (interpersonal or social system). Thus, application of King’s work, across client sys- tems, would be divided into the three systems iden- Client Systems tified within King’s Interacting Systems Framework A major strength of King’s work is that it can (1981): personal (the individual), interpersonal be used with virtually all client populations. Frey addition, applications proposed the Theory of and Norris (1997) used both the Interacting Sys- Goal Attainment as the practice model for case tems Framework and Theory of Goal Attain- management (Hampton, 1994; Tritsch, 1996). The earliest 1995a) and revised into a Theory of Group Power applications involved the use of the framework and within Organizations (2003). Educational settings, theory to guide continuing education (Brown & also considered as social systems, have also been Lee, 1980) and nursing curricula (Daubenmire, the focus of application of King’s work (Bello, 1989; Gulitz & King, 1988). Table 16–9 sum- marizes applications related to clients’ phenomena Phenomena of Concern to Clients of concern; the table also groups these applications, Within King’s work, it is critically important for the primarily identified by disease or medical diagno- nurse to focus on, and address, the phenomenon of sis, as illness management. Without this emphasis on the Health is one area that certainly binds clients client’s perspective, mutual goal-setting cannot and nurses. Hence, a client’s phenomena of concern was end point, or outcome, of nursing care and selected as neutral terminology that clearly demon- something to which clients aspire. In addition, Frey applications, tends to support the goal of improved (1996) expanded her research to include risky health directly and/or indirectly, as the result of the behaviors. Health status is explic- As stated previously, diseases or diagnoses are itly the outcome of concern in practice applica- often identified as the focus for the application of tions by Smith (1988). For example, Kohler (1988) conducted research with patients with broncho- focused on increased morale and satisfaction, and pneumonia, while patients with end-stage renal DeHowitt (1992) studied well-being. In Health promotion has also been an emphasis for addition, clients with chronic inflammatory bowel the application of King’s ideas. The experience of parenting was studied by concerns have also been the focus of work, using Norris and Hoyer (1993), and health behaviors King’s conceptualizations (Murray & Baier, 1996; were Hanna’s (1995) focus of study. Clients’ concerns ranged from King (1981) stated that individuals act to main- psychotic symptoms (Kemppainen, 1990) to fami- tain their own health. Although not explicitly lies experiencing chronic mental illness (Doornbos, stated, the converse is probably true as well: 2002) to clients in short-term group psychotherapy Individuals often do things that are not good for (Laben, Sneed, & Seidel, 1995). Accordingly, it is not surprising that eates applications related to clients’ phenomena the Interacting Systems Framework and related of concern. Frey (1997), Frey and Denyes (1989), and Frey and Fox Multicultural applications of King’s Interact- (1990) looked at both health behaviors and illness ing Systems Framework and related theories are management behaviors in several groups of chil- many. King’s framework and theory for transcultural Applications of the framework and related theories nursing. Spratlen (1976) drew heavily from King’s have been documented in the following countries framework and theory to integrate ethnic cultural beyond the United States: Canada (Coker et al. Key Sugimori, 1992), Portugal (Moreira & Arajo, 2002; elements derived from King’s work were the focus Viera & Rossi, 2000), and Sweden (Rooke, 1995a, on perceptions and communication patterns that 1995b). In Japan, a culture very different from the motivate action, reaction, interaction, and transac- United States with regard to communication style, tion. Rooda (1992) derived propositions from the Kameoka (1995) used the classification system of midrange Theory of Goal Attainment as the frame- nurse-patient interactions identified within the work for a conceptual model for multicultural Theory of Goal Attainment (King, 1981) to analyze nursing. In addition to research Cultural relevance has also been demonstrated and publications regarding the application of in reviews by Frey, Rooke, Sieloff, Messmer, and King’s work to nursing practice internationally, Kameoka (1995) and Husting (1997). King have been Husting identified that cultural issues were implicit translated into other languages, including Japanese variables throughout King’s framework, particular (King, 1976, 1985; Kobayashi, 1970). Therefore, attention was given to the concept of health, which, perception and the influence of culture on percep- according to King (1990), acquires meaning from tion were identified as strengths of King’s theory. Table 16–10 lists applications of King’s work in Undoubtedly, the strongest evidence for the countries outside the United States.

Following are some practice questions that deal with muscle anatomy and contraction: 13 buy lamictal 50 mg fast delivery symptoms to diagnosis. False Pulling Together: Muscles as Organs A muscle organ has two parts: The belly buy 25mg lamictal with amex symptoms 10 weeks pregnant, composed predominantly of muscle fibers The tendon, composed of fibrous, or collagenous, regular connective tissue. If the tendon is a flat, sheet-like structure attaching a wide muscle, it’s called an aponeurosis. Each muscle fiber outside of the sarcolemma is surrounded by areolar connective tissue called endomysium that binds the fibers together into bundles called fasciculi (see Figure 6-2). Each bundle, or fasciculus, is surrounded by areolar connective tissue called perimysium. All the fasciculi together make up the belly of the muscle, which is surrounded by areolar connective tissue called the epimysium. Blood vessels, lymph vessels, and nerves pass into the fasciculus through areolar connective tissue called the trabecula. These blood vessels in turn branch off into capillaries that surround the muscle fibers in the endomysium. Fasciculus Epimysium Muscle fiber (cell) (wrapped by perimysium) (deep fascia) Tendon Figure 6-2: Connective tissue in a Perimysium Bone muscle. Endomysium Blood vessel (between fibers) Illustration by Imagineering Media Services Inc. Nonetheless, it has been demonstrated that fewer action potentials — a weaker stimulus, as it were — causes fewer motor units to become involved in a contraction. So it’s true that a muscle organ can have varying degrees of contrac- tion depending on the level of stimulation. As for how this can be so, one theory pro- poses that individual fibers have specific thresholds of excitation; thus, those with higher thresholds only respond to stronger stimuli. The other theory holds that the deeper a fiber is buried in the muscle, the less accessible it is to incoming stimuli. Complete fatigue occurs when no more twitches can be elicited, even with increasing intensity of stimulation. The short lapse of time between the application of a stimulus and the beginning of muscular response is called the latent period. Two types of muscle contraction relate to tone: Isometric: Occurs when a contracting muscle is unable to move a load (or heft a piece of luggage or push a building to one side). Isotonic: Occurs when the resistance offered by the load (or the gardening hoe or the cold can of soda) is less than the tension developed, thus shortening the muscle and resulting in mechanical work. Each muscle depends upon compan- ions in a muscle group to assist in executing a particular movement. Prime movers: Just as it sounds, these muscles are the workhorses that produce movement. Fixators or fixation muscles: These muscles serve to steady a part while other muscles execute movement. Synergists: These muscles control movement of the proximal joints so that the prime movers can bring about movements of distal joints. Which of the following statements finishes this sentence and makes it not true: A contracting muscle unable to move a load a. Isotonic motion Leveraging Muscular Power Skeletal muscle power is nothing without lever action. The bone acts as a rigid bar, the joint is the fulcrum, and the muscle applies the force. Levers are divided into the weight arm, the area between the fulcrum and the weight; and the power arm, the area between the fulcrum and the force. When the power arm is longer than the weight arm, less force is required to lift the weight, but range, or distance, and speed are sac- rificed. When the weight arm is longer, the range of action and speed increase, but power is sacrificed. Therefore, 90 degrees is the optimum angle for a muscle to attach to a bone and apply the greatest force.

Therefore buy lamictal 50 mg on line treatment wpw, For these reasons cheap lamictal 50mg on-line medicine 8 discogs, it is only used systemically in emergency these should not be given through the same line, situations. Pharmacokinetics • Calcium increases digoxin toxicity and calcium chloride must not be administered if this is suspected. Intravenous magnesium sulphate is some- Drug interactions times effective in treating dysrhythmias caused by digoxin and Tricyclic antidepressants block uptake 1 and so may potenti- in drug-induced torsades de pointes. Adrenoceptor antagonists, both α sia in prevention of further convulsions (see Chapter 28). Magnesium chloride may be particularly useful in settings where magnesium deficiency is common. Decide whether initial management might reasonably However, serial plasma magnesium determinations may be include each of the following: useful in preventing excessive dosing with accumulation and (a) i. Mg2 is a divalent cation and at least some of its beneficial Answer effects are probably due to the consequent neutralization of (a) False fixed negative charges on the outer aspect of the cardiac cell (b) True 2 2 (c) True membranes (as for Ca ). In addition, Mg is a vasodilator (d) False and releases prostacyclin from damaged vascular tissue Comment in vitro. This patient clearly has underlying heart disease and is acutely haemodynamically compromised by the dysrhyth- Adverse effects and contraindications mia. Alternatively (or drugs with neuromuscular blocking activity, including subsequently if adenosine is not effective, which would aminoglycoside antibiotics. Pharmacokinetics Magnesium salts are not well absorbed from the gastrointest- Case history inal tract, accounting for their efficacy as osmotic laxatives when given by mouth. Mg2 is eliminated in the urine and A 66-year-old man made a good recovery from a transmural therapy with magnesium salts should be avoided or the dose (Q-wave) anterior myocardial infarction complicated by mild 2 transient left ventricular dysfunction, and was sent home tak- reduced (and frequency of determination of plasma Mg ing aspirin, atenolol, enalapril and simvastatin. Three months concentration increased) in patients with glomerular filtration later, when he is seen in outpatients, he is feeling reasonably rates 20mL/min. Question Magnesium salts form precipitates if they are mixed with Decide whether management might appropriately include sodium bicarbonate and, as with calcium chloride, magnesium each of the following: salts should not be administered at the same time as sodium (a) consideration of cardiac catheterization; bicarbonate, or through the same line without an intervening (b) invasive electrophysiological studies, including provo- saline flush. Hypermagnesaemia increases neuromuscular cation of dysrhythmia; (c) adding flecainide; blockade caused by drugs with nicotinic-receptor-antagonist (d) stopping atenolol; properties (e. Answer (a) True (b) False Case history (c) False A 16-year-old girl is brought to the Accident and Emergency (d) False Department by her mother having collapsed at home. As a (e) False baby she had cardiac surgery and was followed up by a paedi- (f) False atric cardiologist until the age of 12 years, when she Comment rebelled. She was always small for her age and did not play It is important to continue a beta-blocker, which will games, but went to a normal school and was studying for improve this patient’s survival. On examination, she is ill and unable to give a cardiac catheterization to define his coronary anatomy and history, and has a heart rate of 160 beats per minute (regu- to identify whether he would benefit from some revascular- lar) and blood pressure of 80/60mmHg. Other classes of anti-dysrhythmic drugs murmurs which are difficult to characterize. New Emergency Department complaining of rapid regular pal- England Journal of Medicine 2006; 354: 1039–51. Implantable cardioverter-defibrillators: library for his final examinations which start next week. Decide whether initial management might reasonably include each of the following: (a) i. Answer (a) False (b) True (c) False (d) True (e) False (f) True (g) False Comment Students who are studying for examinations often consume excessive amounts of coffee and a history of caffeine intake should be sought. Vagal manoeuvres may terminate the dysrhythmia but, if not, overnight observation may see the rhythm revert spontaneously to sinus. This mani- Society guidelines and involves the following: fests as the triad of wheeze, cough and breathlessness. These symptoms are due to a combination of constriction of bronchial • assessment of asthma severity (e. Asthma is broadly categorized expiratory flow rate, pulse oximetry and blood gases if into non-allergic and allergic, but there is considerable overlap. Increased parasympa- injection); thetic tone due to local and centrally mediated stimuli also pro- • in refractory cases, consider magnesium sulphate (slow motes bronchoconstriction. Aerosols are particularly useful for ventilation will probably be needed; treating an acute episode of breathlessness. Oral • general care: monitor fluid/electrolyte status (especially preparations have a role in young children who cannot hypokalaemia) and correct if necessary.

Many hypnotherapists say that the patient It was later that the British ophthalmologist benefits most if he or she is willing to participate in James Braid explored Mesmer’s ideas with his the process of hypnosis buy cheap lamictal 100mg 94 medications that can cause glaucoma, and that people who are patients and renamed the technique hypnosis buy 100 mg lamictal free shipping treatment goals for ptsd, after not willing cannot be hypnotized. While scholars infusion A liquid injected into a vein, or a sub- feel that massage originated in China it is certain stance steeped in hot or cold water and ingested for that each country throughout the world had devel- therapeutic purposes. A tea is considered an infu- oped and passed down their methods for treating sion, for example. Ancient writings of Egypt, venous infusion may be a solution containing Persia, Greece, Rome, and Asian countries mention electrolytes, nutrients, and pharmaceutical agents. An infusodecoction is an infusion followed by a We instinctively rub, press, pat, or in some way decoction, that is, a medicine stock that contains a touch when we ache, feel pain, or just don’t feel crude drug that is first steeped in cold water and right. The simple understand- an alternative method for the treatment of certain ing that humans are equipped to heal themselves, cancers, involving the administration of a small and that we can also help others, is the underlying dose of insulin to cancer patients with the intention foundation of shiatsu. If we live according to nat- of inducing hypoglycemia, or low blood sugar ural laws we really shouldn’t have many troubles. It is believed that once low blood sugar level Unfortunately we don’t consistently live that way is achieved, low doses of intravenous conventional and humankind has had to devise ways to deal chemotherapy may be more effective, because with the suffering that we experience. Ultimately insulin potentiates the cells’ ability to be permeated to regain wholeness we must change our way of by the cancer medications. There are many tools that we can use in this insulin receptors than normal cells, and therefore process. In Shiatsu practitioners have long been considered addition insulin can stimulate proliferation of cer- authorities on treating minor diseases in Japan. In tain cancer cells, to create a larger, more receptive general, the Japanese public favors shiatsu treat- target for the chemotherapeutic agents. The pre- Interior Realignment A feng shui approach viously mentioned forms of massage and shiatsu are devised by Denise Linn, of Seattle, Washington, wonderful tools for the betterment of health. With author of Past Lives, Present Dreams; Sacred Space: life forever changing, even these techniques must Clearing and Enhancing the Energy of Your Home; The continue to evolve. Although iridolo- observed that an owl with a broken leg also had a gists take an extensive personal and medical black mark in his iris. Later the doctor observed the history of each patient and may be qualified to same eye mark in a human patient with a broken offer nutritional advice or prescribe certain treat- leg; that discovery led him to investigate marking ment, iridology cannot replace other diagnostic in the iris as a sign of dysfunction or impairment methods in conventional and alternative medicine. It is reported on some websites pertaining to iridol- The ancient Greeks, Egyptians, and Chinese ogy that some Russian scientists are developing maintained that a person’s eyes held information irischromotherapy, which involves curing disease about his or her health. According to tion that helps discover any constitutional weak- Web information on Sufi healing, Sufis revere the ness before a clinical outbreak occurs. It is healing of the sick as the most important of all ser- considered a unique preventive method used to vices to humanity, and a book has been written on determine the body’s tendency toward certain ail- the 800-year tradition of this “divine science” of ments (for example, certain characteristics of the the Christi Order (one of the Sufi healing orders). Iridologists may make tion, fasting and prayer, talismans, and the a videotape or photographic slide of the iris using a ‘infallible remedy. As a Fulbright of the iris, and markings and their positions in the Research Scholar, he studied Tibb medicine in eye are the indicators of problems or potential Afghanistan and has participated in international problems. The left iris corresponds to the left side of health symposia in Afghanistan, India, and Pak- the body, and the right iris corresponds to the right. Working from original material, he has trans- An eye chart has been developed—an illustration lated the handbooks of Avicenna and the standard similar to the “body map” on the soles of the feet in text on Tibb medicine, Mizan-ul-Tibb. He is the reflexology—to designate parts of the eye as they author of The Traditional Healer’s Handbook (Roch- relate to other parts of the body; for example, the ester, Vt. Its people may have tendencies toward excessive acid- website states: “Initiation into the Healing Order ity that may cause ulcers and arthritis, brown-eyed strengthens one’s inner connection with illuminated Issels’s fever therapy 67 Beings of Healing, through our link with Pir-o-Mur- According to the practitioner Ismael Mazzara, shid Inayat Khan, founder of this order. Members “Sufi healing practices cover a number of thera- work with healing practices on a daily basis to pies, including traditional Eastern aromatherapy increase their capacity for the Divine Healing Power (based on fragrances called ‘attars’), and tradi- to come through. A commitment to healing includes tional cupping, which is practiced in both tradi- one’s own personal healing and involves ongoing tional Chinese and Islamic medicine. The Healing particularly effective with dancers and athletes Order aims to make the Sufi Teachings about heal- who need fast relief from muscular aches and ing available through seminars and workshops.

In general order lamictal 200mg otc medicine 319, data about smoking behaviour (General Household Survey 1994) suggests the following about smokers: s Smoking behaviour is on the decline order lamictal 100mg fast delivery medicine 606, but this decrease is greater in men than in women. About 27 per cent of men and 11 per cent of women were drinking more than the recommended sensible amounts of alcohol which at this time were 21 units for men and 14 units for women. Negative effects Doll and Hill (1954) reported that smoking cigarettes was related to lung cancer. Since then, smoking has also been implicated in coronary heart disease and a multitude of other cancers such as throat, stomach and bowel. In addition, the increase in life expectancy over the past 150 years is considerably less for smokers than for non-smokers (see Chapter 2). In industrialized countries smoking is the leading cause of loss of healthy life years. The average smoker dies eight years early and starts to suffer disability 12 years early whilst a quarter of smokers who fail to stop die an average of 23 years early (West and Shiffman 2004). It has been suggested that smokers report positive mood effects from smoking and that smoking can help individuals to cope with difficult circumstances (Graham 1987). For example, alcoholism increases the chance of disorders such as liver cirrhosis, cancers (e. In a longitudinal study, Friedman and Kimball (1986) reported that light and moderate drinkers had lower morbidity and mortality rates than both non-drinkers and heavy drinkers. They argued that alcohol consumption reduces coronary heart disease via the following mechanisms: (1) a reduction in the production of catecholamines when stressed; (2) the protection of blood vessels from cholesterol; (3) a reduction in blood pressure; (4) self-therapy; and (5) a short-term coping strategy. The results from the General Household Survey (1992) also showed some benefits of alcohol consumption with the reported prevalence of ill- health being higher among non-drinkers than among drinkers. However, it has been suggested that the apparent positive effects of alcohol on health may be an artefact of poor health in the non-drinkers who have stopped drinking due to health problems. In an attempt to understand why people smoke and drink, much health psychology research has drawn upon the social cognition models described in Chapter 2. However, there is a vast addiction literature which has also been applied to smoking and drinking. Many theories have been developed to explain addictions and addictive behaviours, including moral models, which regard an addiction as the result of weakness and a lack of moral fibre; biomedical models, which see an addiction as a disease; and social learning theories, which regard addictive behaviours as behaviours that are learned according to the rules of learning theory. The multitude of terms that exist and are used with respect to behaviours such as smoking and alcohol are indicative of these different theoretical perspectives and in addition illustrate the tautological nature of the definitions. For example: s An addict: someone who ‘has no control over their behaviour’, ‘lacks moral fibre’, ‘uses a maladaptive coping mechanism’, ‘has an addictive behaviour’. These different definitions indicate the relationship between terminology and theory. For example, concepts of ‘control’, ‘withdrawal’, ‘tolerance’ are indicative of a biomedical view of addictions. Concepts such as ‘lacking moral fibre’ suggest a moral model of addictions, and ‘maladaptive coping mechanism’ suggests a social learning perspective. In addition, the terms illustrate how difficult it is to define one term without using another with the risk that the definitions become tautologies. Questions about the causes of an addiction can be answered according to the different theoretical perspectives that have been developed over the past 300 years to explain and predict addictions, including the moral model, the 1st disease concept, the 2nd disease concept and the social learning theory. These different theories and how they relate to attitudes to different substances will now be examined. However, parallels can be seen between changes in theoretical perspective over the past 300 years and contemporary attitudes. The seventeenth century and the moral model of addictions During the seventeenth century, alcohol was generally held in high esteem by society. It was regarded as safer than water, nutritious and the innkeeper was valued as a central figure in the community. In addition, at this time humans were considered to be separate from Nature, in terms of possessing a soul and a will and being responsible for their own behaviour. Animals’ behaviour was seen as resulting from biological drives, whereas the behaviour of humans was seen to be a result of their own free choice. Accordingly, alcohol consumption was considered an acceptable behaviour, but excessive alcohol use was regarded as a result of free choice and personal responsibility. Alcoholism was therefore seen as a behaviour that deserved punishment, not treatment; alcoholics were regarded as choosing to behave excessively.