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By Q. Mamuk. Idaho State University. 2018.

LeRoy has been very supportive dealing with Michael’s impending death; appears of Michael throughout the different phases of his ill- fearful of even discussing this subject buy 4mg cardura mastercard blood pressure normal reading. He also says that he is “acting with Michael and desire to be present and support- strangely;” he seems emotionally withdrawn and ive is a powerful motivator for getting him to unusually uncommunicative cheap cardura 4mg mastercard blood pressure chart for 60 year old. When the hos- Personal strengths: Knowledge about stages of grief pice nurse calls to arrange a meeting with LeRoy, and grief work; strong interpersonal skills; teaching LeRoy informs him that he is “managing quite and counseling skills well, thank you,” and that he has no concerns or 4. Nursing Process Worksheet He noted that he finally had a long talk with Health Problem: Anticipatory grieving Michael and can see that he hasn’t been able to Etiology: Inability to allow himself to think about deal with his dying in a conscious manner at all: “I what his life will be like without his life partner; guess I just kept hoping that if I didn’t think about history of using denial as a coping mechanism it, it wouldn’t happen. He also sion of stages of grieving and grief work, and says that he is “acting strangely” and that he seems appointment made for follow-up. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A stimulus, an agent, act, or other influence capa- meals could be prepared to stimulate taste; flowers, ble of initiating a response by the nervous system cards, and pictures could be displayed to stimulate b. Know the danger signals that indicate serious translate the impulse into a sensation. Visual: Read different types of books to the is at high risk for sensory deprivation. Olfactory: Have child identify different odors; patient who is confused cannot process prepare enticing meals and savor the aromas. Perceptual responses: Inaccurate perception of with different foods with varying colors, tastes, sights, sounds, tastes, smells, and body shapes, and textures; introduce finger foods position; poor coordination and equilibrium; into diet. Tactile: Use games and sports to increase body from daydreams to hallucinations contact with child; demonstrate affection by b. Cognitive responses: Inability to control the hugging, holding child in lap, and so on. Developmental considerations: The adult may memory, problem solving, and task performance experience the need to compensate for the loss c. Emotional responses: Inappropriate emotional of one type of stimulation by increasing other responses: apathy, anxiety, fear, anger, belliger- sources of sensory stimuli. Cultural care deprivation is a lack of culturally reception of sensory stimuli; medications that assistive, supportive, or facilitative acts (e. Infant: Soothing sounds, rocking, holding and sensory stimulation if the type of stimulation changing position, changing patterns of light present is developmentally appropriate. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Objective data are underlined; subjective data are in patients include confused patients and patients boldface. Assess the George Gibson, an 81-year-old, married, African patient’s abilities to transmit, perceive, and American man, reluctantly reports, after much prod- react to stimuli during everyday interactions. More and more, people just seem to be by name, and speak in a normal tone of voice. Hearing-impaired patients: Avoid excessive seated on the edge of his chair and bends toward noise, avoid excessive cleaning of ears, and you when you speak to him. Unconscious patients: Be careful of what is said room whenever people come to visit because he is in the patient’s presence, assume the person embarrassed by his inability to hear. Nursing Process Worksheet Health Problem: Sensory/perceptual alteration: Sample Answers auditory 1. What nursing interventions might be appropriate Etiology: Reluctance to accept that he has an for Mr. Therefore, attempts to deny hearing loss and attributes the nursing plan of care should include sensory problem to others who are “mumbling”; has greatly stimulation for Mr. The nurse reduced opportunities for conversation; has not should also investigate if hearing aids would help sought help until now Mr. The nurse should Expected Outcome: After medical evaluation of hear- assess both Mr. Pirolla and his wife to see how they ing loss and treatment, patient demonstrates better are coping with the changes in their social environ- coping skills by increasing amount of time he ment. The nurse should Nursing Interventions: incorporate knowledge of the guidelines for a. Explain that hearing loss often accompanies communicating both with persons with reduced aging and that a medical evaluation is important vision and hearing when developing a teaching to provide proper treatment.

The best route depends on a number of factors that include the nature of the medication and the patient’s condition discount cardura 4 mg visa blood pressure kits walmart. In this chapter you’ll learn the routes and how to administer medication using each route generic 4mg cardura fast delivery blood pressure 88 over 60. Medication and Routes The last time that you had a headache and took an aspirin you were using the oral route to get rid of your headache. The oral route is just one of 11 different routes that are used to administer medication. As the name implies, the oral route means that the patient ingests the medica- tion. Sublingual and buccal are two other routes that also involve the patient’s 97 Copyright © 2006 by The McGraw-Hill Companies, Inc. Medication is also absorbed by the skin using the transdermal route, which is commonly known as the “patch. Patients with lung problems sometimes receive medication using the inhalation route. Medication is delivered using an inhaler that changes liquid medication into a spray. The suppository route is used to administer medication through the rectum and the vagina. Tablets can be divided using a tablet cutter into half or quarters to reduce the dosage that is given to the patient. Some tablets can also be crushed so that the medication can be mixed with food such as applesauce. Capsules must be taken whole because they are enteric-coated so that the medication isn’t released until it reaches the intestines. Food and liquid might interfere with the patient’s ability to absorb the medication depending on the drug. An elixir is a sweet, pleasant-smelling solution of alcohol and water used as a vehicle for medicine. An emulsion is a suspension of small globules of one liquid in a second liquid with which the first will not mix, such as milk fats in milk. And a sus- pension is a preparation of finely divided, undissolved particles dispersed in a liquid, such as bismuth subsalicylate (Pepto-Bismol). When administering liquid medication: • Dilute, shake, or stir the medication only if required (follow the direc- tions on the label). When administering sublingual or buccal medication: • Do not permit the patient to ingest food or liquid if the medication is administered sublingually (under the tongue) or bucally (between the cheek and gum) until the medication is completely absorbed. These include cardiovascular medication such as nitroglycerin, neoplastic drugs (cancer), and hormones (estrogen and birth control medications). In addition, analgesics (Fentanyl), medication used to treat allergic reactions, and smoking cessation drugs such as Nicotrol are also administered through the transdermal route. Transdermal patches provide a consistent blood level and less absorption problems in the gastrointestinal tract that are commonly experienced by patients who take oral medications. The paper has measurement lines on it and the medication is squeezed onto the paper in the amount ordered. Never apply topical med- ication with an ungloved hand because medication may be absorbed into your body as well as into the patient’s body. You’ll need to take special precautions when admin- istering an instillation to prevent spreading the disease. Here’s what you need to do to administer installations in the eye: • Check the prescriber’s order. This prevents the systemic absorption of the medication through the lacrimal canal. Here’s what you need to do to administer eardrops: • Check the prescriber’s order. This is a common route used to administer bronchodilators to patients with breathing problems such as asthma, pneumonia, and chronic obstructive pulmonary disease.

Because of the injury locations buy cardura 4 mg line arteria networks corporation, oral health care providers may be the frst to have the opportunity to diagnose and treat the victims of nonaccidental (inficted) trauma purchase 1 mg cardura free shipping arrhythmia ablation is a treatment for quizlet. Plans should be in place in each oral health care facility whereby intervention can appropri- ately begin on behalf of the suspected victim of violent behavior. Without intervention, the assaults may increase, leading to serious sequelae, including death by homicide. Preventing intimate partner violence, sexual violence and child maltreatment, 1–7. Partner vio- lence among adolescents in opposite-sex romatic relationships: Findings from the National Longitudinal Study of Adolescent Health. A comparison of facial fractures in victims of motor vehicle accidents and battered women. Injuries due to domestic violence against women: Sites on the body, types of injury and the methods of infiction. What distinguishes unintentional injuries from injuries due to intimate part- ner violence: A study in Greek ambulatory settings. Inevitably, the opinion 379 380 Forensic dentistry expressed in a forensic dental case is likely to lead to testimony. Tis chapter will guide the reader through the legal and court systems of the American justice system, explain the need for, and the use of, the expert witness in legal proceedings, and conclude with a review of several case law examples in which forensic dental testimony played an important role. First and foremost, it is an adversarial system in which opposing parties enjoy representation by attorneys who advocate for their client’s position. Te heart of the advocate’s representation is his or her duty to investigate fully the cir- cumstances and events surrounding the legal action coupled with the ability to subject the opposing side’s witnesses to a vigorous cross-examination, allowing the testimony of the witness to be thoroughly tested in front of the trier of fact—judge—or jury. A second principle is known as stare decisis, Latin for “to stand by that which is decided,” or the principle to adhere to prior precedential court decisions furthering the maxim “rule of law, not by man. Constitution estab- lishes the rights of citizens, which neither courts nor legislators can reduce or intrude upon. One can consider the division between criminal cases and civil cases, focus on the diferences between federal courts and state courts, or study the pro- cesses of the courts and how a legal case proceeds through the legal system. In a criminal case the govern- ment (commonly referred to as the State or the People) brings an action to impose sanctions for violations of the criminal code. Te prosecution team is usually led by an elected individual, ofen known as the district or state’s attorney, who is empowered through the ofce to pursue charges against individuals who have been arrested or cited for alleged violations of the law. Te prosecutor’s ofce and those who represent him or her in court are not duty bound to secure convictions but rather to present the state’s case fairly and demonstrate before the judge and jury that the accused has, by pre- sentation of evidence, performed the elements of the crime. For instance, in a homicide, ofen defned as the killing of one human being by another, the prosecutor may require testimony from many sources to prove who was killed, how that individual was killed, when the killing occurred, that the Jurisprudence and legal issues 381 accused had the opportunity to kill, and that the accused did in fact wield the instrumentality that resulted in death. Te prosecution must prove each of the elements to the trier of fact, in most cases a jury, beyond a reasonable doubt. While any dentist might be sued by a patient with an allegation of malpractice, forensic dentists are ofen involved in these types of cases as an expert witness for either the defense or plaintif. In order to prevail in a malpractice case, the plaintif must demonstrate by expert testimony that the defendant dentist performed substandard treatment, that is, rendered care that failed to equal or exceed the standard of care. Te defendant dentist’s attorney must counter the allegations by providing the testimony of a dentist stating that the care was at least equal to or exceeded the prevailing standard. A mere prepon- derance of the evidence, 50% plus a little bit, is all that is required for the prevailing side. Either side can appeal the verdict—a successful plaintif can complain that the damage award is insufcient, or an unsuccessful defendant dentist can argue the fnding of liability itself or complain to the appeals court that the damage award is too high. Most dental expert testimony will be given in cases that arise through state courts. A case arising and decided in one state system has no legal impact on how a similar case may be decided in any other state; however, there are similarities. Te district or trial court (local or regional) that enjoys original jurisdiction over civil and criminal cases that arise within a defned geographical boundary is the court in which the case is frst heard, with evidence and testimony being presented. Cases in these venues are usually argued in front of a jury, although a defen- dant or the parties can sometimes agree to forgo a jury and allow the judge to act as the trier of fact and rule on the law. In cases such as divorce and child custody, a jury trial is not allowed in most jurisdictions. Sitting in review of the decisions rendered at this frst level are the intermediate appellate courts, ofentimes known as the circuit court of appeal, although other names may 382 Forensic dentistry be used.

Design The study involved a randomized controlled design with two conditions: (1) sharing consulting style and (2) directive consulting style order 1 mg cardura with mastercard arteria3d review. Procedure A set of cards was designed to randomly allocate each patient to a condi- tion 1mg cardura with mastercard blood pressure chart to record. When a patient entered the consulting room they were greeted and asked to describe their problem. For example, the doctor’s judgment on the consultation could have been either, ‘This is a serious problem/I don’t think this is a serious problem’ (a directive style) or, ‘Why do you think this has happened? For the treatment advice the doctor could say either, ‘It is essential that you take this medicine’ (a directive style) or, ‘What were you hoping I would be able to do? Each consultation was recorded and assessed by an independent assessor to check that the consulting style used was in accordance with that selected. Measures All subjects were asked to complete a questionnaire immediately after each consultation and one week later. This contained questions about the patient’s satisfaction with the consultation in terms of the following factors: s The doctor’s understanding of the problem. This was measured by items such as ‘I perceived the general practitioner to have a complete understanding’. This was measured by the statements ‘I felt greatly helped’ and ‘I felt much better’. Results The results were analysed to evaluate differences in aspects of patient satisfaction between those patients who had received a directive versus a sharing consulting style. In addition, this difference was also examined in relation to patient characteristics (whether the patient had a physical problem, whether they received a prescription, had any tests and were infrequent attenders). When the results were analysed to examine the role of patient characteristics on satisfaction, the results indicated that the directive style produced higher levels of satisfaction in those patients who rarely attended the surgery, had a physical problem, did not receive tests and received a prescription. Conclusion The results suggest that a directive consulting style was associated with higher levels of patient satisfaction than a sharing consulting style. This provides support for the educational model of doctor–patient communication with the doctor as the ‘expert’ and the patient as the ‘layperson’. In addition, it suggests that patients in the present study preferred an authority figure who offered a formal diagnosis rather than a sharing doctor who asked for the patient’s views. Therefore, although recent research has criticized the traditional educational model of doctor–patient communication, the results from this study suggest that some patients may prefer this approach. Patient’s recall Researchers also examined the process of recall of the information given during the consultation. In a meta-analysis of the research into recall of consultation information, Ley (1981, 1989) found that recall is influenced by a multitude of factors. For example, Ley argued that anxiety, medical knowledge, intellectual level, the importance of the statement, primacy effect and the number of statements increase recall. However, he concluded that recall is not influenced by the age of the patient, which is contrary to some predictions of the effect of ageing on memory and some of the myths and counter- myths of the ageing process. Therefore, studies have been carried out to examine which factors can be used in order to improve compliance. Haynes (1982) took a baseline of 52 per cent compliance with recommendations made during a consultation, and found that information generally only improved compliance to a level of 66 per cent. However, Haynes reported that behavioural and individualized instruction improved compliance to 75 per cent. Recommendations for improving compliance Several recommendations have been made in order to improve communication and therefore improve compliance. Oral information Ley (1989) suggested that one way of improving compliance is to improve communica- tion in terms of the content of an oral communication. He believes the following factors are important: s primacy effect – patients have a tendency to remember the first thing they are told; s to stress the importance of compliance; s to simplify the information; s to use repetition; s to be specific; s to follow up the consultation with additional interviews. Written information Researchers also looked at the use of written information in improving compliance. Ley and Morris (1984) examined the effect of written information about medication and found that it increased knowledge in 90 per cent of the studies, increased compliance in 60 per cent of the studies, and improved outcome in 57 per cent of the studies. Ley’s cognitive hypothesis model, and its emphasis on patient satisfaction, under- standing and recall, has been influential in terms of promoting research into the com- munication between health professionals and patients. In addition, the model has prompted the examination of using information to improve the communication process. As a result of this, the role of information has been explored further in terms of its effect on recovery and outcome.