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Bile aids in the digestion and absorption of fats; it consists of bile pigments order diovan 160 mg fast delivery prehypertension warsaw 2014, bile salts, and cholesterol. The liver secretes diluted bile through the hepatic ducts into the cystic duct and on into the gallbladder. Blood from the interlobular veins and arter- ies circulates through the sinusoids with food and oxygen for the liver cells, picking up materials along the way. The blood then enters the intralobular veins, which carry it to the sublobular veins, which empty into the hepatic vein, which leads to the inferior vena cava. Bile secreted from the liver cells is carried by biliary canaliculi (bile capil- laries) to the bile ducts and then to the hepatic ducts. Considering the number of vital roles the liver plays, the complexity of that process isn’t too surprising. Among the liver’s various functions are Production of blood plasma proteins including albumin, antibodies to fend off disease, a blood anticoagulant called heparin that prevents clotting, and bile pig- ments from red blood cells, the yellow pigment bilirubin, and the green bile pig- ment biliverdin Storage of vitamins and minerals as well as glucose in the form of glycogen Conversion and utilization through enzyme activity of fats, carbohydrates, and proteins Filtering and removal of nonfunctioning red blood cells, toxins (isolated by Kupffer cells in the liver) and waste products from amino acid breakdown, such as urea and ammonia Unfortunately, a number of serious diseases can damage the liver. The hepatitis virus inflames the gland, and cirrhosis caused by repeated toxic injury (often through alco- hol or other substance abuse) destroys Kupffer cells and replaces them with scar tissue. Also, painful gallstones can develop when cholesterol clumps together to form a center around which the gallstone can form. The head is attached to the body of the gland by a slight constriction called the neck, and the opposite end gradually tapers to form a tail. The pancreatic duct extends from the head to the tail, receiving the ducts of various lobules that make up the gland. It generally joins the common bile duct, but some 40 percent of humans have a pancreatic duct and a common bile duct that open separately into the duodenum. Uniquely, the pancreas is both an exocrine gland, meaning that it releases its secretion externally either directly or through a duct, and an endocrine gland, meaning that it produces hormonal secretions that pass directly into the bloodstream without using a duct. However, most of the pancreas is devoted to being an exocrine gland secreting pancreatic juices into the duodenum. The endocrine portion of the gland secretes insulin vital to the control of sugar metabolism in the body through small, scattered clumps of cells known as islets of Langerhans. Because it contains sodium bicarbonate, pancreatic juice is alkaline, or base, with a pH of 8. Enzymes released by the pancreas act upon all types of foods, making its secretions the most important to digestion. Its enzymes include pancreatic amylase, or carbohydrate enzymes; pancreatic lipase, or fat enzymes; trypsin, or protein enzymes; and nuclease, or nucleic acid enzymes. The most commonly known pancreatic disease is called diabetes mellitus, or sugar diabetes, which occurs when the islets of Langerhans cease producing insulin. Without insulin, the body can’t use sugar, which builds up in the blood and is excreted by the kidneys. Chapter 9: Fueling the Functions: The Digestive System 157 Large intestine After chyme works its way through the small intestine, it then must move through 5 feet or so of large intestine. The byproduct of the small intestine’s work enters at the ileocaecal valve and then moves through the following regions of the large intestine: Cecum → Vermiform appendix → Ascending colon→ Transverse colon → Descending colon → Sigmoid colon → Rectum → Anus The large intestine is about 3 inches wide at the start and decreases in width all the way to the anus. As the unabsorbed material moves through the large intestine, excess water is reabsorbed, drying out the material. In fact, most of the body’s water absorp- tion takes place in the large intestine. Peristaltic movement continues, albeit rather feebly, in the cecum and ascending colon. The large intestine has a longitudinal muscle layer in the form of three bands running from the cecum to the rectum called the taenia coli. The muscle that contracts to prevent gastric juices of the stomach from entering the esopha- gus is the a. The enzyme found in the intestinal juices that activates the pancreatic enzyme into an active enzyme that can break down protein is called a.
Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care order 160 mg diovan amex hypertension differential diagnosis, 7th Edition. A mother who smokes cigarettes, drinks are the , , and alcohol, or uses drugs may cause develop-. Accidents, poisonings, burns, drowning, the fetus occurs from the fourth through the aspiration, and falls remain the major eighth week, initiating rapid growth and causes of death in this stage. The most commonly used measurement disorders are common in this stage of scale to assess the neonate at birth is the development. Write down the age group in which the the infant’s inability to obtain or use calories following physiologic characteristics and needed for growth. The unexpected death of an infant under preschooler, S for school-aged, and A for the age of 1 year in which postmortem exami- adolescent/young adult. A test that is commonly used to determine figures, and printing letters and quickly and inexpensively atypical develop- numbers. Match the stage of development listed in Part A ______ Reflexes include sucking, swallowing, with the risk factor associated with that age blinking, sneezing, and yawning. Hormonal changes cause physical ______ The feet, hands, and long bones grow symptoms. Communicable diseases and respiratory ______ Alert to environment, sees color and tract infections begin to develop in this form, hears and turns to sound stage. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Write down the age group in which the right from wrong following psychosocial characteristics and ______ Focuses on learning useful skills with behaviors are commonly developed. Use N an emphasis on doing, succeeding, and for neonate, I for infant, T for toddler, P for accomplishing preschooler, S for school-aged, and A for adolescent/young adult. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Sudden infant death syndrome: and physical reality through concept formation and language development d. Child abuse: ______ Is in phallic stage (Freud) with biologic focus on genitals ______ Superego and conscience begin to 7. Describe age-appropriate methods for prepar- develop ing the following age groups for eye surgery; explain why you have chosen this method. Toddler: ______ Developmental task of learning physi- cal game skills ______ Is in Erikson’s industry versus inferior- b. Briefly describe the growth and development of the fetus in the following three stages of fetal growth. Explain how are assessed by the Denver Developmental you would tailor your care plan for the various Screening test. Define the following infant health problems and the role of the nurse in treating/preventing 9. Pubescence: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A child is admitted to the intensive care unit says, “I’ve been trying to cut back on smoking with third-degree burns. How would your and drinking alcohol, but I haven’t had much nursing care plan differ for a child in each of success. Leming appears nervous and slightly type of dialog you would use to explain underweight. Toddler: was furious when he found out I was pregnant, and he wants nothing to do with the baby. No two parents are the same in their methods and/or ethical/legal competencies are most of raising children. Interview some of your friends to find out how successful they feel their parents were in raising them. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition.
Personal responsibility We are more likely to help if it is clear that others are not helping best diovan 160mg heart attack 6 hours. Self-presentation We may help in order to show others that we are good people (Hardy & Van Vugt, 2006). Influence of self-reported distress and empathy on egoistic versus altruistic motivation to help. Sacrificing time and effort for the good of others: The Attributed to Charles Stangor Saylor. The tendency to help others in need is in part a functional evolutionary adaptation. Although helping others can be costly to us as individuals, helping people who are related to us can perpetuate our own genes (Madsen et al. Burnstein, Crandall, and Kitayama (1994) found that students indicated they would be more likely to help a person who was closely related to them (e. People are more likely to donate kidneys to relatives than to strangers (Borgida, [4] Conner, & Manteufel, 1992), and even children indicate that they are more likely to help their [5] siblings than they are to help a friend (Tisak & Tisak, 1996). Although it makes evolutionary sense that we would help people who we are related to, why would we help people to whom we not related? One explanation for such behavior is based on the principle of reciprocal altruism (Krebs & Davies, 1987; Trivers, [6] 1971). Reciprocal altruismis the principle that, if we help other people now, those others will return the favor should we need their help in the future. By helping others, we both increase our chances of survival and reproductive success and help others increase their survival too. Over the course of evolution, those who engage in reciprocal altruism should be able to reproduce more often than those who do not, thus enabling this kind of altruism to continue. Furthermore, the prevalence of altruism was particularly high in children‘s shows. For [8] instance, Anderson and Bushman (2001) found that playing violent video games led to a decrease in helping. We are more likely to help when we receive rewards for doing so and less likely to help when helping is costly. Parents praise their children who share their toys with others, and may reprimand children who are selfish. We are more likely to help when we have plenty of time than [9] when we are in a hurry (Darley and Batson 1973). When we act altruistically, we gain a reputation as a person with high status who is able and willing to help others, and this status makes us more desirable in the eyes [10] of others (Hardy & Van Vugt, 2006). The outcome of the reinforcement and modeling of altruism is the development of social norms about helping—standards of behavior that we see as appropriate and desirable regarding helping. The reciprocity norm reminds us that we should follow the principles of reciprocal altruism. If someone helps us, then we should help them in the future, and we should help people now with the expectation that they will help us later if we need it. The reciprocity norm is found in everyday adages such as “Scratch my back and I‘ll scratch yours‖ and in religious and philosophical teachings such as the “Golden Rule‖: “Do unto other as you would have them do unto you. We might hope that our children internalize another relevant social norm that seems more altruistic: the social responsibility norm. The social responsibility norm tells us that we should try to help others who need assistance, even without any expectation of future paybacks. The teachings of many religions are based on the social responsibility norm; that we should, as good human beings, reach out and help other people whenever we can. How the Presence of Others Can Reduce Helping Attributed to Charles Stangor Saylor. When the police interviewed Kitty‘s neighbors about the crime, they discovered that 38 of the neighbors indicated that they had seen or heard the fight occurring but not one of them had bothered to intervene, and only one person had called the police. Video Clip: The Case of Kitty Genovese Was Kitty Genovese murdered because there were too many people who heard her cries? Two social psychologists, Bibb Latané and John Darley, were interested in the factors that [11] influenced people to help (or to not help) in such situations (Latané & Darley, 1968). The model has been extensively tested in many studies, and there is substantial support for it.
Do not use a drug if the symptoms it causes are worse Answer Co-amilozide – hyperkalaemia: amiloride generic diovan 160 mg mastercard blood pressure spikes, exacerbation of than those it is intended to relieve. It is seldom sensible to treat the side effects of one drug Chlorpromazine – urinary retention by prescribing another. Ketoprofen – gastric ulcer, antagonism of thiazide diuretic, salt retention, possibly interstitial nephritis In the elderly, it is often important to pay attention to mat- Magnesium trisilicate mixture – additional sodium load ters such as the formulation of the drug to be used – many old (6mmol Na /10mL). Supervision of drug taking may be necessary, as Iatrogenic disease due to multiple drug therapy is common in the elderly. The use of amiloride in renal impairment an elderly person with a serious physical or mental disability leads to hyperkalaemia. This patient’s confusion and rest- cannot be expected to comply with any but the simplest drug lessness were most probably related to his renal failure. Containers require especially clear labelling, and Chlorpromazine may mask some of the symptoms/signs and should be easy to open – child-proof containers are often also delay treatment of the reversible organic disease. The sodium content of some antacids can adversely affect cardiac and renal failure. A proton pump inhibitor should be A previously mentally alert and well-orientated 90-year-old woman became acutely confused two nights after hospital considered as prophylaxis against upper gastro-intestinal admission for bronchial asthma which, on the basis of peak complications in those most at risk. Improper prescription of drugs is a common cause of morbid- Answer ity in elderly people. Common-sense rules for prescribing do Prednisolone, cimetidine, digoxin and nitrazepam. Comment not apply only to the elderly, but are especially important in If an H2-antagonist is necessary, ranitidine is preferred in the this vulnerable group. It is likely that the patient no longer requires digoxin (which accumulates in the elderly). Take a full drug history (see Chapter 1), which should not be used for sedation in elderly (or young) asthmatics. The implications of a angiotensin receptor blockers in heart failure and high cardiovas- growing evidence base for drug use in elderly patients. British Journal of Clinical Pharmacology 2006; 61: Vitamin D and bisphosphonates for fractures and osteoporosis. Drugs and Aging ers in heart failure and thrombolytics in acute myocardial infarc- 2000; 17: 353–62. Three further minor cat- egories of adverse drug reaction have been proposed: Adverse drug reactions are unwanted effects caused by nor- mal therapeutic doses. The classification proposed by Rawlins nephropathy); and Thompson (1977) divides reactions into type A and type B 2. They are dose-related and usually treatment with benzodiazepines or β-adrenoceptor mild, although they may be serious or even fatal (e. The term ‘side effects’ is often applied to minor type products available directly or on prescription. Exposure to drugs in the the drug’s main pharmacological action, are not dose-related population is thus substantial, and the incidence of adverse and are severe, with a considerable mortality. Type A reactions are pathophysiology of type B reactions is poorly if at all under- reported to be responsible for 2–3% of consultations in general stood, and often has a genetic or immunological basis. In a recent prospective analysis of 18820 hospital reactions occur infrequently (1:1000–1:10000 treated subjects admissions by Pirmohamed et al. Most reactions were either Chlorpromazine Sedation Cholestatic jaundice definitely or probably avoidable. Adverse drug reactions are most frequent and severe in the elderly, in neonates, women, Naproxen Gastro-intestinal Agranulocytosis patients with hepatic or renal impairment, and individuals haemorrhage with a history of previous adverse drug reactions. Such reac- Phenytoin Ataxia Hepatitis, tions often occur early in therapy (during the first one to ten lymphadenopathy days). Unfortunately, prick and scratch determine which drug is responsible, as patients are often tak- testing is less useful for assessing the systemic reaction to ing multiple drugs. One or more of several possible approaches drugs than it is for the more usual atopic antigens (e. The following diagnosis of contact sensitivity, but does not reflect considerations should be made to assess causality of the systemic reactions and may itself cause allergy. Provocation effect to the drug: did the clinical event and the time- tests should only be undertaken under expert guidance, course of its development fit with the duration of suspected after obtaining informed consent, and with resuscitation drug treatment and known adverse drug effects? Were other possible testing is rarely helpful, circulating antibodies to the drug causes reasonably excluded?
