Compazine
By P. Phil. American Academy of Art.
If control influences the stress response buy compazine 5mg with amex symptoms questions, does control also influence the effect of stress on health and illness? Animal research Seligman and Visintainer (1985) reported the results of a study whereby rats were injected with live tumour cells and exposed to either controllable or uncontrollable shocks. The results indicated that the uncontrollable shocks resulted in promotion of the tumour growth. This suggests that controllability may influence the stress response, which may then promote illness. In a further study, the relationship between control and coronary heart disease was studied in monkeys (Manuk et al. However, the authors introduced new members to the groups to create an unstable environment. They argued that the dominant monkeys show higher rates of coronary heart disease in the unstable condition than the dominant monkeys in the stable condition, or the sub- missive monkeys in the stable condition. It is suggested that the dominant monkeys have high expectations of control, and are used to experiencing high levels of control. How- ever, in the unstable condition, there is a conflict between their expectations of control and the reality, which the authors argued results in an increase in coronary heart disease. These animal models are obviously problematic in that many assumptions are made about the similarities between the animals’ experience of control and that of humans. However, the results indicate an association between control and health in the predicted direction. For example, the job strain model was developed to examine the effects of control on coronary heart disease (e. The three factors involved in the model are (1) psychological demands of the job in terms of workload; (2) the autonomy of the job, reflecting control; and (3) the satisfaction with the job. A number of theories have been developed to explain how control influences health and mediates the stress–illness link. It has been suggested that high control enables the individual to maintain a healthy lifestyle by believing ‘I can do something to prevent illness’. It has also been suggested that high control enables the individual to change behaviour after illness. For example, even though the individual may have low health status following an illness, if they believe there is something they can do about their health they will change their behaviour. It has been suggested that control directly influences health via physiological changes. It is possible that high control can lead to a feeling of personal responsibility and consequently personal blame and learned helplessness. These feelings could lead either to no behaviour change or to unhealthy behaviours resulting in illness. The possible benefits of low control Most theories of the relationship between control and stress suggest that high control (such as predictability, responsibility, etc. However, in certain situations a perception of low control may result in lowered stress. For example, flying in a plane can be made less stressful by acknowledging that there is nothing one can do about the possibility of crashing. To an extent this perception of helplessness may be less stressful than attempting to control an uncontrollable situation. In addition, they measured aspects of work such as job demand, social support and perceived control over work. The results showed that the working women were not more likely to have coronary heart disease than the non-working women, suggesting that job demand is not simply a pre- dictor of coronary heart disease. However, within the working women, those women who reported low perceived control over their work were more likely to have coronary heart disease than those who reported high perceived control, suggesting that within that group of people with high job demand, low control was a predictor of illness, supporting the predicted association between social support and health. In addition, within the group of working women, those who showed low work support were also more likely to have coronary heart disease, supporting the research on social support and its relationship to illness. The study also looked at how many children both the working and the non-working women had and related this to coronary heart disease. The results showed that a higher number of children increased the risk of coronary heart disease in the working women, but not in the non-working women.
The plasma half-life of gold increases with repeated adminis- tration and ranges from one day to several weeks buy discount compazine 5mg online medications similar to abilify. Gold is Key points bound to plasma proteins and is concentrated in inflamed areas. Gold continues to be excreted in the urine for up to one • Mechanisms are poorly understood; these drugs are year after a course of treatment. Its effect in rheumatoid arthritis is similar to patients with progressive rheumatoid or psoriatic gold. A trial should be considered before a patient Treatment is discontinued if there is no improvement within one becomes disabled. If improvement occurs, the dose is gradually reduced to informed consent should be obtained before they are the minimum effective maintenance dose. Full blood count and prescribed (especially those that are unlicensed for this urine protein determination are performed regularly, initially indication). Penicillamine acts by several mechanisms, including metal • Close monitoring for toxicity (blood counts, ion chelation and dissociation of macroglobulins. Other effects are more serious, and are more common in patients with poor sulphoxidation. Adalimumab, infliximab and etanercerpt are all engineered • Bone marrow hypoplasia, thrombocytopenia and proteins which directly or indirectly inhibit tumour necrosis leukopenia can be fatal. They are a major advance in treating various immune proteinuria in 30% of patients. The drug should be diseases (see Chapter 50), including rheumatoid arthritis, but stopped until proteinuria resolves and treatment then have serious adverse effects, including infusion reactions and resumed at a lower dose. They are currently used by rheumatologists • Other symptoms include hypersensitivity reactions with for adults with active disease which has not responded to two urticaria. They are not continued if a response has not gravis-like syndromes can also be involved. Combinations of these proteins with methotrexate are being investigated for refractory disease, Contraindications with encouraging results. Penicillamine is contraindicated in patients with systemic lupus erythematosus, and should be used with caution, if at all, in individuals with renal or hepatic impairment. A number of hepatic metab- and gives rise to problems because of its limited solubility. Adverse effects Xanthine oxidase Adverse effects include the following: Figure 26. The final enzymatic • peripheral neuropathy; reactions in the production of uric acid are shown in Figure 26. It is more soluble in Colchicine is well absorbed from the gastro-intestinal tract. Plasma uric acid concentration is is partly metabolized, and a major portion is excreted via the lowered either by increasing renal excretion or, more often, by bile and undergoes enterohepatic circulation, contributing to inhibiting synthesis. Hyperuricaemia often occurs in the setting of obesity and excessive ethanol consumption. Hyperuricaemia also Allopurinol is used as long-term prophylaxis for patients occurs when excretion is decreased, for example, in renal fail- with recurrent gout, especially tophaceous gout, urate renal ure or when tubular excretion is diminished by diuretics, pyraz- stones, gout with renal failure and acute urate nephropathy, inamide (Chapter 44) or low doses of salicylate (Chapter 25). It The acute attack is treated with anti-inflammatory analgesic must not be commenced till several weeks after an acute agents (e. Allopurinol is a xanthine oxidase inhibitor and decreases the production of uric acid (Figure 26. It is also used in patients with familial Adverse effects Mediterranean fever and Behçet’s disease. A low dose can be used pro- rashes and life-threatening hypersensitivity reactions (includ- phylactically. It is relatively contraindicated in the elderly and ing Stevens Johnson syndrome) can occur. There is a history of essential hypertension, and he has had a similar but less Drug interactions severe attack three months previously which settled sponta- • Allopurinol decreases the breakdown of 6-mercaptopurine neously.
What number on the sedation that sends additional pain stimuli to the scale would best describe your patient’s seda- central nervous system purchase 5 mg compazine visa treatment by lanshin. Which of the following are accurate Multiple Response Questions descriptors of the gate control theory? Which of the following are characteristics of tatory pain stimuli away from the brain. Which of the following statements accurately be processed by the nervous system at any describe the nature of the pain experience? Patients are able to describe chronic pain through the nervous system, cells in the because it is generally localized. Pain that is resistant to therapy is referred person’s interpretation of the pain. Pain in people whose tissue injury is of a stimulus that causes the subject to rec- nonprogressive or healed is termed chronic ognize pain. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Pain that is resistant to therapy and per- sists despite a variety of interventions c. A patient who experiences acute pain following a noxious stimulus is experiencing 6. Pain that is diffuse or scattered and orig- inates in tendons, ligaments, bones, pain. Superficial pain that usually involves the localized following abdominal surgery is most skin or subcutaneous tissue likely experiencing pain. A person who experiences a “head rush” from eating ice cream too fast is experiencing originates in body organs, the thorax,. Pain that is perceived in an area distant arm following a myocardial infarction is from its point of origin experiencing pain. Somatic pain Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A noninvasive alternative technique infarction that involves electrical stimulation of 13. Pain associated with a knee injury large-diameter fibers to inhibit the trans- mission of painful impulses carried over 14. Pain associated with a gash in the skin subconscious condition by means of suggestion 17. Pain associated with ulcers signal to help the patient learn by trial Match the term for nonpharmacologic pain and error to control the supposedly relief listed in Part A with its definition listed involuntary body mechanisms that may in Part B. Hypnosis iologic, and affective responses to pain that you might observe in these patients: g. Involves using one’s hands to consciously cesarean birth 2 days ago and is using her direct an energy exchange from the prac- call light to request something for her inci- titioner to the patient sional pain. Involves four elements: assuming a com- history of degenerative joint disease and fortable position with the body in good tells you this is a “bad morning” for his alignment, being in quiet surroundings, joints: “I think the weather must be repeating certain words, and adopting a affecting my arthritis. Requires the patient to focus attention on something other than the pain Situation C: 23. An example of mind–body interaction Situation D: used to decrease pain that involves one or all of the senses and focusing on a mental picture Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Give an example of how the following factors the threshold of pain has been reached and may influence a patient’s pain experience. List two experiences you have had with pain an example of each from your own experience management for patients. Which pain control measures were most effective, and what could you have done differently to b. Intractable pain: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition.
Drugs admin- a pharmacokinetic effect) has greater effects in cells isolated from istered to the mother can induce neonatal enzyme activity infants discount compazine 5 mg amex treatment uterine cancer, providing another example of an age-related pharmaco- (e. Virtually all drugs that reach the maternal systemic circulation will enter breast milk, especially lipid-soluble unionized low- molecular-weight drugs. Milk is weakly acidic, so drugs that are weak bases are concentrated in breast milk by trapping of Key points the charged form of the drug (compare with renal elimination; At birth, renal and hepatic function are less efficient than see Chapter 6). Drug effects may be prolonged and the fetus in breast milk is seldom clinically appreciable, accumulation may occur. These factors are exaggerated in although some drugs are contraindicated (Table 10. Appendix 5 of the British National Formulary provides very helpful practical advice. Carbimazole should also on why it is being prescribed, for how long the treat- be prescribed at its lowest effective dose to reduce the risk ment should continue and whether any adverse effects are of hypothyroidism in the neonate/infant. There is a theoretical risk of Reye’s syndrome if aspirin is prescribed to the breast-feeding Case history mother. Warfarin is not contraindicated during breast-feed- A two-year-old epileptic child is seen in the Accident and ing. The more experi- enced medical staff are dealing with emergencies else- where in the hospital. Children under the age of five years may have diffi- Even after adjustment of dose according to surface area, culty in swallowing even small tablets, and hence oral calculation of the correct dose must consider the relatively preparations which taste pleasant are often necessary to large volume of distribution of polar drugs in the first four improve compliance. Liquid preparations are given by means months of life, the immature microsomal enzymes and of a graduated syringe. The British National Formulary and containing elixirs encourages tooth cavities and gingivitis. With a few notable exceptions, drugs in children generally Only in unusual circumstances, i. Of par- application (especially to inflamed or broken skin), or in ticular significance is the potential of chronic corticosteroid infants, does systemic absorption of drugs (e. Intravenous therapy is less painful, but of unknown aetiology consisting of hepatic necrosis and skill is required to cannulate infants’ veins (and a confident encephalopathy, often in the aftermath of a viral illness. Children find intravenous Tetracyclines are deposited in growing bone and teeth, caus- infusions uncomfortable and restrictive. Rectal administration ing staining and occasionally dental hypoplasia, and should (see Chapter 4) is a convenient alternative (e. Dystonias with meto- valuable in the treatment of status epilepticus when intra- clopramide occur more frequently in children and young venous access is often difficult. Rectal administration should also be increased in young children with learning difficulties receiv- considered if the child is vomiting. On examina- tion, he has a mild fever (38°C), bilateral swollen cervical lymph nodes and bilateral wheeze. Not What is the likely cause of the nocturnal cough and how only is there concern about the potential for adverse effects may this be treated? Answer 1 of new drugs on those who are growing and developing Ampicillin rash in infectious mononucleosis (glandular fever). Pharmaceutical companies seldom seek to license their products for use in Baber N, Pritchard D. When drugs are prescribed to children that are Clinical Pharmacology 2003; 56: 489–93. Prescribers take sole responsibility for prescribing disposition, action and therapy in infants and children. The elderly are subject to a variety of complaints, many of which are Absorption of carbohydrates and of several nutrients, includ- chronic and incapacitating, and so they receive a great deal of ing iron, calcium and thiamine, is reduced in elderly people. There is a growing evidence base for the use of Lipid-soluble drugs are absorbed by simple diffusion down drugs in elderly patients, with important implications for pre- the concentration gradient (Chapter 3), and this is not scribing of many important classes of drugs, including statins, impaired by age. However, age per se does not affect drug angiotensin receptor blockers, vitamin D and bisphosphonates absorption to a large extent (Figure 11. Adverse drug reactions and drug interactions become more common with Drug increasing age. In one survey in general ↓Intestinal blood flow practice, 87% of patients over 75 years of age were on regular drug therapy, with 34% taking three to four Absorption↔ different drugs daily. The most commonly prescribed drugs were diuretics (34% of patients), analgesics (27%), ↓Weight tranquillizers and antidepressants (24%), hypnotics (22%) ↓Lean body mass and digoxin (20%).
