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Flaxseed: Ground flaxseed contains insoluble and insoluble fibres that help reduce consti- pation and promote bowel regularity order hydrochlorothiazide 25 mg mastercard arrhythmia online. Peppermint: Contains oils that directly affect the smooth muscle of the digestive tract and reduce spasms. Several studies have found it helpful for reducing pain, bloating, stool frequency, and gas. Take one to three capsules of peppermint oil three times daily, about 15 minutes before meals. Dosage: one capsule (providing at least 1 billion viable cells), two or three times daily with food. Look for a product that is stable at room tempera- ture with guaranteed potency, such as Kyo-Dophilus. Those taking flaxseed had significantly fewer problems with constipation, abdominal pain, and bloating than those taking psyllium. The flaxseed group had even further im- provements in constipation and bloating while continuing their treatment in the three months after the double-blind study ended. The researcher concluded that flaxseed re- lieved constipation more effectively than psyllium (Gastroenterology, 1997: 112; A836). Complementary Supplements Evening primrose oil: Contains gamma linolenic acid, a fatty acid that helps reduce inflam- mation. Melatonin: Plays a role in the regulation of gastrointestinal function and sensation. Avoid caffeine, alcohol, carbonated beverages, fatty or spicy foods, and other known food triggers. The main function of the kidneys is to remove excess fluid and wastes from your blood in the form of urine. Kidney stones, known medically as renal lithiasis, occur when minerals and other substances in the urine form crystals inside your kidneys. Crystals can form in the urine when there is a high concentration of substances such as calcium, oxalate, uric acid, and, rarely, cystinem, or phosphate, or a low level of substances that help prevent crystal formation, such as citrate and magnesium. Crystals also may form if your urine becomes too concen- trated or is too acidic or too alkaline. However, in some cases, these stones can be large and cause excruciating pain and bleeding in the urine, and even permanent damage. Fortunately, there are a number of medical interventions and natural products that can help eliminate kidney stones, as well as lifestyle measures that can be undertaken to prevent them from occurring. Roughly 70–80 percent of all kidney stones contain a combination of calcium and oxa- late. Some people have higher levels of calcium K in their urine than others, increasing the risk of stone formation. Calcium levels may also be higher in those with cancer, kidney disease, or those taking certain diuretics and thyroid hormones. It was once thought that a diet high in calcium increased your risk for developing kidney stones, but this has been disproven. Oxalates are compounds naturally occurring in some fruits and vegetables, such as rhubarb, spinach, and tomatoes. Small kidney stones can partially block the ureters (thin tubes that connect each kidney to the bladder) or the urethra (tube that carries urine out of the body). If left untreated, these stones may also cause recurrent urinary tract infection or kidney damage. In some cases, a small stone can easily be passed by drinking lots of water (half a gallon to three-quarters of a gallon) and being physically active. Stones that are too large to pass or causing bleeding, infection, or kidney damage may require treatment by an urologist, a doctor who specializes in the treatment of urinary tract problems. Percutaneous nephrolithotomy involves removal of the stone through a small incision in your back using a nephroscope. A stone that is lodged in a ureter can be broken down with ultrasound or laser energy and removed with a small instrument called an ureteroscope. Depending on the type of stone, there are medications that can be used to change the pH of your urine to prevent and treat the problem. Lemon contains citric acid, which acidifies the urine and can help assist the passage of calcium oxalate stones.
Will these sit- Normal temperature uations increase the possibility for stressor penetra- range tion? The answer is that the possibility for stressor Genetic structure Response pattern penetration may be increased 12.5 mg hydrochlorothiazide with amex blood pressure medication chronic cough. The actual response Organ strength or depends upon the accordion-like mechanism pre- weakness viously described, along with the other compo- Ego structure Knowns or commonalities nents of the client system. Normal Line of Defense n The normal line of defense represents what the client has become over time, or the usual state of The normal line of defense represents what the client has become over time, or the usual state of wellness. The nurse should determine the client’s usual level of wellness in order to recognize a change in the level of wellness. The normal line of defense is considered dynamic by Neuman, because it can expand or contract over time. Neuman also con- developmental, and spiritual variables occur siders the normal line of defense dynamic because and are considered simultaneously in each client concentric circle. Lines of Resistance Neuman identified the series of concentric circles that surround the basic structure as lines of resist- defense protects the normal line of defense. When the normal line of defense client has more protection from stressors when the is penetrated by stressors, a degree of reaction, or flexible line expands away from the normal line of signs and/or symptoms, will occur. The opposite is true when the flexible line ance are activated following invasion of the normal moves closer to the normal line of defense. Each fectiveness of the buffer system can be reduced by line of resistance contains known and unknown in- single or multiple stressors. These factors fense can be rapidly altered over a relatively short support the client’s basic structure and the normal time period. States of emergency, or short-term line of defense, resulting in protection of system in- conditions, such as loss of sleep, poor nutrition, or tegrity. Examples of the factors that support the dehydration, are examples of what the client is like basic structure and normal line of defense include in the temporary state that is represented by the the body’s mobilization of white blood cells and ac- flexible line of defense (Neuman, 1995). Accurately as- Maintenance of stability lines are penetrated in both reaction sessing the effects and possible effects and reconstitution phases of environmental stressors (inter-, intra-, Interventions are based on: and extrapersonal factors) and using Degree of reaction Resources appropriate prevention by interventions Goals to assist with client adjustments for an Anticipated outcome optimal level of wellness. The level of wellness affected by a condition and interacts with other may be higher or lower than it was prior to the variables in a positive or negative way. When the lines of resistance example of grief or loss (psychological state), which are ineffective, energy depletion and death occur may inactivate, decrease, initiate, or increase spir- (Neuman, 1995). Neuman believes Basic Structure that spiritual variable considerations are necessary The basic structure at the central core structure for a truly holistic perspective and for a truly caring consists of factors that are common to all organisms. Neuman offered the following examples of basic Fulton (1995) has studied the spiritual variable survival factors: temperature range, genetic struc- in depth. She elaborated on research studies that ture, response pattern, organ strength or weakness, extend our understanding of the following aspects ego structure, and commonalities (Neuman, 1995). She suggested Five Client Variables that spiritual needs include (1) the need for mean- Neuman has identified five variables that are con- ing and purpose in life; (2) the need to receive love tained in all client systems: physiological, psycho- and give love; (3) the need for hope and creativity; logical, sociocultural, developmental, and spiritual. The second concept identified by Neuman is the Psychological refers to mental processes and rela- environment. Developmental refers to life-developmental Neuman has identified and defined the following processes. Neuman elaborated on the spiritual variable in External environment—inter- and extrapersonal in order to assist readers in understanding that the nature. Examples of trates all other client system variables and supports intrapersonal forces are presented for each variable. The client-client sys- tem can have a complete unawareness of the Physiological variable—degree of mobility, range of spiritual variable’s presence and potential, deny its body function. These factors include the relationships and resources Health is the third concept in Neuman’s model. Extrapersonal fac- Neuman believes that wellness and illness are on tors include education, finances, employment, and opposite ends of the continuum and that health is other resources (Neuman, 1995).
Refer patient to drug and alcohol counseling with the patient that encompasses the patient’s service discount 25mg hydrochlorothiazide overnight delivery arteria fibularis. Reassure the patient that the “granny” woman goals and outcomes is an important part of her recovery and attempt 4. Include the “granny” Research materials on the Haitian culture, commu- woman’s assessment in medical history of patient. Intellectual and spiritual dimension ticularly widows, are on the borderline of 4. Sociocultural dimension Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Intellectual and spiritual dimension ethical/legal competencies are most likely to bring 8. Acute: A temporary condition of illness in which patient goes through four stages: 1. Chronic: A permanent change caused by Prioritization Question irreversible alterations in normal anatomy and 1. Physical: A family lives in a comfortable home desire for a higher level of wellness? This meets the This is the perfect opportunity for patient teaching family needs of safety and comfort and enhances provided throughout Ms. Economic: A family is able to afford adequate should present information regarding a “heart housing, food, clothing, and community healthy diet,” the need for exercise, and reinforce- demands. Jacobi describes her condition and identifies limit their offspring to three children. This meets three factors in her lifestyle (smoking, diet, exercise) society’s need for more members without putting that can be modified for stroke prevention. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. This meets the chil- care for his wife in his home and acknowledges a dren’s needs to be productive members of society plan to provide a safe environment for himself and and to avoid the pitfalls surrounding his wife. Socialization: Parents seek expert counseling for ethical/legal competencies are most likely to bring a kindergarten child who is having difficulty about the desired outcome? Intellectual: knowledge of Alzheimer’s disease and This meets the child’s need to fit in with other its effect on the family schoolmates and helps correct a problem before Interpersonal: using strong interpersonal skills to it gets out of hand. Physiologic needs: The nurse helps to prepare the and autonomy mother for her cesarean birth and administers Ethical/Legal: skill in working collaboratively with any medications prescribed. Love and belonging needs: The nurse helps the counseling services, community services, skilled husband to cope with his fears and gets him nursing care ready to participate in the birth of his child. What are the ethnic Multiple Response Questions background and religious affiliation of family mem- 1. General systems theory: This theory explains health condition; safety and security needs for a breaking whole things into parts and then learn- safe environment for a patient with Alzheimer’s ing how these parts work together in systems. It disease; love and belonging needs related to his includes the relationship between the whole and desire to remain with, and care for, his wife; self- the parts and defines concepts about how the esteem needs based on his pride in taking care of parts will function and behave. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Improved autonomy of nursing: Nursing is in as the adjustment of living matter to other living the process of defining its own independent things and to environmental conditions. The tion is a dynamic or continuously changing development and use of nursing theory provide process that effects change and involves interac- autonomy in the practice of nursing. Horn with informa- heredity, temperament, emotional and physical tion and practical tips for inserting a nasogastric environment, life experiences, and health status. Nursing theories identify and define interrelated the procedure, the nurse could ask for a return concepts specific to nursing and clearly state the demonstration from Ms. Nursing theories must be logical and use orderly able if any problems occur and provide her with the reasoning and identify relations that are appropriate resources. Nursing theories should increase the nursing her ability to take care of her mother.
The colposcope undoubtedly provides considerable advantages over gross visualization order hydrochlorothiazide 25 mg without prescription blood pressure medication non prescription. First, it provides magnification (5–30 times) and greater illumi- nation, enabling detection of more abnormalities. Slaughter and Brown (123) demonstrated positive colposcopic findings in 87% of female complainants of nonconsensual penile penetration within the previous 48 h, whereas gross 92 Rogers and Newton visualization has historically identified positive genital findings in only 10– 40% of cases (37–39,124,125). Second, with the attachment of a still or video camera, the colposcope allows for a truly contemporaneous, permanent video/photographic record of the genital/anal findings without resorting to simultaneous dictation, which has the potential to distress the complainant. If a video is used, it will docu- ment the entire genital examination and will show any dynamic changes, such as reflex anal dilatation. If appropriate, the medical findings can be demon- strated to the complainant and carer; some teenagers have apparently appreci- ated the opportunity to have any fears of genital disfigurement allayed by the use of this equipment. Finally, if a remote monitor is used, the whole examination can be viewed by another doctor for corroboration or teaching purposes without additional parties having to be present during the intimate examination. Obviously, it is important that in all cases the colposcopic evidence be interpreted in the context of the limited information that is currently available regarding colposcopic assessments after consensual sexual acts (90,126,127). Toluidine Blue Toluidine blue stains nuclei and has been used on the posterior fourchette to identify lacerations of the keratinized squamous epithelium that were not apparent on gross visualization (128,129). Use of toluidine blue increased the detection rate of posterior fourchette lacerations from 4 to 58% in adult (older than 19 years) complainants of nonconsensual vaginal intercourse, from 4 to 28% in sexually abused adolescents (11–18 years old), and from 16. The same frequency of posterior fourchette lacerations has been identi- fied by use of the stain in adolescents after consensual penile penetration and nonconsensual sexual acts (129). In contrast, adult complainants of nonconsensual vaginal intercourse and sexually abused children had signifi- cantly more lacerations demonstrable by toluidine blue staining than control groups (130), although such staining does not identify lacerations that cannot be detected using a colposcope (123). Therefore, if a colposcope is not avail- able, toluidine blue may be an adjunct to the genital assessment of prepubertal and adult complainants of vaginal penetration (129,130). Furthermore, some centers use the stain during colposcopy to provide a clear pictorial presenta- tion of the injuries for later presentation to juries (123). Toluidine blue (1%) is then painted on the posterior fourchette, using Sexual Assualt Examination 93 a swab, before any instrumentation. After a few seconds, the residual stain is removed with lubricating jelly and gauze (128). The time parameters within which the use of toluidine blue is beneficial in highlighting injuries have not been identified. Injuries Little information is available regarding the incidence and type of geni- tal injuries that result from consensual sexual acts involving the female geni- talia. Although penile–vaginal penetration is the most frequent sexual act performed by heterosexual couples, anecdotal reports from doctors who regu- larly conduct nonforensic assessments of the female genitalia (general prac- titioners, gynecologists, or genitourinary physicians) suggest that injuries resultant from sexual activity are rarely identified. However, this may be explained by the nature of routine assessments, which are usually limited to naked-eye inspection or because of the rapid and complete resolution of minor injuries (90). On the other hand, there are reports describing genital injuries in complainants of sexual assault, although, unfortunately, few have matched the findings with the specific complaint or the subsequent outcome in court. To date, no case-control study has compared the genital findings in complainants of sexual assault with those in a sexually active control popu- lation. External Genitalia For penile penetration of the vagina to occur, the penis must first pass between the labia minora and through the hymenal opening. The apposition of the penis and the posterior fourchette in the majority of sexual positions means that this area may be stretched, rubbed, or receive blunt trauma as vaginal penetration is achieved. Lacerations, abrasions, or bruises at the posterior fourchette have all been described after consensual sexual activity, although in all these cases, the examinations were enhanced by the use of toluidine blue or a colposcope (90,128,129). Wilson (131) has also described macroscopi- cally visible hematomata of the labia with consensual sexual activity. Among 311 postpubertal females (age range 11–85 years) who made a “valid” (defined as “police investigation corroborated the victim’s history and the victim did not recant”) complaint of sexual assault, 200 had colposcopically detected injuries at one or more of the following sites on the external genita- lia: posterior fourchette, labia minora, hymen, and fossa navicularis (90). Although all categories of injuries (“tears,” bruises, abrasions, redness, and 94 Rogers and Newton swelling) were described at all sites, the predominant injuries described were site dependent; for example, tears were most frequently described on the pos- terior fourchette (n = 83) and fossa navicularis (n = 28), whereas abrasions were most frequently described on the labia minora (n = 66) and bruises were the most frequent injuries seen on the hymen (n = 28) (90). Adams and col- leagues found similar types and distributions of injuries among the adoles- cent complainants (14–19 years) they examined (132). In this population, tears of the posterior fourchette or fossa navicularis were the most common find- ings (40%). The studies of macroscopic findings among complainants of sexual assault have also found that most of the injuries detected are located on the external genitalia (133,134). Healing of lacerations of the posterior fourchette is predominantly by first intention, with no residual scarring being detected at follow-up assess- ments (90).
