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I. Yugul. Columbia College of Missouri.

A general anesthetic can consist of one medication or a combination of med- ications—called balanced anesthesia—depending on the patient’s age purchase provera 2.5mg with visa menopause sleep, weight generic 2.5 mg provera amex women's health center jobs, medical history buy provera 2.5mg otc women's health questions to ask your doctor, general health, and allergies. The night before the surgery, the patient is given a hypnotic to assist with a good night’s sleep. On the day of the surgery, premedication may be given to the patient about one hour before surgery. A short-acting barbiturate such as thiopental sodium (Pentothal) is then administered in the operating room to induce anes- thesia. Depending on the nature of the operation, the patient may also receive a muscle relaxant. The patient experiences four stages of anesthesia, some of which are not observable because they occur rapidly. These stages are: Stage one: analgesia The patient experiences analgesia (a loss of pain sensation) but remains con- scious and can carry on a conversation. This stage is typically bypassed by administering a barbiturate such as sodium pentothal before the anesthesia. Stage four: medullary paralysis Breathing and other vital functions cease to function because the respiratory cen- ter (medulla oblongata) is paralyzed. These properties make it especially useful in developing countries and during warfare medical treatment. Ketamine is frequently used in pediatric patients because anesthesia and analgesia can be achieved with an intramus- cular injection. It is also used in high-risk geriatric patients and in shock cases, because it also provides cardiac stimulation. Opioids Fentanyl, sufentanil, and alfentanil are frequently used prior to anesthesia and surgery as a sedative and analgesic, as well as a continuous infusion for primary anesthesia. Because opioids rarely affect the cardiovascular system, they are particularly useful for cardiac surgery and other high-risk cases. Opioids act directly on spinal cord receptors, and are frequently used in epidurals for spinal anesthesia. Side effects may include nausea and vomiting, itching, and respiratory depression. Propofol Nonbarbiturate hypnotic agent and the most recently developed (Diprivan) intravenous anesthetic. Its rapid induction and short duration of action are identical to thiopental, but recovery occurs more quickly and with much less nausea and vomiting. Also, propofol is rapidly metabolized in the liver and excreted in the urine, so it can be used for long durations of anesthesia, unlike thiopental. Because of their small molecular size, they are able to penetrate the cell wall reasonably well and can be used to deliver medications. Other topical anesthetics can be delivered using iontophoresis—a therapy that uses a local electric current to introduce the ions of a medicine into the tissues—and anesthetic patch. Tetracaine (Pontocaine) Long-acting—ester—used for spinal anesthesia and topical Bupivicaine Long-acting—amide—can be cardiotoxic at high concentrations, used for infiltration, epidural and nerve blocks. It is commonly used for dental procedures, suturing of skin lacerations, short-term surgery at a local- ized area, spinal anesthesia by blocking nerve impulses (nerve block) below the insertion of the anesthetic, and diagnostic procedures such as lumbar punctures. Local anesthetics are divided into two groups according to their basic chem- ical structure. An ester is a chemical compound formed from the reaction between an acid and an alcohol. Amides are an organic chemical compound formed by reaction of an acid chloride, acid anhydride, or ester with an amine. If it is given too high, the respiratory muscles could be affected and respiratory distress or failure could result. There are 4 types of spinal anesthesia: subarachnoid block, epidural block, the saddle block, and a caudal block. A subarachnoid block is the injection into the subarachnoid space in the third or fourth lumbar space to produce anesthesia. The saddle block is given at the lower end of the spinal column to block the perineal area for procedures such as childbirth. The patient may experience headaches and hypotension as a result of these procedures because of a change in cerebrospinal fluid pressure when the needle is inserted into the spine. The patient should remain in the supine position fol- lowing the procedure and increase fluid intake. Sensory neurons send impulses to the central nervous system, which are transmitted to the brain where they are interpreted. The brain then sends a response to the motor neuron’s brain through the spinal cord that directs specific organ cells to respond to the sensory neuron’s impulse. Previously in this chapter you learned that the autonomic nervous system has two branches. The sympathetic branch stimulates a response and the parasympathetic branch depresses a response by the organ cell. The sympathetic branch stimulates a response using norepinephrine, a neuro- transmitter. Medications that mimic the effect of norepinephrine are called adrenergic drugs or sympathomimetics (mimic sympathetic nervous system actions) (see chart). These drugs are also known as adrenergic agonists because they start a response at the adrenergic receptor sites. Adrenergic blockers prevent the norepinephrine response at the adrenergic receptor sites. The parasympathetic branch is sometimes referred to as the cholinergic sys- tem because an acetylcholine neurotransmitter is used to innervate muscle cells at the end of the neuron. Alpha2 Inhibits the release of norepinephrine, dilates blood vessels, and produces hypoten- sion; decreases gastrointestinal motility and tone. However, the enzyme acetylcholinesterase can inactivate the acetyl- choline before it reaches the receptor cell. Drugs that mimic acetylcholine are cholinergic agonists because they initiate a response. Drugs that block the effect of acetylcholine are called anticholinergic, or parasympatholytics. They are also known as cholinergic antagonists because they inhibit the effect of acetylcholine on the organ. In a fight response, eyes dilate so you can see better and lungs inspire more oxygen while increasing your heart rate. Salivary glands reduce the secretion of saliva giving the person the dry mouth feeling in an emergency.

What comes back to me questionnaire has been distributed in five different is they cared about me buy provera 10 mg fast delivery menstruation or pregnancy bleeding, they took time to talk to me generic provera 5 mg visa menstruation late, hospitals to over 500 participants order provera 2.5 mg mastercard women's health center templeton. Given this, professional nursing practice remains in the forefront of organizational profit- must embrace and illuminate the caring philosophy. The issue of time constraints Staff nurses describe the essence of nursing as and inadequate staffing has been identified as prob- the caring relationship between nurse and patient lematic. However, nurses are practicing hindrance to forming a caring nurse-patient rela- in an environment where the economics and costs tionship. This points out the need for administra- of health care permeate discussions and clinical de- tors to restructure the organization so that the cisions. The focus on costs is not a transient re- maximum of nursing time is focused on direct sponse to shrinking reimbursement; instead, it has nurse-patient interactions. Hospital administrators become the catalyst for change within corporate desire high levels of quality care and see financial health-care organizations. With a system goal of decreasing administrators must maintain adequate staffing ra- length of stay and increasing staffing ratios, nurses tios in order to allow time for nurses to be with need to establish trust and initiate a relationship their patients. As this In the research conducted by Turkel and Ray relationship is being established, nurses need to (2000, 2001, 2003), administrator participants con- focus on being, knowing, and doing all at once firmed the above but also discussed the concomi- (Turkel, 1997) and being there from a patient per- tant need for maintaining care and quality. For the nurses, this means completing a challenge facing administrators in a managed care task while simultaneously engaging with a patient. Ray (1989) asserted that this the patient as a person in all his or her complexity can be accomplished if administrators consider and then identifying the needs for professional both the tangible and intangible benefits of services nursing as they arise. Changes that incorporated the human caring di- Administrators need to recognize caring as a mension and the critical nature that human rela- value-added interaction. From this point of view, tionships play in hospital organizations were the benefits of the interaction outweigh the expense identified by Ray over two decades ago. Caring can be viewed as an described the problems associated with economic “opportunity cost” or the cost of doing it right. This changes in health care and the negative impact eco- concept is applicable to contemporary health-care nomics would have on nurse caring. If people don’t come back to a Current research (Turkel & Ray, 2000, 2001, hospital (because of poor care), “you’ve lost an 2003) on the economics of the nurse-patient rela- opportunity. The re- The economic and political dimensions of bureau- searchers recommend that administrators recog- cratic caring can be used to guide practice. Now is nize and respect the contributions nursing could the time for professional nurses to become proac- make in developing hospital organizations as polit- tive and use theory-based practice to shape their ically moral, caring organizations. Strategies for cratic Caring as a middle-range holographic rebuilding the loss of trust in order to transform practice theory. Administrators need outside of nursing will continue to make the to focus on rebuilding in order to create a better political and economic decisions concerning working environment for the nursing staff. Having an in-depth tered nurses view the rebuilding of trust as the key knowledge of the economics of health care component to the recruitment and retention of will allow nurses to challenge and change the nursing staff. A new theory-based model can be created for nursing practice that supports human caring in relation to the organiza- tion’s economic and political values. The political and economic dimensions of bu- The foundation for professional caring is the reaucratic caring serve as a philosophical/ blending of the humanistic and empirical as- theoretical framework to guide both contem- pects of care. In today’s environment, the porary and futuristic research and theory- nurse needs to integrate caring, knowledge, based nursing practice. Given political and eco- nomic constraints, the art of caring cannot occur in isolation from meeting the physical needs of patients. When caring is defined Having an in-depth knowledge of the solely as science or as art, it is not adequate to economics of health care will allow nurses reflect the reality of current practice. Nurses must be able to understand and ar- ticulate the politics and the economics of nursing practice and health care. Classes that References examine the environment of practice gener- ally, and the politics and the economics of Appell, G. Albany: State University of New York health care in relation to caring, must be in- Press. Patterns of nursing costs Nurses need to search continually for differ- with capitated reimbursement. The holographic model,holistic paradigm,in- Doing more with less no longer works; nurses formation theory, and consciousness. Transcultural nursing research to trans- Advances in Nursing Science, 14(2), 73–87. Theoretical explanations of human care and process for nursing in workforce redevelopment. From certainty to uncertainty: The story of sci- derstanding organizations and ourselves? The development of a nursing classification sys- the nurse-patient relationship within an economic context. Health care economics and human caring: Why grounded theory to instrument development and theoretical the moral conflict must be resolved. The Theory of Bureaucratic Caring for nursing sis within the context of political caring. Locsin Technological Competency as Caring and the Practice of Knowing Persons as Whole Rozzano C. Locsin Introducing the Theory Summary References There is a great demand for a practice of nursing technological competency as caring in nursing is that is based on the authentic intention to know the practice of knowing persons as whole (Locsin, human beings fully as persons rather than as ob- 2001), frequently with the use of varying technolo- jects of care. Contemporary definitions of technology in- creative, imaginative, and innovative ways of af- clude a means to an end, an instrument, a tool, or a firming, appreciating, and celebrating human be- human activity that increases or enhances efficiency ings as whole persons. Conceptualizing technology and these intentions is through expert and competent caring in nursing practice as a dichotomy continues use of nursing technologies (Locsin, 1998). In this practice of nurs- theoretical construct of technology competency as ing, technology is used not to know “what is the caring in nursing (Locsin, 2004). In this model, the focus of nursing is the about the composition of the person; the latter person, a human being whose hopes, dreams, and question requires the understanding of an unpre- aspirations are to live life fully as a caring person dictable, irreducible person who is more than and (Boykin and Schoenhofer, 2001). The former question alludes to the idea of persons as objects; the latter addresses the uniqueness and Introducing the Theory individuality of persons as human beings who con- tinuously unfold and therefore require continuous As a model of practice, technological competency as knowing (Locsin, 2004). It is the view of this chap- One of the earlier definitions of the word person ter, however, that being technologically competent was evident in Hudson’s 1988 publication claiming is being caring. As such, in appreciating this prac- that the “emphasis on inclusive rather than sexist tice model, the following assumptions are posited: language has brought into prominence the use of the word ‘person’” (p. The origin of the word • Persons are whole or complete in the moment person is from the Greek word prosopon, which (Boykin and Schoenhofer, 2001). As such, there is no need to fix them or The ultimate purpose of technological compe- to make them complete again (Boykin and tency in nursing is to acknowledge that wholeness Schoenhofer, 2001). There is no lack or anything of persons is a focus of nursing and that various missing that requires nurses’ intervening to make persons “whole or complete” again, or for nurses to assist in this completion. Their varying situations of care de- competency in nursing is to acknowledge mand calls for creativity, innovation, and imagina- that wholeness of persons is a focus of tion from nurses so that they may come to know nursing. The uniqueness of the person is relative to the response called forth in technological means can and should be used in particular situations.

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The hallucinogens may produce striking changes in perception through one or more of the senses buy provera 2.5mg lowest price women's health kindle. The precise effects a user experiences are a function not only of the drug itself purchase provera 10mg on line women's health center jacksonville fl, but also of the user‘s preexisting mental state and expectations of the drug experience order genuine provera women's health center lake forest hospital. In large part, the user tends to get out of the experience what he or she brings to it. The hallucinations that may be experienced when taking these drugs are strikingly different from everyday experience and frequently are more similar to dreams than to everyday consciousness. Until it was banned in the United States under the Marijuana Tax Act of 1938, it was widely used for medical purposes. In recent years, cannabis has again been frequently prescribed for the treatment of pain and nausea, particularly in cancer sufferers, as well as for a wide variety of other physical and psychological [14] disorders (Ben Amar, 2006). While medical marijuana is now legal in several American states, it is still banned under federal law, putting those states in conflict with the federal government. Marijuana also acts as a stimulant, producing giggling, laughing, and mild intoxication. It acts to enhance perception of sights, sounds, and smells, and may produce a sensation of time slowing down. It is much less likely to lead to antisocial acts than that other popular intoxicant, alcohol, and it is also the one psychedelic drug whose use has not declined in [15] recent years (National Institute on Drug Abuse, 2009). Although the hallucinogens are powerful drugs that produce striking “mind-altering‖ effects, they do not produce physiological or psychological tolerance or dependence. While they are not addictive and pose little physical threat to the body, their use is not advisable in any situation in which the user needs to be alert and attentive, exercise focused awareness or good judgment, or demonstrate normal mental functioning, such as driving a car, studying, or operating machinery. Perhaps this should not be surprising, because many people find using drugs to be fun and enjoyable. Even when we know the potential costs of using drugs, we may engage in them anyway because the pleasures of using the drugs are occurring right now, whereas the potential costs are abstract and occur in the future. Research Focus: Risk Tolerance Predicts Cigarette Use Because drug and alcohol abuse is a behavior that has such important negative consequences for so many people, researchers have tried to understand what leads people to use drugs. Carl Lejuez and his colleagues (Lejuez, Aklin, [16] Bornovalova, & Moolchan, 2005) tested the hypothesis that cigarette smoking was related to a desire to take risks. In their research they compared risk-taking behavior in adolescents who reported having tried a cigarette at least once with those who reported that they had never tried smoking. Eighty percent of the adolescents indicated that they had never tried even a puff of a cigarette, and 20% indicated that they had had at least one puff of a cigarette. With each pump the balloon appears bigger on the screen, and more money accumulates in a temporary ―bank account. At any point during each balloon trial, the participant can stop pumping up the balloon, click on a button, transfer all money from the temporary bank to the permanent bank, and begin with a new balloon. Because the participants do not have precise information about the probability of each balloon exploding, and because each balloon is programmed to explode after a different number of pumps, the participants have to determine how much to pump up the balloon. The number of pumps that participants take is used as a measure of Attributed to Charles Stangor Saylor. Low-tolerance people tend to make a few pumps and then collect the money, whereas more risky people pump more times into each balloon. Supporting the hypothesis that risk tolerance is related to smoking, Lejuez et al. Vaughan, Corbin, and [18] Fromme (2009) found that college students who expressed positive academic values and strong ambitions had less alcohol consumption and alcohol-related problems, and cigarette smoking has declined more among youth from wealthier and more educated homes than among those from lower socioeconomic backgrounds (Johnston, O‘Malley, Bachman, & Schulenberg, [19] 2004). Children try drugs when their friends convince them to do it, and these decisions are based on social norms about the risks and benefits of various drugs. In the period 1991 to 1997, the percentage of 12th-graders who responded that they perceived “great harm in regular marijuana use‖ declined from 79% to 58%, while annual [20] use of marijuana in this group rose from 24% to 39% (Johnston et al. And students binge drink in part when they see that many other people around them are also binging (Clapp, [21] Reed, Holmes, Lange, & Voas, 2006). All recreational drug use is associated with at least some risks, and those who begin using drugs earlier are also more [22] likely to use more dangerous drugs later (Lynskey et al. Furthermore, as we will see in the next section, there are many other enjoyable ways to alter consciousness that are safer. Based on what you have learned in this section, why do you think that they are used, and do you think that their side effects are harmful? Consider the research reported in the research focus on risk and cigarette smoking. Can you see any weaknesses in the study caused by the fact that the results are based on correlational analyses? From first drug use to drug dependence: Developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Concurrent use of cocaine and alcohol is more potent and potentially more toxic than use of either alone—A multiple-dose study 1. Human aggression while under the influence of alcohol and other drugs: An integrative research review. Differences in risk-taking propensity across inner- city adolescent ever- and never-smokers. Drunk in public, drunk in private: The relationship between college students, drinking environments and alcohol consumption. Although the use of psychoactive drugs can easily and profoundly change our experience of consciousness, we can also—and often more safely—alter our consciousness without drugs. These altered states of consciousness are sometimes the result of simple and safe activities, such as sleeping, watching television, exercising, or working on a task that intrigues us. In this section we consider the changes in consciousness that occur through hypnosis, sensory deprivation, and meditation, as well as through other non-drug-induced mechanisms. In his practice, Mesmer passed magnets over the bodies of his patients while telling them their physical and psychological problems would disappear. The patients frequently lapsed into a trancelike state (they were said to be “mesmerized‖) and [1] reported feeling better when they awoke (Hammond, 2008). Although subsequent research testing the effectiveness of Mesmer‘s techniques did not find any long-lasting improvements in his patients, the idea that people‘s experiences and behaviors could be changed through the power of suggestion has remained important in psychology. James Braid, a Scottish physician, coined the term hypnosis in 1843, basing it on the Greek word [2] for sleep(Callahan, 1997). Hypnosis is a trance-like state of consciousness, usually induced by a procedure known as hypnotic induction, which consists of heightened suggestibility, deep relaxation, and intense [3] focus(Nash & Barnier, 2008). Hypnosis became famous in part through its use by Sigmund Freud in an attempt to make unconscious desires and emotions conscious and thus able to be [4] considered and confronted (Baker & Nash, 2008). Because hypnosis is based on the power of suggestion, and because some people are more [5] suggestible than others, these people are more easily hypnotized.

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