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Purplish discoloration “aaah” as the upward movement of the soft palate is observed 17 cheap effexor xr online visa anxiety symptoms nausea. The knees are both bent buy line effexor xr anxiety symptoms 97, with the ing hearing ability uppermost leg at a more acute angle buy 75mg effexor xr otc anxiety 504 plan. A sensory nerve whose function is The position is used to assess the rectum vision. A sensorimotor nerve that is assessed position with the buttocks at the edge of by observing the facial muscles for devi- the examining table and feet supported ation of the jaw to one side and by pal- in stirrups. This position is used to assess pating facial muscles for tone while the the female rectum and genitalia. A motor nerve that affects the movement on the side of the examining table or and strength of the tongue bed. It is used to take vital signs sense of smell and assess the head, neck, posterior and 26. Motor nerves that control the movement anterior thorax and lungs, breasts, heart, of the eyes through the cardinal ﬁelds of and upper extremities. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Nasal speculum: thorax and lungs, breasts, heart, extrem- ities, and peripheral pulses. The patient lies ﬂat on the back with legs together but extended and slightly bent at the knees. Tuning fork: assess the head and neck, anterior thorax and lungs, breasts, heart, abdomen, extremities, and peripheral pulses. The patient lies on the abdomen, ﬂat on the bed, with the head turned to one side. Otoscope: four assessment techniques; give a brief description of each technique and the types of assessments made. Auscultation: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. During auscultation of the heart, the ﬁrst heart sound heard is the (a) _______________ of “lub-dub. Accommodation: (b) _______________ and (c) _______________ valves close and corresponds with the onset of (d) _______________ contraction. This sound is called (e) _______________ and is heard best in the (f) _______________ area. Convergence: The second heart sound, (g) _______________, occurs at the end of (h) _______________ and represents the closure of the (i) _______________ and (j) _______________ 9. List the equipment you would do to prepare the patient, the room, and would assemble before performing the assess- the environment for an examination. In what position would your patient why would you modify these preparations for be placed? A small child Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Write a deﬁnition of each instrument and how it is to be used dur- ing the assessment. Scenario: Billy Collins, a 9-year-old with a his- tory of allergies, including an allergy to insect stings, is spending a week at summer camp. What resources might be helpful for this suddenly reports to the camp counselor that he family? The counselor rushes Billy to the nearest emergency health center after helping him self-inject epinephrine. He presents with itching and hives, difﬁculty breathing, nausea, and palpitations. When his parents arrive, they ask you what more they can do, if anything, to prevent this situation from occurring in the future. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The safety event report becomes a part of Circle the letter that corresponds to the best the medical record. When deciding whether to use restraints on a patient, the nurse should consider which of 4. According to a recent study, unrestrained older patients were three times more likely a. There is no evidence linking a relationship to sustain fall-related injuries than between childhood sexual abuse and certain restrained older patients. There are no physiologic hazards associated with the proper use of restraints on older b. Generally, a physician’s order is not neces- accidents involve the use of alcohol and/or sary to apply restraints. According to Pillitteri, ribavirin, used for respiratory infections in infants and a. Most people who die in house ﬁres do not children, may be harmful to a developing die from burns, but from smoke inhalation. Fire is the major safety problem in hospitals expose residents to potentially unhealthy and the leading cause of accidental death substances. Stressful situations are more devastating to got out of bed and fell, restraints were applied. Which of the following statements reﬂect con- following would be the most appropriate nurs- siderations a nurse should keep in mind when ing intervention for Mrs. A medication regimen that includes diuret- to the use of restraints for ensuring patient ics or analgesics places an individual at risk safety and preventing falls? Allow the patient to use the bathroom expected of another nurse in a similar independently. Which of the following statements accurately will not attempt to get out unassisted. Inhalation anthrax produces fever, fatigue, Multiple Response Questions cough, dyspnea, and pain; the patient’s condition may progress to meningitis, sep- Circle the letters that correspond to the best ticemia, shock, and death. Which of the following statements accurately include a characteristic rash that progresses describe factors affecting safety in the general to crusted scabs in 5 days. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition.
Beecher (1955) effexor xr 37.5mg anxiety 5 see 4 feel, in an early study of the speciﬁc eﬀects of placebos in pain reduction generic effexor xr 150 mg online anxiety verses, suggested that 30 per cent of chronic pain suﬀerers show relief from a placebo when using both subjective (e 150mg effexor xr otc anxiety symptoms zollinger. They reported that half the subjects with angina pain were given a sham operation, and half of the subjects were given a real heart bypass operation. The results indicated that pain reduction in both groups was equal, and the authors concluded that the belief that the individual had had an operation was suﬃcient to cause pain reduction and alleviation of the angina. Since the 1940s, research into the eﬀectiveness of drugs has used randomized controlled trials and placebos to assess the real eﬀects of a drug versus the unreal eﬀects. However, if placebos have a multitude of eﬀects as discussed above, perhaps, rather than being taken out they should be seen as central to health status. If placebos have a multiple number of possible eﬀects, what factors actually mediate these changes? Several theories have been developed to try and understand the process of placebo eﬀects. Non-interactive theories Characteristics of the individual Individual trait theories suggest that certain individuals have characteristics that make them susceptible to placebo eﬀects. Such characteristics have been described as emotional dependency, extraversion, neurosis and being highly suggestible. Research has also suggested that individuals who respond to placebos are introverted. However, many of the characteristics described are conﬂicting and there is little evidence to support consistent traits as predictive of placebo responsiveness. Characteristics of the treatment Other researchers have focused on treatment characteristics and have suggested that the characteristics of the actual process involved in the placebo treatment relates to the eﬀectiveness or degree of the placebo eﬀect. For example, if a treatment is perceived by the individual as being serious, the placebo eﬀect will be greater. Accordingly, surgery, which is likely to be perceived as very serious, has the greatest placebo eﬀect, followed by an injection, followed by having two pills versus one pill. Research has also looked at the size of the pill and suggests that larger pills are more eﬀective than small pills in eliciting a change. Characteristics of the health professional Research has also looked at the characteristics of the health professional suggesting that the kind of professional administering the placebo treatment may determine the degree of the placebo eﬀect. For example, higher professional status and higher concern have been shown to increase the placebo eﬀect. Problems with the non-interactive theories Theories that examine only the patient, only the treatment or only the professional ignore the interaction between patient and health professional that occurs when a placebo eﬀect has taken place. They assume that these factors exist in isolation and can be examined independently of each other. However, if we are to understand placebo eﬀects then perhaps theories of the interaction between health professionals and patients described within the literature (see Chapter 4) can be applied to understanding placebos. Placebo eﬀects should be conceptualized as a multi-dimensional process that depends on an interaction between a multitude of diﬀerent factors. To understand this multi-dimensional process, research has looked at possible mechanisms of the placebo eﬀect. Experimenter bias Experimenter bias refers to the impact that the experimenter’s expectations can have on the outcome of a study. For example, if an experimenter was carrying out a study to examine the eﬀect of seeing an aggressive ﬁlm on a child’s aggressive behaviour (a classic social psychology study) the experimenter’s expectations may themselves be responsible for changing the child’s behaviour (by their own interaction with the child), not the ﬁlm. Subjects were allocated to one of three conditions and were given either an analgesic (a painkiller), a placebo or naloxone (an opiate antagonist, which increases the pain experience). The patients were therefore told that this treatment would either reduce, have no eﬀect or increase their pain. They either believed that the patients would receive one of three of these substances (a chance of receiving a pain killer), or that the patient would receive either a placebo or naloxone (no chance of receiving a pain killer). Therefore, one group of doctors believed that there was a chance that the patient would be given an analgesic and would show pain reduction, and the other half of doctors believed that there was no chance that the patient would receive some form of analgesia. This study, therefore, manipulated both the patients’ beliefs about the kind of treatment they had received and the doctors’ beliefs about the kind of treatment they were administering. The results showed that the subjects who were given the drug treatment by the doctor who believed they had a chance to receive the analgesic, showed a decrease in pain whereas the patients whose doctor believed that they had no chance of receiving the pain killer showed no eﬀect. This suggests that if the doctors believed that the subjects may show pain reduction, this belief was communicated to the subjects who actually reported pain reduction. However, if the doctors believed that the subjects would not show pain reduction, this belief was also communicated to the subjects who accordingly reported no change in their pain experience. This study highlights a role for an interaction between the doctor and the patient and is similar to the eﬀect described as experimenter bias described within social psychology. Experimenter bias suggests that the experimenter is capable of communicating their expectations to the subjects who respond in accordance with these expectations. Therefore, if applied to placebo eﬀects, subjects show improvement because the health professionals expect them to. Ross and Olson (1981) examined the eﬀects of patients’ expectations on recovery following a placebo. They suggested that most patients experience spontaneous recovery following illness as most illnesses go through periods of spontaneous change and that patients attribute these changes to the treatment. Therefore, even if the treatment is a placebo, any change will be understood in terms of the eﬀectiveness of this treatment. This suggests that because patients want to get better and expect to get better, any changes that they experience are attributed to the drugs they have taken. However, Park and Covi (1965) gave sugar pills to a group of neurotic patients and actually told the patients that the pills were sugar pills and would therefore have no eﬀect. The results showed that the patients still showed some reduction in their neuroticism. It could be argued that in this case, even though the patients did not expect the treatment to work, they still responded to the placebo. How- ever, it could also be argued that these patients would still have some expectations that they would get better otherwise they would not have bothered to take the pills. Jensen and Karoly (1991) also argue that patient motivation plays an important role in placebo eﬀects, and diﬀerentiate between patient motivation (the desire to experience a symptom change) and patient expectation (a belief that a symptom change would occur). In a laboratory study, they examined the relative eﬀects of patient motivation and patient expectation of placebo-induced changes in symptom perception following a ‘sedative pill’. The results suggested a role for patient expectation but also suggested that higher motivation was related to a greater placebo eﬀect. Reporting error Reporting error has also been suggested as an explanation of placebo eﬀects. In support of previous theories that emphasize patient expectations, it has been argued that patients expect to show improvement following medical intervention, want to please the doctor and therefore show inaccurate reporting by suggesting that they are getting better, even when their symptoms remain unchanged. Doctors also wish to see an improvement following their intervention, and may also show inaccurate measurement. The theory of reporting error therefore explains placebo eﬀects in terms of error, misrepresentation or misattributions of symptom changes to placebo. However, there are problems with the reporting error theory in that not all symptom changes reported by the patients or reported by the doctor are positive.
According to Hall (1958) buy cheap effexor xr 75 mg on line anxiety nausea, team failure in helping patients live fully with nursing viewed nursing as a set of functions effexor xr 75 mg without prescription anxiety symptoms joint pain, rang- chronic pathology buy effexor xr with visa anxiety symptoms in children facts for families. Simple functions were considered those in which few factors were taken spite of successes in keeping people alive, there was into consideration before making a nursing judg- a failure in helping patients live fully with chronic ment. After the patient’s biological crisis was vided among nursing personnel, who were simply stabilized, Hall believed that care should be the pri- or complexly educated, with the highest educated mary focus and that nurses were the most qualiﬁed leading the nursing team. Hall believed that the to provide the type of care that would enable pa- concept of team nursing was detrimental to nurs- tients to achieve their maximum potential. Hall she questioned why medicine would want the lead- (1958) stated: “There is nothing simple about pa- ership and suggested that the patient with a long- tients who are complex human beings, or a nurse term illness would come to nursing (Hall, 1965). Hall was 1 is when the patient is in biological crisis with a convinced that patient outcomes are improved need for intensive medicine. Phase 2 begins when when direct care is provided by the professional the acute crisis is stabilized and the patient is in nurse. These aspects were envisioned as overlapping circles of care, core, and cure that inﬂuence each other. Hall stated: Everyone in the health professions either neglects or takes into consideration any or all of these, but each Image rights unavailable. She saw nursing’s expertise as the Reproduced with permission from The Canadian Nurse. Hall clearly stated that the focus of nursing is the provision of intimate bodily care. She Tomey, Peskoe, & Gumm, 1989; Stevens-Barnum, reﬂected that the public has long recognized this as 1990). To be expert, the nurse must Hall suggested that the part of nursing that is know how to modify the care depending on the concerned with intimate bodily care (e. The part of nursing that is concerned with Based on her view of the person as patient, Hall intimate bodily care (e. Hall believed that this model re- able to undertake these activities for ﬂected the nature of nursing as a professional inter- themselves. She visualized each of the three overlapping circles as an “aspect of the nursing process related to the patient, to the supporting feeding, toileting, positioning, moving, dressing, sciences and to the underlying philosophical dy- undressing, and maintaining a healthful environ- namics” (Hall, 1958, p. Nursing is re- change in size as the patient progresses through a quired when people are not able to undertake these medical crisis to the rehabilitative phase of the ill- activities for themselves. In the acute care phase, the cure circle is the opportunity for closeness and required seeing the largest. During the evaluation and follow-up phase, process as an interpersonal relationship (Hall, the care circle is predominant. Hall labeled this aspect “care,” and she iden- nursing has been described as the Care, Core, and tiﬁed knowledge in the natural and biological sci- Cure Model (Chinn & Jacobs, 1987; Marriner- ences as foundational to practice. Through this nursing profession was assuming more and more of comforting, the person of the patient, as well as his the medical aspects of care while at the same time or her body, responds to the physical care. Hall cau- giving away the nurturing process of nursing to less tioned against viewing intimate bodily care as a well-prepared persons. Hall stated: task that can be performed by anyone: Interestingly enough, physicians do not have practical To make the distinction between a trade and a profes- doctors. If she feels opens up for something more enriching in growth, better in this role, why not? One good reason why not learning and healing production on the part of the for more and more nurses is that with this increasing patient—you have got a profession. Our intent when trend, patients receive from professional nurses sec- we lay hands on the patient in bodily care is to com- ond class doctoring; and from practical nurses, sec- fort. Seeing the patient through talks out and acts out those things that concern [his or her] medical care without giving up the nur- him—good, bad and indifferent. If nothing more is turing will keep the unique opportunity that personal done with these, what the patient gets is ventilation or closeness provides to further [the] patient’s growth catharsis, if you will. This area empha- beyond—to what I call “nurturer”—someone who fosters learning, someone who fosters growing up sizes the social, emotional, spiritual, and intellec- emotionally, someone who even fosters healing. Through the closeness The second aspect of the nursing process is shared offered by the provision of intimate bodily care, with medicine and is labeled the “cure. Hall (1958) comments on he wants to go and will take or refuse help in get- the two ways that this medical aspect of nursing ting there—the patient will make amazingly more may be viewed. It may be viewed as the nurse rapid progress toward recovery and rehabilitation” assisting the doctor by assuming medical tasks or (Hall, 1958, p. Hall believed that through this process, the patient would emerge as a whole person. The other view of this aspect of nursing is Knowledge and skills the nurse needs in order to to see the nurse helping the patient use self therapeutically include knowing self and through his or her medical, surgical, and learning interpersonal skills. The goals of the inter- rehabilitative care in the role of comforter personal process are to help patients to understand and nurturer. The other view of this aspect of nursing tance of nursing with the patient as opposed to is to see the nurse helping the patient through his nursing at, to, or for the patient. Hall reﬂected on or her medical, surgical, and rehabilitative care in the value of the therapeutic use of self by the pro- the role of comforter and nurturer. What made the love and trust the patient enough to work with him Loeb Center uniquely different was the model of professional nursing that was implemented under Lydia Hall’s guidance. The center’s guiding philos- The nurse who knows self by the same ophy was Hall’s belief that during the rehabilitation token can love and trust the patient phase of an illness experience, professional nurses enough to work with him professionally, were the best prepared to foster the rehabilitation rather than for him technically, or at him process, decrease complications and recurrences, vocationally. Her goals cease being tied up with She saw this being accomplished by the “where can I throw my nursing stuff around,”or “how special and unique way nurses work with can I explain my nursing stuff to get the patient to do patients in a close interpersonal process what we want him to do,” or “how can I understand with the goal of fostering learning, growth, my patient so that I can handle him better. In She saw this being accomplished by the special and this way, the nurse recognizes that the power to heal unique way nurses work with patients in a close in- lies in the patient and not in the nurse unless she is terpersonal process with the goal of fostering learn- healing herself. At the Loeb Center, ability to help the patient tap this source of power in nursing was the chief therapy, with medicine and his continuous growth and development. A new comes comfortable working cooperatively and con- model of organization of nursing services was im- sistently with members of other professions, as she plemented and studied at the center. Hall stated: meshes her contributions with theirs in a concerted program of care and rehabilitation. She will facilitates the interpersonal process and invited the be involved not only in direct bedside care but she will patient to learn to reach the core of his difﬁculties also be the instrument to bring the rehabilitation while seeing him through the cure that is possible. Specialists in re- Through the professional nursing process, the pa- lated therapies will be available on staff as resource tient has the opportunity of making the illness a persons and as consultants. The 80-bed unit The Loeb Center for Nursing was staffed with 44 professional nurses employed and Rehabilitation around the clock. Professional nurses gave direct patient care and teaching and were responsible for Lydia Hall was able to actualize her vision of nurs- eight patients and their families. Senior staff nurses ing through the creation of the Loeb Center for were available on each ward as resources and men- Nursing and Rehabilitation at Monteﬁore Medical tors for staff nurses.