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By U. Kaffu. College of Saint Benedict. 2018.

Healthcare pro- fessionals treat patients who are at risk for negative nitrogen balance by provid- ing the patient with nutrients before the imbalance occurs purchase 100 mg sildenafil free shipping erectile dysfunction lab tests. A common misnomer is that dextrose 5% in water (D5W) sildenafil 100mg visa impotence education, normal saline, and lactated Ringer’s solution provide nutrients to the patient. The parenteral route is the least preferred because the process is three times more expensive than enteral with- out a significantly improved benefit. Enteral nutrition Enteral feeding is the preferred method of providing nutritional support to a patient. Otherwise, the patient may experience uncontrolled vomiting and become at high risk for aspiration should the intestine be obstructed. It consists of a tube passed through the nose and down the esophagus ending shortly below the xiphoid process. A tube is passed through the nose and down the esophagus ending in the small intestine. This consists of liquids that are individually prepared based on the nutritional needs of the patient and can include baby food with added liquid. Powder mixed with milk or water is given in large amounts to provide complete nutritional requirements and can be used as a nutri- tional supplement in smaller amounts. Liquid is used for replacement feedings and consists of 50% carbohydrates, 15% protein, 15% fat, and 20% other nutrients in an isotonic solution (300 to 340 mOsm/kg H2O). Regardless of the group, these solutions consists of • Carbohydrates in the form of dextrose, sucrose, and lactose. The patient may experience nausea, vomiting, aspi- ration, abdominal cramping, and diarrhea if he or she cannot tolerate the large amount of solution given in a short timeframe. This method is used for treating critically ill patients and for patients who have a feeding tube in their small intestine or in the stomach. An insufficient amount of water is given to the patient or a hyperosmolar solution is given, which draws water from the cells to main- tain serum iso-omolality. Prevent this by raising the head of the bed 30° and check for gastric resid- uals by gently aspirating the stomach contents before the next feeding. Decreasing the infusion rate, diluting the solution, changing the solution, discontinuing the medication, or increasing daily water intake helps to manage diarrhea. Calculate the drug order to determine the volume of the drug: D × V or H:V::D:x H D: Desired dose: dose ordered H: Have (on-hand dose; dose on label of container [bottle, vial or ampule]) V: Vehicle: form and amount in which the drug is available (tablet, capsule, liquid) 2. Determine the osmolality of the drug (drug literature or pharmacist) and liquid dilution. D × V = 650 mg × 1 mL = 10 mL H 65 mg H V x 65 mg : 1mL :: 650 mg: :xmL 65x = 650 x = 10 mL of acetaminophen 2. In addition, the patient might be given fat emulsion supplemental therapy to increase the number of calories and to receive fat-soluble vitamins. The infusion is given through a central venous line such as the subclavian or internal jugular vein to prevent irritation to the peripheral veins. The nurse must monitor the patient for signs of complications as a result of inserting the catheter and the infusion of the feeding. The pharmacy uses a laminar airflow hood when preparing parenteral nutritional solutions to reduce this risk. Monitor the patient carefully for hyperglycemia when you initiate parenteral nutrition support because the pancreas needs time to adjust to the hypertonic dextrose solution, which is high in glucose. Sometimes hyperglycemia is tem- porary and dissipates once the pancreas makes the necessary adjustments. To pre- vent this from occurring, begin with 1 liter of solution for the first 24 hours. Increase this by 500 to 1000 mL each day until you reach a daily volume of 2500 mL to 3000 mL. Caution: Don’t suddenly interrupt parenteral nutrition support because the patient can experience hypoglycemia.

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It has been suggested that smokers report positive mood effects from smoking and that smoking can help individuals to cope with difficult circumstances (Graham 1987) purchase 75 mg sildenafil amex erectile dysfunction causes of. For example cheap 100 mg sildenafil otc what age does erectile dysfunction happen, alcoholism increases the chance of disorders such as liver cirrhosis, cancers (e. In a longitudinal study, Friedman and Kimball (1986) reported that light and moderate drinkers had lower morbidity and mortality rates than both non-drinkers and heavy drinkers. They argued that alcohol consumption reduces coronary heart disease via the following mechanisms: (1) a reduction in the production of catecholamines when stressed; (2) the protection of blood vessels from cholesterol; (3) a reduction in blood pressure; (4) self-therapy; and (5) a short-term coping strategy. The results from the General Household Survey (1992) also showed some benefits of alcohol consumption with the reported prevalence of ill- health being higher among non-drinkers than among drinkers. However, it has been suggested that the apparent positive effects of alcohol on health may be an artefact of poor health in the non-drinkers who have stopped drinking due to health problems. In an attempt to understand why people smoke and drink, much health psychology research has drawn upon the social cognition models described in Chapter 2. However, there is a vast addiction literature which has also been applied to smoking and drinking. Many theories have been developed to explain addictions and addictive behaviours, including moral models, which regard an addiction as the result of weakness and a lack of moral fibre; biomedical models, which see an addiction as a disease; and social learning theories, which regard addictive behaviours as behaviours that are learned according to the rules of learning theory. The multitude of terms that exist and are used with respect to behaviours such as smoking and alcohol are indicative of these different theoretical perspectives and in addition illustrate the tautological nature of the definitions. For example: s An addict: someone who ‘has no control over their behaviour’, ‘lacks moral fibre’, ‘uses a maladaptive coping mechanism’, ‘has an addictive behaviour’. These different definitions indicate the relationship between terminology and theory. For example, concepts of ‘control’, ‘withdrawal’, ‘tolerance’ are indicative of a biomedical view of addictions. Concepts such as ‘lacking moral fibre’ suggest a moral model of addictions, and ‘maladaptive coping mechanism’ suggests a social learning perspective. In addition, the terms illustrate how difficult it is to define one term without using another with the risk that the definitions become tautologies. Questions about the causes of an addiction can be answered according to the different theoretical perspectives that have been developed over the past 300 years to explain and predict addictions, including the moral model, the 1st disease concept, the 2nd disease concept and the social learning theory. These different theories and how they relate to attitudes to different substances will now be examined. However, parallels can be seen between changes in theoretical perspective over the past 300 years and contemporary attitudes. The seventeenth century and the moral model of addictions During the seventeenth century, alcohol was generally held in high esteem by society. It was regarded as safer than water, nutritious and the innkeeper was valued as a central figure in the community. In addition, at this time humans were considered to be separate from Nature, in terms of possessing a soul and a will and being responsible for their own behaviour. Animals’ behaviour was seen as resulting from biological drives, whereas the behaviour of humans was seen to be a result of their own free choice. Accordingly, alcohol consumption was considered an acceptable behaviour, but excessive alcohol use was regarded as a result of free choice and personal responsibility. Alcoholism was therefore seen as a behaviour that deserved punishment, not treatment; alcoholics were regarded as choosing to behave excessively. This perspective is similar to the arguments espoused by Thomas Szasz in the 1960s concerning the treatment versus punishment of mentally ill individuals and his distinction between being ‘mad’ or ‘bad’. Szasz (1961) suggested that to label someone ‘mad’ and to treat them, removed the central facet of humanity, namely personal responsibility. He suggested that holding individuals responsible for their behaviour gave them back their sense of responsibility even if this resulted in them being seen as ‘bad’. Similarly, the moral model of addictions considered alcoholics to have chosen to behave excessively and therefore deserving of punishment (acknowledging their responsibility) not treatment (denying them their responsibility).

Con- growth and has learned how to build order against the sciousness is much more than just cognitive trend of disorder generic sildenafil 25mg online erectile dysfunction drug related. Margaret Newman (1994a) defines con- Newman (1994b) goes on to state that few expe- sciousness as rience the sixth stage best sildenafil 25mg erectile dysfunction treated by, unbinding, or the seventh the information of the system: The capacity of the stage, real freedom, unless they have had these system to interact with the environment. In the experiences of transcendence characterized by the human system the informational capacity includes fifth stage. It is in the moving through the choice not only all the things we normally associate with point and the stages of decentering and unbinding consciousness, such as thinking and feeling, but also that a person moves on to higher levels of con- all the information embedded in the nervous system, sciousness (Newman, 1999). The information of these and other systems reveals the corollary between her theory of Health as complexity of the human system and how the infor- Expanding Consciousness and Young’s theory of mation of the system interacts with the information the Evolution of Consciousness in that we “come of the environmental system. Newman sees fers the image of a smooth lake into which two death as a transformation point, with a person’s stones are thrown. As the stones hit the water, con- consciousness continuing to develop beyond the centric waves circle out until the two patterns reach physical life, becoming a part of a universal con- one another and interpenetrate. Nurses are changed been an expansion of consciousness when there is a by their interactions with their patients, just as pa- richer, more meaningful quality to their relation- tients are changed by their interactions with nurses. Relationships that are more open, loving, This mutual transformation extends to the sur- caring, connected, and peaceful are a manifestation rounding environment and relationships of the of expanding consciousness. The nurse and client may also see movement Newman states: “We have come to see nursing as a through Young’s spectrum of evolving conscious- process of relationship that co-evolves as a func- ness, where people transcend their own egos, dedi- tion of the interpenetration of the evolving fields of cate their energy to something greater than the the nurse, client, and the environment in a self- individual self, and learn to build order against organizing, unpredictable way. It is important the pattern from the outside, but by entering into the that the nurse be able to practice from the center of evolving pattern as it unfolds. It involves being with rather demands that nurses develop tolerance for uncer- than doing for. It is caring in its state of disequilibrium that the potential for deepest, most respectful sense. She states, “The rhythmic relating of process of attending to that which is meaningful. The Somali nurse will have to ask Margaret Newman’s Theory of Health as Expand- more clarifying questions and seek to understand ing Consciousness is being used throughout the that which has not been her experience. No matter world, but it has been more quickly embraced and what the background of the nurse and patient, the understood by nurses from indigenous and Eastern clarifying process, if done in an open, caring, and cultures, who are less bound by linear, three- nonjudging manner, provides great insight for both dimensional thought and physical concepts of participants in the pattern-recognition process as health and who are more immersed in the meta- the nurse and the patient realize their interconnect- physical, mystical aspect of human existence. When the nurse-patient interaction is fo- Increasingly, however, the theory is being enthusi- cused on attending to meaning, it transcends astically embraced by nurses in industrialized na- barriers of culture, gender, age, class, race, educa- tions who are finding it increasingly difficult to tion, and ethnicity. The pilot study informed the methodology unless one has fully comprehended sorrow, and used by Newman and Moch (1991) in their re- vice versa. Although they seem to be opposites, search with people with cardiovascular disease. If you want to see a dark view 20 women diagnosed with breast cancer, cen- pattern more clearly, you would put it against a tering the nurse-patient dialogue on the pattern of light background. Moch asked the women in her study to methodology permits a nurse to be present to a describe what was meaningful to them and found client whose life circumstances are very different that in talking about meaningful people and events, from those of the nurse. For example, the pattern- the sequential patterns of interaction between peo- recognition interaction for a homeless 16-year-old ple and their environment become apparent. After completion of the The interview: After the study has been explained interviews, the data are analyzed more intensely and informed consent obtained, the data collec- in light of the theory of health as expanding tion process begins with the nurse asking the consciousness. Young’s spectrum of conscious- participant a simple, open-ended question such ness is applied, and the quality and complexity as, “Tell me about the most meaningful people of the sequential patterns of interaction are eval- and events in your life. If the intent of the research is to look at a simply about meaningful events, the meaning- group of people or at a community, similarities ful relationships usually arise as the stories are of pattern among participants are identified. Follow-up: At the second interview, the diagram (or Newman states: “Not only is our science a human other visual portrayal) is shared with the partic- science, but, within the context of a practice disci- ipant without any causal interpretation. This kind of theory is participant is given the opportunity to comment embodied in the investigator-nurse. This dialectic situation being addressed by making a difference in process is repeated in subsequent interviews, the situation, as well as being informed by the data with data added to the narrative and the dia- of the situation” (Newman, 1994b, p.

Current medication regimen (including the client’s under- standing about the medications and reason for taking) 7 buy sildenafil 75mg low price erectile dysfunction oil treatment. Possible Etiologies (“related to”) Perceived barriers Social support deficits Powerlessness Perceived benefits [Mistrust of regimen and/or health care personnel] Knowledge deficit Complexity of therapeutic regimen Defining Characteristics (“evidenced by”) Makes choices in daily living ineffective for meeting health goals Failure to include treatment regimens in daily living Failure to take action to reduce risk factors Verbalizes difficulty with prescribed regimens Verbalizes desire to manage the illness Goals/Objectives Short-term Goals 1 buy generic sildenafil 75mg erectile dysfunction protocol amino acids. Client will participate in problem-solving efforts toward adequate self-health management. Long-term Goal Client will incorporate changes in lifestyle necessary to main- tain effective self-health management. Client may be mistrustful of treatment regimen or of health care system in general. Promote a trusting relationship with the client by being honest, encouraging client to participate in decision-making, and conveying genuine positive regard. Recognition of strengths and past successes increases self- esteem and indicates to client that he or she can be successful in managing therapeutic regimen. Positive rein- forcement increases self-esteem and encourages repetition of desirable behaviors. Client must understand that the consequence of lack of follow-through is possible decompensation. In an effort to incorporate lifestyle changes and promote wellness, help client develop plans for managing therapeutic regimen, such as support groups, social and family systems, and financial assistance. Client verbalizes understanding of information presented regarding management of therapeutic regimen. Client demonstrates desire and ability to perform strategies necessary to maintain adequate management of therapeutic regimen. Client verbalizes knowledge of available resources from which he or she may seek assistance as required. Possible Etiologies (“related to”) Inadequate comprehension Inadequate social support Low self-efficacy Low socioeconomic status Multiple stressors Psychiatric Home Nursing Care ● 353 Negative attitude toward healthcare [Intense emotional state] Defining Characteristics (“evidenced by”) Demonstrates nonacceptance of health status change Failure to achieve optimal sense of control Failure to take actions that prevent health problems Minimizes health status change Goals/Objectives Short-term Goals 1. Client will discuss with home health nurse the kinds of life- style changes that will occur because of the change in health status. With the help of home health nurse, client will formulate a plan of action for incorporating those changes into his or her lifestyle. Client will demonstrate movement toward independence, considering change in health status. Long-term Goal Client will demonstrate competence to function independently to his or her optimal ability, considering change in health status, by time of discharge from home health care. It is important to identify the client’s strengths so that they may be used to facilitate adap- tation to the change or loss that has occurred. Encourage client to discuss the change or loss and particu- larly to express anger associated with it. Some individuals may not realize that anger is a normal stage in the grieving process. If it is not released in an appropriate manner, it may be turned inward on the self, leading to pathological depression. Encourage client to express fears associated with the change or loss or alteration in lifestyle that the change or loss has created. Change often creates a feeling of disequilibrium and the individual may respond with fears that are irra- tional or unfounded. He or she may benefit from feedback that corrects misperceptions about how life will be with the change in health status. Successes also provide hope that adaptive functioning is possible and decrease feelings of powerlessness. Help client with decision-making regarding incorporation of change or loss into lifestyle. Discuss alternative solu- tions, weighing potential benefits and consequences of each alternative. The great amount of anxiety that usually accompanies a major lifestyle change often interferes with an individual’s ability to solve problems and to make appropriate decisions.

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