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Use state- We have better retrieval when we are Many possibilities 750 mg cipro, but don‘t study under the influence of dependent in the same psychological state as we drugs or alcohol cipro 250mg, unless you plan to use them on the day of retrieval 250 mg cipro. Encoding and Storage: How Our Perceptions Become Memories Encoding is the process by which we place the things that we experience into memory 500 mg cipro. I‘m sure you‘ve been to a party where you‘ve been introduced to someone and then—maybe only seconds later—you realize that you do not remember the person‘s name cipro 1000mg. Of course it‘s not really surprising that you can‘t remember the name cipro 1000 mg, because you probably were distracted and you never encoded the name to begin with cipro 750 mg. We tend to encode things that we need to remember and not bother to encode things that are irrelevant 1000mg cipro. We tend to have poor memory for things that don’t matter cipro 750mg, even if we see them frequently 750mg cipro. Research has found that we are better able to remember information if we encode it in a meaningful way. When we engage in elaborative encoding we process new information in ways that make it more relevant or meaningful (Craik & Lockhart, 1972; Harris &  Qualls, 2000). Imagine that you are trying to remember the characteristics of the different schools of psychology we discussed in Chapter 1 "Introducing Psychology". Rather than simply trying to remember the schools and their characteristics, you might try to relate the information to things you already know. For instance, you might try to remember the fundamentals of the cognitive school of psychology by linking the characteristics to the computer model. For instance, you might link the cognitive school to structuralism because both were concerned with mental processes. That image might help you remember that childhood experiences were an important part of Freudian theory. Each person has his or her unique way of elaborating on information; the important thing is to try to develop unique and meaningful associations among the materials. Research Focus: Elaboration and Memory  In an important study showing the effectiveness of elaborative encoding, Rogers, Kuiper, and Kirker (1977) studied how people recalled information that they had learned under different processing conditions. All the participants were presented with the same list of 40 adjectives to learn, but through the use of random assignment, the participants were given one of four different sets of instructions about how to process the adjectives. Participants assigned to the structural task condition were asked to judge whether the word was printed in uppercase or lowercase letters. Participants in the phonemic task condition were asked whether or not the word rhymed with another given word. In the semantic task condition, the participants were asked if the word was a synonym of another word. And in the self-reference task condition, participants were asked to indicate whether or not the given adjective was or was not true of themselves. After completing the specified task, each participant was asked to recall as many adjectives as he or she could remember. Rogers and his colleagues hypothesized that different types of processing would have different effects on memory. This finding, known as the self-reference effect, is powerful evidence that the self-concept helps us organize and remember information. The next time you are studying for an exam, you might try relating the material to your own experiences. The self-reference effect suggests  that doing so will help you better remember the information (Symons & Johnson, 1997). Using the Contributions of Hermann Ebbinghaus to Improve Your Memory Hermann Ebbinghaus (1850–1909) was a pioneer of the study of memory. In this section we consider three of his most important findings, each of which can help you improve your memory. Ebbinghaus plotted how many of the syllables he could remember against the time that had elapsed since he had studied them. He discovered an important principle of memory: Memory decays rapidly at first, but the amount of decay levels off with time (Figure 8. Although Ebbinghaus looked at forgetting after days had  elapsed, the same effect occurs on longer and shorter time scales. Bahrick (1984) found that students who took a Spanish language course forgot about one half of the vocabulary that they had learned within three years, but that after that time their memory remained pretty much constant. Ebbinghaus also discovered another important principle of learning, known as the spacing effect. The spacing effect refers to the fact that learning is better when the same amount of study is spread out over periods of time than it is when it occurs closer together or at the same time. This means that even if you have only a limited amount of time to study, you‘ll learn more if you study continually throughout the semester (a little bit every day is best) than if you wait to cram at the last minute before your exam (Figure 8. Another good strategy is to study and then wait as long as you can before you forget the material. Then review the information and again wait as long as you can before you forget it. The spacing effect is usually considered in terms of the difference between distributed practice (practice that is spread out over time) and massed practice (practice that comes in one block), with the former approach producing better memory. Leslie, Lee Ann, and Nora all studied for four hours total, but the students who spread out their learning into smaller study sessions did better on the exam. Ebbinghaus also considered the role of overlearning—that is, continuing to practice and study even when we think that we have mastered the material. Ebbinghaus and other researchers have  found that overlearning helps encoding (Driskell, Willis, & Copper, 1992). Students frequently think that they have already mastered the material but then discover when they get to the exam that they have not. The point is clear: Try to keep studying and reviewing, even if you think you already know all the material. Retrieval Even when information has been adequately encoded and stored, it does not do us any good if we cannot retrieve it. Retrieval refers to the process of reactivating information that has been stored Attributed to Charles Stangor Saylor. You can get an idea of the difficulty posed by retrieval by simply reading each of the words (but not the categories) in the sidebar below to someone. Tell the person that after you have read all the words, you will ask her to recall the words. After you read the list to your friend, give her enough time to write down all the words that she can recall. Make sure that she cannot recall any more and then, for the words that were not listed, prompt your friend with some of the category names: “Do you remember any words that were furniture? Retrieval Demonstration Try this test of the ability to retrieve information with a classmate. Apple (Fruit) Dresser (Furniture) Sander (Tool) Pomegranate (Fruit) Sunflower (Flower) Tangerine (Fruit) Chair (Furniture) Peony (Flower) Banana (Fruit) Sofa (Furniture) Bench (Furniture) Strawberry (Fruit) Television stand (Furniture) Magnolia (Flower) Attributed to Charles Stangor Saylor. Read your friend the names of the 10 states listed in the sidebar below, and ask him to name the capital city of each state. Now, for the capital cities that your friend can‘t name, give him just the first letter of the capital city. You‘ll probably find that having the first letters of the cities helps with retrieval. The tip-of-the-tongue experience is a very good example of the inability to retrieve information that is actually stored in memory. States and Capital Cities Try this demonstration of the tip-of-the-tongue phenomenon with a classmate. Georgia (Atlanta) Maryland (Annapolis) California (Sacramento) Louisiana (Baton Rouge) Florida (Tallahassee) Colorado (Denver) New Jersey (Trenton) Arizona (Phoenix) Nebraska (Lincoln) Attributed to Charles Stangor Saylor. Context-dependent learning refers to an increase in retrieval when the external situation in which information is learned matches the  situation in which it is remembered. Godden and Baddeley (1975) conducted a study to test this idea using scuba divers. They asked the divers to learn a list of words either when they were on land or when they were underwater. Then they tested the divers on their memory, either in the same or the opposite situation. For instance, you might want to try to study for an exam in a situation that is similar to the one in which you are going to take the exam. Whereas context-dependent learning refers to a match in the external situation between learning and remembering, state-dependent learning refers to superior retrieval of memories when the individual is in the same physiological or psychological state as during encoding. Research has found, for instance, that animals that learn a maze while under the influence of one drug tend to remember their learning better when they are tested under the influence of the same drug than  when they are tested without the drug (Jackson, Koek, & Colpaert, 1992). And research with humans finds that bilinguals remember better when tested in the same language in which they  learned the material (Marian & Kaushanskaya, 2007). People who learn information when they are in a bad (rather than a good) mood find it easier to recall these memories when they are tested while they are in a bad mood, and vice versa. It is easier to recall unpleasant memories than pleasant ones when we‘re sad, and easier to recall pleasant memories than unpleasant ones when we‘re happy (Bower, 1981; Eich,  2008). Variations in the ability to retrieve information are also seen in the serial position curve. People are able to retrieve more words that were presented to them at the beginning and the end of the list than they are words that were presented in the middle of the list. This pattern, known as the serial position curve, is caused by two retrieval phenomenon: The primacy effect refers to a tendency to better remember stimuli that are presented early in a list. The recency effect refers to the tendency to better remember stimuli that are presented later in a list. There are a number of explanations for primacy and recency effects, but one of them is in terms of the effects of rehearsal on short-term and long-term memory (Baddeley, Eysenck, &  Anderson, 2009). Because we can keep the last words that we learned in the presented list in short-term memory by rehearsing them before the memory test begins, they are relatively easily remembered. So the recency effect can be explained in terms of maintenance rehearsal in short- term memory. And the primacy effect may also be due to rehearsal—when we hear the first word in the list we start to rehearse it, making it more likely that it will be moved from short-term to long-term memory. Retroactive interferenceoccurs when learning something new impairs our ability to retrieve information that was learned earlier. For example, if you have learned to program in one computer language, and then you learn to program in another similar one, you may start to make mistakes programming the first language that you never would have Attributed to Charles Stangor Saylor. In this case the new memories work backward (retroactively) to influence retrieval from memory that is already in place. In contrast to retroactive interference, proactive interference works in a forward direction. Proactive interference occurs when earlier learning impairs our ability to encode information that we try to learn later. For example, if we have learned French as a second language, this knowledge may make it more difficult, at least in some respects, to learn a third language (say Spanish), which involves similar but not identical vocabulary. Forming categories, and using categories to guide behavior, is a fundamental part of human nature. Associated concepts within a category are connected through spreading activation, which occurs when activating one element of a category activates other associated elements. For instance, because tools are associated in a category, reminding people of the word “screwdriver‖ will help them remember the word “wrench. If they have just remembered the word “wrench,‖ they are more likely to remember the word “screwdriver‖ next than they are to remember the word “dahlia,‖ because the words are organized in memory by category and because dahlia‖ is activated by spreading  activation from“wrench‖ (Srull & Wyer, 1989). Some categories have defining features that must be true of all members of the category. For instance, all members of the category “triangles‖ have three sides, and all members of the category “birds‖ lay eggs. But most categories are not so well-defined; the members of the category share some common features, but it is impossible to define which are or are not members of the category. Members of categories (even those with defining features) can be compared to the category prototype, which is the member of the category that is most average or typical of the category. Some category members are more prototypical of, or similar to, the category than others. For instance, some category members (robins and sparrows) are highly prototypical of the category “birds,‖ whereas other category members (penguins and ostriches) are less prototypical. We retrieve information that is prototypical of a category faster than we retrieve information that  is less prototypical (Rosch, 1975). Mental categories are sometimes referred to as schemas—patterns of knowledge in long-term memory that help us organize information. We have schemas about objects (that a triangle has three sides and may take on different angles), about people (that Sam is friendly, likes to golf, and always wears sandals), about events (the particular steps involved in ordering a meal at a restaurant), and about social groups (we call these group schemas stereotypes). Read the following paragraph (Bransford & Johnson,  1972) and then try to write down everything you can remember. If you have to go somewhere else due to lack of facilities, that is the next step; otherwise you are pretty well set. It is difficult to foresee any end to the necessity for this task in the immediate future, but then one never can tell. After the procedure is completed, one arranges the materials into different groups again. Eventually they will be used once more and the whole cycle will then have to be repeated. It turns out that people‘s memory for this information is quite poor, unless they have been told ahead of time that the information describes “doing the laundry,‖ in which case their memory for the material is much better. This demonstration of the role of schemas in memory shows how our existing knowledge can help us organize new information, and how this organization can improve encoding, storage, and retrieval. When pathways in these neural networks are frequently and repeatedly fired, the synapses become more efficient in communicating with each other, and these changes create memory.
May increase dosage by intervals of at least 2 days up to a dosage of 80 mg 2 times a day 1000 mg cipro. Adjust dosage on the basis of toleration and efﬁcacy within the range of 40 to 80 mg 2 times a day cipro 750mg. Maintenance dosage: 10 to 30 mg/day (maintain at lowest effective dose for symptom remission) cipro 500 mg. Dosage increases should not be made before 2 weeks cipro 1000mg, the time required to achieve steady state cipro 750 mg. Maintenance dosage: 10 to 30 mg/day (maintain at lowest effective dose for symptom remission) cipro 250mg. The safety of doses above 10 mg 2 times a day has not been evaluated in clinical trials cipro 500mg. The safety of doses above 10 mg 2 times a day has not been evaluated in clinical trials 250 mg cipro. Risk for activity intolerance related to medication side effects of sedation 500 mg cipro, blurred vision 750mg cipro, and/or weakness. Noncompliance with medication regimen related to suspi- ciousness and mistrust of others. Nursing implica- tions related to each side effect are designated by an asterisk (*). A proﬁle of side effects comparing various antipsychotic medi- cations is presented in Table 28-1. Anticholinergic effects (see Table 28-1 for differences between typicals and atypicals) a. Dry mouth * Provide the client with sugarless candy or gum, ice, and frequent sips of water. Blurred vision * Explain that this symptom will most likely subside after a few weeks. Constipation * Order foods high in ﬁber; encourage increase in physi- cal activity and ﬂuid intake if not contraindicated. Urinary retention * Instruct client to report any difﬁculty urinating; moni- tor intake and output. Skin rash (may occur with all classiﬁcations) * Report appearance of any rash on skin to physician. Sedation (see Table 28-1 for differences between typicals and atypicals) * Discuss with physician possibility of administering drug at bedtime. Photosensitivity (may occur with all classiﬁcations) * Ensure that client wears protective sunblock lotion, cloth- ing, and sunglasses while spending time outdoors. Hormonal effects (may occur with all classiﬁcations, but more common with typicals) a. Decreased libido, retrograde ejaculation, gynecomastia (men) * Provide explanation of the effects and reassurance of re- versibility. If necessary, discuss with physician possibil- ity of ordering alternate medication. Amenorrhea (women) * Offer reassurance of reversibility; instruct client to con- tinue use of contraception, because amenorrhea does not indicate cessation of ovulation. Weight gain (may occur with all classiﬁcations; has been problematic with the atypicals) * Weigh client every other day; order calorie-controlled diet; provide opportunity for physical exercise; provide diet and exercise instruction. This is particularly true with ziprasidone, thioridazine, pimozide, haloperidol, paliperidone, iloperidone, asenapine, and clozapine. Caution is advised in prescribing these medica- tions to individuals with history of arrhythmias. Conditions that produce hypokalemia and/or hypomagnesemia, such as diuretic therapy or diarrhea, should be taken into consider- ation when prescribing. Clozap- ine has also been associated with other cardiac events, such as ischemic changes, arrhythmias, congestive heart failure, myocarditis, and cardiomyopathy. Reduction of seizure threshold (more common with typi- cals than the atypicals, with the exception of clozapine) * Closely observe clients with history of seizures. Dose appears to be an important predictor, with a greater likelihood of seizures occurring at higher doses. Extreme caution is advised in prescribing clozapine for clients with history of seizures. Agranulocytosis (more common with typicals than the atypicals, with the exception of clozapine) * It usually occurs within the ﬁrst 3 months of treatment. If for a 6-month period the counts remain within the acceptable level for the biweekly period, counts may then be monitored every 4 weeks thereafter. Hypersalivation (most common with clozapine) * A signiﬁcant number of clients receiving clozapine (Clozaril) therapy experience extreme salivation. Management has included the use of sugar-free gum to increase the swal- lowing rate, as well as the prescription of medications such as an anticholinergic (e. Pseudoparkinsonism (tremor, shufﬂing gait, drooling, rigidity) * Symptoms may appear 1 to 5 days following initia- tion of antipsychotic medication; occurs most often in women, the elderly, and dehydrated clients. Akathisia (continuous restlessness and ﬁdgeting) * This occurs most frequently in women; symptoms may occur 50 to 60 days following initiation of therapy. Dystonia (involuntary muscular movements [spasms] of face, arms, legs, and neck) * This occurs most often in men and in people younger than 25 years. Oculogyric crisis (uncontrolled rolling back of the eyes) * This may appear as part of the syndrome described as dystonia. The physician should be contacted, and intravenous benztropine mesylate (Cogentin) is commonly administered. Stay with the client and offer reassurance and support during this frightening time. Tardive dyskinesia (bizarre facial and tongue movements, stiff neck, and difﬁculty swallowing) (may occur with all clas- siﬁcations, but more common with typical antipsychotics) * All clients receiving long-term (months or years) antipsy- chotic therapy are at risk. Routine assessments should include temperature and observation for parkinso- nian symptoms. Hyperglycemia and diabetes (more common with atypicals) * studies have suggested an increased risk of treatment- emergent hyperglycemia-related adverse events in clients using atypical antipsychotics (e. Clients with risk factors for diabetes should undergo fasting blood glucose testing at the beginning of treatment and periodically there- after. All clients taking these medications should be moni- tored for symptoms of hyperglycemia (polydipsia, polyuria, polyphagia, and weakness). If these symptoms appear during treatment, the client should undergo fasting blood glucose testing. Causes of death are most commonly related to infections or cardiovascular problems. They are not approved for treatment of elderly patients with dementia-related psychosis. To do so might produce withdrawal symptoms, such as nausea, vomiting, dizziness, gastritis, headache, tachycardia, insom- nia, and tremulousness. Antipsychotic Agents ● 501 ● Consult the physician regarding smoking while taking this medication. Smoking increases the metabolism of some anti- psychotics, possibly requiring adjustment in dosage to achieve therapeutic effect. Many medications con- tain substances that interact with antipsychotics in a way that may be harmful. Antipsychotics are thought to read- ily cross the placental barrier; if so, a fetus could experience adverse effects of the drug. Inform the physician immediately if pregnancy occurs, is suspected, or is planned. Refer to writ- ten materials furnished by health care providers for safe self- administration. May also inhibit the reuptake and storage of dopamine at central dopamine receptors, thereby prolonging the action of dopamine. Decreased allergic response and somnolence are effected by diminished hista- mine activity. It also inhibits the replication of inﬂuenza A virus isolates from each of the subtypes. Activity intolerance related to side effects of drowsiness, diz- ziness, ataxia, weakness, confusion. Nursing implications related to each side effect are designated by an asterisk (*). Constipation * Order foods high in ﬁber; encourage increase in physi- cal activity and ﬂuid intake, if not contraindicated. Paralytic Ileus * A rare, but potentially very serious side effect of anti- cholinergic drugs. Monitor for abdominal distension, absent bowel sounds, nausea, vomiting, epigastric pain. Urinary Retention * Instruct client to report any difﬁculty urinating; moni- tor intake and output. Tachycardia, Decreased Sweating, Elevated Tem- perature * Assess vital signs each shift; document and report signiﬁcant changes to physician. Sedation, Drowsiness, Dizziness * Discuss with physician possibility of administering drug at bedtime. Antiparkinsonian Agents ● 509 * Discuss with physician possible decrease in dosage or change in medication. Orthostatic Hypotension * Instruct client to rise slowly from a lying or sitting position; monitor blood pressure (lying and standing) each shift; document and report signiﬁcant changes. Perspiration is decreased with antiparkinsonian agents, and the body cannot cool itself as well. Many medica- tions contain substances that interact with antiparkinsonian agents in a way that may be harmful. It is thought that antiparkin- sonian agents readily cross the placental barrier; if so, fetus could experience adverse effects of the drug. Refer to written materials furnished by health-care providers for safe self-administration. Do not exceed a vol- ume of 5 mL at any one site because of possible tissue irritation. It is recommended that ramelteon not be taken with or immediately after a high-fat meal. Risk for injury related to abrupt withdrawal from long-term use or decreased mental alertness caused by residual sedation. Disturbed sleep pattern related to situational crises, physical condition, or severe level of anxiety. Risk for activity intolerance related to side effects of lethargy, drowsiness, and dizziness. Risk for acute confusion related to action of the medication on the central nervous system. Nursing implications related to each side effect are designated by an asterisk (*): 1. Drowsiness, dizziness, lethargy (most common side effects) * Instruct client not to drive or operate dangerous machin- ery while taking the medication. Tolerance, physical and psychological dependence * Instruct client to take the medication exactly as directed. Do not take more than the amount prescribed because of the habit-forming potential. Abrupt withdrawal after long-term use may result in serious, even life-threatening, symptoms. It has, however, been associated with cases of rebound insomnia after abrupt discontinuation following long-term use. Orthostatic hypotension, palpitations, tachycardia * Monitor lying and standing blood pressure and pulse every shift. Dry mouth * Have client take frequent sips of water or ice chips, suck on hard candy, or chew sugarless gum. Nausea and vomiting * Have client take drug with food or milk (unless it is a drug in which taking with food is not recommended). Blood dyscrasias * Symptoms of sore throat, fever, malaise, easy bruising, or unusual bleeding should be reported to the physician immediately. Can produce serious withdrawal symptoms, such as depression, insomnia, anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium. Refer to written materi- als furnished by health-care providers regarding the correct method of self-administration. May be increased in increments of 5 mg at weekly intervals until optimal response is obtained. May increase in increments of 5 mg/day at weekly intervals up to a maximum of 60 mg/day. May increase by 10 mg/day at weekly intervals until response is obtained or 60 mg is reached. May increase by 5 mg/ day at weekly intervals until response is obtained or 60 mg is reached. Patients currently taking methylphenidate: Starting dose is 1⁄2 of the methylphenidate dose, up to 10 mg 2 times a day. Patients currently taking methylphenidate: Starting dose is 1⁄2 of the methylphenidate dose, up to 20 mg/day given as a single daily dose. Patients currently taking dexmethylphenidate: Give same daily dose as a single dose.
Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care 750 mg cipro, 7th Edition cipro 1000mg. For the purposes of this exercise 500 mg cipro, develop the one patient goal that demonstrates a direct resolution of the patient problem identified in the nursing diagnosis 1000 mg cipro. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care cipro 750 mg, 7th Edition cipro 1000 mg. Povidone–iodine or hydrogen peroxide should be used to ﬁght infection in the Circle the letter that corresponds to the best wound cipro 250 mg. A patient who is being treated for self- wounds because they damage the cells inﬂicted wounds admits to the nurse that she needed for healing 250 mg cipro. Total lymphocyte count of 1 1000mg cipro,500/mm the ulcer moist because it is susceptible to c 250mg cipro. A patient with a pressure ulcer on his back it is present, but still maintains a moist should be treated by which of the following environment. The wound should be cleaned with each with a saline or occlusive dressing to dressing change. Which of the following vitamins is needed tract and would be used after incision and for collagen synthesis, capillary formation, drainage of an abscess, in abdominal surgery? It would be categorized as Multiple Response Questions which of the following stages? People who are thin may heal more slowly due to the small amounts of subcutaneous c. Vitamins B and D are essential for re- to the area epithelialization and collagen synthesis. People who are taking corticosteroid drugs greatest risk for developing a pressure ulcer? A patient with cardiovascular disease resulting in increased leukocytes and a de- c. Which of the following statements accurately describe the complications that may occur 10. Dehiscence is present when there is a par- elbows tial or total disruption of wound layers. A large wound with considerable tissue loss these complications owing to a thinner allowed to heal naturally by formation of layer of tissue cells. An increase in the ﬂow of serosanguineous which of the following categories of wound ﬂuid from the wound between postopera- healing? Tertiary intention often the result of delayed healing, com- monly manifested by drainage from an d. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. They reﬂect the color of normal granula- edges of the wound to appear normal and tion tissue. The wound should not feel hot upon wound and using wet-to-moist dressings palpation. Incisional pain during wound healing is medication to decrease the growth of usually most severe for the ﬁrst 3 to 5 days bacteria. They are usually treated by using sharp, the proper use of the various types of mechanical, or chemical débridement. A Surgipad is often used to cover an describe a factor in the development of a incision line directly. Op-Site is often used over intravenous uted over a small area without much sub- sites, subclavian catheter insertion sites, cutaneous tissue. Gauze dressings are commonly used to within the ﬁrst 2 days in a person who has cover wounds. The major predisposing factor for a pressure drainage from passing through and being ulcer is internal pressure applied over an absorbed by the outer layer. Which of the following interventions might laries and poor circulation to the tissues. The skin can tolerate considerable pressure ing competent care for a patient with a drain- without cell death, but for short periods ing wound? The duration of pressure, compared to the 45 minutes before changing the dressing, amount of pressure, plays a larger role in if necessary. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Change cold compresses frequently, con- tinuing the application for 1 hour, and re- 9. Which of the following would be appropriate peating the application every 2 to 3 hours actions for the nurse to take when cleaning as ordered. In a home setting, use a bag of frozen veg- change using aggressive motions to etables (such as peas), if desired, as a sub- remove necrotic tissue. The application of heat decreases tissue or open separate swab and remove cap metabolism. Extensive, prolonged heat increases cardiac rubber band or place tube in plastic bag output and pulse rate. Apply an ice bag for 1 hour and then re- to secure; if using Culturette tube, crush move it for about an hour before reapply- ampule of medium at bottom of tube. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The partial or total disruption of wound incision are caused by an accumulation of layers. In the inﬂammatory cellular phase of a of ﬁbroblasts and small blood vessels wound, or cells that ﬁll an open wound when it starts arrive ﬁrst to ingest bacteria and cellular to heal debris. The protrusion of viscera through the vascular, bleeds easily, and is formed in the incisional area proliferative phase is known as tissue. Composed of ﬂuid and cells that escape from the blood vessels and are deposited 5. An abnormal passage from an internal organ in or on tissue surfaces to the skin or from one internal organ to another is known as a(n). Anchoring a bandage by wrapping it around clear, serous portion of the blood and the body part with complete overlapping of drainage from serous membranes the previous bandage turn is the method of bandage wrapping. Ischemia debris, and both dead and live bacteria Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Applied directly over a small wound oozing from the tissue covering the or tube, these dressings are occlusive, wound, often accompanied by purulent decreasing the possibility of contamina- drainage tion while allowing visualization of the wound. A disruption in the normal integrity of muslin) or an elasticized material that the skin fastens together with Velcro. The type of dressing often used over sweat, grow hair, or tan in sunlight intravenous sites, subclavian catheter 15. Give an example of how the following factors material used to wrap a body part affect the likelihood that a patient will develop a pressure ulcer. A special gauze that covers the incision line and allows drainage to pass through a. Mental status: come in various sizes and are commer- cially packaged as single units or in packs. Placed over the smaller gauze to absorb drainage and protect the wound from contamination or injury f. Precut halfway to ﬁt around drains or tubes Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Activity/mobility: stroke in her home, you notice a pressure ulcer developing on her coccyx. Develop a nursing care plan for this patient that involves the family in the treatment of the d. R red protect: that could be asked to assess a patient’s skin integrity in the following areas. B black débride: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Brieﬂy describe the use of the following meth- nutrition, and exposure to friction and shear. Aquathermia pad: admitted to the hospital for aggressive treatment of a bone infection that has not responded to usual methods. She states that the medicines the doc- tor prescribed made her husband feel sick to e. She says her husband spent most of his day in bed and had no energy to get up to f. Warm moist compresses: I was here, my skin got really irritated and I developed several skin wounds. What nursing intervention would be appropri- ate to prevent skin irritation and the develop- ment of pressure ulcers for Mr. Develop a nursing plan to assist the following patients who are at high risk for pressure ulcers. A frail elderly man who is conﬁned to bed and/or ethical/legal competencies are most c. A premature baby on life support What knowledge and skills do you need to prevent pressure ulcers in these patients? Interview the patients to see how the wound has affected their mobility, sensory perception, activity, Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Identify pertinent patient data by placing a single underline beneath the objective data in Scenario: Mrs. Chijioke, an 88-year-old the patient care study and a double underline woman who has lived alone for years, was beneath the subjective data. Complete the Nursing Process Worksheet on had broken her hip and underwent hip repair page 203 to develop a three-part diagnostic surgery 3 days ago. The skin returned to strengths you hope to draw upon as you assist a normal color when pressure was relieved this patient to better health. Chijioke can be lifted out of bed into a chair, she spends most of the day in bed, lying on her back with an abductor pillow between her legs. Her eyes are bright, and she usually attempts a warm smile, but she has little phys- ical strength and lies seemingly motionless for hours. Pretend that you are performing a nursing thin, and her arms are bruised from unsuccess- assessment of this patient after the plan of ful attempts at intravenous therapy. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. For the purposes of this exercise, develop the one patient goal that demonstrates a direct resolution of the patient problem identified in the nursing diagnosis. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Labyrinthine sense Circle the letter that corresponds to the best answer for each question. Amount of movement they permit movements, such as walking, swimming, and laughing, is which of the following? A narrow base of support and high center assists the motor cortex and basal ganglia of gravity by making body movements smooth and coordinated? Bellas is a 40-year-old man in a sedentary observe that both arms swing freely in alter- job who is beginning an exercise program. You are assessing Which of the following effects will exercise which of the following? Which of the metacarpal of the thumb is an example of following should the nurse consider when which of the following types of joints? Patients who can lift their legs only 1 to 2 inches off the bed do not have sufﬁcient 15. The base of support is on the soles of the to the ﬂoor, carefully protecting the pa- feet. Which of the following statements accurately ples of which of the following types of describe typical body movements? Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. For orthostatic hypotension, have the line patient sleep sitting up or in an elevated e. For impaired skin integrity, reposition the patient in correct alignment at least every a. Which of the following are accurate guidelines when teaching crutch walking to patients? Which of the following are accurate steps when assessing a patient’s mobility status? Adjust the bed to the ﬂat position or as low alignment as the patient can tolerate. Head, shoulders, and hips aligned in bed and move down one side of the body at a e. For increased cardiac workload, instruct the patient to lie in the prone position. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The joints between the axis and atlas and the proximal ends of the radius and ulna a. Match the term used to describe body positions and movements in Part A with its deﬁnition listed in Part B.
The healthcare professional must quickly identify the signs and symptoms of the imbalance and then take steps to restore the balance between electrolytes and fluids 1000mg cipro. What is determined by the concentration of electrolytes and other solutes in water? The concentration of a hypotonic intravenous solution has the same con- centration as intracellular fluid 500 mg cipro. Insulin and glucose administered parenterally (a) forces potassium out of the cell cipro 250 mg. Yet today you’re probably eating more nutritional foods—foods you wouldn’t touch when you were a kid—because you’ve learned that healthy foods provide the balanced nutrition needed to fend off diseases 750mg cipro. You might wonder how a chapter on nutrition slipped into a book on phar- macology 250mg cipro. Nutrients are given to patients who are at risk for malnutrition caused by disease and caused by treatments given to cure diseases cipro 750mg. Nutrients are also given to strengthen the patient following a trauma such as surgery cipro 750 mg. In this chapter 500mg cipro, you’ll learn about nutritional support therapies 250 mg cipro, how to pre- pare them cipro 1000mg, how to administer them, and how to avoid any complications that might arise. Nutrition Nutrition is a three-step process that gives the body materials needed to make the body grow and function. Other nutrients become involved in enzyme activities and carbohydrate-fat-protein synthesis. And just like your car, your body can continue to operate without a full complement of nutrients—that is, without a full tank of gas. A healthy, well- nourished person has a nutritional level to last 14 days before they begin to show signs of malnutrition. However, there comes a point when your performance sputters—the level of nutrients fall below the level needed to sustain your daily activity. You simply run out of fuel and become fatigued, irritable, and exhibit an abnormal appearance. These are surgery, trauma, malignancy, and other illnesses that break down (catabolize) the body. A nutritional deficit prolongs healing and severe cases can prevent total recovery. Critically ill patients have sufficient nutrients to sustain them for a few days to a week before they begin to show signs of nutritional deficit. Healthcare professionals provide nutritional support therapy for patients who are at risk for nutritional deficit. Nutritional support therapy replaces nutrients that the patient has lost and thereby provide the patient with the fuel needed for a full recovery. A nutritional deficit is called a negative nitrogen balance, which means that the patient lacks sufficient nitrogen to fight infectious disease. Healthcare pro- fessionals treat patients who are at risk for negative nitrogen balance by provid- ing the patient with nutrients before the imbalance occurs. A common misnomer is that dextrose 5% in water (D5W), 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. Nutrients enter the body as food and are absorbed as chemical reactions break down food into molecules that enter the bloodstream where they are distributed throughout the body. Surgery, trauma, malignancy, and other catabolic illnesses cause a nutritional imbalance that, if prolonged, can have a dramatic impact on the patient that could ultimately lead to death. Enteral nutritional support therapy introduces nutrition into the patient by mouth or a feeding tube that is directly inserted in the stomach or small intestine. Parenteral nutritional support therapy administers high caloric nutrients through large veins such as the subclavian vein. Nausea and vomiting may occur during enteral therapy if which of the following occurs? A healthy, well-nourished person has a nutritional level to last 14 days before they begin to show signs of malnutrition. Fortunately, most times the pain goes away and the inflammation subsides relatively quickly and doesn’t interfere with daily activities. However, this isn’t always the case—especially when the injury is severe such as arthritis, gout, toothache, or other painful conditions including menstrual cramps. For these conditions, medication is needed to decrease the inflammation so your daily activities are not interrupted. In this chapter, you’ll learn about inflammation and the medications that are prescribed to reduce the redness, swelling, warmth, and pain that is associated with inflammation. An Inside Look at Inflammation Inflammation is the body’s protective response to injury to tissues. Injury causes the release of three chemicals that stimulate a vascular response that force 197 Copyright © 2006 by The McGraw-Hill Companies, Inc. This chemical works to bring more blood and lymph fluid to the site of the invasion. These are blood plasma proteins that influence smooth muscle con- tractions, increase blood flow throughout the body, increase the perme- ability of small capillaries, and stimulate pain receptors. They are produced in response to the white blood cells that flow to the area of injured tissue. It is important not to confuse inflammation and infection because they are not the same. Only a small percentage of inflammation is caused by infection from micro- organisms. Trauma, surgery, extreme heat or cold, electricity, and caustic chem- icals cause most inflammation. It is dur- ing this phase that blood vessels dilate (vasodilation) and become more perme- able, enabling fluid and white blood cells to leave the plasma and flow to the injured tissue. White blood cells (also called leukocytes or immune cells) are components found in the blood. They help defend the body against infectious disease and foreign material as part of the immune system. Combating Inflammation Although inflammation is a natural response to injury, this process can be uncomfortable for a patient, especially when there is fever, pain, and swelling. Anti-inflammatory medication can be given to reduce the inflammatory process and bring comfort to the patient. Anti-inflammatory medication stops the production of prostaglandins result- ing in a decrease in the inflammatory process. Inhibits platelet aggregation (grouping to form clot) Many anti-inflammatory medications fall within all three categories. Aspirin is one of them, which is the oldest and least expensive anti-inflammatory med- ication available and, along with acetaminophen and ibuprofen, is the choice for relieving headaches. Corticosteroids, such as prednisone, are frequently used as anti-inflammatory agents. This group of drugs can control inflammation by suppressing or pre- venting many of the components of the inflammatory process at the injured site. There are other anti-inflammatory medications that are not chemically the same as corticosteroid medication. This com- mon form of arthritis is the result of deformation or mismatched joint surfaces, rather than an inflammatory disease. Symptoms include joint stiffness that usually lasts only a few minutes after initiating movement and perhaps an aching pain in weight-bearing joints. Rheumatoid arthritis usually occurs between 30 to 70 years of age and occurs more often in women than in men. Early symptoms may include feelings of fatigue and weakness, joint pain and stiffness, and, joint swelling several weeks later. Joints are inflamed (warm, red, swollen) and often are limited in range of motion. A list of drugs utilized in the treatment of arthritis is provided in the Appendix. Gout has been called the “disease of Kings” because in the past, royalty ate rich foods and drank wine and alcohol and suffered from gout. The most common site of acute gouty inflam- mation is at the joint of the big toe. It is characterized by a uric acid metabolism disorder and a defect in purine (products of certain proteins) metabolism, resulting in an increase in urates (uric acid salts) and an accumulation of uric acid (hyperuricemia) or an ineffective clearance of uric acid in the kidneys. Uric acid solubility is poor in acid urine and urate crystals may form, causing urate calculi (stones). Gout may appear as bumps or “tophi” in the subcutaneous tissue of earlobes, elbows, hands, and the base of the large toe. The complications of untreated or prolonged periods of gout include tophi, gouty arthritis, urinary calculi, and gouty nephropathy. Fluid intake should be increased while taking antigout drugs and the urine should be alkaline. Foods rich in purine, including wine, alcohol, organ meats, sardines, salmon, and gravy should be avoided. The body releases hista- mines, kinins, and prostaglandins that force fluid and white blood cells to the site of the injury to stimulate nerve endings and clean the area so it can heal. The site of the injury becomes red, swollen, and warm and loses its normal function. The vascular phase is where blood vessels dilate and become permeable so fluid and white blood cells can leave the vessel. Anti-inflammatory medication reduces the inflammatory process which may allow the patient to go about normal daily activities while the tissue heals. There are three categories of anti-inflammatory medications: analgesic, to relieve pain; antipyretic, to reduce fever; and anticoagulants, to inhibit blood clotting. You learned in this chapter that inflammation is not an infection although inflammation frequently occurs when a patient becomes infected with a micro- organism. Inflammation occurs in response to tissue injury whether it is from an injury or an acute or chronic disease such as rheumatoid arthritis or gout.
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