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By B. Darmok. Notre Dame College of Ohio.

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 80 mg propranolol sale cardiovascular disease health promotion. This position is used to assess pating facial muscles for tone while the the female rectum and genitalia buy 80mg propranolol mastercard arteries carry blood away from the heart and lungs. 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.

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For example buy 40 mg propranolol with visa coronary heart pain, is the appraisal that symptoms have been reduced a successful outcome or is it a form of denial (a coping strategy)? The individual processes involved in the self-regulatory model will now be examined in greater detail generic propranolol 40mg otc coronary artery growth. However, symptom perception is not a straightforward process (see Chapter 12 for details of pain perception). For example, what might be a sore throat to one person could be another’s tonsillitis and whereas a retired person might consider a cough a serious problem a working person might be too busy to think about it. Pennebaker (1983) has argued that there are individual differences in the amount of attention people pay to their internal states. For example, Pennebaker (1983) reported that individuals who were more focused on their internal states tended to overestimate changes in their heart rate compared with subjects who were externally focused. Being internally focused has also been shown to relate to a perception of slower recovery from illness (Miller et al. Being internally focused may result in a different perception of symptom change, not a more accurate one. Mood, cognitions, environment and symptom perception Skelton and Pennebaker (1982) suggested that symptom perception is influenced by factors such as mood, cognitions and the social environment. Mood: The role of mood in symptom perception is particularly apparent in pain perception with anxiety increasing self-reports of the pain experience (see Chapter 12 for a discussion of anxiety and pain). In addition, anxiety has been proposed as an explanation for placebo pain reduction as taking any form of medication (even a sugar pill) may reduce the individual’s anxiety, increase their sense of control and result in pain reduction (see Chapter 13 for a discussion of anxiety and placebos). In an experimental study, participants were exposed to low intensity somatic sensations induced by breathing air high in carbon dioxide. They were then told that the sensation would be either positive, negative or somewhere between and were asked to rate both the pleasantness and intensity of their symptoms. The results showed that what the participants were told about the sensation influenced their ratings of its pleasantness. The results also showed that although people who rated high on negative affectivity showed similar ratings of pleasantness to those low on negative affectivity they did report more negative meanings and worries about their symptoms. This indicates that expectations about the nature of a symptom can alter the experience of that symptom and that negative mood can influence the attributions made about a symptom. Cognition: An individual’s cognitive state may also influence their symptom per- ception. This is illustrated by the placebo effect with the individual’s expectations of recovery resulting in reduced symptom perception (see Chapter 13). Ruble (1977) carried out a study in which she manipulated women’s expectations about when they were due to start menstruating. She gave sub- jects an ‘accurate physiological test’ and told women either that their period was due very shortly or that it was at least a week away. Pennebaker also reported that symptom perception is related to an individual’s attentional state and that boredom and the absence of environmental stimuli may result in over-reporting, whereas distraction and attention diversion may lead to under-reporting (Pennebaker 1983). Sixty-one women who had been hospitalized during pre-term labour were randomized to receive either information, distraction or nothing (van Zuuren 1998). The results showed that distraction had the most beneficial effect on measures of both physical and psychological symptoms suggesting that symptom per- ception is sensitive to attention. Symptom perception can also be influenced by the ways in which symptoms are elicited. For example, Eiser (2000) carried out an experimental study whereby students were asked to indicate their symptoms, from a list of 30 symp- toms, over the past month and the past year and also to rate their health status. The results showed that those in the ‘exclude’ condition reported 70 per cent more symptoms than those in the ‘endorse’ condition. In addition, those who had endorsed the symptoms rated their health more negatively than those who had excluded symptoms. This suggests that it is not only focus and attention that can influence symptom perception but also the ways in which this focus is directed. These different factors are illustrated by a condition known as ‘medical students’ disease’, which has been described by Mechanic (1962). A large component of the medical curriculum involves learning about the symptoms associated with a multitude of different illnesses. More than two-thirds of medical students incorrectly report that at some time they have had the symptoms they are being taught about. Perhaps this phenomena can be understood in terms of: s Mood: medical students become quite anxious due to their workload.

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Remove all dangerous objects from client’s environment (sharp objects cheap 40mg propranolol fast delivery cardiovascular disease drugs, glass or mirrored items order 40mg propranolol fast delivery cardiovascular system main job, belts, ties, smoking Mood Disorders: Bipolar Disorders ● 151 materials) so that in his or her agitated, hyperactive state, client may not use them to harm self or others. Try to redirect the violent behavior with physical outlets for the client’s hostility (e. Intervene at the first sign of increased anxiety, agitation, or verbal or behavioral aggression. Offer empathetic response to client’s feelings: “You seem anxious (or frustrated, or an- gry) about this situation. Have sufficient staff available to indicate a show of strength to client if necessary. This conveys to the client evidence of control over the situation and provides some physical secu- rity for staff. If the client is not calmed by “talking down” or by medi- cation, use of mechanical restraints may be necessary. The avenue of the “least restrictive alternative” must be selected when planning interventions for a violent client. Restraints should be used only as a last resort, after all other interven- tions have been unsuccessful, and the client is clearly at risk of harm to self or others. If restraint is deemed necessary, ensure that sufficient staff is available to assist. The physician must reissue a new order for restraints every 4 hours for adults and every 1 to 2 hours for children and adolescents. The Joint Commision requires that the client in restraints be observed every 15 minutes to ensure that circulation to extremities is not compromised (check temperature, color, pulses); to assist client with needs related to nutrition, hy- dration, and elimination; and to position client so that com- fort is facilitated and aspiration can be prevented. As agitation decreases, assess client’s readiness for restraint removal or reduction. In collaboration with dietitian, determine the number of calo- ries required to provide adequate nutrition for maintenance or realistic (according to body structure and height) weight gain. Provide client with high-protein, high-calorie, nutritious finger foods and drinks that can be consumed “on the run. The likelihood is greater that he or she will consume food and drinks that can be carried around and eaten with little effort. Nutritious intake is required on a regular basis to compensate for increased caloric requirements due to hyperactivity. This information is necessary to make an accurate nutritional assessment and maintain client’s safety. Determine client’s likes and dislikes, and collaborate with dietitian to provide favorite foods. Administer vitamin and mineral supplements, as ordered by physician, to improve nutritional state. Presence of a trusted individual may provide feeling of security and decrease agitation. Encouragement and posi- tive reinforcement increase self-esteem and foster repeti- tion of desired behaviors. Client may have inadequate or inaccurate knowledge regarding the contribution of good nutrition to overall wellness. Vital signs, blood pressure, and laboratory serum studies are within normal limits. Long-term Goal By time of discharge from treatment, client’s verbalizations will reflect reality-based thinking with no evidence of delusional ideation. Convey your acceptance of client’s need for the false belief, while letting him or her know that you do not share the delu- sion. A positive response would convey to the client that you accept the delusion as reality. Use reasonable doubt as a therapeutic technique: “I understand that you believe this is true, but I personally find it hard to accept. Use the techniques of consensual validation and seeking clari- fi c a t i o n when communication reflects alteration in think- ing.