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Documenting ideas and care purchase cheap risperidone line medications for bipolar disorder, but until all data have been studied from the informant’s emic viewpoint is essential to with the theory tenets 3mg risperidone treatment 99213, she cannot prove them buy 4 mg risperidone medications quizlet. Unknown Full documentation of the informants’ viewpoints buy 3mg risperidone amex symptoms zoloft overdose, care meanings, such as the concepts of protection, experiences, and actions is pursued. Generally, in- respect, love, and many other care concepts, need to formants select what they like to talk about first, be teased out and explored in depth as they are the and the nurse accommodates their interest or key words and ideas in understanding care. During the in-depth study of care meanings and expressions are not always read- the domain of inquiry, all areas of the sunrise ily known; informants ponder about care meanings enabler are identified and confirmed with the in- and are often surprised that nurses are focused on formants. Sometimes in- pants throughout the discovery process and in a formants may be reluctant to share social structure manner in which they feel comfortable and willing and factors such as religion and economical or po- to share their ideas. Leininger’s Theory of Culture Care Diversity and Universality 319 or indigenous) knowledge often has rich care data holistic knowledge base about care. Generic care ideas need dicts the health and well-being of people and fo- to be appropriately integrated into the three modes cuses on the totality of lifeways of individuals, of action and decision for congruent care out- families, groups, communities, and/or institutions comes. Both generic and professional care are inte- related to culture and care phenomena. It gives a grated together so the clients benefit from both comprehensive picture of care knowledge and often types of care. Some The Sunrise Enabler was developed with the nurse researchers have studied care with limited idea to “let the sun enter the researcher’s mind” and variables or in regard to medical symptoms and discover largely unknown care factors of cultures. Discovering the totality of living Generally, a wealth of new and unexpected nursing with a caring ethos in a culture has provided a care knowledge is discovered that has never been wealth of new knowledge about clients’ lifeworld known and used in present-day nursing and med- and care. This characteristic helps nurse re- searchers to discover what exists, or has the poten- Current Status of the Theory tial to be known and used for human caring and health practices. What exists and does not exist is Currently, the theory of culture care diversity and important to discover, as is the potential for future universality is being studied and used in many discoveries. Some theories deal only with abstract schools of nursing within the United States and phenomena, but this theory has both abstract and other countries (Leininger & McFarland, 2002). The theory has grown in recognition and value for Sixth, the theory of culture care is a synthesized several reasons. First, the theory is the only nursing concept; integrated with the ethnonursing method, theory that focuses explicitly and in depth on it has already provided a wealth of many new in- discovering the meaning, uses, and patterns of sights, knowledge areas, and valuable ways to work culture care within and between specific cultures. Thus, it has greatly expanded nurses’ are the new knowledge holdings that support the knowledge about care so essential for nurses to new discipline of transcultural nursing. Third, the theory has the “gold nuggets” to change or transform health a “built-in” and tailor-made ethnonursing nursing care to realize therapeutic outcomes for different research method that helps to realize the theory cultures. It is different from ethnography and other been reported in the Journal of Transcultural research methods. The ethnonursing method is a Nursing and other transcultural nursing books and qualitative method and is valuable in discover- journals since 1980. They substantiate the theory ing largely covert, complex, and generally hidden (Leininger, 1991, 1995, 1997a, 1997b). It was Seventh, the theory and its research findings are the first specific research method designed so that stimulating nursing faculty and clinicians to use the theory and method fit together. This has culture specific care appropriate and safe for cul- brought forth a wealth of new data. Thus, transcultural nursing knowledge is to data methods were not helpful to find hidden be used in clinical and community settings. Nursing administrators in service and academia Fourth, the theory of culture care is the only the- need to be active change leaders to use transcultural ory that searches for comprehensive and holistic nursing findings.

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Administration in humans Morphine relieves both the perception of pain and the emo- suppresses the pituitary–gonadal and pituitary–adrenal axis tional response to it buy generic risperidone 2mg symptoms 3 days past ovulation. High concentrations of Adverse effects opioid peptides are also present in sympathetic ganglia and Certain patients are particularly sensitive to the pharmacolog- the adrenal medulla purchase risperidone 2 mg medicine ball workouts. These include the very young purchase risperidone without prescription treatment conjunctivitis, the elucidated purchase 2mg risperidone otc symptoms ulcerative colitis, but they may play an inhibitory role in the sympa- elderly and those with chronic lung disease, untreated thetic system. Morphine depresses the sensitivity the sensitivity of the receptors decreases, necessitating an of the respiratory centre to carbon dioxide, thus causing a pro- increased dose to produce the same effect (‘tolerance’). Patients with decreased withdrawal of the drug, endogenous opioids are not sufficient respiratory reserve due to asthma, bronchitis, emphysema or to stimulate the insensitive receptors, resulting in a withdrawal hypoxaemia of any cause are more sensitive to the respiratory state characterized by autonomic disturbances, e. Bronchoconstriction occurs via sweating and piloerection (‘cold turkey’) and abdominal pain. Morphine causes vomiting in 20–30% of patients by stimulation of the chemoreceptor trig- Use ger zone. Dopamine receptors are important and opioid- • The most important use of morphine is for pain relief. The induced emesis is responsive to dopamine-receptor antagonists effective dose is highly variable. Morphine increases smooth muscle requirements (if known) should be taken into account tone throughout the gastro-intestinal tract, which is combined when selecting a dose. The result is constipation with hard • Morphine may be given as an intravenous bolus if rapid dry stool. In • Morphine is effective orally, although larger doses are common with most other opioids it causes pupillary constric- needed due to presystemic metabolism. This provides a useful diagnostic sign in narcotic over- given by mouth initially every four hours, giving dosage or chronic abuse. Patients with prostatic hypertrophy additional doses as needed between the regular doses as a may suffer acute retention of urine, as morphine increases the ‘top-up’, the daily dose being reviewed and titrated. Morphine is metabolized by • Spinal (epidural or intrathecal) administration of combination with glucuronic acid and also by N-dealkylation morphine is effective at much lower doses than when and oxidation, about 10% being excreted in the urine as mor- given by other routes and causes fewer systemic side phine and 60–70% as a mixture of glucuronides. It is useful in those few patients with opioid- occurs in the liver and gut wall, with extensive presystemic responsive pain who experience intolerable side effects metabolism. The dose–plasma concentration relationships for when morphine is administered by other routes. There is an advantage in using properties and contributes substantially to the analgesic diamorphine rather than morphine for this purpose, since action of morphine. Only low concentrations of this active its greater solubility permits smaller volumes of more metabolite appear in the blood after a single oral dose. Morphine-6-glucuronide is eliminated in the respiratory depression of the neonate. This is exacerbated by urine, so patients with renal impairment may experience severe the prolonged elimination t1/2 in neonates of about 22 hours. The birth of opiate- dependent babies born to addicted mothers demonstrates the Drug interactions ability of morphine and its glucuronide to cross the placenta. They are more potent but shorter-acting and are used to treat severe pain or as an Use adjunct to anaesthesia. They can be given those of morphine, although it is more potent as an analgesic intrathecally and via patient-controlled devices.

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Sickle cell disease occurs mainly in African black populations and sporadically in the Mediterranean and Middle East generic risperidone 2mg without prescription treatment 5th toe fracture. Haemoglobin S differs from haemoglobin A by the substitution of valine for glutamic acid at position 6 in the $-chain risperidone 4 mg with mastercard medicine 752. Sickled cells have increased mechanical fragility and a shortened survival leading to a haemolytic anaemia buy risperidone 2 mg on line medicine doctor, and also can block small vessels leading to tissue infarction buy risperidone with amex treatment 3 phases malnourished children. Sickle cell disease has a very variable clinical course due to a combination of reasons including the haemoglobin F (HbF) level and socio-economic factors. It usually presents in early childhood with anaemia and jaundice due to a chronic haemolytic anaemia, or painful hands and feet with inflammation of the fingers due to dactylitis. This patient is having a pulmonary crisis characterized by pleuritic chest pain, shortness of breath and hypoxia. It is usually precipitated by dehydration or infection (in this case, a sore throat). The principal differential diagnoses of a patient presenting with pleuritic pain and breath- lessness are pneumonia, pneumothorax and pulmonary emboli. Major potential complications of sickle cell disease • Thrombotic: causing generalized or localized bony pains, abdominal crises, chest crises, neurological signs or priapism. This patient should be admitted for rest, intravenous fluids, oxygen and adequate anal- gesia. The definitive investigation is haemoglobin electrophoresis which will demonstrate HbS, absent HbA and a variable HbF level. Partial exchange transfusion may be needed to reduce the level of his sickle cells to less than 30 per cent. He should be followed up by an expert sickle team since this has been shown to reduce admissions and improve quality of care. He may benefit from long-term hydroxyurea which raises the HbF level and reduces the number of crises. She has had the occasional episode of acute cystitis, approximately on a 2-yearly basis. Examination of the cardiovascular and respiratory systems is otherwise unremarkable. Acute appendicitis classically presents with a short his- tory of central abdominal pain which rapidly localizes to the right iliac fossa. There is guard- ing and ‘board-like’ rigidity and rebound tenderness in the right iliac fossa. Untreated, some cases will resolve spontaneously, whereas others will perforate leading to localized or gener- alized peritonitis. Rarely a delayed diagnosis may result in acute appendicitis progressing to an appendix mass consisting of a haemorrhagic oedematous mass in the ileocaecal region. The symptoms of loin pain and presence of blood and protein in the urine mimicking a urinary tract infection suggest the appen- dix may be retrocaecal. Patients with retro-ileal appendicitis often have little abdominal pain, but irritation of the ileum can lead to severe diarrhoea and vomiting. Patients may also present with subacute intestinal obstruction due to intestinal ileus, or urinary reten- tion due to pelvic peritonitis. Differential diagnosis of acute appendicitis • In young adults the differential diagnoses include irritable bowel syndrome, non- specific mesenteric adenitis, ruptured ectopic pregnancy, twisted or haemorrhagic ovarian cysts, infection of the Fallopian tubes and urinary tract infections. The treatment is appendicectomy as soon as urinary tract infection has been excluded. A 62-year-old lady had been admitted 10 days previously to have a right hemicolectomy performed for a cae- cal carcinoma.

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Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care generic risperidone 2mg treatment ulcerative colitis, 7th Edition buy line risperidone medications requiring prior authorization. Conventional level: This level is obtained when According to Havighurst buy risperidone 2mg with mastercard medications jaundice, the developmental tasks person becomes concerned with identifying with of later adulthood include adjusting to decreasing significant others and shows conformity to their physical strength and health cheap risperidone 4mg without a prescription medicine everyday therapy, adjusting to retirement expectations. Example: A college student gets all and reduced income, and establishing physical A’s in college so his parents will think he is a living arrangements. Postconventional level: This level is associated of dependency on healthcare providers and his with moral judgment that is rational and inter- family. The nurse could then base the nursing plan nalized into one’s standards or values. Example: of care on interventions to foster feelings of A bank teller resists the urge to steal money from personal dignity and worth. Logan states that he is willing to participate in latency stage and will be experiencing increased his care plan and do everything in his power to interest in gender differences and conflict and adjust to his situation by accepting the assistance of resolution of that conflict with parent of same others when necessary sex. Erikson: The 6-year-old is becoming achievement ethical/legal competencies are most likely to bring oriented, and the acceptance of parents and about the desired outcome? Havighurst: The 6-year-old is ready to learn the mental theories to nurse care planning developmental tasks of developing physical Technical: ability to provide technical nursing assis- skills, wholesome attitudes toward self, getting tance to Mr. Logan as needed along with peers, sexual roles, conscience, moral- Interpersonal: ability to use therapeutic communi- ity, personal independence, and so on. An illness cation to meet the emotional and spiritual needs of could stall these processes. Piaget: The 6-year-old is in the preoperational Ethical/Legal: ability to advocate for the unmet stage, including increased language skills and developmental needs of Mr. Kohlberg: Moral development is influenced by Home healthcare services, community services, cultural effects on perceptions of justice in inter- support groups personal relationships. Moral development begins in early childhood and could be affected by a traumatic illness. A health problem of any family member can affect the Chart/Exhibit Questions remainder of the unit. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Age group—Physiologic characteristics and behaviors I—Is in oral stage (Freud); strives for immediate P—Motor abilities include skipping, throwing and gratification of needs; strong sucking need. A—In Freud’s genital stage, libido reemerges in I—Brain grows to about half the adult size mature form. N—Reflexes include sucking, swallowing, blinking, T—Is in anal stage (Freud); focus on pleasure of sneezing, and yawning sphincter control N—Temperature control responds quickly to A—Self-concept is being stabilized, with peer group environmental temperatures as greatest influence. T—Walks forward and backward, runs, kicks, climbs, I—Develops trust (Erikson) if caregiver is and rides tricycle dependable to meet needs T—Drinks from a cup and uses a spoon S—Achieves personal independence; develops con- A—Sebaceous and axillary sweat glands become active science, morality, and scale of values S—Height increases 2 to 3 inches, weight increases A—Tries out different roles, personal choices, and 3 to 6 lbs a year beliefs (identity versus role confusion) A—The feet, hands, and long bones grow rapidly; I—Meets developmental tasks (Havighurst) by muscle mass increases. A—More mature relationships with both males and P—Full set of 20 deciduous teeth; baby teeth fall females of same age out and are replaced. T—Enters Erikson’s stage of autonomy versus shame P—Body is less chubby and becomes leaner and and doubt more coordinated. P—Is in Erikson’s stage of initiative versus guilt A—Primary and secondary development occurs A—Inner turmoil/examination of propriety of with maturation of genitals. T—Developmental tasks of learning to control elim- I—Motor abilities develop, allowing feeding self, ination; begins to learn sex differences, concepts, crawling, and walking. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Preschooler: A preschooler may have fear of pain S—Is in Erikson’s industry versus inferiority stage and body mutilation as well as separation anxi- 3. Preembryonic stage: Lasts about 3 weeks; zygote ety that must be recognized by the nurse.

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They compared the meanings Sweden purchase risperidone 3mg on-line treatment of strep throat, Switzerland risperidone 2 mg otc medicine 1950, the United Kingdom generic 3mg risperidone with mastercard 97140 treatment code, Hong of self-care among Americans order risperidone 3mg without a prescription medicine research, German, and Kong, Taiwan, Thailand, Turkey, Canada, Mexico, Swedish populations. In addition to the cross-cultural comparative re- Moreover, over the past 15 years, the author has search, the Self-Care Deficit Nursing Theory is been privileged to be a part of an international net- being applied in studies with specific cultural work of nurse scholars and scientists focused on the groups. In an ethnographic study based on con- development of disciplinary knowledge derived cepts within Orem’s theory, Villarruel (1995) ex- from the Self-Care Deficit Nursing Theory. Our plored the cultural meanings, expressions, self-care, collaborative work began in 1983 when the author and dependent care actions related to pain with a was invited as a consultant to the faculty of health Mexican American population and commented on sciences at the University of Maastricht in the the theory’s use with this population. Dashiff Netherlands to assist faculty and students in devel- (1992) applied Orem’s theory in her description of oping programs of nursing theory–based research. In 1986, we extended the are currently using the Self-Care Deficit Nursing seminars to include nurses from all parts of Europe. The participants studied the Self- research work cited above was funded in part by Care Deficit Nursing Theory, research methodol- a variety of agencies: the Netherlands Heart ogy, and the interrelatedness of theory and Foundation, the Swiss National Fund, Fulbright research. Each participant developed a self-care Scholarship, Finnish Academy of Science, and the theory-based research project that could be imple- Kellogg Foundation. To date, specific knowledge and, by means of transnational compar- propositions of the theory have been tested in nine isons, identify culture-specific knowledge. Through this theory testing program of current shared programs of research focus on: research, data are being accrued that will provide (1) influences of aging on the self-care abilities answers to the question,“To what extent is the Self- of Americans (Jirovec & Kasno, 1990), Canadians Care Deficit Nursing Theory relevant to the global (Ward-Griffin & Bramwell, 1990), Danes (Loren- community? In 1991, the International Orem Society for lems, such as coronary artery disease, on the self- Nursing Science and Scholarship was founded. The care abilities of Americans (Isenberg, 1987, 1993), society’s mission is to advance nursing science and Canadians (Aish & Isenberg, 1996), and Dutch scholarship through the use of Dorothea E. Orem’s clients (Isenberg, 1993; Isenberg, Evers, & Brouns, nursing conceptualizations in nursing education, 1987; Senten, Evers, Isenberg, & Philipsen, 1991). The results of her study indicated Practice that health state was the predominant predictor of women’s self-care agency and self-care perfor- In this section, we focus on the ways in which the mance (Gallegos, 1997). The level of poverty Self-Care Deficit Nursing Theory is guiding nurs- experienced by the Mexican women also had a sig- ing research because the theory’s utility to nursing nificant influence on their self-care performance. Since the pioneering efforts of Crews (1972) and Backscheider (1974) in the use of the Ailinger, R. Arthritis Care and Research, 6(3), theory in structuring and organizing nursing care 134–140. An examination of the self- have been proclaiming the usefulness of the theory care needs of clients with rheumatoid arthritis... Rehabilitation Nursing, 22(3), guide practice across a wide range of nursing situa- 135–140. An investigation of a nursing system to support tions in all types of care settings, ranging from nutritional self-care in post myocardial infarction patients. Effects of Orem-based to the care of patients in intensive care units nursing intervention on nutritional self-care of myocardial infarction patients. Self-care requirements, self-care capa- ages with all kinds of health-deviation self-care req- bilities and nursing systems in the diabetic nurse manage- uisites and developmental requisites. The influence of health status, burden, and degree of cognitive impairment on the self-care agency and of ambulatory adolescent transplant recipients. Unpublished Nursing services based on Orem’s theory were doctoral dissertation, Wayne State University, Detroit.

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