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Foods to include: • Lean meats generic prevacid 30 mg otc, fish and poultry discount prevacid 30mg on-line, fruits discount prevacid 15mg line, vegetables discount prevacid 15mg overnight delivery, corn, potato, rice, quinoa, and soy. Healthy fats (fish, nuts, and seeds) are very important to help restore essential fatty acids, which are depleted in those with celiac disease. Foods to avoid: • Foods containing wheat, barley, rye, bulgur, Kamut, spelt, and triticale, such as breads, pasta, cereals, baked goods, crackers, and pies. Note: Dairy should be limited initially as damage to the intestines reduces the ability to di- gest lactose (dairy sugar). These studies used pure oats, free of gluten contamination, and the amount per day was limited. The Canadian Celiac Association has stated that consump- tion of pure, uncontaminated oats is safe in the amount of 50–70 g per day (1/2–3/4 166 cup of dry rolled oats) by adults and 20–25 g per day (1/4 cup of dry rolled oats) by children with celiac disease. Note: Some individuals may not tolerate even pure oats, in which case they should be completely avoided. Lifestyle Suggestions To promote healing and support immune function, it is important to get adequate rest, reduce stress, and strictly adhere to the gluten-free diet. C Top Recommended Supplements Digestive enzymes: May be depleted in those with celiac; they aid proper digestion of food and are particularly important in newly diagnosed individuals. Essential fatty acids: Are highly recommended to correct deficiencies, reduce inflammation, and promote healing of intestinal cells. Look for a product that provides both omega-3 (fish) and omega-6 (borage, primrose) fatty acids. Multivitamin and mineral complex: This is absolutely essential to correct deficiencies and promote healing. The most common deficiencies include calcium, magnesium, iron, zinc, vitamins D and K, and folic acid. Even those who are stable on a gluten-free diet and in remission may still have nutrient deficiencies and would benefit from a supplement. Those with severe malnutrition and deficiencies may require higher than typical amounts. Complementary Supplements Fibre: Often deficient in a gluten-free diet due to the elimination of many grains, so supple- ments can help improve bowel function and prevent constipation. Green Food supplement: Provides vitamins, minerals, and fibre; improves energy and recovery. Probiotics: Support intestinal health, restore normal flora, and improve bowel function. Look for a product that is non-dairy, stable at room temperature and provides at least 1 bil- lion live cells. Eat a healthy diet, including fruits, vegetables, lean protein, healthy fats, and glu- ten-free grains. There are various grades of cervical dysplasia, which are classified upon the extent of the abnormal cell growth. Low-grade cervical dysplasia progresses very slowly and typically resolves on its own. High-grade cervical dyspla- sia tends to progress quickly and usually leads to cervical cancer. An estimated 66 percent of cervical dysplasia cases progress to cancer within 10 years. Cervical cancer constitutes more than 10 percent of cancers worldwide and is the second leading cause of death in women between the ages of 15 and 34. With early identifica- tion, treatment, and consistent follow-up, nearly all cases of cervical dysplasia can be cured and cervical cancer can be prevented. In some cases woman may notice: • Abnormal bleeding • Genital warts • Low back pain • Spotting after intercourse • Vaginal discharge Note: These symptoms are not unique to cervical dysplasia and may indicate a different problem. Every woman should have an annual Pap test beginning at age 18 and con- tinuing on past menopause. Many women stop having this done later in life, which is dangerous since the highest incidence of cervical cancer is among those over age 65. Cervical dysplasia is curable, although the lifetime recurrence rate is 20 percent. For early stages of cervical dysplasia doctors may simply recommend frequent moni- toring, as pre-cancerous changes may disappear on their own. The most commonly used procedures include laser therapy, cryocauterization (use of extreme cold to de- stroy abnormal tissue), and loop excision (using a wire loop to remove tissue). Your doctor takes a little scraping of cells in the cervical area for analysis by a laboratory. These natural therapies do not replace the need for regular medical examinations and doctor’s supervision. Dietary Recommendations Foods to include: • Increase intake of whole grains, fresh vegetables, and fruits. They also contain vitamin C, folate, and beta-carotene, which have been found to be deficient in those who develop cervical dys- plasia. Foods to avoid: • Alcohol, caffeine, refined foods, food additives, sugar, and saturated fats may affect hor- mone balance, impair immune function, and worsen symptoms. C • Red meat and dairy products may contain dioxins and chemicals that act as estrogen- mimickers. Lifestyle Suggestions • Minimize exposure to environmental estrogens or xenoestrogens (phthalates, parabens, and dioxins), which are present in pesticides, plastics, and certain skin care products. Indole-3-carbinol: A compound found naturally in cruciferous vegetables that aids in de- toxification of estrogen, protects liver function, and may protect against hormonal cancers. In one study supplements were found to improve lesions in those with cervical dysplasia. Complementary Supplements B-vitamins: Some research has shown that women with low dietary intakes of vitamins B1, B2, B12, and folic acid are at greater risk of developing cervical dysplasia and those with higher intakes of these nutrients from food and supplements are at lower risk. Not specifically studied for cervical dysplasia, but may help by reducing the harm- ful effects of estrogen. However, it is known that vitamin C sup- ports immune function and is an antioxidant that protects against cellular damage. Beta-carotene: Some research suggests that a deficiency in beta-carotene increases the risk of cervical dysplasia and cancer, and that supplements may promote a regression or decline C in the signs of cervical dysplasia. It is thought that women are more likely to report the symptoms to their doctors than men. However, these drugs can cause side effects that may actually be worse than the symptoms of the condition. These medications include antidepressants (Paxil, Zoloft, and Wellbutrin), anti-anxiety drugs (Xanax and Ativan), anti-inflammatory drugs (Motrin), and allergy drugs (antihistamines and decongestants).

Its sensory neurons order prevacid 30mg online, which send the only function of glial cells—whose name means sense data to the brain order 30 mg prevacid mastercard, are called afferent generic prevacid 15mg overnight delivery, or receptor generic 15mg prevacid overnight delivery, “glue”—was to hold the neurons together, but current re- neurons; motor neurons, which receive motor commands search suggests a more active role in facilitating commu- from the brain, are called efferent, or effector, neurons. The neurons, which consist of three elements— dendrites, cell body, and axon—send electrical impulses The brain is a mass of neural tissue that occupies the from cell to cell along pathways which receive, process, cranial cavity of the skull and functions as the center of store, and retrieve information. It is com- posed of three primary divisions: the forebrain, midbrain, Cerebral cortex and hindbrain, which are divided into the left and right hemispheres and control multiple functions such as re- See Brain ceiving sensory messages, movement, language, regulat- ing involuntary body processes, producing emotions, thinking, and memory. The first division, the forebrain, is the largest and most complicated of the brain structures and is responsible for most types of complex mental ac- Character tivity and behavior. It is involved in a huge array of re- sponses, including initiating movements, receiving sensa- General term in psychology used to describe be- tions, emoting, thinking, talking, creating, and imagining. Its parts, which are covered by the Character is most often used in reference to a set of cerebral cortex, include the corpus callosum, striatum, basic innate, developed, and acquired motivations that septum, hippocampus, and amygdala. These qualities of an in- dividual’s motivation are shaped during all stages of The midbrain, or mesencephalon, is the small area childhood. Its three sections are the traits that make up individual’s character are normally tectum, tegmentum, and crus cerebri. The term brain have been shown to control smooth and reflexive character is sometimes used as roughly synonymous movements, and it is important in the regulation of atten- with the term personality, although such usage does lit- tion, sleep, and arousal. Some psy- cephalon), which is basically a continuation of the spinal chologists believe that differences in character among in- cord, is the part of the brain that receives incoming mes- dividuals largely reflect affective, or emotional, differ- sages first. Lying beneath the cerebral hemispheres, it con- ences, that are the result of biochemical or other organic sists of three structures: the cerebellum, the medulla, and variations. Many psychologists claim that character, to the pons, which control such vital functions of the auto- some extent, is a function of experience. These psychol- nomic nervous system as breathing, blood pressure, and ogists, generally, believe that, as the early behavior of an heart rate. The cerebellum, a large convoluted structure at- individual directed toward a primary, instinctive goal is tached to the back surface of the brain stem, receives infor- modified by environmental circumstances, the motiva- mation from hundreds of thousands of sensory receptors in tional system of the individual is also modified, and the the eyes, ears, skin, muscles, and joints, and uses the infor- character of the individual is affected. There is some dis- mation to regulate coordination, balance, and movement, pute among psychologists about whether, or to what ex- especially finely coordinated movements such as threading tent, character may be controlled by conscious or ratio- a needle or tracking a moving target. The medulla, situated nal decisions, and about whether, or to what extent, char- just above the spinal cord, controls heartbeat and breathing acter may be dominated by unconscious or irrational and contains the reticular formation which extends into and forces. The pons, a band of nerve fibers connect- among psychologists that, while much research remains ing the midbrain, medulla (hindbrain), and cerebrum, con- to be done to delineate the genetic, instinctive, organic, trols sleep and dreaming. The pons and medulla, because cognitive, and other aspects of character, the develop- of their shape and position at the base of the brain, are ment of a reasonably stable and harmonious character is often referred to as the brainstem. Further Reading Character education, a periodic but recurring theme Changeux, Jean-Pierre. New York: Pantheon for schools to teach basic values and moral reasoning to Books, 1985. Character education initiatives have developed at the local and state levels, but reflect a na- tional trend. Opponents, including the American Civil Liberties Union, object to character education because it could lead to teaching religious be- liefs. Some religious groups oppose it as well, since pub- lic school teachers must avoid teaching religion and could make character a virtue that is anti-religious. Character Education in America’s Blue Ribbon Schools: Best Practices for Meeting the Challenge. Jean Martin Charcot 1825-1893 French psychiatrist who specialized in the study of hysteria, using hypnosis as a basis for treatment. In 1862 he was appointed senior physician at the in psychological or in physiological disturbances and, if Salpêtrière, a hospital for the treatment of the mentally physiological, where in the central nervous system the ill. It became a center for psychiatric training and psychi- abnormality might be located. Charcot became noted for atric care, for Charcot had a flair for theatrics in addition his ability to diagnose and locate the physiological dis- to his reputation for sound science, and his lectures and turbances of nervous system functioning. Finally, Charcot made popular the use of hypnosis Charcot’s contributions fall largely into three cate- as a part of diagnosis and therapy. First, he studied the etiology and cure of hysteri- the time as “mesmerism” (named for Franz Anton Mes- cal disorders (psychoneuroses). These disorders involve mer), was regarded by the medical profession as charla- what appear to be physiological disturbances such as tanism. Charcot found hypnotism useful in distinguish- convulsions, paralyses, blindness, deafness, anesthesias, ing true psychoneurotics from fakers and, like Mesmer, and amnesias. However, there is no evidence of physio- found that hysterical symptoms could be relieved logical abnormalities in psychoneuroses since the root of through its use. While in this condition, the patient was thought to be a disorder found only in women (the can sometimes recall events in his life which are not re- Greek word hystera means uterus), but his demonstra- called in the waking state, and he is susceptible to the tions were eventually influential in correcting this idea. In 1882 Charcot presented a Charcot, however, continued to think of hysteria as a fe- summary of his findings to the French Academy of Sci- male disorder. Freud was later to associate hysterical ences, where they were favorably received. One of the major Further Reading problems for early psychiatry was that of determining Guillian, Georges. An introduction to the history of medi- United States Department of Health and Human Services cine. Obviously, these categories are not mutually exclusive (that is, any given child can experience one or all, and all types of abuse are forms of “emotional maltreatment”). Statistically, it is difficult to find reliable national fig- Child abuse ures for cases of child abuse because each state keeps its The act of harming children by neglect, physical own records and has its own definitions of what consti- force, violence, sexual attack, or by inflicting psy- tutes abuse. One of the most commonly cited reports comes from Prevent Child For much of history, children were considered the Abuse America, formerly known as the National Com- property of parents. The family system was rarely, if mittee for the Prevention of Child Abuse headquartered in ever, intervened upon by society. If a mother or father Chicago, which conducts an annual national survey of the routinely abused their children, the abuse went unno- 50 states to acquire the most current data available. It was largely con- An estimated 3,154,000 children were reported to sidered a parent’s prerogative to do whatever he or she child protective service agencies as alleged victims of wanted with their child. This means that 45 children out of and, seemingly, the prevalence of child abuse have be- 1,000 were reported as abused or neglected and 14 con- come widespread. On average, three number of child abuse cases indicates increased occur- children died each day in the United States from abuse or rences of abuse or increased public awareness that en- neglect in 1997. These figures represent substantiated cases, four types, although many psychologists dispute the use- meaning they were investigated by child protection ser- fulness of doing so. Like any statistics on child abuse, these must be considered incomplete, since not all cases of abuse are reported. Telephone: toll-free (800) 422-4453 Still, newly arrived immigrants not yet acculturated •National Coalition Against Domestic Violence Telephone: (303) 839-1852 in the United States may, to their surprise, face social service intervention for their cultural practices toward • National Council on Child Abuse and Family Violence children, deemed as child abuse in the United States. Physical abuse does appear more frequently • National Runaway Switchboard in poor families. The possibility of abuse should be investigated if a child shows a number of these symptoms, or any of them to a marked degree: Sexual Abuse Being overly affectionate or knowledgeable in a sexual way inappropriate to the child’s age Medical problems such as chronic itching, pain in the genitals, venereal diseases Other extreme reactions, such as depression, self-mutilation, suicide attempts, running away, overdoses, anorexia Personality changes such as becoming insecure or clinging Regressing to younger behavior patterns such as thumb sucking or bringing out discarded cuddly toys Sudden loss of appetite or compulsive eating Being isolated or withdrawn Inability to concentrate Lack of trust or fear someone they know well, such as not wanting to be alone with a babysitter Starting to wet again, day or night/nightmares Become worried about clothing being removed Suddenly drawing sexually explicit pictures Trying to be “ultra-good” or perfect; overreacting to criticism Physical Abuse Unexplained recurrent injuries or burns Improbable excuses or refusal to explain injuries Wearing clothes to cover injuries, even in hot weather Refusal to undress for gym Bald patches Chronic running away Fear of medical help or examination Self-destructive tendencies Aggression towards others Fear of physical contact—shrinking back if touched Admitting that they are punished, but the punishment is excessive (such as a child being beaten every night to “make him/her study”) Fear of suspected abuser being contacted Emotional Abuse Physical, mental, and emotional development lags Sudden speech disorders Continual self-depreciation (“I’m stupid, ugly, worthless, etc.

If the victim Intellectual: knowledge of developmental variables has no pulse generic 15mg prevacid overnight delivery, artificial circulation must be affecting respiratory function started with breathing order prevacid 30 mg fast delivery. The nurse is responsible for collecting the baseline necessary to diagnose and treat respiratory problems data before the examination generic prevacid 30mg with mastercard. Pain medication Ethical/Legal: knowledge of patients’ and families’ should be administered before the test if rights related to refusal of care requested generic prevacid 30mg fast delivery. Objective data are underlined; subjective data are in procedure, the nurse should observe the patient boldface. A chest x-ray is usually Toni is a 14-year-old girl who is in the adolescent done to verify the absence of complications. Help the patient assume a position that allows chart reveals that on several occasions when her free movement of the diaphragm and expansion mother was visiting, she began hyperventilating of the chest wall to promote ease of respiration. Keep the patient’s secretions thin by asking the ing for breath on these occasions, she nevertheless patient to drink 2 to 3 quarts of clear fluids daily. Perform cupping on the patient’s lungs to the midst of a divorce and that it hasn’t been easy loosen pulmonary secretions. Use vibration to help loosen respiratory rough time at school, and I guess I’ve been too secretions. McIntyre’s chart for ratory rate and rhythm (not to exceed 24) during advance directives or a living will and if one is not her mother’s visits. A counselor could be called in to facilitate the its probable cause, and its effect on her lifestyle. Demonstrate consciously controlled breathing should take into consideration age-related changes and encourage her to use it during periods of that may be increasing Ms. What would be a successful outcome for this patient and maintain eye contact during conver- patient? If fear is the cause of her anxiety, encourage her to of, and signs, an advance directive to direct her express concerns. What intellectual, technical, interpersonal, and/or with the patient the possibility of developing effec- ethical/legal competencies are most likely to bring tive coping skills with professional counseling. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Osmosis: The solvent water passes from an area of lesser solute concentration to an area of greater solute concentration until an equilibrium is established. The solute moves from an area of higher concentration to an area of lower concentration until an equilibrium is established. Active transport: A process that requires energy for the movement of substances through a cell membrane from an area of lesser concentration to an area of higher concentration. Ingested liquids: Fluid intake is regulated by the thirst mechanism and is stimulated by intracel- lular dehydration and decreased blood volume. Metabolic oxidation: Water is an end product of oxidation that occurs during the metabolism of food. Kidneys: Approximately 170 L of plasma is filtered daily in the adult, while only 1. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Increased hematocrit: Severe dehydration and vessels are responsible for pumping and carry- shock (when hemoconcentration rises consider- ing nutrients and water throughout the body. Thyroid: Thyroxine, released by the thyroid of incompatible blood gland, increases blood flow in the body. Increased hemoglobin: Hemoconcentration of turn increases renal circulation, which results the blood in increased glomerular filtration and urinary d. Nervous system: The nervous system acts as a select electrolytes switchboard and inhibits and stimulates mecha- c. Respiratory acidosis: An excess of carbonic acid attempt to prevent losses when possible. Physiologic changes that accompany the aging and resulting in the retention of carbon diox- process may affect the patient’s ability to main- ide. Select a vein large enough to accommodate the concentration increases, the kidneys retain needle. Select a site while moving toward the heart and carbon dioxide is being excreted faster than away from a damaged vein. The kidneys attempt to alleviate this changes, assessing patient for evidence of imbalance by increasing bicarbonate excretion infection or other complications, and maintaining and hydrogen retention. The kidneys excrete potas- should also be aware that fluid restriction may be sium and sodium along with excess bicarbonate ordered and prepare the patient by explaining the and retain hydrogen within carbonic acid. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The nurse could fluid/day; (2) urine specific gravity within normal then work with the patient to develop short-term range (1. Fluids could be served in small Nursing Interventions: cups to make the cup appear to contain more liquid a. Give oral fluids that are nonirritating, as nurse should provide oral hygiene at regular inter- tolerated. What intellectual, technical, interpersonal, and/or output average 2,700 mL fluid/day; pulse returned ethical/legal competencies are most likely to bring to baseline; skin turgor improved; mucous about the desired outcome? Patient strengths: Previously healthy; concerned maintain fluid, electrolyte, and acid–base balance friends; highly motivated to correct deficit Technical: ability to use the equipment and proto- Personal strengths: Strong knowledge of fluid, elec- cols necessary to maintain and restore fluid, trolyte, and acid–base balance; good interpersonal electrolyte, and acid–base balance skills Ethical/Legal: strong sense of accountability for the 4. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Actively demonstrate your commitment to nursing and concern about the nursing profes- 1. Sample answer: sion’s public image: Nurses should be aware of Nurses interacting with older adults need to take their impact on society, and the image they simple measures such as addressing older patients project should be positive. Developmental considerations: A teenager Patient goal: Patient will express satisfaction needs to be trusted and guided to make good with ability to live with altered body image. Culture: As a child internalizes the values of or manage new role parents and peers, culture begins to influence Patient goal: Patient reports feeling less anxious his/her sense of self. Diagnosis: Altered Health Maintenance related money a person earns may influence his/her to low self-esteem and inability to cope with self-concept. History of success or failure: A child who Patient goal: Patient will acknowledge his own repeatedly fails in school may have difficulty self-worth and express a desire to take care of succeeding in life. Diagnosis: Knowledge Deficit: how to help person perceives stressors in his/her life and child develop self-esteem, related to lack of reacts to them. Aging, illness, or trauma: A paralyzing injury Patient goal: Patient will describe methods of will most likely affect self-concept. Dispel the myth that it is necessary to know all abuse, related to low self-esteem and sense of there is to know about nursing to be a good hopelessness nurse: Nurses must accept the fact that they Patient goal: Patient will verbalize that she is must constantly learn new theories and proce- liked and deserves to live without fear of abuse. Realistically evaluate strengths and weaknesses: changed body image, disturbance in self- A periodic review of a nurse’s skills, strengths, concept and weaknesses should be built into the Patient goal: Patient will describe self practice.