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When a nurse asks a patient how having a patient’s condition and help the nurse newborn at home will affect her lifestyle clarinex 5mg mastercard, she in planning care is asking a(n) type of a question purchase 5 mg clarinex fast delivery. A nurse who gathers data about a newly diag- nosed case of hypertension in a 52-year-old 7 discount 5 mg clarinex overnight delivery. Compares a patient’s current status to African American patient is performing a(n) baseline data obtained earlier type of assessment. 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. An 85-year-old African American man is ended questions, and reflective questions that admitted to the coronary care unit after could be used to elicit information from your experiencing a possible stroke. A teenage boy is admitted to the hospital children who has recently been diagnosed with severe stomach pains and a possible with diabetes; she is admitted to the hospital ruptured appendix. Closed questions: questions (closed, open-ended, reflective, direct) resulted in the best interviews. Recall the last time you went to a doctor’s office for a checkup or medical problem. What would assessment priorities when collecting patient you do to incorporate this learning into your data. Patient’s developmental stage: Use the following expanded scenario from Chapter 12 in your textbook to answer the questions below. Patient’s need for nursing: Scenario: Susan Morgan is a 34-year-old woman newly diagnosed with multiple sclero- sis. Explain when the immediate communication year and planned to do lots of hiking and of data is indicated. It’s not fair for him to be tied down to me if I can’t be the wife and partner that he thought he married. A 50-year-old woman with diabetes and diabetic foot ulcers is admitted to the emer- gency room for observation after she expe- rienced a blackout. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. What resources might be helpful for and/or ethical/legal competencies are most Ms. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Which of the following nursing diagnoses Circle the letter that corresponds to the best would be written when the nurse suspects that answer for each question. Nursing diagnoses are written to describe clearly the responsibility of the nurse? Tailoring treatment and medication potential health problem that can be regimens for each individual prevented or resolved by an independent d. Which of the following statements describe ate nursing diagnosis for a toddler who has the purpose of diagnosing? To identify a disease in an individual, negligence in providing a safe environment? To identify how an individual, group, or parents community responds to actual or potential b. High Risk for Injury related to impaired health and life processes home management c. Make sure the patient problem and etiology performed by the nursing staff are linked by the phrase “related to. Make sure defining characteristics follow vidual, group, or community can draw on the etiology and are linked by the phrase to prevent or resolve problems “as manifested by” or “as evidenced by. Write nursing diagnoses in legally advisable ing interventions to achieve outcomes for terms. A possible diagnosis is a clinical judgment about an individual, group, or community d. When a nurse writes a patient outcome that describing a suspected problem for which requires pain medication for goal achievement, additional data are needed. Patient complaints of chills and nausea are cluster of actual or risk nursing diagnoses considered significant data or. Which of the following nursing diagnoses are which the data can be compared are termed written correctly? When a nurse groups patient cues that point fluid loss to the existence of a patient health problem, b. Nutrition Deficit related to inability to eat a patient data indicating that patient teaching balanced diet and counseling for a colostomy is needed, a(n) should be written. What part of the following nursing diagnosis would be considered the etiology: Spiritual 4. Which of the following are accurate guidelines Distress related to inability to accept the death for writing nursing diagnoses? Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Match the examples listed in Part B with the True False four steps involved in the interpretation and 3. Answers will pattern, or model that can be used to compare be used more than once. A nurse compares a 15-month-old child’s terms for health problems that may be identi- motor abilities with the norms for that fied and treated by nurses. The problem statement of a nursing diagnosis recovering from a mastectomy, cries at identifies the physiologic, psychological, soci- night, refuses to eat, and sleeps all day. A nurse determines that a man with a his- the nurse suspects that a health problem tory of diabetes is highly motivated to exists but needs to gather more data to develop a healthy pattern of nutrition in confirm the diagnosis. In the diagnosing step, the nurse collects underlined word or words to make the statement patient data. Actual or potential health problems that can be prevented or resolved by independent Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. What questions would you ask a patient to appetite validate the following nursing diagnoses? No problem: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition.

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Various lists of hierarchies order clarinex 5 mg otc, differing in detail and terminology order 5mg clarinex, have been published buy 5mg clarinex with amex. Just to mention some, from the Bandolier group, in descending order of validity: 1. Evidence from published well-designed trials without randomisation, single group pre–post, cohort, time series or matched case- controlled studies. Evidence from well-designed non-experimental studies from more than one centre or research group. Opinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert consensus committees. Level 5, the lowest level, is not to be confused with simple expert opinion and personal experience that is sometimes called eminence-based medicine. Theory and clinical experience in eighteenth-century extemporaneous prescriptions – a reciprocal relationship? Oxford: Oxford University Press, 2006: 8 for comments about science and clinical practice, although the theme runs throughout the book. It is not the purpose to list herbal databases here, but another widely used in North America is Natural Standard. Unfortunately, the majority of sources of information on herbs do not provide evidence that a specific botanical specimen was gathered by or known to an informant. Reference to purgative action seems out of keeping with other uses that can be rationalised on the basis of astringency (see below) and confusion with another ‘alder’ (in fact, alder buckthorn) has to be considered. To offer just one point: a number of illnesses are listed because of a reputation to relieve a common symptom, although the latter is not specifically mentioned, e. Halifax: Nimbus Publishing, 1994: 22, on the use of alder in Conne River relates a case of ‘lameness’ – the patient recovered despite a doctor saying that there was ‘no cure’: ‘The individual collected a large bag of alder leaves and spent the following night treating the problem. The leaves were placed over the affected areas of the body, and were replaced with a fresh covering whenever they became “too hot. This account by Chief Joe has been told to many visitors to the Conne River reserve, especially on a walk through the community’s Medicine Trail. For example, from the writings of well-known herb author, Steven Foster: Black cohosh Cimicifuga racemosa (Actaea racemosa). The impact of the materia medica of the North American Indians on professional practice. The comment is based on a clinical paper in the same issue of the journal: Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and on various blood parameters in post- menopausal women: a double-blind placebo-controlled and conjugated estrogens-controlled 64 | Traditional medicine study. Intentional ignorance: a history of blind assessment and placebo controls in medicine. Hagar seemingly did not consider whether or not the ‘directions’ for preparing the seven sorts incorpo- rated, knowingly or unknowingly, empirical advice long recognised among Euro-North Americans for collecting herbs, e. Specifically for Conne River, a well-known healer Kitty Burke was said to be successful in making the plaster. Traditional Medicine, unpublished manuscript (copy kindly provided by Dr Margaret Mackey). Brief report – ethnomedicine: the sweat lodge healing experience: an integrative medical perspective. Aung generally follows the language commonly used, namely in terms of benefits from physical, mental and spiritual purification that discharges emotional and other forms of pollution. To reinforce that ‘ritual events’ span all areas of healthcare, the following references are useful: Montagne M. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. They have brought with them their own conceptions of the environ- ment and world, and amalgamated their diverse religious beliefs with those of the native groups. Traditionally, the elders are responsible for transmitting ancestral knowledge to their younger generations, but the Colombian State education system, contrary to that of the indigenous groups, separates the children from their elders. This has resulted in the present generation of indigenous children following a school curriculum with no allowance for a smooth transition between one system and the other. Similarly, there is an enormous gap between the traditional medicine practised widely in Colombia, and that of western medicine. These researchers looked at the process of adaptation to urban medicine while retaining native traditional medicine. The Colombian Amazon forest is inhabited by numerous native ethnic groups, migrants and colonists. They speak diverse languages and dialects, many of them from totally unrelated linguistic families and they all have their own particular traditions including medical practice. The sabedores live mainly in resguardos of the departments of Amazonas and Caquetá medio. Resguardos are areas protected by the Colombian government for the benefit of the indigenous people and environment. In the department of Amazonas alone there are 26 different ethnic groups recorded who live in 19 indigenous resguardos. As these groups live in the tropical forest, they have unsurpassed knowledge of survival and living in this environment. However, also due to living in this highly diverse habitat, the indigenous groups have been exposed to the effects of colonists and outsiders who have come to search for plants, animal skins and minerals. In particular, the Uitoto groups were victims of the rubber trade of the nineteenth and twentieth centuries where their numbers were reduced to a minimum as a result of slave labour and torture. Notwithstanding these influences, many of the ethnic groups have maintained their language and traditions. We refer to selected examples of traditional medicine used by a few of these Amazon ethnic groups, including indigenous elders who live on the border of Peru/Brazil/Colombia or in the Ecuadorian Amazon forest. Traditional Amazonian medical practice The Historia In spite of the problems involved, the elders of the Amazon ethnic groups continue to practise the traditions of their oral Historia, a mythical work that contains all the historical actions of the gods of creation of the universe, the world, humanity, origin of the pueblos and punishments (illnesses and healing, evilness and how to combat it). In this way, the ethnic groups follow their ancestral knowledge to achieve a valid manner for survival and maintenance of their daily lives. The Historia is related by means of ‘words of power’ in a sacred space in the maloca – the plurifamilial house for the extended family by the sabedores (see below). This includes how to make a diagnosis, look for possible cures, combat and allay spiritual illness, and extract ‘bad energies’ implanted by ‘spells’ and revenge, as well those of physical illnesses. To be recognised as a healer capable of managing and applying numerous techniques in the treat- ment of illnesses, the sabedor must demonstrate his powers of healing to his community and beyond. He or she must become familiar with the ritual plants, their effects and their results in order to ‘extract’ illnesses.

Local vasoconstrictive mediators unsuccessfully attempt to compensate quality 5 mg clarinex, making peripheries cold and cyanosed cheap clarinex 5 mg otc. Fluid resuscitation with colloids (see Chapter 33) should therefore restore colloid osmotic and perfusion pressures cheap clarinex 5 mg with mastercard, without compounding interstitial oedema. Exogenous albumin only temporarily increases serum albumin, so that endogenous production (through adequate nutrition) should be promoted. Shoemaker and Beez (1996) suggest that mortality correlates with oxygen debt, and so treatment to reverse oxygen debt improves survival prospects. Oxygen debt, the difference between oxygen demand and oxygen delivery, cannot be measured directly, but Shoemaker et al. Phospholipidase is activated by endotoxin, which then triggers the platelet activating factor (Clarke 1997). Implications for practice ■ severe shock necessitates close haemodynamic monitoring and observation Shock 261 ■ where possible, underlying causes of shock should be removed (e. Reviews of particular types of shock, such as Visser and Purday’s (1998) article on cardiogenic shock, appear periodically. Clinical scenario Brian Geller is a 62-year-old man, who was originally admitted to hospital with severe abdominal pain from ruptured gastric and duodenal ulcers. He admits to smoking more than 20 cigarettes and drinking over half a bottle of spirits per day. Surgery was performed and Mr Geller was recovering when he developed a chest infection. Review treatment goals and justify choice of: Invasive ventilation (mode, rates, volumes, etc. The syndrome is largely a creation of the success of intensive care: within living memory single failure of a major organ was usually terminal. The treatment and support of each organ and system follow those described in previous chapters, and so are not repeated here. Instead, this chapter provides a synthesis of progressive pathology, prognosis and issues specific to the syndrome as a whole, rather than the individual parts discussed elsewhere. The syndrome extends problems originating at cellular level, complex interactions of mediators creating a range of (sometimes contradictory) effects. Lack of consensus about both terms and interpretation hinders comparison; for example, prognosis is considerably better for failure of two rather than four major organs. However caused, gross ischaemia causes hypoxia, anaerobic metabolism and failure of most or all organs. Cytokines (especially tumour necrosis factor and interleukin 1) trigger hyperglycaemia and extreme protein catabolism (‘autocannibalism’) (Beal & Cerra 1994). As mitochondria develop abnormalities, energy production is severely impaired (Tan & Oh 1997b), leading to cell failure. Widespread cell failure impairs healing, exposing patients to further nosocomial infection (Tan & Oh 1997b). The liver, being especially rich in xanthine oxidase (Davidson & Boom 1995), is particularly prone to ischaemic damage. Systemic hypotension and hypoperfusion leads to hepatic and respiratory failure and renal failure, often (but not always) in that order. The lack of support for Shoemaker’s use of supranormal treatments is discussed in Chapter 25. Infection rates from central lines are far higher than from peripheral lines; sicker patients have more central lines, and so the risk to critically ill patients may not reflect the much cited sevenfold from peripheral versus ninetyfold from central lines. However, the transfer of drugs that can be given peripherally may enable removal of a central line, or the removal of an unused peripheral line, which may significantly reduce infection risks. Critically ill patients have low antioxidant levels (especially vitamins C and E) (Davidson & Boom 1995). Giving vitamin E, the most important intracellular chain-breaking antioxidant (Davidson & Boom 1995), appears particularly beneficial. Other antioxidants that may Multiorgan dysfunction syndrome 265 prove useful include intracellular glutathione (Davidson & Boom 1995) and enzymes such as cytosolic superoxide dismutase (which includes zinc, long used for skin healing). Reperfusion of ischaemic tissues which have survived through anaerobic metabolism flushes toxic oxygen metabolites and radicals into the cardiovascular system. These can trigger a further cascade of vasoactive and other endogenous chemicals (see Chapter 23). Apparent recovery can therefore be reversed with one or more vital organs failing for a second time. High incidence and paucity of curative (rather than supportive) treatments has encouraged a search for novel solutions. Such is the need that possible solutions are sometimes pursued with little (or even adverse) benefit. This chapter illustrates how progression from single to multiorgan failure remains the greatest challenge facing intensive care. Clinical scenario Brian Geller, a 62-year-old gentleman, was originally admitted to hospital with severe abdominal pain from ruptured gastric and duodenal ulcers. He is intubated, has a urinary catheter in situ, and an abdominal wound with one drain. This chapter concentrates on pathophysiology and medical interventions and treatments. As much nursing time is devoted to assisting doctors (monitoring, giving prescribed treatments), nurses need to understand pathology and treatments. A 1992 consensus conference modified terminology to Acute Respiratory Distress Syndrome (Bernard et al. Alveoli being inherently unstable and prone to atelectasis, surfactant lack causes high intra-alveolar pressures and barotrauma, accelerating alveolar collapse and pulmonary oedema formation. Terminology again varies, and in practice these two stages are part of a continuum rather than distinct entities; but descriptions are clinically useful to understand disease progression. The early or exudative stage, which begins as endothelial injury causes progressive pulmonary capillary permeability, results in ■ interstitial and alveolar oedema (DiRusso et al. Proliferative/fibrotic stages Early insults to lung tissue cause progression to diffuse problems. Treatment Preventing further ventilator-induced injury and system support are the main-stays of treatment. Conventionally, treatment aimed to normalise blood gases, but the excessive peak airway pressures needed to achieve this accelerate alveolar damage (barotrauma, volotrauma). Current treatment has moved from short-term aims of normalising blood gases to longer-term aims of limiting damage and recruiting alveoli (Artigas et al. Fluid management necessitates balancing adequate perfusion without aggravating pulmonary oedema.

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Top Recommended Supplements Antioxidants: Research on a specific combination and dosage of antioxidant vitamins and minerals found that they significantly reduced the progression of macular degeneration and the risk of further visual loss cheap clarinex 5 mg online. Note: 80 mg of zinc is a high dose generic 5mg clarinex visa, and can impair copper absorption generic 5mg clarinex mastercard, which is why it is important to also supple- ment with copper. Lutein: Studies have found that supplements can prevent disease progression and improve vision in those with both early and advanced macular degeneration. Complementary Supplements Fish oils: Mounting evidence supports the benefits of fish oil for reducing the risk of macular degeneration. Ginkgo biloba: Some research has shown that it can improve vision in those with macular degeneration. Eat more eye-healthy foods: carrots, spinach, broccoli, kale, collard greens, berries, peppers, citrus fruits, nuts, seeds, whole grains, and fish. While many people fear Alzheimer’s disease, only a small percentage of people over age 65 develop this disease. Memory loss can become more frequent and serious with age, but it is not a M consequence of aging. In order for our memory to function well, the brain requires healthy nerve cells and adequate supplies of blood, nutrients, and neurotransmitters (chemicals that relay messages between nerve cells). As we age, nerve cells shrink and damage to blood vessels can hamper circulation, which hampers the supply of blood and nutrients to the brain. There are many things that can be done to prevent age-related memory loss, such as physical and mental exercise, supplements, and dietary changes. Even those who are elderly and have experienced memory loss can take steps to improve their memory. Even a small stroke can impair memory, and a proper diagnosis and treatment are necessary to prevent further strokes. There are a few prescription medications that are used to help improve memory: M Hydergine (ergoloid mesylates) is reported to improve oxygen flow to the brain and improve memory and cognitive impairment. Eldepryl (selegiline) is a drug commonly used for treating Parkinson’s disease, but it also offers benefits for memory and brain function. The word “nootropic” comes from the Greek words noos, which means “mind,” and tropos, which means “changed” or “turn. Dietary Recommendations Foods to include: • Brewer’s yeast, wheat germs, spirulina, and eggs contain B-complex vitamins, which are essential for memory and cognitive function. Wheat germ and whole grains also contain the antioxidant vitamin E, which helps protect against free radical damage. In particular spinach, broccoli, and leafy greens have been shown to offer cognitive benefits. Foods to avoid: • Alcohol destroys brain cells and alters brain chemistry causing memory loss; minimize or avoid completely. Of the types of vegetables studied, green leafy vegetables had the strongest associ- ation with slowing the rate of cognitive decline. Also, reducing foods high in saturated fat and cholesterol and eating fish with beneficial omega-3 fatty acids, such as salmon and tuna, may benefit brain health (Neurology, 2006: 67; 1370–1376). Lifestyle Suggestions • Don’t smoke, as smoking damages blood vessels and hampers memory. Challenging the brain with such activities as reading, writing, do- ing puzzles and crosswords, and playing games stimulates brain cells and the connections between the cells, and may help improve memory and prevent cognitive decline. Being overweight increases the risk of high blood pressure and cholesterol, factors associated with memory loss. Top Recommended Supplements Acetyl-L-carnitine: An amino acid derivative that crosses into the brain and increases the levels of acetycholine, a brain neurotransmitter essential for memory and learning. Studies have found it helpful for improving memory and cognitive function in the elderly. Ginkgo biloba: Improves memory and cognitive function by increasing blood flow to the brain. It is particularly helpful for the elderly and those with atherosclerosis or Alzheimer’s. Dosage: 120–240 mg daily, standardized to 6 percent terpene lactones and 24 percent flavone glycosides. Several studies involving more than 1,000 people have found it effective in improving memory in both college-age people and the elderly. Complementary Supplements M Bacopa monnieri: An herb that has been shown to enhance several aspects of mental function. It increases availability of acetylcholine in the brain, which improves memory and cognition. A deficiency of B1, B6, and B12 is more common among the elderly, and can hamper memory and cognitive function. Those with poor intestinal health may require monthly injec- tions of vitamin B12. Melatonin: A hormone that regulates sleep/wake cycles; having adequate sleep is important for cognitive function. Supplements of melatonin have been found to improve sleep quality, mood, and memory. Vitamin E: A potent antioxidant that protects the brain from damage due to oxidative stress and inflammation. Studies in older adults have found that those with higher blood levels of vitamin E have better brain function. Consider supplements of acetyl-L-carnitine, fish oils, ginkgo biloba, and phospha- tidylserine. At puberty ovulation starts and eggs are released by the ovaries each month for the pur- pose of conception. As the years go by, the amount of eggs gradually declines until menopause, when the ovaries shut down and stop producing estrogen and progester- M one, the two main female sex hormones. Menopause occurs when ovulation ceases and a woman can no longer conceive naturally. After menopause the adrenal glands, which supply some sex hormones through- out life, become the primary source. Women who have poor adrenal function, which can be caused by chronic stress, poor diet, lack of sleep, or excessive caffeine, are not able to provide adequate hormone amounts, and may have more severe menopausal symptoms. There are many lifestyle measures and supplements that can promote hormone balance and ease menopausal concerns. The milestone of menopause is reached when a woman goes one year without a menstrual period. The average age for menopause is about 51 years, but it can oc- cur naturally between ages 40 and 55. During this time hormone levels fluctuate and the menstrual cycle becomes erratic, yet you may still be able to conceive. High cortisol levels caused by stress can negatively impact these hormones as well.

Neuman described this line of de- ogy following a reaction to stressors buy cheap clarinex 5 mg line, appropri- fense as an accordion-like mechanism that acts like ate ranking of intervention priorities buy clarinex 5 mg low cost, and a protective buffer system to help prevent stressor treatment to reduce their noxious effects safe 5mg clarinex. A holistic view of a dynamic open client-client system interacting with environmental stressors, along with client and caregiver collaborative participation in promoting an optimum state of wellness. What are the effects of short- Basic structure term loss of sleep, poor nutrition, or dehydration Basic factors common to all organisms, i. Will these sit- Normal temperature uations increase the possibility for stressor penetra- range tion? The answer is that the possibility for stressor Genetic structure Response pattern penetration may be increased. The actual response Organ strength or depends upon the accordion-like mechanism pre- weakness viously described, along with the other compo- Ego structure Knowns or commonalities nents of the client system. Normal Line of Defense n The normal line of defense represents what the client has become over time, or the usual state of The normal line of defense represents what the client has become over time, or the usual state of wellness. The nurse should determine the client’s usual level of wellness in order to recognize a change in the level of wellness. The normal line of defense is considered dynamic by Neuman, because it can expand or contract over time. Neuman also con- developmental, and spiritual variables occur siders the normal line of defense dynamic because and are considered simultaneously in each client concentric circle. Lines of Resistance Neuman identified the series of concentric circles that surround the basic structure as lines of resist- defense protects the normal line of defense. When the normal line of defense client has more protection from stressors when the is penetrated by stressors, a degree of reaction, or flexible line expands away from the normal line of signs and/or symptoms, will occur. The opposite is true when the flexible line ance are activated following invasion of the normal moves closer to the normal line of defense. Each fectiveness of the buffer system can be reduced by line of resistance contains known and unknown in- single or multiple stressors. These factors fense can be rapidly altered over a relatively short support the client’s basic structure and the normal time period. States of emergency, or short-term line of defense, resulting in protection of system in- conditions, such as loss of sleep, poor nutrition, or tegrity. Examples of the factors that support the dehydration, are examples of what the client is like basic structure and normal line of defense include in the temporary state that is represented by the the body’s mobilization of white blood cells and ac- flexible line of defense (Neuman, 1995). Accurately as- Maintenance of stability lines are penetrated in both reaction sessing the effects and possible effects and reconstitution phases of environmental stressors (inter-, intra-, Interventions are based on: and extrapersonal factors) and using Degree of reaction Resources appropriate prevention by interventions Goals to assist with client adjustments for an Anticipated outcome optimal level of wellness. The level of wellness affected by a condition and interacts with other may be higher or lower than it was prior to the variables in a positive or negative way. When the lines of resistance example of grief or loss (psychological state), which are ineffective, energy depletion and death occur may inactivate, decrease, initiate, or increase spir- (Neuman, 1995). Neuman believes Basic Structure that spiritual variable considerations are necessary The basic structure at the central core structure for a truly holistic perspective and for a truly caring consists of factors that are common to all organisms. Neuman offered the following examples of basic Fulton (1995) has studied the spiritual variable survival factors: temperature range, genetic struc- in depth. She elaborated on research studies that ture, response pattern, organ strength or weakness, extend our understanding of the following aspects ego structure, and commonalities (Neuman, 1995). She suggested Five Client Variables that spiritual needs include (1) the need for mean- Neuman has identified five variables that are con- ing and purpose in life; (2) the need to receive love tained in all client systems: physiological, psycho- and give love; (3) the need for hope and creativity; logical, sociocultural, developmental, and spiritual. The second concept identified by Neuman is the Psychological refers to mental processes and rela- environment. Developmental refers to life-developmental Neuman has identified and defined the following processes. Neuman elaborated on the spiritual variable in External environment—inter- and extrapersonal in order to assist readers in understanding that the nature. Examples of trates all other client system variables and supports intrapersonal forces are presented for each variable. The client-client sys- tem can have a complete unawareness of the Physiological variable—degree of mobility, range of spiritual variable’s presence and potential, deny its body function. These factors include the relationships and resources Health is the third concept in Neuman’s model. Extrapersonal fac- Neuman believes that wellness and illness are on tors include education, finances, employment, and opposite ends of the continuum and that health is other resources (Neuman, 1995). Wellness Neuman (1995) has identified a third environ- exists when more energy is built and stored than ment as the “created environment. Neuman cluding the basic structure of energy factors toward views health as a manifestation of living energy system integration, stability, and integrity to create available to preserve and enhance system integrity. This safe, created environment Health is seen as varying levels within a normal offers a protective coping shield that helps the range, rising and falling throughout the life span. A major objective of the created These changes are in response to basic structure environment is to stimulate the client’s health. The created envi- Nursing is the fourth concept in Neuman’s model ronment supersedes or goes beyond the internal and is depicted in Figure 18–4. The created environment provides an insulat- Nursing’s major concern is to keep the ing effect to change the response or possible re- client system stable by (1) accurately sponse of the client to environmental stressors. Neuman outcome of the created environment (extent of its defined optimal as the best possible health state use and client value), and (3) the ideal that has yet achievable at a given point in time. Nursing actions, to be created (the protection that is needed or pos- which she labels as prevention by intervention, are sible, to a lesser or greater degree). Neuman has cre- is necessary to best understand and support the ated a typology for her prevention by intervention client’s created environment (Neuman, 1995). They include primary prevention Neuman suggested that nursing may wish to pur- by intervention, secondary prevention by interven- sue and further develop an understanding of the tion, and tertiary prevention by intervention. Neuman pointed out that one or among the client, the environment, health, and all three of these prevention modalities give direc- nursing in the process of keeping the system stable. These formats are presented in the third stressor is suspected or identified, before a reaction edition of Neuman’s book (1995, pp. They protect the normal line of de- format demonstrates a process that guides infor- fense and strengthen the flexible lines of defense. The Neuman used the nursing process within three goal of these interventions is to “retain” optimal categories: nursing diagnosis, nursing goals, and stability or wellness. Comprehensive data are col- primary prevention along with secondary and ter- lected prior to formulating a nursing diagnosis. Once a reaction This process is facilitated using guides such as the occurs from a stressor, the nurse can use secondary assessment and intervention tool mentioned in prevention as intervention to protect the basic Neuman’s book (1995). Nursing goals are deter- structure by strengthening the internal lines of re- mined mutually with the caregiver–client-client sistance.

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And it is not because tional therapy order clarinex 5 mg free shipping, hypnosis 5mg clarinex with visa, osteopathy generic clarinex 5mg without a prescription, relaxation the mechanism is working wrongly, that I am ill. I techniques, guided imagery and visualization, am ill because of wounds to the soul, to the deep aromatherapy, homeopathy, meditation, yoga, emotional self” (The Complete Poems of D. The public This is testimony to what a good portion of the calls these “alternative medicines,” resonating population now refers to as “the mind-body con- with the part of the Constitution of the World nection. Traditional medicine has accomplished and Included are a great number of ‘systems,’ including continues to accomplish phenomenal strides in manipulative medicine, ayurveda, shiatsu, hypno- all aspects of medicine. However, many patients sis, biofeedback, acupuncture, acupressure, holistic who found no relief from traditional treatment medicine, macrobiotics, rolfing, Christian Science, began to seek help elsewhere—that is, in modal- reflexotherapy, homeopathy, aroma therapy, and ities that claimed no hard and fast scientific faith healing. This is not to say that, were these proof, but only a huge sweep of anecdotal suc- methods subjected to scientific study, all of them cess. Word spread, and now vis- ‘cures’ but still unproven because they haven’t its to a chiropractor are covered by most leading been scientifically tested or because tests show health insurance companies. In other words, chi- they’re ineffective or harmful,” and complementary ropractic entered and took root in the main- to “treatments used to support other evidence- stream, as have acupuncture, acupressure, and based therapies. Instead of curing cancer, comple- xvii xviii The Encyclopedia of Complementary and Alternative Medicine mentary treatments help control symptoms, reduce quantum physics, the biochemical molecules that stress, or improve well-being. His famous E = mc2 mathemati- native medicine practices, many of which are still cally described how matter and energy were resented or denounced by the American Medical interrelated. But many medical schools through- were, in fact, two different forms of the same out the country now see fit to include courses on thing. At the time Einstein came up with this con- patients’ emotional issues, nutrition (not histori- clusion, few scientists could entirely understand cally a standard medical-school course), and the its magnitude. Since all energy vibrates and like, and acknowledge that, indeed, there is a oscillates at different rates, then, at least at the mind-body connection working at top speed. Bernie Siegel, a renowned oncologist and And in the eyes of mainstream America as best-selling author, documented his experiences well. In the spirit of Frank Sinatra’s affable with what he says is obviously a connection remark, “I’m for whatever gets you through the between the palpable, visible, audible human night,” it has been reported that eight of 10 body and mysterious forces and mechanisms patients have tried alternative treatments, and of interpreted as “mind. Given the had the courage to come forward and report their thousands upon thousands of alternative practi- findings that support this concept include Dr. Norman his book, Radical Healing: Integrating the World’s Shealy, and hundreds of others. Finally, in the Great Therapeutic Traditions to Create a New Transfor- 21st century, mind-body ideas not only have mative Medicine, Rudolph Ballentine, M. By integrating Introduction xix them, superimposing one upon another in layer mat. If you come across an isolated term pertain- after layer of complementary perspectives and ing to alternative or complementary medicine, techniques, we can arrive at an amalgam that is you can look it up within these pages for identifi- far more potent and thorough than any one of cation and cross-reference. One of the most influential and beloved propo- • Sixty percent of physicians have referred nents of positive life change based on a better- patients to complementary care practitioners. In Self alternative therapies, including Blue Cross of Matters: Creating Your Life from the Inside Out (Simon Washington and Alaska, Blue Cross of Califor- and Schuster Source, New York, 2001), McGraw nia, California Pacific, Catholic HealthCare gives the basis for a self-improvement strategy West, HealthNet, Kaiser Permanente, Mutual of that easily applies to choosing health care: “Trust Omaha, Oxford Health Plans, and Prudential. At the same time, be ruthless about test- Health Benefit Services, based in California, ing your thoughts. Verify that your own internal that is geared toward creating greater credibility responses and interpretations will stand up to the and access for less invasive, more natural test of authenticity. Give yourself permission health care, and to enable all Americans to to generate as many alternative responses as pos- select the type of medical care and physi- sible. Replace any group is also parent to Holistic Health Insurance response that causes you trouble and pain with & Financial Services, Alternative Health Insur- one that moves you toward what you want, need, ance Administrators, the National Marketing and deserve. Instead we turn to our medicine their health plans should cover alternative cabinets. But rently valued at more than $24 billion, with a at the same time, record numbers of Americans growth rate of close to 15 percent per year are spending record numbers of their health care (Rauber, Modern Healthcare, September 1998). While some studies show holistic recommendations over the next year; that patients are generally happy with their own because patient acceptance is greater for these doctors, managed care, with its provider lists and therapies, better compliance results (Health required numbers of patients a doctor must see Products Research, Inc. Illustrated Encyclopedia of Natural Remedies, pointed • Eight states have passed health freedom (prac- out that the physician’s role is to be a “triage offi- tice protection) bills for M. Triage is usually associated with victims of Holistic Veterinary Medical Association among accidents, war, or natural disaster and is geared to the 27 U. Stead advised that when life and Medicine of the National Institutes of Health to function are not at risk, as in the vast majority of determine by objective scientific evaluation the symptomatic illnesses, the patient should ‘go into efficacy and safety of practices and procedures of the department stores and choose that which unconventional medicine; and encourages its most appeals. These powerful responses won’t reverse treatment options; (2) search for underlying every incidence of disease or illness; otherwise, causes of disease, as is preferable to treating only we would live forever. But by beginning to recog- symptoms; (3) use the Hippocratic idea (including nize these powers, we are enhancing vital ele- that the life forces pervade all of nature) of find- ments of the recovery process. When in the 1970s he was afflicted with person; (6) establish a high-quality relationship ankylosing spondylitis, a life-threatening degen- with the patient and encourage the patient to take erative spinal disease, and given a dim prognosis, responsibility for his or her health; (7) consider he decided to take massive doses of vitamin C in the needs, desires, awareness, and insight of both addition to his physician’s treatments and intro- patient and physician; (8) influence patients by duced laughter as the best medicine of all. After shame, greed, and depression; (11) adopt an atti- each laugh session, his doctor tested Cousins’s tude of unconditional love for all; and (12) pursue blood sedimentation rate (an indicator of the the highest qualities of the physical, environmen- status of inflammation in the body) and found tal, mental, emotional, spiritual, and social aspects that it dropped consistently, until, in 1976, of being human. The first The establishment of this and other organiza- published account of this experience appeared in tions promoting alternative and complementary the New England Journal of Medicine, and Cousins medicine would have likely been a source of per- received an honorary degree in medicine from xxii The Encyclopedia of Complementary and Alternative Medicine Yale University. Since then, laughter has actually and all the personal attraction that goes with been scientifically measured and shown to reduce them. People in general have given little attention stress and pain by creating changes in certain to health until it was destroyed. In addi- waited until they were ill before they thought of tion, increased antibody production in the upper the proper care of their bodies. Then they called respiratory tract; an increase of lymphocytes, in a doctor and there ended their responsibility, or cells that fight tumors and viruses; and the lung- at least so they thought. The idea that they alone expanding, heart rate–increasing exercise of might be responsible for their health or disease laughing all serve to encourage people to heed and that responsibility for their recovery rested on Proverbs 17:22: “A merry heart doeth good like a them and not on the doctor was foreign to their medicine. To them health and disease were largely Other respected figures in our society also con- matters of chance. All this has passed, or is rapidly tribute admirably to a more global view of healing. Health and disease are now known to be The Harvard-educated novelist and filmmaker subject to laws eternal and unchangeable, as are Michael Crichton, M. Individual responsibility for Power to Heal, wrote: one’s own health or disease is coming to be gen- erally recognized. With the generally growing Accompanying the use of more refined technol- recognition of this responsibility has come an ogy to prevent and treat illness, psychoimmunol- increasing interest in ways and means of preserv- ogy, the science that deals with the mind’s role in ing and restoring health. People are interested in helping the immune system to fight disease, will learning how to care for their own health. They become a vitally important clinical field in the are no longer content to place an almost unlim- years to come—perhaps the most important med- ited faith in potions and pills. The encouragement of healthy thinking may dating back so many years that pinpoints the eventually become an integral aspect of treat- medical climate of today. Does it imply that we ment for everything from allergies to liver trans- have stagnated to a certain degree in our thinking plants.