Thorazine

By O. Farmon. Mount Vernon Nazarene College. 2018.

The voice simply becomes more insistent until you have no choice but to open your eyes purchase thorazine 100mg with mastercard. This is to determine if the medication is having an effect or if the patient is experi- encing an undesirable side effect buy thorazine 100 mg overnight delivery. In cases where the patient is being treated with a narrow spectrum antibiotic discount thorazine 100mg free shipping, blood may be drawn to determine if the antibiotic is working on the infection. Administering medication, evaluating the patient’s response, and determining if the drug is working as planned are pharmacology activities that are part of the nursing process. This chapter takes a look at the nursing process as it relates to giving medications. During the assessment step, the nurse is gather- ing subjective and objective data from the patient that will later be used to arrive at a nursing diagnosis. Subjective data is information that is reported by the patient such as, “I’m feeling warm. Diagnosis is the patient’s problem, which is determined by analyzing data collected during the patient’s assessment. The data could lead the nurse to deter- mine that the patient has more than one problem. For example, a nurse might diagnose an alteration in mobility in a patient who has had a stroke. The nurse might also determine this patient has a potential for alteration in nutrition because he or she is having difficulty swallowing because of the stroke. The plan takes the form of a care plan that itemizes the patient’s nursing diagnosis. The care plan contains at least one nursing intervention for each nursing diagnosis, the expected out- come for each intervention, and how the nurse will evaluate the outcome. For example, the final outcome goal for an alteration in mobility might be to have the patient get out of bed and ambulate without assistance. However, the inter- ventions will begin with getting the patient out of bed and to the chair or assist- ing the patient to walk short distances each day. For example, the nurse will assist the patient to the chair the first time and might delegate the task to a nursing assis- tant thereafter if the patient does not have any problems. If the patient continues to have no problems getting out of bed, the nurse may change the interventions to include walking short distances in addition to getting out of bed and increase those distances each day. When the patient is able to get out of bed and walk without assistance, the final goal will have been achieved. If the nurse determines during the evaluation step that the intervention didn’t work or the expected outcome has been achieved, the nurse begins the nursing process again, starting with the assessment step and then revises the care plan as the patient’s problem changes. A portion of the assessment process directly relates to administering medication to the patient. Before medication is given to a patient, the nurse must make the follow assessments. A drug order must be written by a physician, dentist, physician assistant, or advanced practice nurse and contain: • The date and time the order is written • The name of the drug • The dosage • The route of administration • The frequency of administration • The duration (how long the patient is to receive the drug) • The signature of the prescriber Identify the brand and generic name for the drug Drugs are known under several names. The nurse is required to know why the drug is given to the patient and what symptoms a patient exhibits to indicate that the drug should be administered. The nurse cannot rely solely on the prescriber because the patient’s condition might have changed since the patient was assessed. These include, but are not limited to, writing an order or a prescrip- tion for the wrong patient, for a drug to which the patient is allergic, for a drug that will interact badly with another drug the patient is taking, a dose that is too small or too large for the patient based on weight, or simply the wrong drug. Medication errors can be reduced or eliminated if everyone involved in the process uses critical thinking skills and checks and double checks the orders, the patient, and the medication. It is critical that the nurse understands how the drug is absorbed, distributed, metabolized, and eliminated before administering the drug to the patient. For example, the patient might have lower than expected urinary output and is unable to excrete the drug in normal volume resulting in a potential toxic buildup in the body. The nurse must also know the drug’s onset of action, peak action, and dura- tion of action. As you’ll recall from the previous chapter, onset is the time period when the drug reaches the minimally effective concentration in the plasma. The effectiveness of a drug can be influenced by interactions with food, herbal remedies, and other drugs that alter or modify the drug’s action. Such interac- tions might increase the drug’s effectiveness, decrease it, or neutralize it. A side effect is a physiological response in the patient’s body that is not re- lated to the drug’s primary action. Some side effects are beneficial while side effects—such as nausea and vomiting—are undesirable. By knowing a drug’s possible side effects, the nurse can prepare to manage them before the patient is given the drug. A drug’s toxicity is the drug concentration in plasma and accumulation in tissues that exceeds the drug’s therapeutic range. The nurse must note the signs and symptoms that indicate the patient is having an adverse reaction to a drug or that the drug has reached toxic levels.

Te suspect was sentenced to death for the murder of his girl- friend’s three-year-old daughter order thorazine 100mg otc. Even though other forensic dentists con- cluded that the marks were not even bitemarks buy thorazine 100mg lowest price, the jury found him guilty generic thorazine 100mg online. Improved technology and an increasing awareness of previously untested assumptions by forensic dentists have developed. Tis is the result of a concerted efort by some forensic dentists to build a solid scientifc foundation and reliable protocols for bitemark comparisons. As a direct result of past mistakes there is now a better understanding by forensic dentists of the inherent variability and resulting distortion of marks lef by human teeth in human skin. Tere is an increasing acceptance by forensic dentists that there is rarely, if ever, a scientifc basis to justify an opinion that a specifc person in an open population made a bitemark on human skin with scientifc certainty, be it total or reasonable, science, the law, and Forensic identifcation based solely on the analysis of the pattern information. Scientifc studies being performed by forensic dentists are expected to demonstrate that there are reliable methods and approaches to comparing bitemark evidence that minimize the potential for subjective bias and other factors that have, in the past, led to errors. As these studies are examined and other studies are undertaken by the forensic dental community they are expected to improve this troubled area of forensic science. However, forensic odontologists and court reporters were very rare at that time; there is no dependable record of the event, analysis, comparisons, or testimony. Moreover, there were a limited number of suspects in this closed-population case and the suspects reportedly confessed. Agrippina the Younger, fourth wife of Emperor Claudius I and the ambitious mother by a previous marriage of Nero, contracted for the death of Lollia Paulina. To ensure that the contract was accurately concluded, Agrippina had Paulina’s head brought to her. Te confrmation of identifcation was made based on dental mis- alignments and other peculiarities. A signifcant battle during the invasion of the sacred city of Kanauji involved the sacking of the holy shrines of Muttra, the birthplace of Krishna, an important site in the Hindu religion. During the siege, Jai Chand, the Raja of Kanauji, was murdered afer being taken prisoner and was identifed by his false teeth when he was found among those slain. Te duke’s page was able to identify him according to his dentition, as he had lost some teeth in a fall years previously. Te fort was later captured by British General Forbes, who arranged to have the dead buried prior to leaving for Philadelphia. Tree years later, a Native American who had fought in the battle remembered Ofcer Halket and was able to lead Halket’s son to the area where he was killed during the battle. Joseph Warren—Paul Revere In Boston in 1776, at the battle for Breed’s Hill (often misidentified as Bunker Hill), Dr. His face was unrecogniz- able as he suffered a fatal head wound, a rifle ball to the left side of his face. Pattison Te earliest known use of a dentist as an expert witness in court occurred in 1814 in the case of a Janet McAlister in Scotland. Te night afer her burial, the trio was alleged to have moved her body to the nearby College Street Medical School. James Alexander, who was able to ft the dentures into 14 Forensic dentistry the skull. Te defense testimony stated the dentures could be “ftted to any skull” and, therefore, did not ft just this skull. Guerin’s identifcation was accomplished by the abrasions caused by clay pipes he had a habit of using when smoking. Te abrasive marks in the dentition were unique and were similarly described by multiple witnesses. Later, the son of the married couple accused them of murder, stating that he saw his mother leave the home with some- thing heavy and large in a bag. A woman ftting the description of the missing woman was found on the streets in a “squalid” condition and stated her name was Caroline Walsh. It was pointed out in the trial that the missing Caroline Walsh had perfect teeth. In 1816, a plan to erect a monument to the young prince generated rumors that he was still alive, now thirty-one years of age, and that another child had been buried in his place. In 1846, during the reconstruction of a church, a lead cofn containing the skeleton of a child was found near a side entrance. Milicent, a physician, examined the bones and concluded the child had died of bad health and neglect. Recamier, examined the bones and said they were those of an individual, ffeen or sixteen years of age. Recamier’s age assessment was accepted and the body was reinterred in an unmarked place. Based on tooth development, three experts aged the remains at between sixteen years plus and eighteen years plus.

In an attempt to clarify the problem of whether the obese eat more than the non-obese discount thorazine 100mg amex, Spitzer and Rodin (1981) examined the research into eating behaviour and suggested that ‘of twenty nine studies examining the effects of body weight on amount eaten in laboratory studies generic 100 mg thorazine amex. Therefore order thorazine 100mg otc, the answer to the question ‘do the obese eat more/differently to the non- obese? Over recent years, research has focused on the eating behaviour of the obese not in terms of calories consumed, or in terms of amount eaten, but more specifically in terms of the type of food eaten. Population data indicates that calorie consumption has decreased since the 1970s and that this decrease is unrelated to the increase in obesity (see Figures 15. However, this data also shows that the ratio between carbohydrate consumption and fat consumption has changed; whereas we now eat less carbohydrate, we eat proportionally more fat (Prentice and Jebb 1995). One theory that has been developed is that, although the obese may not eat more than the non-obese overall, they may eat proportionally more fat. Further, it has been argued that not all calories are equal (Prentice 1995) and that calories from fat may lead to greater weight gain than calories from carbohydrates. To support this theory, one study of 11,500 people in Scotland showed that men consuming the lowest proportion of carbohydrate in their diets were four times more likely to be obese than those consuming the highest pro- portion of carbohydrate. A similar relationship was also found for women, although the difference was only two- to three-fold. Therefore, it was concluded that relatively lower carbohydrate consumption is related to lower levels of obesity (Bolton-Smith and Woodward 1994). A similar study in Leeds also provided support for the fat proportion theory of obesity (Blundell and Macdiarmid 1997). This study reported that high fat eaters who derived more than 45 per cent of their energy from fat were 19 times more likely to be obese than those who derived less than 35 per cent of their energy from fat. Therefore, these studies suggest that the obese do not eat more overall than the non-obese, nor do they eat more calories, carbohydrate or fat per se than the non- obese. But they do eat more fat compared with the amount of carbohydrate; the proportion of fat in their diet is higher. As a possible explanation of these results, research has examined the role of fat and carbohydrates in appetite regulation. First, it has been suggested that it takes more energy to burn carbohydrates than fat. Further, as the body prefers to burn carbohydrates than fat, carbohydrate intake is accompanied by an increase of carbohydrate oxidation. In contrast, increased fat intake is not accom- panied by an increase in fat oxidation. Second, it has been suggested that complex carbohydrates (such as bread, potatoes, pasta, rice) reduce hunger and cause reduced food intake due to their bulk and the amount of fibre they contain. Third, it has been suggested that fat does not switch off the desire to eat, making it easier to eat more and more fat without feeling full. The evidence for the causes of obesity is therefore complex and can be summarized as follows: s There is good evidence for a genetic basis to obesity. Perhaps an integration of all theories is needed before proper conclusions can be drawn. Treatment approaches therefore focused on encouraging the obese to eat ‘normally’ and this consistently involved putting them on a diet. Stuart (1967) and Stuart and Davis (1972) developed a behavioural programme for obesity involving monitoring food intake, modifying cues for inappropriate eating and encouraging self-reward for appropriate behaviour, which was widely adopted by hospitals and clinics. The programme aimed to encourage eating in response to physiological hunger and not in response to mood cues such as boredom or depression, or in response to external cues such as the sight and smell of food or the sight of other people eating. In 1958, Stunkard concluded his review of the past 30 years’ attempts to promote weight loss in the obese with the statement, ‘Most obese persons will not stay in treatment for obesity. Of those who stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it’ (Stunkard 1958). More recent evaluations of their effectiveness indicate that although traditional behavioural therapies may lead to initial weight losses of on average 0. Therefore, traditional behavioural programmes make some unsubstantiated assumptions about the causes of obesity by encouraging the obese to eat ‘normally’ like individuals of normal weight. Multidimensional behavioural programmes The failure of traditional treatment packages for obesity resulted in longer periods of treatment, an emphasis on follow-up and the introduction of a multidimensional perspective to obesity treatment. Recent comprehensive, multidimensional cognitive– behavioural packages aim to broaden the perspective for obesity treatment and combine traditional self-monitoring methods with information, exercise, cognitive restructuring, attitude change and relapse prevention (e. Brownell and Wadden (1991) emphasized the need for a multidimensional approach, the importance of screen- ing patients for entry onto a treatment programme and the need to match the individual with the most appropriate package. State-of-the-art behavioural treatment programmes aim to encourage the obese to eat less than they do usually rather than encouraging them to eat less than the non-obese. Analysis of the effectiveness of this treatment approach suggests that average weight loss during the treatment programme is 0. In a comprehensive review of the treat- ment interventions for obesity, Wilson (1994) suggested that although there has been an improvement in the effectiveness of obesity treatment since the 1970s, success rates are still poor. Wadden (1993) examined both the short- and long-term effectiveness of both mod- erate and severe caloric restriction on weight loss.

Because of the experimental design cheap thorazine 100mg online, the results allow some conclusions to be made about the direction of causality cheap thorazine 100 mg without prescription. However safe 100 mg thorazine, as with many health- related behaviours, adherence to health promotion recommendations may be more motivated by short-term immediate effects (e. Therefore, understanding the immediate effects of exercise on mood has obvious implications for encouraging individuals to take regular exercise. Methodology Subjects The subjects were 36 male amateur athletes who were regularly involved in a variety of sports and exercised for more than 30 minutes at least three times per week, and 36 inactive men who exercised for less than 30 minutes per week. Design All subjects took part in two exercise sessions and completed measures of mood before and after each exercise session. Procedure At session one, all subjects completed a set of profile questionnaires (back- ground physical and psychological measures) and took part in a maximal exercise session on a cycle ergonometer. At session two, subjects were randomly allocated to 20 minutes of either maximal, moderate or minimal exercise. All subjects completed ratings of mood before exercise, 2 minutes after exercise and after 30 minutes of recovery. Measures The subjects rated items relating to tension/anxiety, mental vigour, depression/dejection, exhilaration and perceived exertion before and after each exercise session. In addition, all subjects completed measures of (1) personality and (2) trait anxiety once only at the beginning of the first session. Results The results were analysed to examine the effect of the differing degrees of exercise on changes in mood in the sportsmen and the inactive men. However, all subjects reported increased exhilaration and increased mental vigour two minutes after both the maximal and moderate exercise compared with the minimal condition, and in addition, the increase in exhilaration was maintained after the 30 minutes of recovery. Conclusion The authors conclude that both maximal and moderate exercise results in beneficial changes in both mental vigour and exhilaration in both sportsmen and inactive men and suggest that ‘exercise leads to positive mood changes even among people who are unaccustomed to physical exertion’. They also suggest that greater attention to the immediate effects of exercise may improve adherence to exercise programmes. Because of the potential benefits of exercise, research has evaluated which factors are related to exercise behaviour. The determinants of exercise can be categorized as either social/political or individual. Social/political predictors of exercise An increased reliance on technology and reduced daily activity in paid and domestic work may have resulted in an increase in the number of people having relatively seden- tary lifestyles. In addition, a shift towards a belief that exercise is good for an individual’s well-being and is relevant for everyone has set the scene for social and political changes in terms of emphasizing exercise. Therefore, since the late 1960s many government initiatives have aimed to promote sport and exercise. Factors such as the availability of facilities and cultural attitudes towards exercise may be related to individual participa- tion. Consequently, the Sports Council launched an official campaign in 1972 in an attempt to create a suitable climate for increasing exercise behaviour. Initiatives such as ‘Sport for All’, ‘Fun Runs’ and targets for council facilities, such as swimming pools and sports centres, were part of this initiative. In collaboration with the Sports Council, McIntosh and Charlton (1985) reported that the provision of council services had exceeded the Sports Council’s targets by 100 per cent. This evaluation concluded that: s Central government funding for sport and specific local authority allocations have helped participation in sport. This could take the form of vouchers for free access to the local leisure centre, an exercise routine with a health and fitness advisor at the leisure centre, or recommendations from the health and fitness advisor to follow a home-based exercise programme, such as walking. An alternative and more simple approach involves the promotion of stair rather than escalator or lift use. In addition, they can target the most sedentary members of the population who are least likely to adopt more structured forms of exercise. This is in line with calls to promote changes in exercise behaviour which can be incorporated into everyday life (Dunn et al. Research also indicates that stair climbing can lead to weight loss, improved fitness and energy expenditure and reduced risk of osteoporosis in women (e. For example, some research has explored the impact of motivational posters between stairs and escalators or lifts and has shown that such a simple intervention can increase stair walking (e. The results showed that larger posters were more effective at promoting stair use, that effectiveness was not related overall to whether the message emphasized time and health (i. Therefore, these initiatives have aimed to develop a suitable climate for promoting exercise. In addition, as a result of government emphasis on exercise, specific exercise programmes have been established in an attempt to assess the best means of encouraging participation. In particular it is possible to differentiate between individual and supervised exercise programmes. Using random telephone numbers they identified 357 adults, aged 50–65, who led relatively sedentary lifestyles.