By U. Randall. Paine College. 2018.

Which of the metacarpal of the thumb is an example of following should the nurse consider when which of the following types of joints? Patients who can lift their legs only 1 to 2 inches off the bed do not have sufficient 15 order ivermectin 3mg. The base of support is on the soles of the to the floor buy 3mg ivermectin with visa, carefully protecting the pa- feet discount ivermectin 3 mg visa. Which of the following statements accurately ples of which of the following types of describe typical body movements? Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. For orthostatic hypotension, have the line patient sleep sitting up or in an elevated e. For impaired skin integrity, reposition the patient in correct alignment at least every a. Which of the following are accurate guidelines when teaching crutch walking to patients? Which of the following are accurate steps when assessing a patient’s mobility status? Adjust the bed to the flat position or as low alignment as the patient can tolerate. Head, shoulders, and hips aligned in bed and move down one side of the body at a e. For increased cardiac workload, instruct the patient to lie in the prone position. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The joints between the axis and atlas and the proximal ends of the radius and ulna a. Match the term used to describe body positions and movements in Part A with its definition listed in Part B. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Lateral movement of a body part toward the midline of the body Circle the word “true” or “false” that follows the statement. Movement of the sole of the foot inward the underlined word or words to make the 14. Ligaments are tough, fibrous bands that bind joints together and connect bones and carti- Match the condition related to muscle mass lage. Increased muscle mass resulting from the center of gravity, the greater the stability exercise or training of the object. Impaired muscle strength or weakness Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Should a patient faint or begin to fall while the location of a limb or body part as a result walking, the nurse should stand with his/her of joint movements stimulating special nerve feet apart to create a wide base of support and endings in muscles, tendons, and fascia. The cerebral motor cortex integrates semivol- untary movements such as walking, 14. Atelectasis is an incomplete expansion or col- reduce the energy needed to overcome the lapse of lung tissue. Briefly explain the effects of exercise and impossible, and the patient experiences immobility on the body systems listed in the extreme difficulty in walking. True False Body System Effects of Exercise Effects of Immobility Cardiovascular Respiratory Gastrointestinal Urinary Musculoskeletal Metabolic Integumentary Psychological Well-Being Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Briefly describe how the following devices are used to promote correct alignment or allevi- ate discomfort on body parts. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Give two examples of normal and abnormal findings when assessing the mobility status of a patient in the following areas. Mulherin is a 60-year-old woman admit- ted to a healthcare facility for degenerative Abnormal: joint disease. Explain how you would assess, diagnose, and plan an exercise program for this patient. Exercise program: ______________________ Normal: Abnormal: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Although the specifics of the medicolegal assessment of the male genitalia are case dependent generic ivermectin 3mg with amex, the principles of the examination 3 mg ivermectin visa, whether of the com- plainant or the defendant generic ivermectin 3mg mastercard, are the same. Penile Size Forensic practitioners may be asked to provide evidence on the size of a defendant’s penis in the flaccid state to support a hypothesis that a certain sexual act could not have occurred because of intergenital disproportion between the complainant and the defendant. However, such measurements are unhelpful because it is not possible to predict the maximum erectile size from the flaccid length, and there is “no statistical support for the ‘phallic fallacy’ that the larger penis increases in size with full erection to a significantly greater degree than does the smaller penis” (153). Furthermore, even when the erect penis is mea- sured during automanipulation or active coition, the measurements are recog- nized to be unreliable (153). Erections Forensic practitioners may also be asked to comment on a person’s abil- ity to achieve a penile erection, particularly if the male is young or elderly. Masters and Johnson (153) note that during their research, “penile erection has been observed in males of all ages ranging from baby boys immediately after delivery to men in their late eighties;” they report that one 89-year-old study subject was able to achieve a full penile erection and ejaculate. There- fore, it is not possible to reach a conclusion regarding erectile efficiency based on age alone. When a defendant reports erectile dysfunction, the expert opin- ion of a urologist should be sought. Penile erection may result from visual stimulation (including fantasy) or tactile stimulation. The penis, scrotum, and rectum are all sensitive to tactile stimulation (153), which may explain why involuntary penile erections can be experienced by a male subjected to nonconsensual anal intercourse. Semen Production Semen is not produced until the male experiences puberty, which usu- ally begins between 9 and 14 years of age (154). The normal volume of a single ejaculate is between 2 and 7 mL, and it will contain approx 50–120 million spermatozoa/mL. There are numerous congenital and acquired causes for impaired spermatogenesis (155), resulting in either decreased numbers (oligozoospermia) or absence of (azoospermia) spermatozoa. Both condi- tions may be permanent or transitory depending on the underlying cause. It is not possible to determine whether spermatozoa are present in the ejaculate without microscopic assessment. However, analy- sis of a defendant’s semen is not a routine part of the forensic assessment. Forensic Evidence After an allegation of fellatio, swabs from the complainant’s penis can be examined for saliva, but, as discussed earlier in Subheading 7. When an allegation of vaginal or anal intercourse is made, penile swabs from the sus- pect can be examined for cells, feces, hairs, fibers, blood, and lubricants. Swabs taken from the meatus and urethra are not suitable for microscopic assess- ment because some male urethral cells can be similar to vaginal cells (7). Therefore, when vaginal intercourse is alleged, two swabs (the first wet, the second dry) should be obtained sequentially from the coronal sulcus, and two additional swabs (the first wet, the second dry) should be taken sequentially from the glans and the shaft together. The swabs must be labeled accord- ingly, and the order in which the samples were obtained must be relayed to the scientist. The same samples are also taken if it is believed that a lubricant or condom has been used during a sexual act or if the assault involved fellatio or anal intercourse. Microscopic and Biochemical Analyses Such analyses of the penile swabs may be undertaken to identify cellular material, blood, or amylase. When the complaint is of anal intercourse, swabs that are discolored by fecal material can be analyzed for urobilinogen and examined microscopically for vegetable matter. Blood and feces have been recovered from penile swabs taken 15 and 18 hours, respectively, after the incident (for saliva, see Subheading 7. Medical Evidence When obtaining the relevant forensic samples, the forensic practitioner should inspect the male genitalia with particular reference to the following points: 1. Pubic hair should be described in terms of its coarseness, distribution (Tanner stages 1–5), and color. A note should be made if the pubic hair appears to have been plucked (including bleeding hair follicles), shaved, cut, or dyed. Acquired abnormalities, such as circumcision, Peyronie’s disease, balanitis xerotica obliterans, vasectomy scars, phimosis, tattoos, and piercing. Foreign bodies may be worn around the base of the penis, sometimes also encir- cling the scrotum, in an attempt to increase and sustain penile tumescence. Such devices may result in local and distal genital trauma (penile tourniquet syndrome) (157). In several case reports, children have had human hairs wrapped around the penis; these hairs may be virtually invisible because of edema or epithelialization (158). Kerry and Chapman (159) have described the deliberate application of such a ligature by parents who were attempting to prevent enuresis. After consensual sexual intercourse, lacerations of the foreskin and frenulum, meatitis, traumatic urethritis, penile edema, traumatic lymphangitis, paraphimosis, and penile “fractures” have all been described (160– 163).

A Extraction-synthesis is the process of moving the number of studies using the method have been descriptions from the language of the participants published over the past 15 years (for example discount 3 mg ivermectin fast delivery, see across levels of abstraction to the language of sci- Bournes buy generic ivermectin 3mg online, 2002a; Bournes & Mitchell cheap 3 mg ivermectin with amex, 2002; ence (Parse, 1998, 2001a). The structure, as evolved, answers the date with the world and friends and people. The extraction-synthesis process added, “my experience of feeling confident changes is illustrated here, beginning with Ben’s story. Sometimes I have confidence and other times I don’t, it depends on how familiar I am with Ben at 42 years of age said that feeling confident is “an the situation” and “on the feedback I get from the overall feeling good, like I have something to offer,” other person I am dealing with. If I feel intimidated and “like my thoughts and ideas have value and then I don’t always feel confident. He said, from the language art of all participants: buoyant “speaking with somebody and helping strangers who assuredness amid unsureness, sustaining engage- seem motivated or encouraged by what I have to say, ments, and persistently pursuing the cherished. They that’s makes me feel good, like I have done something were then synthesized into the structure. Artistic expression is “cocreating an descriptions of their patterns of relating with oth- artform incarnating the researcher’s transfiguring ers. Buoyant Assuredness Amid Unsureness The core concept, buoyant assuredness amid unsureness, captures participants’ descriptions of The first core concept, buoyant assuredness amid feeling confident as an uplifting experience of being unsureness, captures the participants’ descriptions certain, yet all-at-once uncertain about themselves of feeling confident as an enriching and exhilarating and about the people and projects in their lives. At feeling of surety experienced together with the the structural transposition level, the ideas cap- unsettling tentativeness of wavering with the ambi- tured by buoyant assuredness amid unsureness guity in their lives. As they spoke about their expe- are conceptualized as elated certainty-uncertainty. It’s the moments when the injury totally goes way people continuously experience doubt and un- away. I do not feel injured, I do not look injured, I sureness, even when they describe being energized do not think injured and it feels good, it provides and uplifted by a feeling of sureness about the peo- energy. I am still lacking cept connect the participants’ experiences of feeling confidence in my ability to return to work. I can’t confident with their having faith or trusting that, work hands on any more and I am afraid of the pain despite the continuous presence of unsureness, of not being able to do the job that I love. When I was first trying to get off the this study also demonstrate the ways others cocre- ventilator, I was terrified. They plugged the trach, ate persons’ experiences of certainty-uncertainty put a nasal cannula on me and said go to town. The descriptions that con- member anxiety over not being able to get enough tributed to the core concept of buoyant assured- oxygen. The nasal cannula had come out of my nose and the ness amid unsureness demonstrated the dimension nurse came and shoved it back and said, ‘You’re fine, of uncertainty that is emphasized with some pat- stop messing around. Looking at pictures of water-skiing Sustaining Engagements really gives me a whole new rush of confidence. The second core concept, sustaining engagements, Those pictures help refuel the fire. I have an intimate complishments, and relationships that “reawak- connection with my bicycle. One participant shared, dent as emboldening involvements with others, “I try to do things that make me feel good about activities, and objects. I with human becoming as connecting-separating— feel better about myself, because I am able to do the paradoxical rhythm of being with and away more, smile more, that is confidence inspiring. When the participants in this study spoke est little things, as small as being able to operate a about feeling confident in ways that led the re- door handle, gives me the confidence to keep on the searcher to the core concept of sustaining engage- healing path,” while someone else described feeling ments, they talked about the importance of being confident as a “freedom to believe in myself that I with and away from family, friends, health-care get from motorcycling, water skiing, and boating. For example, one partici- luminated in the words of one participant who de- pant described confidence as inspiring connections scribed feeling confident as the moments when she with old photographs of himself and his family tak- is either with someone, or she is doing something, ing part in activities from which he was simultane- and her injury “just disappears. And those episodes usually scribed connecting with people and activities— happen when I am dealing with a challenge and I such as skiing, horseback riding, public speaking, am managing it. I think that when it disappears for teaching, or attending school—that helped them me, people around me see it less too, and that’s di- to feel confident, yet also separating from the rectly related to confidence. Partici- evident in their descriptions of feeling loved, pants described feeling confident in relation to supported, and cared for. One participant said, connecting with either friends or health-care “Staying near the things I love, my friends and fam- providers who were helpful and who inspired their ily having confidence in me, every experience I face, confidence and separating from those who did not positive or negative, they all reawaken my confi- as they were persisting and striving to accomplish dence. When they fident in connection with sustaining engagements described their experiences of feeling confident, the with objects or symbols of their confidence. They described feeling confident as “hav- confident–feeling unsure, underscore the impor- ing drive,” “just going ahead,” “being willing to try tance of health professionals being available to bear again,” and “standing up for what you believe in. It also helps nurses and nected with “taking charge, moving forward, and others to understand that even though persons may focusing on buying a house, starting up a business, describe feeling confident about something in the [and] getting my life back into shape.

This enzyme breaks is given by injection eight-hourly (an oral preparation is also down imipenem in the kidney buy ivermectin 3mg on line. It is expensive generic 3 mg ivermectin with amex, although spectrum of activity against Gram-positive ivermectin 3mg amex, Gram-negative and when used against Gram-negative organisms that would other- anaerobic organisms. It is β-lactamase stable and is used for treat- wise necessitate use of an aminoglycoside, this cost is partly ing severe infections of the lung and abdomen, and in patients offset by savings from the lack of need for plasma concentra- with septicaemia, where the source of the organism is unknown. Meropenem is similar to imipenem, but is stable to renal dehy- Of the third-generation cephalosporins, ceftazidime, cef- dropeptidase I and therefore can be given without cilastatin. Imipenem is generally well tolerated, but seizures, myoclonus, confusion, nausea and vomiting, hypersensitivity, positive Adverse effects Coombs’ test, taste disturbances and thrombophlebitis have all About 10% of patients who are allergic to penicillins are also been reported. Some first-generation cephalosporins and can be used to treat central nervous system infection. Some of the third- Pharmacokinetics generation drugs are associated with bleeding due to increased Imipenem is filtered and metabolized in the kidney by dehy- prothrombin times, which is reversible with vitamin K. Imipenem is given intravenously as an infusion in three or four divided daily doses. They are powerful bactericidal agents that are active Aztreonam is primarily active against aerobic Gram-negative against many Gram-negative organisms and some Gram- organisms and is an alternative to an aminoglycoside. Gentamicin is widely used and has a Chloramphenicol inhibits bacterial ribosome function by broad spectrum, but is ineffective against anaerobes, many inhibiting the 50S ribosomal peptidyl transferase, thereby pre- streptococci and pneumococci. Amikacin is more effective than gentamicin for Adverse effects pseudomonal infections and is occasionally effective against These include: organisms resistant to gentamicin. Topical gentamicin or tobramycin anaemia occurs unpredictably with an incidence of eye drops are used to treat eye infections. Chloramphenicol accumulates in neonates (especially if Adverse effects premature) due to reduced glucuronidation in the immature liver (see Chapter 10). Therapeutic monitoring is performed by measuring plasma concentrations before dosing Pharmacokinetics (trough) and at ‘peak’ levels (usually at an arbitrary one hour Chloramphenicol is well absorbed following oral administra- after dosing). Eighth nerve damage is potentially catastrophic tion and can also be given by the intramuscular and intra- and is often irreversible. Drug interactions Pharmacokinetics Chloramphenicol inhibits the metabolism of warfarin, phenytoin and theophylline. Aminoglycosides are poorly absorbed from the gut and are given by intramuscular or intravenous injection. Distinctively, they are effective reduction and/or an increased dose interval is required. Uses include respiratory infections (including Mycoplasma pneumoniae, psittacosis and Legionnaires’ disease), whooping cough, Campylobacter enteritis and non-specific urethritis. It is useful for skin infections, such as low- Chloramphenicol has a broad spectrum of activity and pene- grade cellulitis and infected acne, and is acceptable for patients trates tissues exceptionally well. It is bacteriostatic, but is with an infective exacerbation of chronic bronchitis. It is most extremely effective against streptococci, staphylococci, commonly administered by mouth four times daily, although H. Nausea, vomiting, diarrhoea and abdominal cramps are the most common adverse effects reported, related to Pharmacokinetics direct pharmacological actions rather than allergy. Cholestatic Tetracyclines are well absorbed orally when fasting, but their jaundice has been reported following prolonged use. They undergo Intravenous administration frequently causes local pain and elimination by both the liver and the kidney. The shorter-acting drugs are given four times daily and the longer-acting ones once daily. Doxycycline is Erythromycin inhibits cytochrome P450 and causes accumu- given once daily, can be taken with food and is not contraindi- lation of theophylline, warfarin and terfenadine. Uses Azithromycin and clarithromycin are more expensive than erythromycin, but cause fewer gastro-intestinal side effects. Fusidic acid is combined with other drugs to treat staphylo- coccal infections, including penicillin-resistant strains. Gram-positive and Gram-negative organisms and, in addition organisms such as Rickettsia, Chlamydia and Mycoplasma. They Adverse effects are used in atypical pneumonias and chlamydial and rick- Adverse effects are rare, but include cholestatic jaundice. Pharmacokinetics They are not used routinely for staphylococcal or streptococ- When administered either orally or intravenously, its half-life cal infections because of the development of resistance. It is Mechanism of action eliminated by a combination of hepatic metabolism and renal Vancomycin inhibits bacterial cell wall synthesis.