By J. Sibur-Narad. Mesa State College.

Due to their rapid action and good skin penetration cheap 100 mg cafergot with amex, the main areas of application of al- cohols are surgical and hygienic disinfection of the skin and hands order generic cafergot line. Today best cafergot 100mg, phenol derivatives substituted with organic groups and/or halo- gens (alkylated, arylated, and halogenated phenols), are widely used. One common feature of phenolic substances is their weak performance against spores and viruses. They bind to organic materials to a moderate degree only, making them suitable for disinfection of excreted materials. Chlorine, iodine, and derivatives of these halogens are suitable for use as disinfectants. Chlorine and iodine show a generalized microbicidal ef- fect and also kill spores. Calcium hypochlorite (chlorinated lime) can be used in nonspecific disinfec- tion of excretions. Chloramines are organic chlorine compounds that split off chlorine in aqueous solutions. The most important iodine preparations arethe solutions of iodine and potassium iodide in alcohol (tinc- ture of iodine) used to disinfect skin and small wounds. While iodo- phores are less irritant to the skin than pure iodine, they are also less effective as germicides. This group includes ozone, hydrogenperoxide, potassium perman- ganate, and peracetic acid. These substances (also known as surface-active agents, tensides, or detergents) include anionic, cationic, amphoteric, and nonionic detergent compounds, of which the cationic and amphoteric types are the most effec- tive (Fig. They have no effect at all on tuberculosis bacteria (with the exception of amphotensides), spores, or nonencapsulated viruses. Their efficacy is good against Gram-pos- itive bacteria, but less so against Gram-negative rods. Their advantages in- clude low toxicity levels, lack of odor, good skin tolerance, and a cleaning ef- fect. Practical Disinfection The objective of surgical hand disinfection is to render a surgeon’s hands as free of organisms as possible. Alcoholic preparations are best suited for this purpose, although they are not sporicidal and have only a brief duration of action. Principles of Sterilization and Disinfection 41 Alcohols are therefore often combined with other disinfectants (e. Alcohols and/or iodine compounds are suitable for disinfecting patient’s skin in preparation for surgery and injections. Strong-smelling agents are the logical choice for disinfection of ex- cretions (feces, sputum, urine, etc. Con- taminated hospital sewage can also be thermally disinfected (80–100 8C) if necessary. Suitable agents include aldehyde and phenol derivatives combined with surfactants. Instrument disinfection is used only for instruments that do not cause inju- ries to skin or mucosa (e. Laundry disinfection can be done by chemical means or in combination with heat treatment. The substances used include derivatives of phenols, alde- hydes and chlorine as well as surfactant compounds. Chlorine is the agent of choice for disinfection of drinking water and swimming-pool water. Final room disinfection is the procedure carried out after hospital care of an infection patient is completed and is applied to a room and all of its furnish- ings. Evaporation or atomization of formaldehyde (5 g/m3), which used to be the preferred method, requires an exposure period of six hours. This proce- dure is now being superseded by methods involving surface and spray dis- infection with products containing formaldehyde. Hospital disinfection is an important tool in the prevention of cross-infec- tions among hospital patients. Zinkernagel 2 Introduction & Resistance to disease is based on innate mechanisms and adaptive or acquired immunity. Acquired immune mechanisms act in a specific manner and function to supplement the important nonspecific or natural resistance mechanisms such as physical barriers, granulocytes, macrophages, and chemical barriers (lysozymes, etc. The specific immune mechanisms constitute a combination of less specific factors, including the activation of macrophages, complement, and necrosis factors; the early recognition of invading agents, by cells exhibiting a low level of specificity, (natural killer cells, cd [gamma-delta] T cells); and systems geared toward highly specific recognition (antibodies and ab [alpha-beta] T cells). Many components of the specific immune defenses also contribute to nonspecific or natural defenses such as natural antibodies, complement, interleukins, interferons, macrophages, and natural killer cells. For example, a person who has had measles once will not suffer from measels a second time, and is thus called immune. However, such spe- cific or acquired immune mechanisms do not represent the only factors which determine resistance to infection. The canine distemper virus is a close relative of the measles virus, but never causes an infection in humans. Our immune system recognizes the pathogen as foreign based on certain surface structures, and eliminates it. Humans are thus born with resistance against many microorganisms (innate immunity) and can acquire resistance to others (adaptive or acquired im- munity; Fig. Activation of the mechanisms of innate immunity, also known as the primary immune defenses, takes place when a pathogen breaches the outer barriers of the body. Specific immune defense factors are mobilized later to fortify and regulate these primary defenses. Responses of the adaptive immune system not only engender immunity in the strict sense, but can also contribute to pathogenic processes. The terms immuno- pathology, autoimmunity, and allergy designate a group of immune Kayser, Medical Microbiology © 2005 Thieme All rights reserved. The latter comprises cellular (T-cell responses) and humoral (anti- bodies) components.

It must continuing path of knowledge development over be open to adapting and extending in order to time purchase generic cafergot on-line, but that there are periodic times of revolution guide nursing endeavors and to reflect develop- when traditional thought is challenged by new ment within nursing order cafergot in united states online. In addition cheap cafergot 100mg online, opinion among nurses about terms used to de- Kuhn’s work has meaning for nursing and other scribe theoretical development, the following dis- practice disciplines because of his recognition that cussion of types of theoretical development in science is the work of a community of scholars in nursing is offered as a context for further under- the context of society. The metaparadigm is as new perspectives are being articulated, some tra- very general and is intended to reflect agreement ditional views are being strengthened, and some among members of the discipline about the field views are taking their places as part of our history. This is the most abstract level of nurs- ing knowledge and closely mirrors beliefs held about nursing. The metaparadigm offers a context As we continue to move away from the for developing conceptual models and theories. All nurses have some awareness of nursing’s As we continue to move away from the historical metaparadigm by virtue of being nurses. However, conception of nursing as a part of medical science, because the term may not be familiar, it offers no developments in the nursing discipline are directed direct guidance for research and practice (Walker & by several new worldviews. Historically, the meta- and innovative perspectives on person, nursing, paradigm of nursing described concepts of person, and knowledge development. Modifications ing paradigm are being brought about by nursing and alternative concepts for this framework are scholars addressing disciplinary concerns based on being explored throughout the discipline (Fawcett, values and beliefs about nursing as a human sci- 2000). An example of alternative concepts is the ence, caring in nursing, and holistic nursing. In recent years, increas- 2000) asserts that nursing theory is one component ing attention has been directed to the nature of of a hierarchical structure of nursing knowledge nursing’s relationship with the environment development that includes metaparadigm, philos- (Schuster & Brown, 1994; Kleffel, 1996). Newman, ophy, conceptual models, nursing theory, and em- Sime, and Corcoran-Perry (1991, p. Reed (1995) abstract than conceptual models or systems, al- challenges nurses to continue the dialogue about though they vary in scope and levels of abstraction. Higgins and Moore (2000) continue exam- structions about the nature and goals of nursing. Theories developed at the middle range include specific concepts and are less abstract than grand theories. A phi- and levels of abstraction of nursing theories, they losophy comprises statements of enduring values are also sometimes described by the content or and beliefs held by members of the discipline. Types of Nursing Theory Philosophical statements are practical guides for examining issues and clarifying priorities of the Nursing theories have been organized into cate- discipline. George (2001) sets forth cate- to examine compatibility among personal, profes- gories of theories according to the orientation of sional, organizational, and societal beliefs and the theorist: nursing problems, interactions, gen- values. Conceptual models are sets of general concepts and Meleis (1997) describes types of nursing theory propositions that provide perspectives on the based on their levels of abstraction and goal orien- major concepts of the metaparadigm, such as per- tation. Barnum (1998) divides theories into those son, health and well-being, and the environment. Types of nursing theories generally in- beliefs, as in philosophical statements and prefer- clude grand theory, middle-range theory, and ences for practice and research approaches. Conceptual models are less abstract Grand theories have the broadest scope and present than the metaparadigm and more abstract than general concepts and propositions. Theories at this theories, offering guidance (not distinct direction) level may both reflect and provide insights useful to nursing endeavors. Conceptual models may also for practice but are not designed for empirical test- be called “conceptual frameworks” or “systems. This limits the use of grand theories for direct- ing, explaining, and predicting nursing in particular situations. In general, nursing theory describes and explains Development of grand theories resulted from the phenomena of interest to nursing in a system- the deliberate effort of committed scholars who atic way in order to provide understanding for use have engaged in thoughtful reflection on nursing in nursing practice and research. Although there is debate about which nursing theories are grand in scope, the fol- Nursing practice theory has the most limited scope lowing are usually considered to be at this level: and level of abstraction and is developed for use Leininger’s Theory of Culture Care Diversity and within a specific range of nursing situations. Universality, Newman’s Theory of Health as Theories developed at this level have a more direct Expanding Consciousness, Rogers’ Science of impact on nursing practice than do theories that Unitary Human Beings, Orem’s Self-Care Deficit are more abstract. Nursing practice theories pro- Nursing Theory, and Parse’s Theory of Human vide frameworks for nursing interventions and pre- Becoming. These theories are presented in the third dict outcomes and the impact of nursing practice. At the same time, nursing questions, actions, and procedures may be described or developed as nurs- ing practice theories. Practice theories theories that are both broad enough to be useful in should also reflect concepts and propositions of complex situations and appropriate for empirical more abstract levels of nursing theory. Nursing scholars proposed using this level veloped at this level is also termed prescriptive the- of theory because of the difficulty in testing grand ory (Dickoff, James, & Wiedenbach, 1968; Crowley, theory (Jacox, 1974). Middle-range theories are 1968), situation-specific theory (Meleis, 1997), and more narrow in scope than grand theories and offer micro theory (Chinn & Kramer, 2004). The depth and sitions at a lower level of abstraction and hold great complexity of nursing practice may be fully appre- promise for increasing theory-based research and ciated as nursing phenomena and relations among nursing practice strategies. Benner (1984) demon- ports of nurses’ experiences of developing and using middle-range theory. A wide range of nursing The day-to-day experience of nurses is a practice situations and nursing issues are being ad- major source of nursing practice theory. The methods used for developing middle-range theories are many and represent some of the most exciting work being strated that dialogue with expert nurses in practice published in nursing today. Many of these new the- is fruitful for discovery and development of prac- ories are built on content from related disciplines tice theory. Research findings on various nursing and are brought into nursing practice and research problems offer data to develop nursing practice (Lenz, Suppe, Gift, Pugh, & Milligan, 1995; Polk, theories as nursing engages in research-based de- 1997; Eakes, Burke, & Hainsworth, 1998). Nursing practice ature also offers middle-range nursing theories that theory has been articulated using multiple ways of are directly related to grand theories of nursing knowing through reflective practice (Johns & (Olson & Hanchett, 1997; Ducharme, Ricard, Freshwater, 1998). The process includes quiet re- Duquette, Levesque, & Lachance, 1998; Dunn, flection on practice, remembering and noting fea- 2004). Reports of nursing theory developed at this tures of nursing situations, attending to one’s own level include implications for instrument develop- feelings, reevaluating the experience, and integrat- ment, theory testing through research, and nursing ing new knowing with other experience (Gray & practice strategies. These have particular rele- Nursing theories address the phenomena of inter- vance for nursing and illustrate the need for est to nursing, including the focus of nursing; the nursing theory.

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Boric acid suppositories should not be used during pregnancy order cafergot with visa, and it is very toxic if taken orally buy cafergot in united states online. V Lactobacillus acidophilus: A type of friendly bacteria (probiotic) that is part of the normal vaginal flora and helps prevent overgrowth of Candida order cafergot online pills. Dosage: Two or three capsules daily of a product that pro- vides at least one billion vaible cells per capsule, such as Kyo-Dophilus. Complementary Supplements Tea tree oil: Has antibacterial and antifungal properties. Studies have found topically ap- plied tea tree oil helpful for Trichomoniasis, Candida albicans, and other vaginal infections. Vitamin E: When used orally or vaginally, it may help relieve itching and irritation and soothe the delicate vaginal tissue. It is estimated that at least 15 percent of the adult population in Canada suf- fers from varicose veins. The heart pumps oxygenated blood from the lungs through the arteries to the cells throughout the body. Tiny one-way valves inside our veins function as trapdoors opening and closing with each muscle contraction to prevent the backflow of blood. Varicose veins result from damage to the valves or vein walls, leading to pooling of blood, vein swelling, and increased venous pressure. These veins spread out on the surface of the skin in a web-like fashion, hence their name. Varicose veins are not life threatening; however, they can increase the risk of developing a blood clot, which is a serious concern. Other factors that may contribute to or worsen varicose veins include: exposure to ex- cessive heat, use of birth control pills or estrogen, and wearing high-heeled shoes. Blood is rerouted through other veins and the damaged vein is absorbed by the body. Bypass: An artificial or transplanted vein is connected to the damaged vein to help improve blood flow. Compression stockings: These specially designed stockings provide firm support to improve blood flow back to the heart and prevent swelling in the legs. The incidence of varicose veins is higher in developed (Western) countries due to life- style factors: poor diet (low fibre), lack of activity, and obesity. The best food sources are fruits, vegetables, whole grains (oats and bran), legumes, nuts, and seeds (flaxseed and sunflower seeds). Foods to avoid: • Saturated fats (animal fats) and trans fats (fast food and processed food) can impede circulation in both the veins and arteries, cause free radical damage, and trigger inflam- mation. Activities that involve movement of the calf muscle will help pump blood back to the heart. Move around, flex your ankles, circle your foot, do calf raises, and shift your body weight. Top Recommended Supplements Diosmin: A flavonoid that improves the tone and strength of the blood vessels, reduces swelling, fights free-radical damage, and stimulates lymphatic flow. Diosmin has a quick onset of action (one to two weeks) and is not associated with any side effects or drug interactions. Horse chestnut seed extract: Promotes circulation, improves vein wall tone, and relieves V swelling. It may cause nausea and upset stomach and can enhance the effect of blood-thinning medications. Pine bark extract: A flavonoid that offers antioxidant activity, strengthens capillaries, improves circulation, and supports the integrity of collagen and elastin (proteins in connec- tive tissue that support organs, joints, blood vessels, and muscles). In addition to diosmin and pine bark, other antioxidants to consider are vitamins C and E, bilberry, and grape seed extract. Butcher’s Broom: Improves the strength and tone of the veins, acts as a mild diuretic, and has mild anti-inflammatory effects. Boost intake of fibre and antioxidant-rich foods, and reduce your intake of satu- rated fats, processed foods, and sodium. Exercise regularly, elevate your feet when resting, and avoid standing or sitting in the same spot. While the words “obese” and “overweight” are used synonymously, there is a great difference between these terms in both definition and associated health risk. This term can be misleading because it does not distinguish between body fat and lean muscle mass. For example, it is possible to be overweight without be- ing obese, such as a bodybuilder. Having a greater proportion of muscle mass would make this individual appear overweight according to standard weight/height charts, yet this person could have low body fat and be in good physical shape. There are several methods that are used to determine overweight, obesity, and the level of associated health risks. Body composition can be measured by: Bioelectric impedance: A machine is used to measure an electric signal as it passes through lean body mass and fat. This method is more effective than skin-fold caliper testing, but is not 100 percent accurate. Near infrared technology: Infrared light is shone on the skin (usually bicep area). The reflected light is measured by a special sensor, transmitted into the computer, and translated into percentage of body fat. This method is highly accurate, comparable to underwater weighing, but slightly more expensive than the above two methods. Skin-fold calipers: Measures the thickness of subcutaneous fat at various locations on the body. The measurements obtained are used in special equations to obtain an estimated percent fat value. This method is not very accurate and is dependent upon the skills and judgment of the person performing the test. Below are recommended body fat ranges for women and men along with the ranges considered to be overweight or obese: Women Men Normal 15–25 percent 10–20 percent Overweight 25.

Client is expresses anger and hostility outwardly in a safe and acceptable manner cheap cafergot generic. Related/Risk Factors (“related to”) [Substance use/detoxification at time of incarceration order cafergot 100 mg online, exhibit- ing any of the following: Substance intoxication Substance withdrawal Disorientation Seizures Hallucinations Psychomotor agitation Unstable vital signs Delirium Flashbacks Panic level of anxiety] Goals/Objectives Short-term Goal Client’s condition will stabilize within 72 hours discount 100 mg cafergot otc. Assess client’s level of disorientation to determine spe- cific requirements for safety. Knowledge of client’s level of functioning is necessary to formulate appropriate plan of care. Knowledge regarding substance ingestion is important for accurate as- sessment of client condition. Observe client behaviors frequently; assign staff on one- to-one basis if condition warrants it; accompany and assist client when ambulating; use wheelchair for transporting long distances. Pad headboard and side rails of bed with thick towels to protect client in case of seizure. Use mechanical restraints as necessary to protect client if excessive hyperactivity accompanies the disorientation. Ensure that smoking materials and other potentially harmful objects are stored outside client’s access. Monitor vital signs every 15 minutes initially and less fre- quently as acute symptoms subside. Vital signs provide the most reliable information regarding client condition and need for medication during acute detoxification period. Com- mon medical interventions for detoxification from the fol- lowing substances include: a. Benzodiazepines are the most widely used group of drugs for substitution therapy in alcohol withdrawal. The approach to treatment is to start with relatively high doses and reduce the dosage by 20% to 25% each day until withdrawal is complete. In clients with liver disease, ac- cumulation of the longer-acting agents, such as chlordi- azepoxide (Librium), may be problematic, and the use of the shorter-acting benzodiazepine, oxazepam (Serax), is more appropriate. Some physicians may order anticonvul- sant medication to be used prophylactically; however, this is not a universal intervention. Multivitamin therapy, in combination with daily thiamine (either orally or by injec- tion), is common protocol. Narcotic antagonists, such as naloxone (Narcan), naltrexone (ReVia), or nalmefene (Revex), are admin- istered for opioid intoxication. Substitution therapy may be instituted to decrease withdrawal symptoms using propoxyphene (Darvon) for weaker effects or methadone Forensic Nursing ● 369 (Dolophine) for longer effects. Food and Drug Administration approved two forms of the drug buprenorphine for treating opiate dependence. Buprenorphine is less powerful than methadone but is considered to be somewhat safer and causes fewer side effects, making it especially attractive for clients who are mildly or moderately addicted. Substitution therapy may be instituted to decrease withdrawal symptoms using a long-acting barbi- turate, such as phenobarbital (Luminal). Some physicians prescribe oxazepam (Serax) as needed for objective symp- toms, gradually decreasing the dosage until the drug is dis- continued. Long-acting benzodiazepines are commonly used for substitution therapy when the abused substance is a nonbarbiturate central nervous system depressant. Treatment of stimulant intoxication is geared toward stabilization of vital signs. Intravenous antihyper- tensives may be used, along with intravenous diazepam (Valium) to control seizures. Minor tranquilizers, such as chlordiazepoxide, may be administered orally for the first few days while the client is “crashing. Client is no longer exhibiting any signs or symptoms of sub- stance intoxication or withdrawal. Client shows no evidence of physical injury obtained during substance intoxication or withdrawal. Traditional medicine as it is currently practiced in the United States is based on scientific methodol- ogy. Traditional medicine is also known as allopathic medicine and is the type historically taught in U. The term alternative medicine has come to be recognized as practices that differ from the usual traditional practices in the treatment of disease. When prayer specifically for health reasons is included in the definition of alternative medi- cine, the numbers are even higher. More than $27 billion a year is spent on alternative medical therapies in the United States. Individuals who seek alternative therapy, however, are often reimbursed at lower rates than are those who choose traditional practitioners. Positive lifestyle changes are encouraged, and practitioners serve as educators as well as treatment specialists. Complementary medicine is viewed as holistic health-care, which deals with not only the physical perspective but also the emotional and spir- itual components of the individual. Tom Coniglione, former professor of medicine at the University of Oklahoma Health Sciences Center, has stated, We must look at treating the “total person” in order to be more efficient and balanced within the medical community. Even find- ing doctors who are well-rounded and balanced has become a cri- terion in the admitting process for medical students. Medicine has changed from just looking at the “scientist perspective of organ and disease” to the total perspective of lifestyle and real impact/results to the patient. This evolution is a progressive and very positive shift in the right direction (Coniglione, 1998, p. In fact, restoring harmony and balance between body and mind is often the goal of complementary health-care approaches. Virtually every culture in the world has relied on herbs and plants to treat illness. At the root of Chinese medicine is the Pen Tsao, a Chinese text written around 3000 b. When the Pilgrims came to America in the 1600s, they brought with them a variety of herbs to be established and used for medicinal purposes. The new settlers soon discovered that the Native Americans had their own varieties of plants that they used for healing. Many people are seeking a return to herbal remedies, because they perceive these remedies as being less potent than prescrip- tion drugs and as being free of adverse side effects.

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