Arthritis Australia

By D. Lisk. Louisiana College. 2018.

The patient’s renal failure may have been due to hypertension discount 5 mg hytrin otc, or a primary glomerulonephritis such as IgA nephropathy generic hytrin 5 mg otc. African- Caribbeans are more prone to develop hypertensive renal failure than other racial groups. Antihypertensive medications are needed to treat her blood pressure adequately, oral phos- phate binders and vitamin D preparations to control her secondary hyperparathyroidism, and erythropoietin injections to treat her anaemia. Hospital-based haemodialysis or home-based peri- toneal dialysis are the options available. She became unwell 2 days previously when she started to develop a fever and an ache in her back. She has had no previous significant medical history, apart from an uncomplicated episode of cystitis 3 months ago. Acute pyelonephritis is much more common in women than men, and occurs due to ascent of bacteria up the urin- ary tract. Pregnancy, diabetes mellitus, immunosuppression and structurally abnormal uri- nary tracts increase the likelihood of ascending infection. Differential diagnosis Pyelonephritis causes loin pain which can be unilateral or bilateral. The differential diagnoses of loin pain include obstructive uropathy, renal infarction, renal cell carcinoma, renal papillary necrosis, renal calculi, glomerulonephritis, polycystic kidney disease, medullary sponge kidney and loin-pain haematuria syndrome. Fever may be as high as 40°C with associated systemic symptoms of anorexia, nausea and vomiting. Some patients may have preceding symptoms of cystitis (dysuria, urinary fre- quency, urgency and haematuria), but these lower urinary tract symptoms do not always occur in patients with acute pyelonephritis. Elderly patients with pyelonephritis may present with non- specific symptoms and confusion. Pyelonephritis may also mimic other conditions such as acute appendicitis, acute cholecystitis, acute pancreatitis and lower lobe pneumonia. There is usually marked tenderness over the kidneys both posteriorly and anteriorly. Microscopic haematuria, proteinuria and leucocytes in the urine occur because of inflam- mation in the urinary tract. The presence of bacteria in the urine is confirmed by the reduction of nitrates to nitrites. Blood and urine cultures should be taken, and she should be commenced on intravenous fluids and antibiotics, until the organism is identified, and then an oral antibiotic to which the organism is sensitive can be used. In patients with obstructive uropathy, infection may lead to a pyonephrosis with severe loin pain, fever, septic shock and renal failure. If there is evidence of a hydronephrosis in the context of urinary sepsis, a nephro- stomy should be inserted urgently to prevent these complications. Patients with an uncomplicated renal infection should be treated with a 2-week course of antibiotics, and then have a repeat culture 10–14 days after treatment has finished to con- firm eradication of infection. In patients with infection complicated by stones, or renal scarring, a 6-week course of treatment should be given. His neurological examination is otherwise normal, apart from some weakness in shoulder abduction and hip flexion. In addition psychiatric disturbances, typically depression, may occur in Cushing’s syndrome. The term ‘Cushing’s syndrome’ is a wider one, and encompasses a group of dis- orders due to overproduction of cortisol. The principal causes of obesity are: • genetic • environmental: excessive food intake, lack of exercise • hormonal: hypothyroidism, Cushing’s syndrome, polycystic ovaries and hyper- prolactinaemia • alcohol-induced pseudo-Cushing’s syndrome. There should be loss of the normal diurnal rhythm with an elevated midnight cortisol level or increased urinary conjugated cortisol excretion. It is then important to exclude common causes of abnormal cortisol excretion such as stress/depression or alcohol abuse. This patient drinks alcohol moderately and has a normal gamma-glutamyl transpeptidase. His depression seems to be a consequence of his cortisol excess rather than a cause, as he has no psychiatric history. He is having problems with stairs and his social circumstances need to be considered, but his mobility should improve with appropriate treatment. Bronchial carcinoma is a possibility as he is a heavy smoker and the onset of his Cushing’s syndrome has been rapid. His mother died 3 years previously from Alzheimer’s disease, and his wife is concerned that he is dementing. She had also noticed that he has been drinking more fluid and getting up 2–3 times in the night to pass urine.

Is the theory a with analysis and evaluation of specific nursing grand nursing theory? Not all as- pects of theory described in an evaluation guide will be evident in all levels of theory hytrin 2 mg sale. Whall (1996) recognizes this in offering guides for analysis and evaluation of nursing the- particular guides for analysis and evaluation that ory discount hytrin 2mg fast delivery. Done individually or as a group, this is an ad- vary according to three types of nursing theory: ditional opportunity to learn and to share. This is models, middle-range theories, and practice theo- demanding work, but along with the challenge, this ries. It may be helpful to think of analysis of theory as neces- sary for adequate study of a nursing theory and evaluation of theory as the assessment of a theory’s Analysis and Evaluation utility for particular purposes. Guides for theory of Nursing Theory evaluation are intended as tools to inform us about theories and to encourage further development, re- It is important to understand definitions of nursing finement, and use of theory. There are no guides for theory (as described in Chapter 1) before moving theory analysis and evaluation that are adequate to theory analysis and evaluation. These have tions is adequate for study of any nursing theory, continued in use over time and offer direction for choose the definition that seems to best fit with guides in use today. For ex- ory should: ample, one of the definitions by Chinn and Jacobs (1987) or Chinn and Kramer (2004) may be chosen • define the congruence of nursing practice with for using theory in research. The definition by Silva societal expectations of nursing decisions and (1997) may be more appropriate for study of nurs- actions; ing theory for use in practice. Another way to think • clarify the social significance of nursing, or the about this is to consider whether the definition of impact of nursing on persons receiving nursing; nursing theory in use fits the theory being analyzed and and evaluated. Look carefully at the theory, read the • describe social utility, or usefulness of the theory theory as presented by the theorist, and read what in practice, research, and education. The whole The following are outlines of the most fre- quently used guides for analysis and evaluation. Parts about nursing theory of the individual nursing of the theory without the whole will not scholar and offer various interesting approaches to be fully meaningful and may lead to mis- the study of nursing theory. The guidelines set forth questions that tion of these elements may take place, as summa- clarify the facts about aspects of theory: purpose, rized here: concepts, definitions, relationships, structure, as- sumptions, and scope. These authors suggest that • Relations between structure and function of the the next step in the evaluation process is critical re- theory, including clarity, consistency, and sim- flection about whether and how the nursing theory plicity works. Questions are posed to guide this reflection: • Diagram of theory to further understand the theory by creating a visual representation • Is the theory clearly stated? Questions for analysis in this frame- work flow from the structural hierarchy of nursing knowledge proposed by Fawcett and defined in Chapter 1. The questions for evaluation guide ex- amination of theory content and use for practical Nursing theory, knowledge development purposes. Following is a summary of the Fawcett through research, and nursing practice are (2000) framework. In order to en- For theory analysis, consideration is given to: hance both nursing practice and nursing the- ory, it is incumbent upon the practicing nurse • scope of the theory to study theory, just as it is upon the theorist • metaparadigm concepts and propositions in- to study the practice of nursing. Considering cluded in the theory a commitment to study nursing theory raises • values and beliefs reflected in the theory many questions from nurses about to un- • relation of the theory to a conceptual model and dertake this important work. This chapter to related disciplines presented some of the questions worth con- • concepts and propositions of the theory sidering before undertaking extensive study For theory evaluation, consideration is given to: and deciding on a theory to guide practice. Analysis and evaluation of nursing theory • significance of the theory and relations with are the main ways of studying nursing structure of knowledge theory. Literature presents a number of dif- • consistency and clarity of concepts, expressed in ferent guides to analyzing and evaluating congruent, concise language theory. Aesthetic Meleis (1997) states that the structural and knowing grounded in an explicit conception of nursing. Fundamental patterns of knowing in nurs- are assumptions, concepts, and propositions of the ing. Integrated knowledge de- nurse-client interactions, environment, and nurs- velopment in nursing (6th ed. The structure of nursing knowledge: Analysis care through self-awareness and reflection (pp. Parker Study of Theory for Nursing Practice A Guide for Study of Nursing Theory for Use in Practice Study of Theory for Nursing Administration Summary References Nurses, individually and in groups, are affected Theories and practices from related disciplines by rapid and dramatic change throughout health are brought to nursing to use for nursing purposes. Nurses practice in increas- The scope of nursing practice is continually being ingly diverse settings and often develop organized nursing practices through which accessible health The scope of nursing practice is continu- care to communities can be provided. Community ally being expanded to include additional members may be active participants in selecting, knowledge and skills from related designing, and evaluating the nursing they receive. This guide was tice in hospitals, an increasing number of nurses developed for use by practicing nurses and students practice elsewhere in the community, taking the in undergraduate and graduate nursing education venue of their practice closer to those served by programs. The guide may be used to to provide nursing often realize that they share the study most of the nursing theories developed at all same values and beliefs about nursing. It has been used to create surveys of nursing nursing theories can clarify the purposes of nursing theories. An early motivation for developing this and facilitate building a cohesive practice to meet guide was the work by the Nursing Development these purposes.

It seems that children modify their language through imitation buy cheap hytrin 1mg line, reinforcement cheap 1mg hytrin with visa, and shaping, as would be predicted by learning theories. For one, children learn words too fast for them to be learned through reinforcement. Between the ages of 18 months and 5 years, children learn up to [17] 10 new words every day (Anglin, 1993). Generativity refers to the fact that speakers of a language can compose sentences to represent new ideas that they have never before been exposed to. Language is not a predefined set of ideas and sentences that we choose when we need them, but rather a system of rules and procedures that allows us to create an infinite number of statements, thoughts, and ideas, including those that have never previously occurred. When a child says that she “swimmed‖ in the pool, for instance, she is showing generativity. No adult speaker of English would ever say “swimmed,‖ yet it is easily generated from the normal system of producing language. A group of deaf children in a school in Nicaragua, whose teachers could not sign, invented a way to communicate through made-up signs (Senghas, Senghas, & Pyers, [19] 2005). The development of this new Nicaraguan Sign Language has continued and changed as new generations of students have come to the school and started using the language. Although the original system was not a real language, it is becoming closer and closer every year, showing the development of a new language in modern times. The linguist Noam Chomsky is a believer in the nature approach to language, arguing that human brains contain a language acquisition device that includes a universal grammar that underlies all [20] human language (Chomsky, 1965, 1972). According to this approach, each of the many languages spoken around the world (there are between 6,000 and 8,000) is an individual example of the same underlying set of procedures that are hardwired into human brains. Chomsky‘s account proposes that children are born with a knowledge of general rules of syntax that determine how sentences are constructed. Chomsky differentiates between the deep structure of an idea—how the idea is represented in the fundamental universal grammar that is common to all languages, and the surface structure of the idea—how it is expressed in any one language. Once we hear or express a thought in surface structure, we generally forget exactly how it happened. Although there is general agreement among psychologists that babies are genetically programmed to learn language, there is still debate about Chomsky‘s idea that there is a universal [21] grammar that can account for all language learning. In their search they found languages that did not have noun or verb phrases, that did not have tenses (e. Bilingualism and Cognitive Development Although it is less common in the United States than in other countries,bilingualism (the ability to speak two languages) is becoming more and more frequent in the modern world. These laws are in part based on the idea that students will have a stronger identity with the school, the culture, and the government if they speak only English, and in part based on the idea that speaking two languages may interfere with cognitive development. Some early psychological research showed that, when compared with monolingual children, bilingual children performed more slowly when processing language, and their verbal scores were lower. But these tests were frequently given in English, even when this was not the child‘s first language, and the children tested were often of lower socioeconomic status than the [22] monolingual children (Andrews, 1982). More current research that has controlled for these factors has found that, although bilingual children may in some cases learn language somewhat slower than do monolingual children [23] (Oller & Pearson, 2002), bilingual and monolingual children do not significantly differ in the final depth of language learning, nor do they generally confuse the two languages (Nicoladis & [24] Genesee, 1997). In fact, participants who speak two languages have been found to have better cognitive functioning, cognitive flexibility, and analytic skills in comparison to monolinguals [25] (Bialystok, 2009). Furthermore, the increased density is stronger in those individuals who are most proficient in their second language and who learned the second language earlier. Thus, rather than slowing language development, learning a second language seems to increase cognitive abilities. Structural plasticity in the bilingual brain: Proficiency in a second language and age at acquisition affect grey-matter density. Some species communicate using scents; others use visual displays, such as baring the teeth, puffing up the fur, or flapping the wings; and still others use vocal sounds. Male songbirds, such as canaries and finches, sing songs to attract mates and to protect territory, and chimpanzees use a combination of facial expressions, sounds, and actions, such as slapping the ground, to convey aggression (de [27] Waal, 1989). Honeybees use a “waggle dance‖ to direct other bees to the location of food [28] sources (von Frisch, 1956). The language of vervet monkeys is relatively advanced in the sense that they use specific sounds to communicate specific meanings. Vervets make different calls to signify that they have seen either a leopard, a snake, or a hawk (Seyfarth & Cheney, [29] 1997). Despite their wide abilities to communicate, efforts to teach animals to use language have had only limited success. One of the early efforts was made by Catherine and Keith Hayes, who raised a chimpanzee named Viki in their home along with their own children.

To form an intense cheap 5mg hytrin, lasting hood isolation relationship or a commit- (20–30 years) ment to another person buy discount hytrin 5 mg online, a cause, an institution, or a creative effort Adulthood Generativity To achieve the life goals while vs. Differentiation Commencement of a primary recogni- tion of separateness from the mothering figure 10–16 b. Practicing Increased independ- months ence through loco- motor functioning; increased sense of separateness of self 16–24 c. Rapprochement Acute awareness of months separateness of self; learning to seek “emotional refueling” from mothering figure to maintain feeling of security 24–36 months d. Consolidation Sense of separate- ness established; on the way to object constancy (i. Punishment and Behavior is moti- (common from obedience vated by fear of ages 4 to orientation punishment 10 years) 2. Interpersonal Behavior is (common from concordance motivated by ages 10 to 13 orientation the expecta- years and into tions of others; adulthood) strong desire for approval and acceptance 4. Social contract Behavior is moti- tional (can legalistic vated by respect occur from orientation for universal adolescence on) laws and moral principles and guided by an internal set of values 6. Psychiatric/mental health nursing: Concepts of care in evidence-based practice (6th ed. She acknowl- alcohol Preventing attended edge the every day unaccept- nursing existence and cannot able or school to of a real stop fails to undesirable please her situation or acknowl- thoughts or parents. Identifica- A teen- Repression: An accident tion: ager who Involuntar- victim can An attempt required ily blocking remember to increase lengthy unpleasant nothing self-worth rehabilita- feelings and about his by acquir- tion after experiences accident. Intellectuali- S’s husband Sublimation: A mother zation: is being Rechan- whose son An attempt transferred neling of was killed to avoid with his job drives or by a drunk expressing to a city far impulses driver actual emo- away from that are chan- tions asso- her parents. Introjection: Children Suppression: Scarlett Integrating integrate The O’Hara the beliefs their par- voluntary says, “I and values ents’ value blocking of don’t want of another system unpleasant to think individual into the feelings and about that into one’s process of experiences now. On his feeling tone and raped, experience way home or emotion without that one he stops associated showing finds intol- and buys with it. Projection Sue feels a Attributing strong sexual feelings or attraction impulses to her track unacceptable coach and to one’s self tells her to another friend, “He’s person. Psychiatric/mental health nursing: Concepts of care in evidence-based practice (6th ed. This is congruent with Peplau’s (1962) identification of counseling as the major subrole of nurs- ing in psychiatry. If Sullivan’s (1953) belief is true, that is, that all emotional problems stem from difficulties with interpersonal relationships, then this role of the nurse in psychiatry becomes especially meaningful and purposeful. The therapeutic interpersonal relationship is the means by which the nursing process is implemented. Tasks of the relationship have been categorized into four phases: the preinteraction phase, the orientation (introductory) phase, the working phase, and the termination phase. Although each phase is presented as specific and distinct from the others, there may be some overlapping of tasks, particularly when the interaction is limited. The Preinteraction Phase The preinteraction phase involves preparation for the first encounter with the client. Obtaining available information about the client from the chart, significant others, or other health-team members. Examining one’s feelings, fears, and anxieties about work- ing with a particular client. For example, the nurse may have been reared in an alcoholic family and have ambivalent feel- ings about caring for a client who is alcohol dependent. All individuals bring attitudes and feelings from prior experi- ences to the clinical setting. The nurse needs to be aware of how these preconceptions may affect his or her ability to care for individual clients. The Orientation (Introductory) Phase During the orientation phase, the nurse and client become acquainted. Establishing a contract for intervention that details the expectations and responsibilities of both the nurse and client 3. Developing a plan of action that is realistic for meeting the established goals 8. Exploring feelings of both the client and the nurse in terms of the introductory phase. Introductions are often uncom- fortable, and the participants may experience some anxiety until a degree of rapport has been established. Several interactions may be required to fulfill the tasks associated with this phase. The Working Phase The therapeutic work of the relationship is accomplished during this phase. Maintaining the trust and rapport that was established dur- ing the orientation phase 2. Overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues 5. A plan for continuing care or for assistance during stress- ful life experiences is mutually established by the nurse and client.