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Te use of amalgam flling material is declining and is being replaced with the use of increasingly varied composite resin materials trusted 3 mg exelon. Dental techniques buy 1.5mg exelon mastercard, including microdentistry and the use of fowable resins, have made the postmortem examination process more complex. Forensic dentists must inspect restorations during postmortem examinations with a great deal more scrutiny than in the past, when “tooth colored” restorations were usually only seen in anterior teeth. Te restored surfaces of a tooth may appear more extensive in the postmortem exam than is recorded in an antemortem record for a specifc tooth. Te forensic dentist that assumes this to be a discrepancy may make the error of forgetting that additional dental treatment to that tooth may have occurred afer the latest antemortem record entry. Multisurface amalgam restorations may have been replaced with full crowns by a diferent dentist. Tese occurrences can Forensic dental identifcation 183 be labeled as “explainable discrepancies” or “logical progressions” and are not necessarily reasons to exclude a record in the compari- son process if other overwhelming information indicates that the two records are records of the same individual. When examining the antemortem radiographs, care must be taken to ensure that the x-rays are oriented correctly. If the antemortem x-rays are duplicates and not labeled as L or R and the flm dimple location is indeterminable, then the forensic dentist must request additional information from the submitting dentist, most ofen the original flms. Original flms should always be acquired and examined since duplicate flms are very ofen incorrectly oriented (see Chapter 10). Even if fve restorations are consistent among the ante- mortem and postmortem records, signifcant doubt must be raised if one unexplained exclusionary item is noted. For example, if the antemortem records show a full crown on a certain tooth and the postmortem record shows an occlusal amalgam on the same tooth, the comparison results in exclusion. Once a body is released, it may be buried or cremated before discovery that a record is inadequate or an image is substandard. Te accurate reconstruction of the antemortem record is an equally important phase of the identifcation process. With careful attention to detail, dental identifcations can be completed in a relatively short time period and at a reasonable cost when compared to other means of identifca- tion. In some instances, the forensic dentist may fnd it useful to consider the new technologies available to assist in the comparison process. With advances in this and other forensic identifcation sciences, new methods will become more commonplace. Trough the cooperative eforts of medical examiners, coroners, law enforcement ofcials, and forensic odontologists, dental com- parisons can be efciently and accurately completed to identify or exclude. Uses and disclosures for which consent, an authori- zation, or opportunity to agree or object is not required, uses and disclosures about decedents. Paper presented at American Academy of Forensic Sciences, Annual Meeting, F7, New Orleans. Paper presented at American Academy of Forensic Sciences, Annual Meeting, F6, Seattle. Te diversity of adult dental patterns in the United States and the implications for personal identifcation. Establishing personal identifcation based on specifc patterns of missing, flled, and unrestored teeth. Computer-aided dental identifcation: An objective method for assessment of radiographic image similarity. Detection and classifcation of composite resins in incinerated teeth for forensic purposes. Identifcation through x-ray fuorescence analysis of dental restorative resin materials: A comprehensive study of noncremated, cremated, and processed-cremated individuals. Identifcation of incinerated root canal flling materials afer exposure to high heat incineration. In fact, research and development spanning from 1831 until 1895 incrementally led to his discovery. Tis included work by Faraday, Geissler, and Hittof in creating and developing the frst high-tension electrical evacu- ated tubes, which produced what were named cathode rays within the device. Te cathode rays produced a spark caused by a stream of high-speed electrons traversing a small gap and striking a metal target. Tis work was followed by Sir William Crookes and Professor Heinrich Hertz, who demonstrated that 187 188 Forensic dentistry cathode rays produced forescence and heat within and without the tube. However, Röentgen did, in fact, discover that other invisible rays emanating from the device possessed the ability to penetrate solid objects and produce photographic shadows of fesh and bones. When there is a confict between the written dental record and antemortem radiographs of a subject, deference is given to the radiographs as the gold standard having less potential for human error than charted dental information.

Perhaps the most important stage in the model that may lead to variability is the development of the original hypothesis generic exelon 4.5mg on line. Health professionals are usually described as having professional beliefs 1.5 mg exelon with amex, which are often assumed to be consistent and predictable. However, the development of the original hypothesis involves the health professional’s own health beliefs, which may vary as much as those of the patient. Components of models such as the health belief model, the protection motivation theory and attribution theory have been developed to examine health professionals’ beliefs. The beliefs involved in making the original hypothesis can be categorized as follows: 1 The health professional’s own beliefs about the nature of clinical problems. For example, if a health professional believes that health and illness are determined by biomedical factors (e. However, a health professional who views health and illness as relating to psychosocial factors may develop hypotheses reflecting this perspective (e. Health professionals will have pre-existing beliefs about the prevalence and incidence of any given health problem that will influence the process of developing a hypothesis. For example, some doctors may regard childhood asthma as a common complaint and hypothesize that a child presenting with a cough has asthma, whereas others may believe that childhood asthma is rare and so will not consider this hypothesis. Weinman (1987) argued that health professionals are motivated to consider the ‘pay-off’ involved in reaching a correct diagnosis and that this will influence their choice of hypothesis. He suggested that this pay-off is related to their beliefs about the seriousness and treatability of an illness. For example, a child presenting with abdominal pain may result in an original hypothesis of appendicitis as this is both a serious and treatable condition, and the benefits of arriving at the correct diagnosis for this condition far outweigh the costs involved (such as time-wasting) if this hypothesis is refuted. Marteau and Baum (1984) have argued that health professionals vary in their perceptions of the serious- ness of diabetes and that these beliefs will influence their recommendations for treatment. Brewin (1984) carried out a study looking at the relationship between medical students’ perceptions of the controllability of a patient’s life events and the hypothetical prescription of antidepressants. The results showed that the students reported variability in their beliefs about the controllability of life events; if the patient was seen not to be in control (i. This suggests that not only do health professionals report inconsistency and variability in their beliefs, this variability may be translated into variability in their behaviour. The original hypothesis will also be related to the health professional’s existing knowledge of the patient. Such factors may include the patient’s medical history, knowledge about their psychological state, an under- standing of their psychosocial environment and a belief about why the patient uses the medical services. Stereotypes are sometimes seen as problematic and as confounding the decision-making process. However, most meet- ings between health professionals and patients are time-limited and consequently stereotypes play a central role in developing and testing a hypothesis and reaching a management decision. Stereotypes reflect the process of ‘cognitive economy’ and may be developed according to a multitude of factors such as how the patient looks/talks/ walks or whether they remind the health professional of previous patients. Without stereotypes, consultations between health professionals and patients would be extremely time-consuming. Other factors which may influence the development of the original hypothesis include: 1 The health professional’s mood. The health professional’s mood may influence the choice of hypotheses and the subsequent process of testing this hypothesis. Positive affect was induced by informing subjects in this group that they had performed in the top 3 per cent of all graduate students nationwide in an anagram task. All subjects were then given a set of hypothetical patients and asked to decide which one was most likely to have lung cancer. The results showed that those subjects in the positive affect group spent less time to reach the correct decision and showed greater interest in the case histories by going beyond the assigned task. The authors therefore concluded that mood influenced the subjects’ decision-making processes. Factors such as age, sex, weight, geographical location, previous experience and the health professional’s own behaviour may also effect the decision-making process. For example, smoking doctors have been shown to spend more time counselling about smoking than their non- smoking counterparts (Stokes and Rigotti 1988). Further, thinner practice nurses have been shown to have different beliefs about obesity and offer different advice to obese patients than overweight practice nurses (Hoppe and Ogden 1997). In summary, variability in health professionals’ behaviour can be understood in terms of the factors involved in the decision-making process. In particular, many factors pre-dating the development of the original hypothesis such as the health professional’s own beliefs may contribute to this variability.

Often the stolen items (for which the individual usually has enough money to pay) are given away order exelon 6 mg otc, discarded buy discount exelon 6 mg online, returned, or kept and hidden. The individual with kleptomania steals purely for the sake of stealing and for the sense of relief and gratification that follows an episode. The preoccupation with gambling, and the impulse to gamble, in- tensifies when the individual is under stress. Many pathological gamblers exhibit characteristics associated with narcissism and grandiosity and often have difficulties with intimacy, empathy, and trust. Motivation for the behavior is self- gratification, and even though some individuals with pyromania may take precautions to avoid apprehension, many are totally indifferent to the consequences of their behavior. The impulse is preceded by an increasing sense of tension, and the individual experiences a sense of release or gratification from pulling out the hair. A familial tendency appears to be a factor in some cases of intermittent explosive disorder and patho- logical gambling. Brain trauma or dysfunction and mental retardation have also been implicated in the predisposi- tion to impulse control disorders. Various dysfunctional family patterns have been suggested as contributors in the predisposition to impulse control disorders. These include the following: • Child abuse or neglect • Parental rejection or abandonment • Harsh or inconsistent discipline • Emotional deprivation • Parental substance abuse • Parental unpredictability Symptomatology (Subjective and Objective Data) 1. Increasing tension before committing the theft, followed by pleasure or relief during and following the act 6. The need to gamble or loss of money interferes with social and occupational functioning 11. Increasing tension followed by a sense of release or gratifica- tion from pulling out the hair 15. Impulse Control Disorders ● 259 Related/Risk Factors (“related to”) [Possible familial tendency] [Dysfunctional family system, resulting in behaviors such as the following: Child abuse or neglect Parental rejection or abandonment Harsh or inconsistent discipline Emotional deprivation Parental substance abuse Parental unpredictability] Body language (e. Long-term Goal Client will not harm others or the property of others (time dimension to be individually determined). Be honest, keep all promises, and con- vey the message that it is not the person but the behavior that is unacceptable. Maintain low level of stimuli in client’s environment (low lighting, few people, simple decor, low noise level). A stimu- lating environment may increase agitation and promote aggressive behavior. Make the client’s environment as safe as possible by removing all potentially dangerous objects. Because of weak ego development, client may be unable to use ego defense mechanisms correctly. Helping him or her recognize this in a nonthreatening manner may help reveal unresolved issues so that they may be confronted. Help client recognize the signs that tension is increasing and ways in which violence can be averted. Activities that require physical exertion are helpful in relieving pent-up tension. Explain to the client that should explosive behavior occur, staff will intervene in whatever way is required (e. This conveys to the client evidence of control over the situation and provides a feeling of safety and security. The client is able to verbalize the symptoms of increasing tension and adaptive ways of coping with it. Related/Risk Factors (“related to”) [Central nervous system trauma] [Mental retardation] [Early emotional deprivation] [Parental rejection or abandonment] [Child abuse or neglect] [History of self-mutilative behaviors in response to increasing anxiety: hair-pulling, biting, head-banging, scratching] Goals/Objectives Short-term Goals 1. Client will cooperate with plan of behavior modification in an effort to respond more adaptively to stress (time dimen- sion ongoing). Intervene to protect client when self-mutilative behaviors, such as head-banging or hair-pulling, become evident. A helmet may be used to protect against head-banging, hand mittsto prevent hair-pulling, and appropriate padding to pro- tect extremities from injury during hysterical movements. Try to determine if self-mutilative behaviors occur in re- sponse to increasing anxiety, and if so, to what the anxiety may be attributed. Assist with plan for behavior modification in an effort to teach the client more adaptive ways of responding to stress. Encourage client to discuss feelings, particularly anger, in an effort to confront unresolved issues and expose internalized rage that may be triggering self-mutilative behaviors. Offer self to client during times of increasing anxiety, to pro- vide feelings of security and decrease need for self-mutilative behaviors. Anxiety is maintained at a level at which client feels no need for self-mutilation.

Place the following stages of a sleep cycle in interventions for patients experiencing insom- the order in which they would normally occur discount 1.5 mg exelon overnight delivery. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care buy 3mg exelon amex, 7th Edition. Which two systems in the brainstem are quality of sleep believed to work together to control the cyclic nature of sleep? Marked muscle contraction that results in the jerking of one or both legs during sleep 2. Match the sleep disorder listed in Part A with its appropriate definition listed in Part B. Constitutes about 5% of sleep Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. List the average amount of sleep required for True False the following age groups. Older adults: time, he/she will return to sleep again by starting at the point in the cycle where 3. Exercise that occurs within a 2-hour interval before normal bedtime stimulates sleep. The administration of a larger mid-afternoon dose of asthma medication may prevent i. True False Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Maher, age 28, consumes four in a sleep history when a sleep disturbance is alcoholic drinks when watching television noted. After eliminating the alcohol from her diet, she complains of waking after a short period and not being able to fall back to sleep. Eichorn, age 45, has two teenage sons confirm that a patient is getting sufficient rest who are often out late at night. She cannot to provide energy for the day’s activities or val- get to sleep until they are both home idate the existence of a sleep disturbance that safely, and even then she continues to is decreasing the quantity or quality of sleep. Describe how you would prepare a restful environment for a home healthcare patient b. List three measures a nurse can take to help falling asleep, but the noise of the hospital alleviate a patient’s sleep problem. Loper, a 74-year-old patient in a long- ask a patient to assess for the following sleep term care facility, is bored during the day factors. Quality of sleep: that he is sleepy all the time but cannot sleep when he lies down after work. Number and duration of naps: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Interview several friends or relatives to find out what they do to prepare for a restful night’s sleep. Nature of a sleep disturbance: man who has recently been admitted to a long-term care facility. Onset of a disturbance: don’t fall asleep until after midnight and then I’m up twice to go to the bathroom and have a lot of trouble falling back to sleep. Causes of a disturbance: ter has mentioned to the nurse that her father spends a lot of time napping during the day. What intellectual, technical, interpersonal, factors on the ward that would contribute to a and/or ethical/legal competencies are most patient’s sleep deficit. Develop a sleep teaching tool that explains the typical sleep patterns and requirements for patients of all ages (infants to older adults). What resources might be helpful for Include common factors that disrupt sleep pat- terns, total amount of sleep required, and pos- Mr. Interview individuals who have tried your interventions and evaluate the like- lihood that your teaching tool will resolve sleep problems. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. I used to think my sleep habits were bad at school, but this is a Read the following patient care study and use hundred times worse because there never your nursing process skills to answer the seems to be time to crash. Identify pertinent patient data by placing a nurse, has been in her new position as a criti- single underline beneath the objective data in cal care staff nurse in a large tertiary-care med- the case study and a double underline beneath ical center for 3 months. Complete the Nursing Process Worksheet on of time for other things I want to do, but I’m page 223 to develop a three-part diagnostic not so sure anymore,” she says. Write down the patient and personal nursing it seems I’m always tired and all I think about strengths you hope to draw on as you assist all day long is how soon I can get back to bed.