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By K. Torn. John F. Kennedy University.

Prac- (“No anesthetic cheap 1 mg estradiol, no knife; bail-jumping Reverend ticed also in North America by visiting Filipino Antonia Agpaoa will heal you with his bare hands generic 2mg estradiol with mastercard,” shamans, psychic surgery often involves the 1978 July: 45–47, and “Trick or treatment? Marchant writes: “A recent Yukon bloody but painless and invisible ‘incision’ in the Medical Association report on psychic surgery notes patient’s abdomen. This is not a physically invasive that some individuals with chronic, non-specific process, and the patient is able to leave the operat- disorders who had undergone psychic surgery ing table without discomfort. Either they are ashamed that they have healing in Brazil which appear to incorporate (+) qi been made fools of, or they have died—so we usu- 130 psychic surgery ally have no proof against faith healers. In a signed three death certificates for people who separate study conducted by Dr. Leonard Cobb and would never return alive from their miracle tours his associates, placebo surgery proved to be more (although not from Agpaoa’s tours). Wright and Carol Wright testified real operation, only 32% reported satisfactory before a U. What this research established is that the Seattle investigating travel agents promoting tours mere form (metaphor) of surgical procedures can to visit the Philippine healers. They were taught how to shop for animal guidelines on psychic surgery and other alternative parts used to make up a ‘bullet. This does not ventionalTherapie) deny the value of faith healing for psychological In his essay ”Unraveling the Enigma of Psychic conditions but places limitations upon its useful- Surgery” (http://www. In healers should provide their ‘gift of healing’ with- the 1950s, several American doctors conducted an out fee or acceptance of donations (i. Once awakened, the five patients were of diseased tissue from the body without leaving an monitored during their recovery from the opera- incision as has been practiced in the Philippines for tions. To the amazement of the physicians, a signif- some years is denounced as a complete fraud; not icant percentage of the patients who had received only does it waste money and cause psychological placebo operations were cured. Henry harm through promoting false hope, it can prevent Beecher reviewed two double-blind studies of the people from seeking valuable health care before it placebo operations. Psycho- are based upon the principles of science that under- somatic illnesses are not considered mental ill- lie consumer protection law. Alternative medicine handbook: the complete reference guide to alternative and complementary therapies. Qi is an invisible The practice of qigong may involve breathing substance, as well as an immaterial force that has exercises, meditation, and hands-on manipulation palpable and observable manifestations. Within the context of the human “Medical” qigong may be used as a self-healing tech- person, Qi is that which enlivens the body and is nique and as an aid to help others heal. Qigong mas- differentiated according to specific functional sys- ters, as they are known, make a conscious effort tems. All physical and mental activities are manifes- through focused mental intent, meditation, or tations of Qi: sensing, cogitating, feeling, digesting, prayer to send healing ch’i to ailing individuals, or stirring, propagating. Qi governs the shape and in a technique called “external qi healing” or exter- activity of the body and its process of forming and nal qigong they draw excessive energy, which may organizing itself. Qi also means the totality of Blood, also be damaging, away from an individual who is Moisture, and Qi, earth, sea, and air, the total sum- experiencing dysfunction or pain. Zong qi that are easily adapted to an individual’s condition, refers to the energy that accumulates in the thorax, strength, and circumstances. Wei qi, known as defensive qi, flows In Reinventing Medicine: Beyond Mind-Body to a under the skin and protects against environmental New Era of Healing (HarperSanFrancisco, 1999), or external bacteria and other potential pathogens. When the mas- referred to as a branch of energy medicine, the ters came to the United States they collaborated qigong philosophy is that clogged, impure, or pol- with a research team at Mt. Sinai School of Medi- luted qi causes disease or dysfunction and that it cine to test the effects of qigong in a sophisticated, can be removed or cleansed so the body may be well-controlled experiment published in 1994. Sinai Regular qigong practice is said to initiate the team was composed of David J. The bio- sion, and addictive cravings; boost the immune sys- chemical reaction is highly complex and occurs in tem by increasing the rate and flow of lymphatic stages. It requires the binding of calcium to a pro- fluid and help the body resist disease and infection. In all of nine trials, the qigong masters were able to modify the biochemical reac- qi xian Deficient, or decreasing, qi, which results tion by an average of 15 percent, which is an effect in less than optimal body functioning. The odds against a chance explanation of the outcome were less than one in qi zhi Stagnant or sluggish qi. R radical healing An integrated approach to healing each one’s abdomen just above the navel, he found and healing traditions set forth by Rudolph M. He Radical Healing: Integrating the World’s Great Therapeu- found the same phenomenon in patients with other tic Traditions to Create a New Transformative Medicine diseases as well. The approach Abrams came to believe that disease was actually a combines theories, techniques, and remedies from form of radiating energy and manifestation of an Ayurveda, homeopathy, traditional Chinese medi- imbalance of electrons throughout the body, and on cine, European and Native American herbology, this premise he devised a variable resistance meter, nutrition, and psychotherapeutic bodywork. He would then palpate the abdomen terminals of a plant’s root, which extend its action of a healthy individual and make a diagnosis. Some of the beliefs and Collins Publishers, 2000): “Radionics is one of the assumptions about our reality that sustain and pro- few areas in vibrational medicine capable of provid- mote our suffering are the deepest and most resis- ing tools that allow a trained radionics operator to tant to change. It is those assumptions that can measure and quantify the energy characteristics of make diseases seem untreatable or ‘incurable.

About 40 to 50 percent of moth- ers—especially first-time mothers—experience mild post- The natural childbirth movement begun by Fernand partum depression trusted estradiol 2mg,thought to be caused by a combina- Lamaze purchase 2mg estradiol with visa, which advocates birth without drugs or medical tion of biochemical factors and adjustment to the pres- intervention, departed from the practices of the 1940s sures and demands of parenthood. A smaller percentage— and 1950s, when the administration of drugs and med- between 5 and 10 percent—become severely depressed. Natural childbirth methods use non- medical relaxation techniques for pain control and allow Abnormalities present at the time of birth, known as for more active participation in labor by the mother and a birth defects or congenital defects, occur in one of every lay coach, usually the husband. Women who birth defects have been identified, ranging from minor use the Lamaze method are taught to perform three ac- dark sports or a birthmarks to serious disfigurements or tivities simultaneously during contractions: breathing in limited lifespans. Congenital heart defects occur to one of a special pattern, chanting a nonsense or meaningless every 125 to 150 infants born in the U. Down syn- drome is the most frequently occurring chromosomal ab- The home delivery movement, which became popu- normality, occurring to one of every 800 to 1,000 infants lar in the United States during the 1970s, gave way to the born in the United States. Annually, care of children with establishment of birthing centers (in or affiliated with birth defects in the U. Environment includes maternal illness, such as the absence of medical professionals. Other environmental factors include: al- birth movement has also focused on easing the birth ex- cohol and drugs, consumed during the pregnancy, and ex- perience for the infant. Heavy alcohol physician Frederick Leboyer described modern hospital consumption during pregnancy can trigger fetal alcohol birth as “torture of the innocent” and proposed measures syndrome in newborns, characterized by underweight, to make the transition to life outside the womb a more small eyes, a short upturned nose with a broad bridge, gentle one for the newborn. Thalidomide, lights and a quiet atmosphere in the delivery room, post- prescribed in the 1950s as a mild sedative, led to the birth poning cutting of the umbilical cord, and bathing the in- of 7,000 severely deformed babies, suffering from a con- fant in lukewarm water. Psychologists Otto Rank and dition called phocomelia, characterized by extremely R. Laing have elaborated on the idea of birth trauma short limbs that were often without fingers or toes. Spina bifida, a neural tube defect, is liefs that influence an adult’s behavior and attitudes. These factors include, for example, poor health, close properly during the first month of pregnancy. In anatomical abnormalities, prematurity, and unusual orien- worst cases, the spinal cord protrudes through the back. In some women, the “shunting” to relieve the fluid build up and redirect it pelvic space is too small for spontaneous birth of a baby, into the abdominal area. Sophisticated medical tech- and the delivery of the child is accomplished through a niques allow most children with spina bifida to live well surgical opening made in the mother’s abdominal wall and into adulthood. For a Health Service recommends that women of childbearing healthy mother and child, the risks of childbirth are ex- age in the U. Fritz Klein, a noted psychiatrist, has expanded the other two neural two defects: anencephaly or en- on Kinsey’s work, creating the Klein Sexual Orientation cephalocele. Amniocentesis or ultrasound testing can di- Grid, which takes into account seven different variables agnose spina bifida before birth. Klein’s variables provide a more detailed look at Sickle-cell anemia, Tay-Sachs, color blindness, one’s sexuality, examining preferences in attraction, be- deafness, and extra digits on the hand or feet are heredi- havior, fantasies, emotional involvement, social involve- tary birth defects passed on through generations by ab- ment, lifestyle, and self-identification. Birth defects may not impact each genera- for sexual development over time, an important element tion, but the abnormal gene is passed on. The Illustrated Book of Pregnancy and Klein’s grid, exploring only three, rather than seven, Childbirth. Sexual activities are actual behaviors such See also Fetal alcohol effect and syndrome as kissing, fellatio, and intercourse. Bisexuality Some studies of fraternal and identical twins show Sexual orientation defined as sexual involvement that identical twins are more likely to be bisexual than are with members of both sexes concurrently (within fraternal twins, suggesting a genetic basis for bisexual the period of one year) or any sexual attraction to predisposition. These studies have yet to be tested ade- or involvement with members of both sexes at any quately to be considered conclusive, however. Debate over why people are hetero-, homo-, or bi- Some define it narrowly as sexual involvement with mem- sexual is a fairly recent phenomenon. Identification by bers of both sexes concurrently (within a twelve-month sexual preference only began in the 19th century, and be- period or less). Today, however, there any sexual attraction to or involvement with members of is tremendous pressure for a person to declare a sexual both sexes at any time in one’s life. The idea of bisexuality is threatening to qualify as bisexual in its narrow definition. A comprehen- some people because sexuality is no longer clearly de- sive study, “Sex in America,” conducted in 1992 by the fined between homosexuality and heterosexuality. They are considered “too gay” to be cans who fit the broad definition of bisexuality, estimates straight, and “too straight” to be gay. Homosexual support groups may reject them if they reveal their het- Sigmund Freud believed that bisexuality was a erosexual sides; heterosexuals may reject them if they re- “disposition” common to all humans. Many bisexuals remain every individual has a masculine and feminine side, and in the closet, hiding their gender-encompassing feelings that each side is heterosexually attracted to members of from others, and sometimes even from themselves.

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Plasmapheresis uses similar circuits to haemofiltration (usually used intermittently rather than continuously) buy estradiol 1mg cheap, and so most principles of haemofiltration apply to plasmapheresis estradiol 2 mg visa. Haemofiltration considerably increases nursing workload; while caring for patients receiving haemofiltration can be rewarding, nurses should understand the potential complications. The terminology used to describe modes often varies between units (and in literature); ‘haemodialysis’ and ‘haemofiltration’ are interchanged and variously interpreted (Table 35. Material referring to ‘haemofiltration’ in this chapter also applies to variants (diafiltration, plasmapheresis) unless stated otherwise. Renal replacement therapies mimic normal renal function by placing semipermeable membranes between the patient’s blood and a collection Table 35. Filtration is the passage of fluid through this filter; dialysis is a similar movement of solutes. In the human kidney, both occur passively at the glomerular bed and actively as filtrate passes through renal tubules. While technically separate functions, in practice filtration necessarily contains solutes, while osmotic pressure of solutes on either side of the filter inevitably influences filtration. Peritoneal blood and dialysis fluid (infused through an abdominal catheter) achieves equilibrium of most solutes. Using fluids with large (glucose) molecules, excess body fluid is drawn by osmosis into dialysate, then removed by negative pressure (usually gravity). Peritoneal dialysis has many limitations, including: ■ limited dialysate volumes (abdominal distension causes pain, lung splinting and impairs major organ perfusion) ■ solute removal is limited by filtrate-to-plasma concentrations (toxin levels are reduced, not eliminated) ■ loss of albumin and other large molecules (the peritoneum is highly permeable) ■ peritonitis ■ contraindications (e. Haemodialysis (and haemodiafiltration) combines diffusion, ultrafiltration and convection; toxin removal is so efficient that a few (3–5) hours treatment once or twice each week enables people with chronic renal failure to live fairly normal lives. However complications of haemofiltration include ■ cardiovascular instability ■ disequilibrium syndrome ■ immunological deficiency ■ limited water and solute removal These complications can be especially problematic with critical illness. Hypotensive episodes are twice as likely with haemodialysis as with haemofiltration (Henderson 1987). However caused, disequilibrium syndrome rarely occurs, but when it does it can be distressing for both patients and others; neurological effects include confusion, aggression, nausea/vomiting, muscle twitching, lethargy, blurred vision and possible coning. Critical illness and sedation can mask many of these symptoms, but not the discomfort problems for patients. Removing intravascular fluid encourages replacement by extravascular fluid, but limited transfer occurs during the few hours of haemodialysis, whereas continuous treatments (e. It mimics human glomerular filtration, as plasma is forced under pressure through a semipermeable Haemofiltration 347 membrane (ultrafiltration), and solutes are drawn across the membrane by convection. Unlike the human kidney, haemofiltration (and haemodialysis) cannot selectively reabsorb. Ultrafiltrate volumes are large (although smaller than healthy human ultrafiltrate), so that large infusions are needed to mimic reabsorption. Driving pressure was therefore the differential between a patient’s arterial and venous blood pressures. Anticoagulation was added to prevent thrombus formation in extracorporeal circuits; replacement fluid was given to mimic tubular reabsorption. Manufacturers are rationalising terminology by renaming ‘arterial’ circuits ‘afferent’ and ‘venous’ circuits ‘efferent’; this follows human renal physiology, and is logical, and so although not (as yet) universal, it is used here. Compared with haemodialysis, haemofiltration: ■ enables filtration despite hypotension ■ improves cardiovascular stability ■ enables more gentle removal of solutes (less disequilibrium) ■ removes significantly larger fluid volumes High-speed haemofiltration for short periods may achieve better clearance than haemodialysis, but circuits are relatively costly and time-consuming to prime, and the use of intermittent filtration is almost exclusively confined to hospitals with on-site renal units (Amoroso et al. Haemodiafiltration Ultrafiltrate countercurrent was not used with early haemofilters, so solute clearance remained poor once ultrafiltrate concentrations in filters approached plasma levels. Most units now add countercurrent to haemofiltration, calling it simply ‘haemofiltration’ (literature describing haemofiltration may not always clarify whether it refers to systems with or without countercurrents). Intensive care nursing 348 Theoretically, countercurrent clearance is proportional to countercurrent volume, but exchanges above 2–3 litres per hour do not significantly increase clearance (Miller et al. Prediluting blood (before the filter) reduces viscosity, increasing filtrate volume, urea clearance and filter life (reducing need for anticoagulation) (Kaplan 1985a); but anecdotal reports suggest predilution both hastens coagulation and reduces filter life, perhaps due to activation of clotting factors; further research is needed both to identify mechanisms and to guide practice. Free-flow ultrafiltrate relies on gravity (height difference between the filter and collection bag) to create negative pressure, but most systems now control ultrafiltrate with volumetric pumps, so that the ultrafiltrate pump speed determines negative pressure. Filter membranes Cuprophane or cellulose, used for early filters (Kwan 1997), activate the immune complement system, releasing highly vasoactive substances (e. These cause: ■ hypotensive crises ■ neutropenia Haemofiltration 349 ■ thrombocytopenia ■ hypoxia (neutrophil sequestration in pulmonary circulation). Often containing more than 20,000 fine capillary 2 tubes, they have large surface areas (often 2 m (Ervine & Milroy 1997)), a small volume and, being cylindrical, they are also sturdy. Small capillary tube diameter (65 micrometres (Ervine & Milroy 1997)) usually necessitates anticoagulation to prevent thrombosis and obstruction. Ervine and Milroy (1997) suggest hollow fibre threshold is usually about 30 kDa, but various pore-size filters are available: most of the filters now used can double this threshold. Fibres are glued with polyurethane, making them less biocompatible than flat plate filters (Molnar & Shearer 1998). Although overall surface area is smaller than with hollow fibres, flat plates can clear small molecules more efficiently (Hinds & Watson 1996) and are less prone to clotting, and so require less anticoagulation. Most systems now measure transmembrane pressure directly, although some older systems may still rely on indirect indications (e.

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Accident-prone behavior: Some people seem to motion or needs the use of his hands to push up be more likely than others to have accidents purchase 1 mg estradiol free shipping. Once standing cheap estradiol 2mg on line, ask the patient setting in which the patient is at risk for injury, to keep his eyes open and stand as still as possible. Ask him to open his eyes Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Healthcare-associated infection safety issues in her home and formulates a plan to correct them. Blood, semen, vaginal secretions ethical/legal competencies are most likely to bring 14. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Direct contact: Transmission of disease through techniques to prevent further spread of a present touching, kissing, or sexual contact organism and prevent nosocomial infections. Using practices that help promote the best pos- coughing, sneezing, or talking sible physical condition in patients 5. Nature of organisms present: Some organisms are mechanism that eliminates the invading easily destroyed, whereas others can withstand pathogen and allows tissue repair to occur certain commonly used sterilization and disinfec- b. Number of organisms present: The more organ- protein such as bacteria or, in some cases, the isms present on an item, the longer it takes to body’s own proteins. Intact skin and mucous membranes protect the lumens, crevices, or joints requires special care. The body’s white blood cells influence resistance the preparation and cleaning of equipment. Age, sex, race, and hereditary factors influence disinfection: The choice of chemical or physical susceptibility. Assessing: Early detection and surveillance tech- into consideration the availability and niques are critical. Failure to observe recurring infections, observe nonverbal cues, recommended time periods for disinfection and and obtain the history of the current disease. Hospital: The infection-control nurse is respon- rately reflects the patient’s condition. Planning: Effective nursing interventions can effective infection-control techniques and for control or prevent infection. Home care setting: The infection-control of events that results in infection control as nurse’s duties include surveillance for agency- patient goals are formulated. Implementing: The nurse uses principles of asep- sultation, performance of epidemiologic tic technique to halt the spread of microorgan- investigations and quality improvement activi- isms and minimize the threat of infection. Risk for Infection related to altered skin improve, a patient’s outcome by assessing integrity/burns the person at risk, selecting appropriate nursing b. Effective nursing interventions can control or diagnoses, planning and intervening to prevent infection. The nurse should review maintain a safe environment, and evaluating patient data, consider the cycle of events that the plan of care to determine whether it is result in the development of an infection, and working. Community: Use sterilized combs and brushes holistic manner that respects her human dignity, in beauty and barber shops; examine food han- while at the same time, maintaining a safe environ- dlers for evidence of disease. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Allopathy: Generally used to describe and allowing her to express negative feelings. Turheis to recognize her able advances in biotechnology, surgical strengths and explore other options to fulfill her interventions, pharmaceutical approaches, and self-esteem needs. Turheis will report feeling better connections and interactions between parts of about her situation and will state three positive the whole; focuses on reductionism. What intellectual, technical, interpersonal, and/or pathic and complementary/alternative therapies; ethical/legal competencies are most likely to bring coordinates best possible treatment plan for about the desired outcome? Yoga: A set of exercises that consist of various compassion to patients requiring infection-control physical postures practiced to promote strength precautions and flexibility, increase endurance, or promote Ethical/Legal: demonstration of a commitment to relaxation safety and quality; strong advocacy abilities Nursing Considerations: Encourage patients to 4. Some positions are visits contraindicated in patients with certain physical conditions. Aromatherapy Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition.

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