By R. Ressel. Trinity College of Florida.

The effects of β 1 stimulation include (Moss & Craigo 1994): ■ increased contractility ■ improved atrioventricular conduction ■ quicker relaxation of myocardium ■ increased stroke volume ■ increased heart rate (with potential dysrhythmias) ■ therefore net increased cardiac output ■ increased release of insulin buy motrin 600mg lowest price, renin and antidiuretic hormone (Moss & Craigo 1994) ■ transient hyperkalaemia: as potassium moves out from hepatic cells ■ followed by prolonged hypokalaemia as potassium moves into blood and muscle cells Beta2 receptors are found mainly in bronchial smooth muscle purchase 600mg motrin otc, but a significant minority are also found in myocardium (15 per cent of ventricle and 30–40 per cent of atrial beta receptors (Moss & Craigo 1994)) order motrin 400mg with visa. Beta2 stimulation is especially chronotropic 600mg motrin with mastercard, increasing myocardial workload and predisposing to dysrhythmias (hence tachycardic/dysrhymthmic effects of bronchodilators such as salbutamol) 600 mg motrin free shipping. Beta2 receptors are also found in other smooth muscle, such as blood vessels and skeletal muscle, vasodilating arterioles and reducing systemic vascular resistance (afterload). Insufficient brain stem production causes neurotransmission failure in Parkinson’s disease, but dopamine cannot permeate mature blood-brain barriers (van den Berghe & de Zehger 1996), and so intravenous dopamine does not affect cerebral receptors. Renal juxtaglomerular apparatus contains dopamine receptors; stimulation dilates afferent arterioles, increasing blood flow to the Bowman’s capsule, so increasing urine output. Provided sufficient drug is given to stimulate dopamine receptors, stimulation continues regardless of dose. Gut receptors similarly increase splanchnic perfusion, but attempts to reduce the translocation of gut bacteria with low-dose dopamine have proved disappointing (Azar et al. Prolonged beta stimulation causes ‘down regulation’—progressive destruction of beta receptors, requiring progressively larger doses of inotropes to achieve the same effect. Destruction starts within minutes of exposure to stimulants, reaching clinically detectable levels by 72 hours (Sherry & Barham 1997). Monitoring Ideally all drugs would be titrated to a patient’s weight; in practice, most drugs have a wide enough therapeutic range to enable ‘standard doses’, making both production and prescription safer and simpler. Most inotropes have very short half-lives (a few minutes); overdoses can cause massive, life-threatening hypertension, necessitating close monitoring and careful titration. While short half-lives make accumulation unlikely, flushing or failure of delivery (pump failure; change of syringe) can make blood pressure labile. Inotropes 337 Monitoring inotropes necessitates both careful monitoring of cardiovascular effects and careful recording of amounts delivered. Short half-lives of inotropes and gross hypertensive effects necessitate continuous (or very frequent—every minute) blood pressure measurement. Other cardiovascular monitoring, such as cardiac output studies, will probably be required. Peripheral vasoconstriction, especially from alpha stimulants, necessitates frequent monitoring of peripheral oxygen saturation (SpO2). Traditionally inotropes are measured in micrograms per kilogram per minute (see below), or variants (e. As normotension is the desired end of inotrope therapy, the value of investing nursing time in complex calculations is questionable, especially with calculations based on estimated weights, necessitating recalculation when one guess is replaced by another. Adrenaline (adrenalin, epinephrine) The adrenal medulla produces two hormones, both called ‘catecholamines’. Adrenaline, the main adrenal medullary hormone, stimulates alpha, β 1 and β 2 receptors, triggering the ‘fight or flight’ stress response via the sympathetic nervous system: ■ vasoconstriction (alpha receptors) ■ increased cardiac output (β 1 , β 2) Acting on both alpha and beta receptors, adrenaline effectively increases all factors contributing to blood pressure; it has therefore become the major inotrope used during cardiac arrests, where immediate short-term restoration of systemic blood pressure and circulation is essential. Since prolonged critical illness is more complex, it necessitates careful balancing of factors. Its bronchodilatory qualities (β 2) make nebulised adrenaline useful during asthma crises, especially with children. Intensive care nursing 338 Adrenaline causes gross tachycardia; with critical illness, increased myocardial oxygen consumption in already hypoxic patients may provoke angina or infarction. Alpha effects include peripheral shutdown, including reductions in glomerular filtration rates; the short half-life of bolus adrenaline does not make this problematic during resuscitation, but continued infusion during critical illness may aggravate impending renal failure. Adrenaline depresses insulin secretion, while blocking peripheral insulin receptors; with depressed insulin secretion and increased glycogenolysis, this causes stress-induced diabetes (whether adrenaline is endogenous or exogenous). Normoglycaemia may be restored once intravenous adrenaline is removed, although depleted intracellular glucose supply may prolong cellular recovery. Almost uniquely among drugs, adrenaline is marketed in the virtually obsolete form of ratios. The ratio represents grams per ml, so that 1:1,000=1 gram per 1,000 ml=1,000 mg per 1,000 ml=1 mg per ml; similarly, 1:10,000=1 mg per 10 ml; 1:1,000 is usually marketed in 1 ml ampoules and 1:10,000 in 10 ml ampoules (so that both contain 1 mg per ampoule). While 1:10,000 may be used neat for an infusion, 1:1,000 should be diluted before administration. Noradrenaline Noradrenaline, a natural catecholamine, primarily stimulates alpha receptors, causing intense arteriolar vasoconstriction.

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Yin organs involving nutrition that balances yin and yang (also known as zang) are the liver purchase 600 mg motrin, heart motrin 400 mg mastercard, spleen purchase motrin 600mg on line, characteristics buy 600 mg motrin overnight delivery. Macrobiotic therapists believe that lungs buy 600 mg motrin free shipping, and kidneys and are considered the solid excessive yin qualities (essentially calm and organs that contain what Chinese medicine calls peacefulness) may result in depression, fatigue the essences—tears, sweat, saliva, mucus, and sex- syndromes, and sleep disorders, and excessive ual secretions. Yin phenomena refer to cold, wet, yang (essentially energy and activity) qualities quiescent, deteriorating, chronic, slow, empty, and may lead to tension, insomnia, hyperactivity, and contracted, and lack of yin generates heat and dry- irritability. Fruits, leafy green vegetables, Yang, which includes bodily functioning and the nuts and seeds, tofu, and some other foods are generation of metabolic heat, decreases when yin considered to be yin. Yang organs (also known as fu) are the bles, seafood, legumes, salt, and cottage cheese are gallbladder, small and large intestines, stomach, considered yang. Yang manifests as birth, warmth, claims that within every yin there is an element of activity, noise, form, and light. This phenomena are heat, dryness, growth, fullness, refers to the ability of each force to take on charac- suddenness, and acuteness. Lack of yang generates teristics of the other or of both to dip into each other cold and dampness. Yogic breathing and exercises have philosophers and the variety of styles of Hatha yoga been widely accepted into the Western mainstream developed over the decades. Yoga has know of yoga relies on Hatha to inspire a spiritual been shown to help lower blood pressure and heart interest in the subject, although yoga may be prac- rate and suppress other bodily functions in order to ticed solely for physical purposes such as stress achieve a state of total relaxation. Perhaps this is why many believe yoga is The language of yoga is Sanskrit, considered the old- best approached not as a mere workout routine, est literary language of India and the basis of many but as a journey to one’s whole, best self. The com- There is much debate about who is responsible for bination of breathing techniques, exercise, medita- the oldest documentation of yoga. According to tion, and “right action” is taught to anyone seeking native Indic tradition, it was a grammarian known to promote or restore health and perhaps adopt the as Patanjali. Other than his brief work, The Yoga belief that this will help unite his or her soul with Sutras of Patanjali, dating back approximately 2,000 God. It is believed that cleansing and strengthening years, little more is known about his life. The text the body and focusing the mind enable the spirit to does not credit Patanjali or anyone else as the connect with the divine. The first person to attribute this classical result of achieving full consciousness or self-realiza- work to him was Vacaspati Mishra, the 10th-cen- tion, also known as atman, and unity with brahman tury author of the Tattva-Vaisharadi commentary (totality). Meditation was the earliest form of yoga, and In 196 aphorisms contained in four chapters Buddha is considered by some to be the first yogi. Hatha is one of seven concepts, or “limbs,” as they are commonly known, limbs of Raja yoga, all of which are thought to be of Raja yoga: yama (moral discipline), niyama (reli- necessary to unite the body, mind, and spirit. Ancient engraved seals Patanjali believed that practicing these eight dis- of deities striking yogic poses have been discovered ciplines and sowing the seed of nonattachment in in the Indus Valley, one of the world’s first urban one’s heart would allow a person to achieve the civilizations, located in what is now Pakistan and ultimate freedom of spirit. These artifacts suggest that yoga is that effect which comes to those who have given must have existed before 3000 B. He also wrote commentaries of the Brahma Gorakhnath, who lived sometime between A. Although there are no known copies of an incarnation of Lord Shiva, he was born in 509 the work remaining, the information imparted B. Legend has it that a crocodile grabbed young (Goraksanatha is a Sanskrit form of Gorakhnath), Shankara’s foot while he bathed in a river. When she niyama (disciplines), which precede asana in Patan- agreed, he uttered a mantra. According to Bengal lit- Govinda, a realized sage, and attained self-realiza- erature, he was born of the matted hair of the god tion (samadhi). As the purest and strongest of ies called Mutts, which exist today throughout yogis, he put the goddess Durga to shame with his India. Gorakhnath has been For studies of logic and metaphysics Shankara’s described as the most influential Indian since work is highly recommended. Ramakrishna Paramhansa As in the Yoga-Sutra, there is no mention of an Ramakrishna Paramhansa (1836–86) was a scholar author.

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Self-esteem and self-consistency: A theoret- ical and empirical link between two primary motivations motrin 600mg without a prescription. Gender differences in self-consistency: This chapter focused on the Roy Adaptation Evidence from an investigation of self-concept structure discount 600 mg motrin free shipping. Model as a basis for developing knowledge Journal of Youth and Adolescence motrin 600mg for sale, 17(1) motrin 600 mg with visa, 41–57 discount 400mg motrin with mastercard. Two major constructs of the model and role perspective on aging and self through the adult years: An empirical evaluation. American Journal of Sociology, 94, were elaborated: coping and adaptation pro- 1117–1145. Madison: University of strategies with observed cognitive behavior Wisconsin Press. The working brain: An introduction to Theoretical update and knowledge for practice. Retreived May 14, adaptation model-based research: Twenty-five years of contribu- 2004. Decision-making by the physically ill and adap- Clinical Gerontologist, 5(1/2), 165–173. Cognitive processing in patients with closed head hearing in the aged in regard to speech perception in quiet injury. Interviewing with hearing impaired older per- Phenomenon and practice: Human responses to neurological sons. While she developed the model strictly as a teach- Betty Neuman developed the Neuman Systems ing aid, the model is now used globally as a nursing Model in 1970 to “provide unity, or a focal point, conceptual model. She is an author, lecturer, and dynamic energy exchange, the system also can independent nursing curriculum consultant. Energy can move toward Neuman has published numerous books and jour- extinction (entropy) by gradual disorganization, nal articles in response to requests for support in increasing randomness, and energy dissipation. Neuman received honorary client system and presents nursing as a field prima- doctorates from Grand Valley State University in rily concerned with defining appropriate nursing Allendale, Michigan, in 1998, and from Neuman actions in stressor-related situations or in possible College in Aston, Pennsylvania, in 1992. The client and Neuman is an honorary fellow in the American environment may be positively or negatively af- Academy of Nursing. There is a tendency within any system to maintain a steady state or balance among the various disruptive forces operating within or The Neuman Systems Model upon it. Neuman has identified these forces as stressors and suggests that possible reactions and The Neuman Systems Model provides a comprehen- actual reactions with identifiable signs or symp- sive, flexible, holistic, and systems-based perspective toms may be mitigated through appropriate early for nursing. Neuman (1995) defined conceptual model concepts, whereas other proposi- tions state the relationships among conceptual model concepts in a general manner. In Fawcett’s Neuman (1995) defined system as a perva- (1995a) analysis of the Neuman Systems Model, sive order that holds together its parts. With this definition in mind, she writes that believes that Neuman’s primary, secondary, and nursing can be readily conceptualized as a complete tertiary preventions provide the required linkages whole, with identifiable smaller wholes or parts. The fol- The complete whole structure is maintained by in- lowing propositions describe, define, and connect terrelationships among identifiable smaller wholes concepts essential to understanding the conceptual or parts through regulations that evolve out of the model that is presented in the next section of this dynamics of the open system. Although each individual client or group as a gentropy or evolution as a system absorbs energy client system is unique, each system is a com- to increase its organization, complexity, and devel- posite of common known factors or innate opment when it moves toward a steady or wellness characteristics within a normal, given range of state. An open system of energy exchange is never response contained within a basic structure. Many known, unknown, and universal envi- toward differentiation and elaboration for further ronmental stressors exist. Tertiary prevention relates to the adaptive pro- interrelationships of client variables—physio- cesses taking place as reconstitution begins and logical, psychological, sociocultural, develop- maintenance factors move the client back in a mental, and spiritual—at any point in time can circular manner toward primary prevention. The client as a system is in a dynamic, constant by the flexible line of defense against possible energy exchange with the environment reaction to a single stressor or a combination of (Neuman, 1995, pp. The conceptual model was resents change over time through coping with developed to explain the client-client system as an diverse stress encounters. When the cushioning, accordion-like effect of tive relationships that exist between the client and the flexible line of defense is no longer capable the caregiver in Neuman’s model. Neuman now of protecting the client-client system against an believes the model can be equally well applied to environmental stressor, the stressor breaks a group, larger community, or social issue and is ap- through the normal line of defense. The inter- propriate for nursing and other health disciplines relationships of variables—physiological, psy- (Neuman, 1995). The client, whether in a state of wellness or client system, environment, and nursing aspects of illness, is a dynamic composite of the interre- the nursing domain.

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