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Conventional level: This level is obtained when According to Havighurst buy tinidazole with amex antibiotic 3 days, the developmental tasks person becomes concerned with identifying with of later adulthood include adjusting to decreasing significant others and shows conformity to their physical strength and health purchase 500mg tinidazole fast delivery antibiotics for acne south africa, adjusting to retirement expectations cheap 500 mg tinidazole amex antimicrobial effectiveness test. Example: A college student gets all and reduced income order line tinidazole infection movies, and establishing physical A’s in college so his parents will think he is a living arrangements. Postconventional level: This level is associated of dependency on healthcare providers and his with moral judgment that is rational and inter- family. The nurse could then base the nursing plan nalized into one’s standards or values. Example: of care on interventions to foster feelings of A bank teller resists the urge to steal money from personal dignity and worth. Logan states that he is willing to participate in latency stage and will be experiencing increased his care plan and do everything in his power to interest in gender differences and conflict and adjust to his situation by accepting the assistance of resolution of that conflict with parent of same others when necessary sex. Erikson: The 6-year-old is becoming achievement ethical/legal competencies are most likely to bring oriented, and the acceptance of parents and about the desired outcome? Havighurst: The 6-year-old is ready to learn the mental theories to nurse care planning developmental tasks of developing physical Technical: ability to provide technical nursing assis- skills, wholesome attitudes toward self, getting tance to Mr. Logan as needed along with peers, sexual roles, conscience, moral- Interpersonal: ability to use therapeutic communi- ity, personal independence, and so on. An illness cation to meet the emotional and spiritual needs of could stall these processes. Piaget: The 6-year-old is in the preoperational Ethical/Legal: ability to advocate for the unmet stage, including increased language skills and developmental needs of Mr. Kohlberg: Moral development is influenced by Home healthcare services, community services, cultural effects on perceptions of justice in inter- support groups personal relationships. Moral development begins in early childhood and could be affected by a traumatic illness. A health problem of any family member can affect the Chart/Exhibit Questions remainder of the unit. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Age group—Physiologic characteristics and behaviors I—Is in oral stage (Freud); strives for immediate P—Motor abilities include skipping, throwing and gratification of needs; strong sucking need. A—In Freud’s genital stage, libido reemerges in I—Brain grows to about half the adult size mature form. N—Reflexes include sucking, swallowing, blinking, T—Is in anal stage (Freud); focus on pleasure of sneezing, and yawning sphincter control N—Temperature control responds quickly to A—Self-concept is being stabilized, with peer group environmental temperatures as greatest influence. T—Walks forward and backward, runs, kicks, climbs, I—Develops trust (Erikson) if caregiver is and rides tricycle dependable to meet needs T—Drinks from a cup and uses a spoon S—Achieves personal independence; develops con- A—Sebaceous and axillary sweat glands become active science, morality, and scale of values S—Height increases 2 to 3 inches, weight increases A—Tries out different roles, personal choices, and 3 to 6 lbs a year beliefs (identity versus role confusion) A—The feet, hands, and long bones grow rapidly; I—Meets developmental tasks (Havighurst) by muscle mass increases. A—More mature relationships with both males and P—Full set of 20 deciduous teeth; baby teeth fall females of same age out and are replaced. T—Enters Erikson’s stage of autonomy versus shame P—Body is less chubby and becomes leaner and and doubt more coordinated. P—Is in Erikson’s stage of initiative versus guilt A—Primary and secondary development occurs A—Inner turmoil/examination of propriety of with maturation of genitals. T—Developmental tasks of learning to control elim- I—Motor abilities develop, allowing feeding self, ination; begins to learn sex differences, concepts, crawling, and walking. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Preschooler: A preschooler may have fear of pain S—Is in Erikson’s industry versus inferiority stage and body mutilation as well as separation anxi- 3. Preembryonic stage: Lasts about 3 weeks; zygote ety that must be recognized by the nurse. The implants in the uterine wall and has three distinct child needs much reassurance and parental sup- cell layers: ectoderm, endoderm, and mesoderm. Embryonic stage: fourth through eighth week; possible; allowing the child to practice on a doll rapid growth and differentiation of the germ cell may be helpful. School-aged child: Body image, self-concept, and and human features are recognizable. Fetal stage: 9 weeks to birth; continued growth has well-developed language skills and ability to and development of all body organs and systems store information in long-term memory. Personal and social interaction in the stage called identity versus role confusion. Infant sleeps, eats, and eliminates easily; smiles group acting as the influential body. The nurse spontaneously; cries in response to significant should be aware of the adolescent’s need to needs. Infant has volatile and labile responses, often is prevention of illness and promotion of wellness restless sleeper, is highly sensitive to noises and through teaching family members. The nurse should edu- motion, helping caregivers find the means of cate the parents about colic and teach them helping toddlers through encouraging independ- measures to help relieve the symptoms. Failure to thrive is a condition thought to be for parents of active toddlers should be taught. Preschooler: Promoting wellness continues for infant and the primary caregiver that results in the preschooler, with emphasis on teaching acci- severely inadequate physiologic development. Sudden infant death syndrome is the sudden, aged children are traffic, bicycle, and water safety. Parents should be aware that Nurses should work with parents and teachers to the highest incidence occurs in families who are recognize mental health disorders and to encour- poor or live in crowded housing in cold months age physical fitness and positive self-identity. Adolescent and young adult: Nurses should edu- health, smoking, and nutrition are being investi- cate adolescents and family members about sub- gated; infants should sleep on their side or back. Nurses and parents should be aware of physical, or sexual abuse of a child by a parent or the adolescent’s need to belong to a peer group, other caregiver. Prepubescence: Secondary sex characteristics vide interventions for high-risk families. Pubescence: Secondary sex characteristics permanence, following simple commands, and continue to develop, and ova and sperm begin anticipating events. Postpubescence: Reproductive functioning and nurse should be aware that the toddler may secondary sex characteristics reach adult maturity. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Leming states that she values Physiologic development: The early years are her health and the health of her fetus enough to marked by maximum physical development and stop smoking and drinking alcohol. What intellectual, technical, interpersonal, and/or social relationships, increased responsibility, and ethical/legal competencies are most likely to bring awareness of one’s own mortality about the desired outcome? Cognitive, moral, and spiritual development: Intellectual: knowledge of the developmental needs Intellectual abilities change from those of the of fetuses and the effects of maternal behaviors, young adult. There is increased motivation to such as smoking and alcohol consumption on the learn. Problem-solving abilities remain, although fetus response time may be slightly longer. Older adulthood: assistance necessary to assess and meet the needs Physiologic development: The process of aging of a pregnant woman and her fetus becomes more rapid. All organ systems undergo Interpersonal: ability to demonstrate nonjudgmen- some degree of decline, and the body becomes tal attitude when interacting in potentially less efficient.


As skin ages order tinidazole paypal infection hyperglycemia, epidermis flattens discount tinidazole 300 mg without a prescription virus asthma, with loss of papillae (Herbert 1991) so that epidermal and dermal layers peel apart more easily order tinidazole 1000mg amex antibiotics for uti price, causing pressure sores from sheering (see Chapter 12) discount tinidazole american express bacteria quotes. Capillary loss reduces oxygen, nutrients and hydration; skin becomes dryer, more brittle and prone to tearing with delayed healing. Most pressure sores occur in people over 70 years of age (Mihissin & Houghton 1995), hence the weighting for age on Waterlow and other assessment scales. Pressure area aids can reduce the incidence of pressure sores, but optimising endogenous factors (nutrition, perfusion) reduces risks. Muscular and skeletal atrophy contribute to weakness (which delays weaning from ventilation). Mortality is easily measured, but quality of life is a more valuable (if more subjective) measure of outcome. Conflicting research and practice makes healthcare for the critically ill older adults into a covert lottery. Ageism ‘Ageism’, the ‘notion that people cease to be people…by virtue of having lived a specific number of years’ (Comfort 1977:35), leads to ■ prejudice ■ stereotyping ■ negatives attitudes (Redfern 1991) and may be overt (e. Today’s elders grew up before the National Health Service existed, and so remember a very different society (and social values)—doctors (and nurses) then were presumed always to know best. Therefore, the beliefs and values of the older patients may differ significantly from those of the nurses caring for them—and different generational values may cause misunderstandings. Bereavement, social mobility and physical immobility are more likely to leave older people isolated, depriving them of the social supports (families, friends) that younger people usually have; friends and family may treat the older person as a burden. Psychological isolation can become self-fulfilling, encouraging older people to adopt child-like dependent behaviour and/or appear confused. Problems encountered by older people using hospital services can persist after leaving the department; specialised assessment forms for older people (e. De Beauvoir (1970) is highly readable, providing challenging sociological perspectives. Some useful, albeit largely quantitative, medical studies have been published in recent years, including Castillo-Lorente et al. The effect of physiological ageing on older patients in intensive care is discussed by Kilner and Janes (1997). Clinical scenario Frank Hobson is a very socially active and independent 84-year-old retired civil servant. Note the main age-related physiological changes and how these are incorporated into planning postoperative care. Immunocompromise and infection are often part of a complex pathological process; related material can be found in other chapters, especially chapters 9, 39 and 40. Exogenous infection is usually through contact (staff, procedures, equipment), but can also be airborne. Immunity develops with age and exposure to pathogens so that children are at greater risk of infection (e. Highly invasive equipment used with critically ill patients provides multiple entry sites for microorganisms so that benefits should be weighed against infection risks. Enteral tubes and infected feeds facilitate microorganisms entry into the gut, bypassing many nonspecific immune defences (e. Feeds standing for prolonged times at room temperature provide ideal media for bacterial growth. Forty-five per cent of patients stayed over 5 days, with infection rates tripling after 3– 4 days. Patients staying longer were usually sicker, but exposure to secondary infections compounded mortality. The report suggested that one-half of nosocomial infections were preventable, with risks increasing when units had more than eleven beds. Organisms Bacteria are small, usually 1–2 micrometres in diameter, and a single bacterium will divide up to a million times within 6 hours (Wilson 1997). Gram positive or gram negative levels indicate whether bacteria retain crystal violet-iodine complex stain (Murray et al. Gram negative organisms cause 70 per cent of all cases of sepsis (Wardle 1996), while mortality from gram negative septicaemia is 40–70 per cent (Michie & Marley 1992). There are over 170 strains of Staphylococci, mutations and variants making control problematic. Skin colonisation (throat, groin, axillae) by Staphylococci is widespread (Murray et al. Chlorhexidine reduces surface colonisation, while most strains remain susceptible to vancomycin (Murray et al. Most strains of Pseudomonas cannot survive human body temperatures, but Pseudomonas aeruginosa grows at body temperatures, tolerates 40–42°C (Murray et al. An opportunistic organism, skin colonisation occurs in only 2 per cent of healthy adults, but 38 per cent of hospitalised patients and 78 per cent of immunocompromised patients (Murray et al. Amphotericin is the most widely used anti-fungal drug, although some fungi have developed resistance to this (Richardson 1994). Controlling infection Infection-free environments remain unrealistic, but the spread of infection can be controlled. Endogenous infection requires ■ a source Infection control 131 ■ means of transmission ■ means of entry. Family and friends rarely move between patients, but staff can easily transfer hospital (often resistant) pathogens between patients. Hygiene (especially handwashing) temporarily reduces numbers of skin-surface bacteria; particularly problematic pathogens may be targeted by specific treatments for staff (e. The use of gloves and no-touch techniques significantly reduces cross-infection, but handwashing remains the simplest and most important way to reduce infection; minimising movement of staff between patients also reduces risks. Airborne bacteria can also be transmitted through ■ dust ■ airborne skin scales ■ droplets (e. Taylor’s (1978) classic study of nurses’ handwashing techniques identified poor technique by qualified staff; student nurses fared better, possibly due to recent education or anxieties about their clinical assessment. Poor handwashing technique may be improved through continuing (in-service) education (Gould & Chamberlain 1994) and feedback (Mayer et al. Intensive care nursing 132 Taylor also found that while palms of hands were effectively cleaned when handwashing, thumbs, tips of fingers and backs of hands were poorly washed. Fingertips, the most likely part to touch patients, may harbour bacteria unless consciously washed— observing almost anyone washing their hands (in or outside hospital) supports Taylor’s observation. Hands should be dried thoroughly after washing; wet hands (and wet alcohol) provide ideal warm, moist environments for bacterial growth. Recontamination after handwashing can be reduced by ■ elbow-operated taps ■ disposable towels (not trailing in water) ■ foot-operated pedal bins. These should be accessible and maintained (tap levers blocked by other wall fittings, empty towel dispensers or broken pedal bins are counterproductive). Chlorhexidine causes a greater reduction in skin surface bacteria than soap (Doebbling et al.

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No part of this work covered by the copyright herein may be reproduced or used in any form or by any means—graphic, electronic or mechanical without the prior written permission of the publisher. Any request for photocopying, recording, taping or information storage and retrieval systems of any part of this book shall be directed in writing to The Canadian Copyright Licensing Agency (Access Copyright). Care has been taken to trace ownership of copyright material contained in this book. The publisher will gladly receive any information that will enable them to rectify any reference or credit line in sub- sequent editions. Numerous product names appear throughout this book, most of which are registered trademarks, although the symbol is respectfully omitted. The author(s) and publisher are not engaged in rendering medi- cal, therapeutic, or other services in this publication. This publication is not intended to provide a basis for action in particular circumstances without consideration by a competent professional. The author(s) and publisher expressly disclaim any responsibility for any liability, loss, or risk, personal or otherwise, which is incurred as a consequence, directly or indirectly, of the use and application of any of the con- tents of this book. Library and Archives Canada Cataloguing in Publication Data Torkos, Sherry The Canadian encyclopedia of natural medicine / Sherry Torkos. Mississauga, Ontario L5R 4J3 Printed in Canada This book is printed with biodegradable vegetable-based inks. There are now over 29,000 commercially available dietary supplements in North America, with over 4,000 ingredients alone purported to assist in weight loss. There is a lineup of authors touting the fad diet du jour, conflicting media messages on the benefits and pitfalls of diet, and a wild west of unbridled health claims for supplements. It is not entirely surprising that consumers, patients, and health care providers alike are all craving sound, unbiased, and scientifically grounded information. Enter trusted pharmacist Sherry Torkos, a renowned expert and talented writer who has consistently set the gold standard in health promotion literature. Like thou- sands of others, I have always been impressed by Sherry’s books, with their superb coverage of women’s health, emotional disorders, anti-aging interventions, and sound, scientifically based measures for the maintenance of a healthy, lean body. It was no shock to me that Sherry would take on the Mount Everest of nutritional projects—the daunting task of covering the need-to-know information regarding nutrition, lifestyle, and supplements in relation to the most common medical disorders and diseases. In addition to the global aspects of diet and nutrients, lifestyle habits, and stress management for overall health, Sherry provides condition-specific advice on complementary interventions, dietary modifications, and key nutritional and herbal supplements—all without overwhelming the reader. The end result is the ultimate resource for consumers, patients, and health care providers. Pharmacists, doctors and patients will also appreciate the unique and detailed descriptions of the prescrip- tion drugs that can deplete vitamins and minerals. This drug–nutrient interaction is an underappreciated factor and a particularly important one when considering that prescription drug usage in Canada now exceeds $20 billion. It will be obvious and appreciated by readers that this is an exhaustive work, a cross-over book that will be useful and reader-friendly to both consumers and doc- tors alike. Leaving no stone unturned, Sherry has elegantly put together a book that stands alone. She has filtered out the hype and synthesized thousands of scientific x | Foreword papers from various medical disciplines—there simply is no other book like it. This resource is timely and destined to become one that will be referred to over and over again. Most importantly, it is a resource that allows for informed choice without bias or commercial spin, providing practical advice that is sure to make a difference in the lives of many. The book strikes me as an extension of Sherry herself, a trusted advisor in the otherwise confusing world of nutrition and natural health products. To my husband Rick and my family, who have stood by me through this book and many others, I thank you for your patience and understanding of my commitment to this project and all the long hours required. Joey Shulman, Lorna Vanderhaeghe, and Farid Wassef, I appreciate your time and expertise in reviewing sections of my manuscript. Bryce Wylde, many thanks for providing the chapter on homeopathy and for sharing your knowledge and passion. To Katherine Zia, my developmental editor and publicist, whom I have had the pleasure of working with for over ten years, a tremendous thanks and much apprecia- tion for all the help you gave me in researching, planning, and staying on track with this book. To the team at Wiley: Jennifer Smith, Leah Fairbank, Liz McCurdy, Lindsay Humphreys, and the design department, thanks for all your help throughout this project. To my copyeditor, Valerie Ahwee, I appreciate all your hard work in reviewing my manuscript and your fine editorial assistance. Finally I would like to thank you, the reader, for your interest in health and well- ness and for your desire to read this book. He has been in private practice for 20 years, specializing in Chinese medicine, sports medicine and nutrition. Ali completed his course on Body/Mind Medicine at Harvard Medical School, and he is a member of the postgraduate association at Harvard. Jean-Yves Dionne, pharmacist, is a scientific advisor and natu- ral health products consultant for several companies. He is often called upon to speak to health professionals about complemen- tary medicines. In 2003, he received the Aventis Pharma award for outstanding contribution to teaching for the course Phytotherapy and Natural Health Products at the Faculté de Pharmacie de l’Université de Montréal. Jean-Yves is co-author of Herbs: Everyday Reference for Health Professionals, published by the Canadian Pharmacists Association. Dionne sits on the board of the Table Filière des Plantes Médicinales du Québec (medicinal herbs round table), of the Canadian Natural Health Product Research Society and the Canadian Natural Product Association. Rhonda Dorren received her Bachelor of Science degree in Pharmacy at the University of Alberta in Edmonton. A licensed pharmacist in Alberta and an author, she has developed a con- sultation practice in Natural Medicine Pharmacy, utilizing a unique blend of allopathic and biological medicines. Sam Graci Sam Graci is a Canadian lifestyle researcher and the author of four #1 best-selling books in Canada. His latest book, The Bone-Building Solution, is co-authored with Carolyn DeMarco, M. A portion of the proceeds from the sale of his four books are donated to Scouts Canada for their tree-planting program and also donated to non- profit environmental groups.

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