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Afer the World Trade Center attacks in 2001 cheap 1 mg prazosin free shipping cholesterol definition importance, frefghters who perished were found to be wearing other frefghters’ turnout coats buy prazosin discount cholesterol olive oil. Identifcation errors could have been made from attempting to make positive identifcations using personal efects alone buy cheap prazosin 2 mg online cholesterol yahoo. Scars may be from previous trauma or surgical intervention and can be further investi- gated by the pathologist purchase prazosin once a day cholesterol granuloma. Tattoos, if sufciently unique, can be used as an identifer of an individual or may indicate that individual belonged to a particular group or gang. See Chapters 5 and 11 for information concern- ing tattoos and scars and for methods for better imaging this evidence. A swab from a close relative, stored blood, or material from the decedent’s hairbrush or toothbrush may provide adequate comparison material. By providing efcient, accurate, and cost-efective human identifcation, forensic dentists play important roles in death investigation. Aggripina the Younger, wife of Emperor Cassius and mother of future Emperor Nero, contracted for the killing of a perceived rival, Lollia Paulina. In his account Dio reported, “She did not recognize the woman’s head when it was brought to her; she opened the mouth with her own hand and inspected the teeth, which had certain peculiarities. Bringing closure to a tragic or unexpected event will ofen give some peace and closure to the immediate family members in their time of grief. Although confrmation of death may be terrible, it ultimately leads to the possibility of resolution of a difcult time for family members. Te cause and manner of death may be very important items of information for life insurance companies and to the decedent’s family. Increased benefts for accidental death or clauses precluding payment for deaths from suicide, acts of war, or engaging in dangerous activities ofen mean that these cases are decided in courts of law. In multiple fatality incidents, identifcation of decedents is ofen difcult and commingling of remains may occur. In these situations great care must be taken to correlate all body fragments to the appropriate decedent. Dental identifcation may provide an identifed fragment to which other unknown fragments can be compared. See Chapter 16 for additional information concerning the legal aspects of forensic dental identifcation. Te mechanism of this process involves comparing features of an unknown specimen to those of a known individual. An accurate and detailed evaluation of the postmortem specimen will aford the best possibility of successfully comparing that information to antemortem information. Attention to detail at the postmortem exami- nation precludes errors that can lead to nonidentifcation and the need to repeat steps to get an accurate postmortem record. By following a step-wise examination checklist that includes photography, dental radiography, and dental charting, a forensic odontologist or forensic dental team can create consistently accurate postmortem dental records. Photography of a specimen can provide the ability to view specifc features without having to revisit the morgue. Tese photographs should be taken to allow orientation as well as closeup photographs of the dental structures. Tis photo documentation can prove extremely valuable in cases where the han- dling of the specimen could lead to further degradation of fragile remains. Tis is ofen the case with dental structures that have become desiccated or carbon- ized from extreme heat. Using macro or closeup photographs of the dentition can also provide additional information that may lead to identifcation and is discussed in more detail in the comparison section of this chapter. Te goal of the postmortem dental examination is to locate, identify, and document anatomical structures, dental restorations, and dental appliances that will aid the comparison process. Te more information documented in this examination, the greater the likelihood of successful comparison to an antemortem record. In a fully intact body with no injuries to the facial structures, the ability to locate specifc dental structures will be simple in comparison to cases in which individuals have been subjected to explosions, rapid deceleration injuries, extreme heat, or crushing forces. Tis radiograph facilitates locating radiopaque structures that can assist in locating dental structures within the speci- men or body bag. Once these items are identifed on this large radiograph, the examiner can use this image to assist in locating structures of interest, including teeth, dental prosthetic items, and bony structures of the mandible or maxilla. Once all available dental material is found, forensic odontologists should take dental radiographs in an efort to reproduce similar exposures and angulations anticipated in the antemortem dental record. Since the source and type of radiographs may be unknown at this point in the process, it is recommended that a full series of radiographs be obtained. Tis series of flms should include posterior and anterior periapical radiographs and bite- wing radiographs. If the specimen is fragmented, the radiographer should consider the necessary flm placement and tube head angulations to repli- cate those normally obtained in a clinical setting. For convenience in image capturing the examiner may also fnd it helpful to radiograph the maxillary and mandibular teeth separately in bitewing radiograph projections. If the examiner is taking images of fragmented remains, care should be taken to ensure that consistent projection geometry is maintained by placing the flm or digital sensor on the lingual aspect of the specimen. Again, care- fully following protocol is important, as the examiner may not have a second chance to complete the radiographic examination. Attention to detail is nec- essary, and any images that are not adequate should be retaken so complete radiographic information is available for comparison to antemortem data. If digital radiography is available, the examiner will fnd the retake of images to be straightforward since the need to process flms is eliminated and the image is instantly viewable. Additional details concerning forensic dental radiography techniques can be found in Chapter 10. Te postmortem record, whether digital or paper, should be recorded in a form that will assist in the comparison process. It should be a format that records and displays the relevant features of the dentition to demonstrate missing teeth and the restored surfaces (Table 9. Tis action, securing antemortem dental records, is a crucial step in dental iden- tifcation, and the quality of these records is totally dependent on practicing dentists keeping accurate records of the dental status of their patients. Dentists are required by law, in most jurisdictions, to maintain their patients’ original records. Tis places a dental practitioner in an uncom- fortable position when asked to release an original dental record for com- parison and possible dental identifcation. Dentists are almost always 170 Forensic dentistry anxious to help but concerned about the proper management of their patients’ health records. With the current ability to digitize a dental chart, the duplication of an original record can be relatively easily per- formed. Duplication of the record in this fashion provides the dental ofce and the forensic investigator with a digital copy of the record and the amount of time that the treating ofce is without the original record is minimized.
She told the nurse practitioner that and her foster mother reports that she no her job as a computer programmer is stressful longer recognizes her child generic prazosin 2mg otc cholesterol from food good bad. When alone in and these monthly symptoms are affecting her her crib buy prazosin 1mg free shipping cholesterol esterase, she seldom moves buy prazosin 2 mg without a prescription cholesterol medication side effects liver, and she moans job performance and relationships 2 mg prazosin with mastercard cholesterol medication lawsuit. Several nurses have expressed great frus- nurse if there is anything available to control tration caring for Tabitha because they ﬁnd it these symptoms. What nursing interventions might the they see how much pain these procedures nurse use to help minimize the effects of cause. Identify pertinent patient data by placing a single underline beneath the objective data in the case study and a double underline beneath the subjective data. What would be a successful outcome for this page 232 to develop a three-part diagnostic patient? Write down the patient and personal nursing strengths you hope to draw on as you assist this patient to better health. What intellectual, technical, interpersonal, Patient strengths: and/or ethical/legal competencies are most likely to bring about the desired outcome? Pretend that you are performing a nursing assessment of this patient after the plan of care is implemented. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. For the purposes of this exercise, develop the one patient goal that demonstrates a direct resolution of the patient problem identified in the nursing diagnosis. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Nutrient needs remain the same through- and least expensive source of calories in the out the life cycle. To provide the blood-clotting factor nurse should consider which of the following guidelines? Check tube placement by adding food dye to the tube feed as a means of detecting as- c. Which of the following vitamins is water every 4 to 8 hours during a continuous soluble? Vitamin B per shift to ensure the presence of peristal- sis and a functional intestinal tract. A nutritional therapy for patients who have which of the following nutrients due to their nonfunctional gastrointestinal tracts or larger muscle mass? Place the patient in the Trendelenburg posi- tion to facilitate the ﬂuid aspiration process. Checking the placement of a gastrostomy or Circle the letters that correspond to the best jejunostomy tube requires regular comparisons answers for each question. Prolonged fasting Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The percentage of carbohydrates decreases nutrients because they are needed by the as ﬁber intake increases. Vitamins are inorganic compounds needed for transport through the blood or for use by the body in moderate amounts. The period between when carbohydrates most are either not synthesized in the body are consumed and when they are used for or not made in sufﬁcient quantities. All carbohydrates, except for indigestible all body ﬂuids and tissues in the form of ﬁber, provide 12 cal/g regardless of the salts or combined with organic compounds. Which of the following statements regarding are microminerals because they are needed the function of protein in the body are by the body in amounts of less than accurate? Water accounts for 35% to 50% of the different proteins are made by combining adult’s total weight. Which of the following are daily recommended food servings for speciﬁc food groups according b. Dietary protein is broken down into amino acid particles by pancreatic enzymes in the c. The body’s protein tissues are in a constant describe factors that inﬂuence nutrient state of ﬂux. Fats in the diet are soluble in water and, caloric needs of the older adult increase. Food fats contain mixtures of saturated and are greater in infancy than at any other unsaturated fatty aids depending on the time in life. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Elevate the head of the bed at least 30 functions degrees during the feeding and for at least 2. Change the delivery set every other day oncotic pressure according to agency policy. Check the residual before intermittent feed- ings and every 8 hours during continuous 7. Is necessary for absorption of fat-soluble vitamins Fill-in-the-Blank Questions 9. Scurvy, hemorrhage, delayed wound healing Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Hypokalemia, muscle cramps and weak- detoxiﬁcation reactions ness, irregular heartbeat 26. Microcytic anemia, pallor, decreased clotting, nerve transmission, muscle work capacity, fatigue, weakness contraction 16. Oxidizes sulfur and products of sulfur inﬂammation and poor wound healing metabolism Match the function in Part B with the mineral 34. List one food source for each balance; energy metabolism mineral on the line provided at the end of the sentence. Micronutrients Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The study of nutrients and how they are person to mild or subclinical deﬁciencies of handled by the body vitamin A, vitamin C, folate, and vitamin B6. Vitamins and minerals that are required in much smaller amounts to regulate and control body processes e. Explain the difference between the following the function and recommended percentage fatty acids, and give an example of each. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Brieﬂy describe the following eating disorders and the typical characteristics of individuals c.
A major milestone in puberty for girls is menarche buy cheap prazosin 1 mg cholesterol levels when to take medication, the first menstrual period buy 2mg prazosin mastercard plasma cholesterol definition, typically  experienced at around 12 or 13 years of age (Anderson order prazosin 1 mg visa cholesterol ratio levels, Dannal generic 1mg prazosin mastercard cholesterol levels history, & Must, 2003). The age of menarche varies substantially and is determined by genetics, as well as by diet and lifestyle, since a certain amount of body fat is needed to attain menarche. Girls who are very slim, who engage in strenuous athletic activities, or who are malnourished may begin to menstruate later. Even after menstruation begins, girls whose level of body fat drops below the critical level may stop having their periods. The sequence of events for puberty is more predictable than the age at which they occur. Some girls may begin to grow pubic hair at age 10 but not attain menarche until age 15. In boys, facial hair may not appear until 10 years after the initial onset of puberty. The timing of puberty in both boys and girls can have significant psychological consequences. Boys who mature earlier attain some social advantages because they are taller and stronger and, Attributed to Charles Stangor Saylor. At the same time, however, early-maturing boys are at greater risk for delinquency and are more likely than their peers to engage in antisocial behaviors, including drug and alcohol use, truancy, and precocious sexual activity. Girls who mature early may find their maturity stressful, particularly if they experience teasing or sexual harassment (Mendle, Turkheimer, & Emery, 2007; Pescovitz  & Walvoord, 2007). Early-maturing girls are also more likely to have emotional problems, a lower self-image, and higher rates of depression, anxiety, and disordered eating than their peers  (Ge, Conger, & Elder, 1996). Cognitive Development in Adolescence Although the most rapid cognitive changes occur during childhood, the brain continues to develop throughout adolescence, and even into the 20s (Weinberger, Elvevåg, & Giedd,  2005). During adolescence, the brain continues to form new neural connections, but also casts  off unused neurons and connections (Blakemore, 2008). As teenagers mature, the prefrontal cortex, the area of the brain responsible for reasoning, planning, and problem solving, also  continues to develop (Goldberg, 2001). And myelin, the fatty tissue that forms around axons and neurons and helps speed transmissions between different regions of the brain, also continues  to grow (Rapoport et al. Adolescents often seem to act impulsively, rather than thoughtfully, and this may be in part because the development of the prefrontal cortex is, in general, slower than the development of the emotional parts of the brain, including the limbic system (Blakemore,  2008). Furthermore, the hormonal surge that is associated with puberty, which primarily influences emotional responses, may create strong emotions and lead to impulsive behavior. It has been hypothesized that adolescents may engage in risky behavior, such as smoking, drug use, dangerous driving, and unprotected sex in part because they have not yet fully acquired the mental ability to curb impulsive behavior or to make entirely rational judgments (Steinberg,  2007). Teenagers are likely to be highly self-conscious, often creating an imaginary audience in which they feel that everyone is constantly watching them (Goossens, Beyers, Emmen, & van Aken,  2002). Because teens think so much about themselves, they mistakenly believe that others  must be thinking about them, too (Rycek, Stuhr, McDermott, Benker, & Swartz, 1998). It is no wonder that everything a teen‘s parents do suddenly feels embarrassing to them when they are in public. Social Development in Adolescence Some of the most important changes that occur during adolescence involve the further development of the self-concept and the development of new attachments. Whereas young children are most strongly attached to their parents, the important attachments of adolescents  move increasingly away from parents and increasingly toward peers (Harris, 1998). In his approach, adolescents are asked questions regarding their exploration of and commitment to issues related to occupation, politics, religion, and sexual behavior. The responses to the questions allow the researchers to classify the adolescent into one of four identity categories (seeTable 6. The individual has not engaged in any identity experimentation and has established an identity Foreclosure status based on the choices or values of others. The individual is exploring various choices but has not yet made a clear commitment to any of Moratorium status them. Identity-achievement status The individual has attained a coherent and committed identity based on personal decisions. Studies assessing how teens pass through Marcia‘s stages show that, although most teens eventually succeed in developing a stable identity, the path to it is not always easy and there are many routes that can be taken. Some teens may simply adopt the beliefs of their parents or the first role that is offered to them, perhaps at the expense of searching for other, more promising possibilities (foreclosure status). Other teens may spend years trying on different possible identities (moratorium status) before finally choosing one. To help them work through the process of developing an identity, teenagers may well try out different identities in different social situations. They may maintain one identity at home and a different type of persona when they are with their peers. Eventually, most teenagers do integrate the different possibilities into a single self-concept and a comfortable sense of identity (identity- achievement status). For teenagers, the peer group provides valuable information about the self-concept. I’m even doing my sophomore year in China so I can get a  better view of what I want. The writer here is trying out several (perhaps conflicting) identities, and the identities any teen experiments with are defined by the group the person chooses to be a part of. The friendship groups (cliques, crowds, or gangs) that are such an important part of the adolescent experience allow the young adult to try out different identities, and these groups provide a sense of belonging and acceptance  (Rubin, Bukowski, & Parker, 2006). A big part of what the adolescent is learning is social identity, the part of the self-concept that is derived from one’s group memberships. Adolescents define their social identities according to how they are similar to and differ from others, finding meaning in the sports, religious, school, gender, and ethnic categories they belong to. Developing Moral Reasoning: Kohlberg’s Theory The independence that comes with adolescence requires independent thinking as well as the development of morality—standards of behavior that are generally agreed on within a culture to be right or proper. Just as Piaget believed that children‘s cognitive development follows specific  patterns, Lawrence Kohlberg (1984) argued that children learn their moral values through active thinking and reasoning, and that moral development follows a series of stages. To study moral development, Kohlberg posed moral dilemmas to children, teenagers, and adults, such as the following: A man’s wife is dying of cancer and there is only one drug that can save her. The only place to get the drug is at the store of a pharmacist who is known to overcharge people for drugs. The man can only pay $1,000, but the pharmacist wants $2,000, and refuses to sell it to him for less, Attributed to Charles Stangor Saylor. A person at this level will argue, “The man Young children morality shouldn‘t steal the drug, as he may get caught and go to jail. At this developmental phase, people are able to value the good that can be derived from holding to social norms in the form of laws or less formalized rules. For example, a person at this level may Older children, say,“He should not steal the drug, as everyone will see him as a thief, and his wife, adolescents, Conventional who needs the drug, wouldn‘t want to be cured because of thievery,‖ or,“No most adults morality matter what, he should obey the law because stealing is a crime.
Care must be taken by the nurse to avoid imposing his or her own value sys- tem on the client order prazosin online from canada cholesterol levels seafood chart. Because of underdeveloped ego and ﬁx- ation in early developmental level purchase 2 mg prazosin with visa cholesterol level in quail eggs, client may not have established own value system order prazosin 2mg on line cholesterol from shrimp is it good. In order to accomplish this discount prazosin master card cholesterol know your numbers, ownership of beliefs and attitudes must be identiﬁed and clariﬁed. Photographs may help to increase client’s awareness of self as separate from others. Alleviate anxiety by providing assurance to client that he or she will not be left alone. Early childhood traumas may predispose borderline clients to extreme fears of abandonment. Before this technique is used, however, assess cultural inﬂuences and degree of trust. Touch and physical presence provide reality for the client and serve to strengthen weak ego boundaries. Client is able to distinguish between own thoughts and feel- ings and those of others. Client claims ownership of those thoughts and feelings and does not use projection in relationships with others. Personality Disorders ● 293 Possible Etiologies (“related to”) [Lack of positive feedback] [Unmet dependency needs] [Retarded ego development] [Repeated negative feedback, resulting in diminished self- worth] [Dysfunctional family system] [Fixation in earlier level of development] Deﬁning Characteristics (“evidenced by”) [Difﬁculty accepting positive reinforcement] [Self-destructive behavior] [Frequent use of derogatory and critical remarks against the self] Lack of eye contact [Manipulation of one staff member against another in an attempt to gain special privileges] [Inability to form close, personal relationships] [Inability to tolerate being alone] [Degradation of others in an attempt to increase own feelings of self-worth] Hesitancy to try new things or situations [because of fear of failure] Goals/Objectives Short-term Goals 1. Client will exhibit increased feelings of self-worth as evi- denced by verbal expression of positive aspects about self, past accomplishments, and future prospects. Client will exhibit increased feelings of self-worth by setting realistic goals and trying to reach them, thereby demonstrat- ing a decrease in fear of failure. It is important for client to achieve something, so plan for activities in which success is likely. Promote understanding of your acceptance for him or her as a worth- while human being. Enforce the limits and impose the consequences for violations in a matter-of-fact manner. Negative feedback can be ex- tremely threatening to a person with low self-esteem and possibly aggravate the problem. Encourage independence in the performance of personal re- sponsibilities, as well as in decision-making related to client’s self-care. Positive reinforcement enhances self-esteem and encourages repetition of desirable behaviors. Help client increase level of self-awareness through criti- cal examination of feelings, attitudes, and behaviors. Self- exploration in the presence of a trusted individual may help the client come to terms with unresolved issues. Help client identify positive self-attributes as well as those aspects of the self he or she ﬁnds undesirable. Individuals with low self- esteem often have difﬁculty recognizing their positive at- tributes. They may also lack problem-solving ability and require assistance to formulate a plan for implementing the desired changes. Client demonstrates ability to make independent decisions regarding management of own self-care. Client sets realistic goals for self and demonstrates willing- ness to reach them. These behav- iors violate the rights of others, and individuals with this disorder display no evidence of guilt feelings at having done so. Individuals with antisocial personalities are often labeled sociopathic or psychopathic in the lay literature. Personality Disorders ● 295 Predisposing Factors to Antisocial Personality Disorder 1. Twin and adoptive studies have implicated the role of genetics in antisocial personal- ity disorder (Skodol & Gunderson, 2008). These studies of families of individuals with antisocial personality show higher numbers of relatives with antisocial personality or alcoholism than are found in the general population. Ad- ditional studies have shown that children of parents with antisocial behavior are more likely to be diagnosed as an- tisocial personality, even when they are separated at birth from their biological parents and reared by individuals without the disorder. Characteristics associated with tempera- ment in the newborn may be signiﬁcant in the predispo- sition to antisocial personality. Parents who bring their children with behavior disorders to clinics often report that the child displayed temper tantrums from infancy and would become furious when awaiting a bottle or a diaper change. As these children mature, they commonly develop a bullying attitude toward other children. Parents report that they are undaunted by punishment and gener- ally quite unmanageable. They are daring and foolhardy in their willingness to chance physical harm, and they seem unaffected by pain. Antisocial personality dis- order frequently arises from a chaotic home environment. Parental deprivation during the ﬁrst 5 years of life appears to be a critical predisposing factor in the development of antisocial personality disorder. Separation due to parental delinquency appears to be more highly correlated with the disorder than is parental loss from other causes. The pres- ence or intermittent appearance of inconsistent impulsive parents, not the loss of a consistent parent, is environmen- tally most damaging. Studies have shown that individuals with antisocial per- sonality disorder often have been severely physically abused in childhood. Second, it may result in injury to the child’s central nervous system, thereby impairing the child’s ability to function appropriately. Disordered family functioning has been implicated as an important factor in determining whether an individual devel- ops antisocial personality (Hill, 2003; Skodol & Gunderson, 2008; Ramsland, 2009). The following circumstances may be inﬂuential in the predisposition to the disorder: • Absence of parental discipline • Extreme poverty • Removal from the home • Growing up without parental ﬁgures of both genders • Erratic and inconsistent methods of discipline • Being “rescued” each time they are in trouble (never hav- ing to suffer the consequences of their own behavior) • Maternal deprivation Symptomatology (Subjective and Objective Data) 1. Extremely low-self esteem (abuses other people in an at- tempt to validate his or her own superiority) 2. Failure to follow social and legal norms; repeated perfor- mance of antisocial acts that are grounds for arrest (whether arrested or not) 5. Inability to develop satisfactory, enduring, intimate rela- tionship with a sexual partner 6. Related/Risk Factors (“related to”) [Rage reactions] History of witnessing family violence Neurological impairment (e. Be honest, keep all promises, and convey the message to the client that it is not him or her, but the behavior that is unacceptable.
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