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By J. Fadi. C. R. Drew University of Medicine and Science.

Behaviors associated with this stage include a preoccupation with the loss order 50 mg precose diabetes symptoms xanax, intense weeping and expressions of anger toward the self and others buy cheap precose 50 mg diabetic diet vegetarian, and feelings of ambivalence and guilt associ- ated with the loss. Feelings of despair occur in response to the realization that the loss has occurred. Activities of daily living become increasingly disorganized, and behavior is characterized by restlessness Loss and Bereavement ● 393 and aimlessness. Efforts to regain productive patterns of behavior are ineffective and the individual experiences fear, helplessness, and hopelessness. Perceptions of visualizing or being in the presence of that which has been lost may occur. Social isolation is com- mon, and the individual may feel a great deal of loneliness. The individual begins a reinvestment in new relationships and indicates a readiness to move forward with- in the environment. The initial reaction to a loss is a stunned, numb feeling and refusal by the individual to acknowledge the reality of the loss. Engel states that this stage is an attempt by the individual to protect the self “against the effects of the overwhelming stress by raising the threshold against its recognition or against the painful feelings evoked thereby. Behaviors associated with this stage include excessive crying and regression to a state of helplessness and a childlike manner. Awareness of the loss creates feelings of emptiness, frustration, anguish, and de- spair. Anger may be directed toward the self or toward others in the environment who are held accountable for the loss. Examples include funerals, wakes, special attire, a gathering of friends and family, and religious practices customary to the spiritual beliefs of the bereaved. Participation in these rituals is thought to assist the individual to accept the reality of the loss and to facilitate the recovery process. The concept of the loss is idealized, and the individual may even imitate admired qualities of a person who has been lost. Preoccupation with the loss gradually decreases over a year or more, and the individual eventually begins to reinvest feelings in others. Obsession with the loss has ended, and the individual is able to go on with his or her life. Worden’s four tasks of mourning include the following: Task I: Accepting the Reality of the Loss. When some- thing of value is lost, it is common for individuals to refuse to believe that the loss has occurred. Behaviors include misidentifying individuals in the environment for their lost loved one, retaining possessions of the lost loved one as though he or she has not died, and removing all remind- ers of the lost loved one so as not to have to face the reality of the loss. Worden (2009) stated: Coming to an acceptance of the reality of the loss takes time since it involves not only an intellectual acceptance but also an emotional one. The bereaved person may be intellectually aware of the final- ity of the loss long before the emotions allow full acceptance of the information as true (p. It is thought that traditional rituals such as the funeral help some individuals move toward acceptance of the loss. People accomplish this by refusing to allow themselves to think painful thoughts, by idealizing or avoiding reminders of what has been lost, and by using alcohol or drugs. The intensity of the pain and the manner in which it is experienced are different for all individuals. Failure to do so generally results in some form of depression that commonly requires therapy, which then focuses on work- ing through the pain of grief that the individual failed to work through at the time of the loss. It usually takes a number of months for a bereaved person to realize what his or her world will be like without the lost entity. In the case of a lost loved one, how the environment changes will depend on the types of roles that person ful- filled in life.

Large numbers of women began to health center work outside the home generic precose 25 mg with mastercard diabetes type 2 icd code, asserting their b cheap precose 25 mg line diabete gestationnel symptomes. Serving as a role model of health for practice in a wide variety of healthcare patients by maintaining a healthy weight settings. Male dominance in the healthcare profes- to use a wheelchair sion slowed the progress of professionalism e. Administering an insulin shot to a diabetic provide more easily controlled and less patient expensive staff for the hospital. Learning how to use a new piece of hospital demonstrate the aim of nursing to facilitate equipment would most likely occur in which coping? Which of the following nursing education programs attracts more men, minorities, and d. Assisting a patient and his/her family to nontraditional students and prepares nurses prepare for death to give care to patients in various structured e. Which of the following is used by the nurse knowledge to identify the patient’s healthcare needs and strengths and to establish and carry out a b. Which of the following nursing actions demonstrate the aim of nursing to promote d. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Nurse practice acts are regulated by the administrators and physicians; males domi- federal government. The enforcement of rules and regulations belief that illness is caused by sin and gods’ does not fall within the scope of nurse displeasure existed; priests were physicians. Nurse practice acts establish the criteria for the education and licensure of nurses. Which of the following statements regarding 16th century, the 18th and 19th centuries, and nursing licenses are accurate? Nursing was broadened in all areas and was practiced in a wide variety of settings; c. The nursing license can be denied due to for family and delivering physical care and criminal actions. The role of medicine developed from the pre- cation, and women were more assertive and civilization era, through the eras signifying the independent. Place the events that defined these eras listed below in the correct chronologic order to follow this timeline. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Practical nursing was developed to prepare is a professional organization for registered nurses to give bedside nursing care to nurses in the United States. Nursing has evolved through history from a tice, the , integrates both the art technical service to a knowledge-centered and science of nursing. Nursing has been defined in many ways, but there are essential elements present in most 1. In early civilizations influenced by the theory of animism, the roles of physician and nurse were interchangeable. True False Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Describe how the following issues are affect- porate the following broad aims of nursing ing nursing in transition: into a nursing care plan for a patient who is a. Technologic advances: undergoing diagnostic tests for lung cancer and who smokes two packs of cigarettes a day. Give an example of a nursing action that might be performed by a nurse relying on the c.

It should be realized that only some of the compounds synthesized will be more potent than the original lead A S precose 50 mg line diabetes symptoms in young adults. The first step in the Topliss approach is to synthesize the 4-chloro derivative (B) of A cheap 50mg precose visa diabetes type 2 beer. Suppose the activity of B is greater than that of A, then following the M branch the Topliss tree (Figure 4. In this case, the Topliss tree shows that the next most promising analogue is the 4-trifluromethyl derivative of (D) of A. At this point one would also synthesize and biologically test the 2,4-dichloro (E) and the 4-nitro analogues (F) of A. It is emphasized that the decision tree is not a synthetic pathway for the production of each of the analogues. It simply suggests which of the substituents would be likely to yield a more potent analogue. The synthetic route for producing each of the suggested analogues would vary for each analogue and would use the most appropriate starting materials. The Topliss decision tree does not give all the possible analogues but it is likely that a number of the most active analogues will be found by this method. Illustrate the answer by reference to the changes in the activities of 4-alkylresorcinols caused by changes in the chain length of the 4-alkyl group. Assume that these groups are introduced into the section of the lead’s structure that does not contain its pharmacophore. These equations are obtained using so called ‘models’ of the system being studied (see sections 5. The reliability of the mathematical methods used to obtain and solve the equations is well known and so in most cases it is possible to obtain a reliable estimate of the accuracy of the results. In some cases the calculated values are believed to be more accurate than the experimentally determined figures because of the higher degree of experimental error in the experimental work. Graphics packages that convert the data for the structure of a chemical species into a variety of easy to understand visual formats have also been developed (Figure 5. Consequently, in medicinal chemistry, it is now possible to visualize the three dimensional shapes of both the ligands and their target sites. In addition, sophisticated computational chemistry packages also allow the medicinal chemist to evaluate the interactions between a compound and its target site before synthesizing that compound (see section 5. This means that the medicinal chemist need only synthesize and test the most promising of the compounds, which considerably increases the chances of discovering a potent drug. Molecular modelling is a complex subject and it is not possible to cover it in depth in this text. For workers wishing to use it as a tool in drug design it will be necessary to either ask a competent computational chemist to make the necessary calculations and graphic conversions or to treat the computer as a black box and use the relevant computer program according to its manufacturer’s instructions. The most common com- putational methods are based on either molecular or quantum mechanics. In these equations the positions of the atoms in the structure are represented by either Cartesian or polar coordinates (Figure 5. In the past, the initial values of these atomic coordinates were set by the modeller. However, as it is now customary to construct models from existing structural fragments (see section 5. Once the energy equation is established, the computer computes the set of coordinates which correspond to a minimum total energy value for the system. This set of coordinates is converted into the required visual display by the graphics package (Figure 5. However, although the calculations made by computers are always accurate, the calculated result should be checked for accuracy against experimental observations. In this respect it is essential that the approximations on which the calculations are based are understood. For example, most calculations are based on a frozen molecule at 0 K in a vacuum and so do not take into account that the structure is vibrating or the influence of the medium in which the chemical species is found. Calculations taking these factors into account would undoubtedly give a more realistic picture of the structure. Quantum mechanics calculations are more expensive to carry out because they require considerable more computing power and time than molecular mechanics calculations.

An increase in the rate of production of an enzyme that metabolizes the drug is a relatively common reason for drug resistance generic precose 50mg visa diabetic cat. An- other general reason for drug resistance is the down-regulation of receptors (Appendix 5) cheap 50mg precose visa blood sugar 68 after eating. Down-regulation occurs when repeated stimulation of a receptor results in the receptor being broken down. This results in the drug being less effective because there are fewer receptors available for it to act on. Drug resistance may also be due to the appearance of a significantly high proportion of drug resistant strains of microorganisms. These strains arise naturally and can rapidly multiply and become the currently predominant strain of that microorganism. For example, antimalarial drugs are proving less effective because of an increase in the proportion of drug resistant strains of the malaria parasite. New drugs are constantly required to combat drug resistance, even though it can be minimized by the correct use of medicines by patients. These products, obtained from animal, vege- table and mineral sources, were sometimes very effective. Information about these ancient remedies was not readily available to users until the invention of the printing press in the 15th century. This invention led to the widespread publication and circulation of herbals and pharmacopoeias. This resulted in a rapid increase in the use, and misuse, of herbal and other remedies. However, improved communications between practitioners in the 18th and 19th centuries resulted in the progressive removal of preparations that were either ineffective or too toxic from herbals and pharmacopoeias. Initially this development was centred around the natural products isolated from plant and animal material, but as knowledge increased a wider range of pharmaceutically active compounds were used as the starting point for the development of drugs. The compounds on which a development is based are now known as lead compounds, while the synthetic compounds developed from a lead are referred to as its analogues. The work of the medicinal chemist is centred around the discovery of new lead compounds with specific medical properties. It includes the devel- opment of more effective and safer analogues from both these new and existing lead compounds. This usually involves synthesizing and testing many hundreds of compounds before a suitable compound is produced. It is currently estimated that for every 10 000 compounds synthesized one is suitable for medical use. The first rational development of synthetic drugs was carried out by Paul Ehrlich and Sacachiro Hata, who produced the antiprotozoal arsphemamine in 1910 by combining synthesis with reliable biological screening and evaluation procedures. Ehrlich, at the begining of the 20th century, had recognized that both the beneficial and toxic properties of a drug were important to its evaluation. He realized that the more effective drugs showed a greater selectiv- ity for the target microorganism than its host. However, in practice index values can only be used as a limited guide to the relative usefulness of different compounds. One of its most successful uses has been in the development in the 1970s of the antiulcer agents cimetidine and ranitidine. In 1905 he proposed that so called receptive substances in the body could accept either a stimulating compound, which would cause a biological response, or a non-stimulating compound, which would prevent a bio- logical response. It is now universally accepted that the binding of a chemical agent, referred to as a ligand (see also section 7. Furthermore, a drug is most effective when its structure or a significant part of its structure, both as regards molecular shape and electron distribution (stereo- electronic structure), is complementary with the stereoelectronic structure of the receptor responsible for the desired biological action. The section of the structure of a ligand that binds to a receptor is known as its pharmacophore. Furthermore, it is now believed that side effects can arise when the drug binds to either the receptor responsible for the desired biological response or to different receptors. The mid- to late 20th century has seen an explosion of our understanding of the chemistry of disease states, biological structures and processes. This increase in knowledge has given medicinal chemists a clearer picture of how drugs are distributed through the body and transported across membranes and their mode of operation and metabolism.

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