Q. Runak. Cornell University.

Can these ques- tegrated with all domains of the discipline and tions be recognized as appropriate for scholarly practice of nursing purchase cheap levitra plus online. New discount levitra plus online, more open and inclusive ways to theo- ways to inform nurses for humane leadership in na- rize about nursing will be developed buy levitra plus 400 mg online. Abdellah notes that nurses in with other disciplines such as politics, economics, other countries have often developed their systems and aesthetics. These authors expect a continuing of education, practice, and research based on learn- emphasis on unifying theory and practice that will ing from our mistakes. She further proposes an in- contribute to the validation of the nursing disci- ternational electronic “think tank” for nurses pline. Reed (1995) notes the “ground shifting” with around the globe to dialogue about nursing reforming of philosophies of nursing science and (McAuliffe, 1998). Such opportunities could lead calls for a more open philosophy, grounded in nurses to truly listen, learn, and adapt theoretical nursing’s values, which connects science, philoso- perspectives to accommodate cultural variations. Theorists will work in groups to We must somehow come to appreciate the essence develop knowledge in an area of concern to nurs- and beauty of nursing, just as Nightingale knew it ing, and these phenomena of interest, rather than to be. Perhaps it will be realized that the essence of the name of the author, will define the theory nursing is universal and that only the ways of ex- (Meleis, 1992). One challenge of nursing theory is the per- Nursing’s philosophies and theories must in- spective that theory is always in the process of creasingly reflect nursing’s values for understand- developing and that, at the same time, it is ing, respect, and commitment to health beliefs and useful for the purposes and work of the disci- practices of cultures throughout the world. Continuing students of the discipline are required to study and know It is important to question to what extent the basis for their contributions to nursing theories developed and used in one major and to those we serve, while at the same time culture are appropriate for use in other be open to new ways of thinking, knowing, cultures. Exploring structures of nursing knowledge and understanding the portant to question to what extent theories devel- nature of nursing as a discipline of knowledge oped and used in one major culture are appropriate and professional practice provides a frame of for use in other cultures. Structuring the nursing knowledge system:A ty- A retrospective and prospective on nursing theory. Terminology in structuring and developing Nursing Science Quarterly, 16(3), 225–231. Image: Journal of Nursing Scholarship, 30(3), 275– linguistic journey to nursing practice. This provides ex- vance the discipline and professional practice of cellent opportunity for nurses in practice and in nursing. One of the most urgent issues facing the administration to study, review, and evaluate nurs- ing theories for use in practice. Communicating these reviews with the nursing theorists would be One of the most urgent issues facing the useful as a way to initiate dialogue among nurses discipline of nursing is the artificial sepa- and to form new bridges between the theory and ration of nursing theory and practice. This chapter discusses evaluating and selecting discipline of nursing is the artificial separation of nursing theories for use in nursing: practice, educa- nursing theory and practice. The examination and use of nursing theories Although nursing theory is essential for all nursing, are essential for closing the gap between nursing the main focus of theory analysis and evaluation in theory and nursing practice. Nurses in practice this chapter is the use of nursing theories in nursing have a responsibility to study and value nursing practice. The chapter begins with responses to the theories, just as nursing theory scholars must un- questions: Why study nursing theory? What does derstand and appreciate the day-to-day practice of the practicing nurse want from nursing theory? When practicing nurses and nurse scholars work together, the discipline and practice of nursing ben- Reasons for Studying efit, and nursing service to our clients is enhanced. Nursing Theory Examples in this book are plentiful as use of nurs- ing theories in nursing practice is described and Nursing practice is essential for developing, testing, theory-based research to improve practice is high- and refining nursing theory. When nurses in this book developed or refined their theories are thinking about nursing, their ideas are about based on dialogue with nurses who shared descrip- the content and structure of the discipline of nurs- tions of their practice. Even if nurses do not conceptualize them in of this book include Ernestine Wiedenbach, this way, their ideas are about nursing theory. We might consider that as as- brief encounter during a question period at a con- pects of nursing theories are explored and refined ference. Creative ence, asked a nurse theorist, “What is the meaning of this theory to my practice? Creative nursing practice is the direct re- I want to connect—but how can connections be sult of ongoing theory-based thinking, made between your ideas and my reality? I just nursing practice is the direct result of ongoing the- didn’t know I knew it and I need help to use it in ory-based thinking, decision making, and action of my practice” (Parker, 1993, p. Nursing practice must continue to con- in the discipline, all nurses must be continuing stu- tribute to thinking and theorizing in nursing, just dents, must join in community to advance nursing as nursing theory must be used to advance practice. Today, agencies that employ practice is guided by enduring values and beliefs as nurses are increasingly receiving recognition when well as by knowledge held by individual nurses. Nursing theories held by other nurses in the discipline, including inform the nurse about what nursing is and guide nurse scholars and those who study and write the use of other ideas and techniques for nursing about nursing’s metaparadigm, philosophies, and purposes. In addition, nursing theorists and nurses If nursing theory is to be useful—or practical— in practice think about and work with the same it must be brought into practice. At the same time, phenomena, including the person nursed, the ac- nurses can be guided by nursing theory in a full tions and relationships in the nursing situation, range of nursing situations. Historically, this is proaches to understanding needs for nursing and not uncommon to nursing and is deeply ingrained designing care to address these needs. Chapters of in the medical system, as well as in many settings in this book affirm the use of nursing theory in prac- which nurses practice today. The depth and scope of tice and the study and assessment of theory for ul- the practice of nurses who follow notions about timate use in practice. Nurses who learn to practice from nursing Questions from Practicing perspectives are awakened to the challenges and op- Nurses about Using portunities of practicing nursing more fully and with a greater sense of autonomy, respect, and satis- Nursing Theory faction for themselves and those they nurse. Nurses who practice from a nursing perspective approach Study of nursing theory may either precede or fol- clients and families in ways unique to nursing, they low selection of a nursing theory for use in nursing ask questions and receive and process information practice. Analysis and evaluation of nursing theory about needs for nursing differently, and they create are key ways to study theory. These activities are de- nursing responses that are more wholistic and manding and deserve the full commitment of client-focused. Because it is un- thinking about nursing knowledge and practice and derstood that study of nursing theory is not a sim- are then able to bring knowledge from other disci- ple, short-term endeavor, nurses often question plines into their practice—not to direct their prac- doing such work. These queries also identify specific livery systems and are able to choose to bring the issues that are important to nurses who consider full range of health sciences and technologies into study of nursing theory. In the same way, no group actually owns techniques, though • Does this theory reflect nursing practice as I disciplines do claim them for their practice. Will it support what I believe blood pressure readings and did not give intramus- to be excellent nursing practice? Can unable, but because they did not claim the use of the language of the theory help me explain, these techniques to facilitate their nursing. Will I be able to realization can also lead to understanding that the use the terms to communicate with others?

Here are the common nursing diagnoses that are the related to a patient who is receiving tetracyclines purchase levitra plus once a day. Chloramphenicol is given for treatment of meningitis (H influenzae buy levitra plus 400mg free shipping, S pneumoniae buy 400mg levitra plus with mastercard, and N meningitides), parathyroid fever, Q fever, Rocky Mountain spotted fever, typhoid fever, typhus infections, brain abscesses, and bacterial septicemia. Chloramphenicol should not be used for a patient who is pregnant or is breastfeeding. Neonates may develop gray syndrome, which is blue-gray skin, hypothermia, irregular breathing, coma, and cardiovascular collapse. Chloramphenicol is not recommended for use with a patient who is undergo- ing radiation therapy or who has bone marrow depression. Monitor the chloramphenicol serum level to assure that chloramphenicol stays within therapeutic limits. Serious adverse effects include blood dyscrasias, optic neuritis, and possi- bly irreversible bone marrow depression that may lead to aplastic anemia. Chloramphenicol is known to increase bone marrow depression when given with anticonvulsants. Patients who are taking antidiabetic medication may see an increase in the level of that medication when taken with chloramphenicol resulting in hypo- glycemia. Therefore, diabetics who take chloramphenicol must closely monitor their blood glucose level. Chloramphenicol also causes a decrease in the therapeutic effect of clin- damycin, erythromycin, or lincomycin. Chloramphenicol increases the drug serum levels of phenobarbital (Luminal), phenytoin (Dilantin), or warfarin (Coumadin) which can lead to toxicity. Chloramphenicol, Nursing Diagnosis, and Collaborative Problems Patients who take chloramphenicol may also experience rash, fever, and dysp- nea. Here are the common nursing diagnoses that are related to a patient who is taking chloramphenicol. Make sure that the patient doesn’t have an allergic reaction to any fluoro- quinolone. If they are allergic to one drug within the fluoroquinolone family, then they are highly likely to be allergic to other fluoroquinolone medications. Patients who take fluoroquinolones can, in rare cases, experience dizziness, drowsiness, restlessness, stomach distress, diarrhea, nausea and vomiting, psy- chosis, confusion, hallucinations, tremors, hypersensitivity, and interstitial nephritis (kidney). The dose of fluoroquinolones should be lowered in patients with hepatic (liver) or renal (kidney) problems. Administer fluoroquinolones with a full glass of water to minimize the pos- sibility of crystalluria. Ofloxacin, a member of the fluoroquinolones family, must be infused into a large vein over 60 minutes to minimize discomfort and venous irritation. The patient should be provided with the same instructions as those given to a patient who is receiving penicillin (see Penicillin and Patient Education). Tell the patient to report blurry or double vision, sensitivity to light, dizziness, light- headedness, or depression. If fluoroquinolones are self administered, tell the patient to avoid taking the drug within two hours of taking an antacid. Patients who are taking theophylline or other xanthines with fluoro- quinolones should be aware that the theophylline plasma levels can rise lead- ing to toxicity. If the patient takes fluoroquinolones while also taking warfarin, the anticoag- ulant effect of warfarin increases and could result in bleeding. Fluoroquinolones, Nursing Diagnosis, and Collaborative Problems Patients who receive fluoroquinolones may also experience rash, fever, dyspnea, nephritis, blood in the urine, lower back pain, rash, edema, and photosensitivity (increased sensitivity of skin to sunlight). Here are the common nursing diagnoses that are the related to a patient who is receiving fluoroquinolones. Time: q8h Protein-Binding: 20% Half-Life: 1 h Pregnancy Category: C Side Effects: pseudomembranous colitis, hypersensitivity, diarrhea, nausea, vomiting, headache, and rash Drug interaction: None Contraindications: Use with caution with clients with allergy to imipenem, cilastin or other beta-lactams. They also should abstain from cola, alcohol, choco- late, and spices which irritate the bladder. Sulfonamides may adversely affect the level of some medications causing a toxic effect. Avoid using sulfonamides with anticoagulants such as coumarin or indanedione derivatives and anticonvulsants (hydantoin) as well as oral anti- diabetic agents and methotrexate. Patients need at least 3000 mL of fluid each day in order to flush the urinary tract and follow good hygiene to reduce the likelihood of acquiring the infec- tion again. Patients should avoid the use of antacids while taking sulfonamides because antacids decrease the absorption of sulfonamides. Tuberculosis Tuberculosis is caused by acid-fast bacillus Mycobacterium tuberculosis. The incidence had decreased in the United States but increased again in the 1980s. The conditions may be mild such as tinea pedis (ahtlete’s foot), or severe as in pulmonary conditions or meningitis. Candidiasis might be an opportunistic infection when the defense mechanisms are impaired. Antibiotics, oral contraceptives, and immuno- suppressives may alter the body’s defense mechanisms. Infections can be mild (vaginal yeast infection) or severe (systemic fungal infection). Polyenes such as amphotericin B are the drug of choice for treating severe systemic infections. It is effective against numerous diseases including histo- plasmosis, cryptococcosis, coccidioidomycosis, aspergillosis, blastomycosis, and candidiasis (system infection), however, it is very toxic. Side effects and adverse reactions include flushing, fever, chills, nausea, vomiting, hypotension, paresthesias, and thrombophlebitis. It is highly toxic, causes nephrotoxicity and electrolyte imbalance, especially hypokalemia (low potassium) and hypomagnesemia (low serum magnesium). Nystatin (Mycostatin) can be given orally or topically to treat candidal infec- tion. It is more commonly used as an oral suspension for candidal infec- tion in the mouth as a swish and swallow. Side effects include anorexia, nausea, vomiting, diarrhea (large doses), stom- ach cramps, rash; vaginal: rash, burning sensation. The Imidazole group is effective against candidiasis (superficial and systemic), coccidioidomycosis, cryptococcosis, histoplasmosis, and paracoccidioidomycosis. Antimalarial Malaria is still one of the most prevalent protozoan diseases in the world. The tissue phase causes no clinical symptoms in the human and the erythrocytic phase invades red blood cells and causes chills, fever, and sweating, In the United States the 1000 cases reported annually are almost all from interna- tional travel.

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They can cause serious side effects order levitra plus paypal, including osteo- porosis buy genuine levitra plus online, weight gain generic 400mg levitra plus free shipping, high blood pressure, diabetes, and increased risk of infection. Immunosuppressants, such as azathioprine (Imuran) and cyclophosphamide (Cy- toxan), suppress the immune system and help to bring lupus into remission. These drugs are used only for severe cases as they cause anemia and increase the risk of infection and cancer. Non-steroidal anti-inflammatory drugs help to reduce joint and muscle pain and inflammation. Examples include ibuprofen (Motrin), naproxen (Naprosyn), and ce- lecoxib (Celebrex). Foods to include: • Cranberries and cranberry juice can help prevent urinary tract infections in those at risk. Foods high in calcium include milk and milk products and, to a lesser extent, broccoli, greens (chard, okra, kale, and spinach), sauerkraut, cabbage, rutabaga, and salmon (with bones). Foods high in vitamin C include fresh tomatoes, broccoli, citrus fruits, strawberries, cauliflower, cantaloupe, cabbage, and green peppers. Foods to avoid: L • Alcohol hampers immune function; has negative effects on your liver, kidneys, heart, and muscles; and may interact with your medications. These drugs can also stop the absorption of nutrients such as vitamins B6, C, and D, zinc, and potassium and interfere with cells’ ability to use them. In addition, corticosteroids can cause loss of muscle protein, change the body’s ability to handle blood sugar (glucose), and increase fat deposits and sodium retention. In order to counteract the nutrition-zapping effects of corticosteroids, eat a healthful diet and take a daily multivitamin and mineral supplement. Regu- lar exercise improves heart and lung function, helps reduce stress, and gives you more energy. Weight-bearing activities such as walking also help to improve bone strength and ward off osteoporosis. Smoking causes lung and heart damage, and those with lupus are already at risk of these problems. Complementary Supplements Antioxidants: Help to quench free radicals, which are generated by inflammation. Many people with lupus have low levels of antioxidants, such as beta-carotene and vitamin C. These antioxidants are essential for good health, immune function, and disease protection. Antioxidants may play a protective role against lupus complication such as joint, muscle, and organ damage. Those with lupus who are taking corti- costeroids are at significant risk of osteoporosis. Supplementing with calcium and vitamin D can help protect against bone loss, plus vitamin D levels have been found to be lower in those with lupus and this vitamin is essential for immune function. Look for a product that also contains magnesium and zinc, which are also essential for bone health. Celadrin: A patented blend of fatty acids that reduces inflammation and pain, lubricates joints, and promotes healing. Flaxseed oil: Some preliminary research suggests that flaxseed might help prevent or treat lupus nephritis. Moducare: A combination of beta-sitoserol and beta-sitosterolin, which help to balance/ correct immune function. Studies show that Mo- ducare is helpful for reducing pain and inflammation associated with rheumatoid arthritis. If you are taking medications to manage your lupus, consult with your doctor and pharmacist before you start taking any new herbal or other supplements to avoid any potential interactions. Avoid soy, alfalfa, mushrooms, beans, alcohol, saturated and trans fats, sugar, and caffeine. The macula is part of the retina, which is located on the inside back wall of the eyeball and is responsible for central vision. Deterioration of the macula results in blurring and loss of central vision, which worsens over time, leading to blindness. Macular degeneration is the leading cause of visual loss in people over 60 years and the second leading cause of blindness (after cataracts) in those over 65. There are two forms of macular degeneration: Dry: This is the most common form and is responsible for 90 percent of cases. It occurs when the macula breaks down and thins over time due to aging, free radical damage, and lack of blood and oxygen to the macula. Cellular debris accumulates under the retina and central vision slowly deteriorates over time. Wet: Also known as hemorrhagic macular degeneration, this is less common but more serious, as it develops suddenly and progresses fast. It occurs when blood vessels grow under the macula, pushing against it and leaking fluid, which causes scarring of the macula and permanent damage to central vision. Early detection and intervention can help to reduce visual loss from macular degen- eration. It is possible to slow down the progression and prevent macular degeneration with lifestyle measures and supplements. These procedures prevent further dam- age to the macula and further visual loss, but they do not restore vision that is lost. Research has shown that antioxidant supplements can prevent worsening of this condition and further vision loss. Carotenoids are antioxidants found in yellow, orange, and dark green fruits and vegetables. Kale, collard greens, spinach, and broccoli are the best sources of the lutein and zeaxanthin. In one study, those with the highest levels of these antioxidants had a 70 percent lower risk of develop- ing macular degeneration. The best food sources of vitamin C are berries (acai, blueberry, and cranberry), tomatoes, peppers, and citrus fruits. Fish provide beneficial omega-3 fatty acids that reduce inflamma- tion and also protect against heart disease. Foods to avoid: • Fast food and processed foods contain hydrogenated fats (trans fats), saturated fats, and chemicals that can generate free radicals and have been associated with an increased risk M of macular degeneration. Top Recommended Supplements Antioxidants: Research on a specific combination and dosage of antioxidant vitamins and minerals found that they significantly reduced the progression of macular degeneration and the risk of further visual loss. Note: 80 mg of zinc is a high dose, and can impair copper absorption, which is why it is important to also supple- ment with copper. Lutein: Studies have found that supplements can prevent disease progression and improve vision in those with both early and advanced macular degeneration. Complementary Supplements Fish oils: Mounting evidence supports the benefits of fish oil for reducing the risk of macular degeneration.

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The definitive investigation is haemoglobin electrophoresis which will demonstrate HbS 400mg levitra plus with visa, absent HbA and a variable HbF level purchase levitra plus with visa. Partial exchange transfusion may be needed to reduce the level of his sickle cells to less than 30 per cent buy levitra plus 400mg on-line. He should be followed up by an expert sickle team since this has been shown to reduce admissions and improve quality of care. He may benefit from long-term hydroxyurea which raises the HbF level and reduces the number of crises. She has had the occasional episode of acute cystitis, approximately on a 2-yearly basis. Examination of the cardiovascular and respiratory systems is otherwise unremarkable. Acute appendicitis classically presents with a short his- tory of central abdominal pain which rapidly localizes to the right iliac fossa. There is guard- ing and ‘board-like’ rigidity and rebound tenderness in the right iliac fossa. Untreated, some cases will resolve spontaneously, whereas others will perforate leading to localized or gener- alized peritonitis. Rarely a delayed diagnosis may result in acute appendicitis progressing to an appendix mass consisting of a haemorrhagic oedematous mass in the ileocaecal region. The symptoms of loin pain and presence of blood and protein in the urine mimicking a urinary tract infection suggest the appen- dix may be retrocaecal. Patients with retro-ileal appendicitis often have little abdominal pain, but irritation of the ileum can lead to severe diarrhoea and vomiting. Patients may also present with subacute intestinal obstruction due to intestinal ileus, or urinary reten- tion due to pelvic peritonitis. Differential diagnosis of acute appendicitis • In young adults the differential diagnoses include irritable bowel syndrome, non- specific mesenteric adenitis, ruptured ectopic pregnancy, twisted or haemorrhagic ovarian cysts, infection of the Fallopian tubes and urinary tract infections. The treatment is appendicectomy as soon as urinary tract infection has been excluded. A 62-year-old lady had been admitted 10 days previously to have a right hemicolectomy performed for a cae- cal carcinoma. This was discovered on colonoscopy which was performed to investigate an iron-deficiency anaemia and change in bowel habit. The initial surgery was uneventful, and she was given cefuroxime and metronidazole as routine antibiotic prophy- laxis. Over the next 5 days the patient remained persistently febrile, with negative blood cultures. In the last 24 h, she has also become relatively hypotensive with her systolic blood pressure being about 95 mmHg despite intravenous colloids. Her pulse rate is 110/min regular, blood pressure 95/60 mmHg and jugular venous pressure is not raised. Her sepsis is due to an anastomotic leak with a localized peritonitis which has been partially controlled with antibiotics. Her sepsis syndrome is manifested by fever, tachycardia, hypotension, hypoglycaemia, metabolic acidosis (low bicarbonate) and oliguria. The low sodium and high potassium are common in this condition as cell membrane function becomes less effective. The elevated white count is a marker for bacterial infection and the low platelet count is part of the picture of disseminated intravas- cular coagulation. Jaundice and abnormal liver function tests are common features of intra- abdominal sepsis. Aminoglycosides (gentamicin, streptomycin, amikacin) cause auditory and vestibular dysfunction, as well as acute renal failure. Risk factors for aminoglycoside nephro- toxicity are higher doses and duration of treatment, increased age, pre-existing renal insuffi- ciency, hepatic failure and volume depletion. Monitoring of trough levels is important although an increase in the trough level generally indicates decreased excretion of the drug caused by a fall in the glomerular flow rate. She requires transfer to the intensive care unit where she will need invasive circulatory monitoring with an arterial line and central venous pres- sure line to allow accurate assessment of her colloid and inotrope requirements. She also needs urgent renal replacement therapy to correct her acidosis and hyperkalaemia. In a haemo- dynamically unstable patient like this, continuous haemofiltration is the preferred method. Once haemodynamically stable, the patient should have a laparotomy to drain any collection and form a temporary colostomy. Over this time her appetite has gone down a little and she thinks that she has lost around 5 kg in weight. The intensity of the pain has become slightly worse over this time and it is now present on most days. She has developed a dif- ferent sort of cramping abdominal pain located mainly in the right iliac fossa. This pain has been associated with a feeling of the need to pass her motions and often with some diarrhoea. During these episodes her husband has commented that she looked red in the face but she has associated this with the abdominal discomfort and the embarrassment from the urgent need to have her bowels open. She has smoked 15 cigarettes daily for the last 45 years and she drinks around 7 units of alcohol each week. She has noticed a little breathlessness on occasions over the last few months and has heard herself wheeze on sev- eral occasions. She has never had any problems with asthma and there is no family history of asthma or other atopic conditions. She worked as a school secretary for 30 years and has never been involved in a job involv- ing any industrial exposure. The typical clinical features of the carcinoid syndrome are facial flush- ing, abdominal cramps and diarrhoea. The symptoms are characteristically intermittent and may come at times of increased release on activity. Carcinoids do not generally produce their symptoms until they have metastasized to the liver from their original site, which is usu- ally in the small bowel. In the small bowel the tumours may produce local symptoms of obstruction or bleeding. The tumour can be reduced in size with consequent lessening of symptoms by embolization of its arterial supply using interventional radiology techniques. When odd symptoms such as those described here occur, the diagnosis of carcinoid tumour should always be remembered and investigated.