Mark Corson

By N. Thorek. American InterContinental University.

The first chapter therefore explores the values underlying intensive care nursing; the second chapter develops these through outlining two influential moments in psychology order procardia 30mg with mastercard. The third chapter examines issues about the environment in which intensive care patients are nursed procardia 30mg overnight delivery. The human needs and problems of nursing rituals are explored in the chapters on pain management cheap procardia 30 mg amex, pyrexia, nutrition, mouthcare, eyecare and skincare. The next two chapters then explore the extremes of age: paediatrics and older adults. Chapter 1 Nursing perspectives Introduction This book explores issues for intensive care nursing practice, and this first section establishes its core fundamental aspects. To help readers to do this, this first chapter explores what nursing means in the context of intensive care and the following chapter outlines two schools of psychology (behaviourism and humanism) that have influenced healthcare and society. Acknowledging and continuously re-evaluating our individual values and beliefs is part of human growth, so that examining nursing’s values and beliefs within the context of our own area of practice is part of our professional growth. This is something that each nurse can usefully explore and there are a number of published exercises available in this respect (e. Manley 1994), but essentially it means working out a nursing philosophy for oneself. What is meant by this is not some esoteric message hung neatly on a wall and seldom read or practised—such as ‘man is a bio-psycho-social being’—but, rather, simple values which may be more meaningful—such as ‘remember our patients are human’. Care can (and should) be therapeutic, but therapy (cure) without care is almost a contradiction in terms. These units offered potentially life-saving intervention during acute physiological crises, with the emphasis on medical need and availability of technology. As the technology and medical skills of the speciality developed, so technicians were needed to maintain and operate machines. However, the fact that technology provides a valuable means of monitoring and treatment should not allow it to become a substitute for care. For nursing to retain a patient-centred focus, it is the patients themselves and not the machines that must remain central to the nurse’s role. Healthcare assistants (and, potentially, robots) can be trained to perform technological tasks—and are cheaper to employ. Doctor-nurse relationships Ford and Walsh (1994) observed that nurses working in high dependency areas often have good relationships with medical staff. But Ford and Walsh suggest this good relationship is on the terms of the medical staff. For example, nursing’s focus on the emotional costs to intensive care patients may limit the wider recognition of nursing as a profession (Phillips 1996). However, while recognising and respecting the valuable and unique role of doctors, this collaboration by nurses should not mean subservience (i. Intensive care nursing 4 Psychology The increasing emphasis by the nursing profession on psychology and the psychological needs of patients, whether conscious or unconscious, makes psychological care an essential part of holistic care—a focus noticeably absent in the medical and technological perspectives above. However, psychology and physiology are not two separate and distinct pigeon-holes that some nursing (and other) course timetables might suggest, and the subject of homeostatic imbalances from psychological distress is explored in Chapter 3. In recognising both the physical and psychological needs of patients, nurses can add a humane, holistic perspective into their care, preparing their patients for recovery and discharge. The importance of assessing and planning nursing care is a recurring theme in many of the later chapters of this book. Following Ashworth’s seminal study of 1980, psychological stresses specific to, or accentuated by, intensive care have been widely discussed in nursing literature. To this end, it is often necessary, unfortunately, to add knowingly to the patient’s suffering, but this is one of the costs of critical illness (Carnevale 1991). Nursing perspectives 5 Holistic care The intrinsic needs of patients derive from their own physiological deficits, including many ‘activities of living’ (e. Waldmann and Gaine (1996) describe one patient, unable to drink, feeling tortured by hearing a can opened—opening cans of enterai feed away from a patient’s hearing may reduce such unintentional, but unnecessary, suffering. Thus, nurses need to question every nursing action proactively, no matter how small and apparently insignificant it may seem to be. Psychological approaches to nursing should be individually planned and implemented according to each patient’s needs. These needs can be assessed through the patients themselves and augmented by information from families and friends. Different nurses will feel comfortable with different approaches, but all should recognise the individual human being within each patient. Unlike the other medical and paramedical professions, nurses do not treat a problem or a set of problems. A fundamental role of a nurse, therefore, is to be with and for the patient; this is compatible with the advocacy role promoted by A Strategy for Nursing (DoH 1989). This role is facilitated by making patients the focus in the organisation of care (such as through primary/named nursing). This constant presence of a specific nurse at the patient’s bedside should allow more holistic, patient-centred care. Intensive care nursing 6 Relatives Relatives, together with friends and significant others, form an important part of each person’s life, and they too are similarly distressed by the patient’s illness. The psychological crises experienced by relatives necessitate skilful psychological care, such as the provision of information to allay anxiety and make decisions, and facilities to meet their physical needs (Curry 1995).

Models of the relationship between psychological factors and physical health suggest that the link between psychology and health may be via behaviour change (e buy 30 mg procardia with visa. This study is based on the belief that psychological variables such as coping style cheap 30 mg procardia otc, stress and social support may influence health and illness directly through changes in the individual’s physiology (their immune system) regardless of behaviour cheap procardia 30 mg visa. Subjects were excluded from the study if they were taking anti-viral medication, had a history of alcohol/ substance abuse, a history of psychiatric disorder, or had a severe head trauma. Design The study was cross-sectional with all subjects completing all measures once. Measures The subjects completed the following psychosocial, behavioural control and physiological measures. For the present study, the authors focused on the number of life events and categorized subjects as either mild (0–5), moderate (6–10), high (11–15) or very high (>15). The authors used a shortened 20-item version and computed a total ‘perceived social support’ score. The present study examined these items in terms of (i) active coping (made up of all the problem focused strategies, such as planning, suppression of competing activities, restraint coping, seeking instrumental support, active coping, and three of the emotion-focused scales, such as seeking emotional support, positive reinterpretation, acceptance); (ii) disengagement/ denial (which is made up of behavioural and mental disengagement items and denial); (iii) focus on and venting emotions; and (iv) turning to religion (see Chapter 3 for a discussion of coping). The present study computed a composite ‘emotional distress score’ composed of items relating to anxiety, depression, fatigue and confusion. Subjects completed measures of diet (using a food frequency questionnaire), alcohol and substance use (e. These were included in order to determine whether any differences in immune status were due to the psychosocial or behavioural factors. In addition, immune functioning was also related to diet (vitamin A) and alcohol use. This supports the prediction that psychosocial variables may influence health and illness. However, the results indicate that the link between psychological variables and health status is probably via both a behavioural pathway (i. Cancer is defined as an uncontrolled growth of abnormal cells, which produces tumours called neoplasms. There are two types of tumours: benign tumours, which do not spread throughout the body, and malignant tumours, which show metastasis (the process of cells breaking off from the tumour and moving elsewhere). There are three types of cancer cells: carcinomas, which constitute 90 per cent of all cancer cells and which originate in tissue cells; sarcomas, which originate in connective tissue; and leukaemias, which originate in the blood. The main causes of cancer mortality among men in England and Wales are lung cancer (36 per cent), colorectal cancer (11 per cent), prostate cancer (9 per cent); and among women are breast cancer (20 per cent), lung cancer (15 per cent), colorectal cancer (14 per cent), ovarian cancer (6 per cent), cervical cancer (3 per cent). While the overall number of cancer deaths do not appear to be rising, the incidence of lung cancer deaths in women has risen over the past few years. The role of psychology in cancer A role for psychology in cancer was first suggested by Galen in  200–300, who argued for an association between melancholia and cancer, and also by Gedman in 1701, who suggested that cancer might be related to life disasters. Psychology therefore plays a role in terms, attitudes and beliefs about cancer and predicting behaviours, such as smoking, diet and screening which are implicated in its initiation (details of these behaviours can be found in Chapters 2, 5, 6, 7, 8 and 9). In addition, sufferers of cancer report psychological consequences, which have implications for their quality of life. The role of psychology in cancer is also illustrated by the following observations: s Cancer cells are present in most people but not everybody gets cancer; in addition although research suggests a link between smoking and lung cancer, not all heavy smokers get lung cancer. The role of psychology in cancer will now be examined in terms of (1) the initiation and promotion of cancer; (2) the psychological consequences of cancer; (3) dealing with the symptoms of cancer; and (4) longevity and promoting a disease-free interval. The psychosocial factors in the initiation and promotion of cancer 1 Behavioural factors. Behavioural factors have been shown to play a role in the initiation and promotion of cancer. These behaviours can be predicted by examining individual health beliefs (see Chapters 2, 5, 6 and 9). They found that if this stressor could be controlled there was a decrease in the rate of tumour development. However, if the stressor was perceived as uncontrollable this resulted in an increase in the development. However, Sklar and Anisman (1981) argued that an increase in stress increased the promotion of cancer not its initiation (see Chapter 11 for a discussion of the relationship between stress and illness). It has also been suggested that life events play a role in cancer (see Chapter 10 for a discussion of life events). A study by Jacobs and Charles (1980) examined the differences in life events between families who had a cancer victim and families who did not. They reported that in families who had a cancer victim there were higher numbers who had moved house, higher numbers who had changed some form of their behaviour, higher numbers who had had a change in health status other than the cancer person, and higher numbers of divorces indicating that life events may well be a factor contributing to the onset of cancer. They identified 29 studies, from 1966 to 1997, which met their inclusion criteria (adult women with breast cancer, group of cancer-free controls, measure of stressful life events) and concluded that although several individual studies report a relationship between life events and breast cancer, when methodological problems are taken into account and when the data across the different studies is merged ‘the research shows no good evidence of a relationship between stressful life events and breast cancer’. Control also seems to play a role in the initiation and promotion of cancer and it has been argued that control over stressors and control over environmental factors may be related to an increase in the onset of cancer (see Chapter 11 for a discussion of control and the stress–illness link). If an individual is subjected to stress, then the methods they use to cope with this stress may well be related to the onset of cancer. For example, maladaptive, disengagement coping strategies, such as smoking and alcohol, may have a relationship with an increase in cancer (see Chapters 3 and 11 for a discussion of coping). Bieliauskas (1980) highlighted a relationship between depression and cancer and suggests that chronic mild depression, but not clinical depression may be related to cancer. Over the past few years there has been some interest in the relationship between personality and cancer. Temoshok and Fox (1984) argued that individuals who develop cancer have a ‘type C personality’. A type C personality is described as passive, appeasing, helpless, other focused and unexpressive of emotion.

One notable change was a 6-fold increase in the relative abundance of cyanobacterial sequences and a dramatic die-off of algae within the artificial streams cheap procardia 30mg otc. Selection of cyanobacteria over algae could have significant implications for higher trophic levels within streams buy 30mg procardia amex. Response plan to control and manage the threat of multidrug-resistant gonorrhoea in Europe purchase procardia 30mg without prescription. Clinical implications and treatment of multiresistant streptococcus pneumoniae pneumonia. The emergence of multidrug resistance among the latest generation of pathogens suggests that the discovery of new scaffolds should be a priority…Two factors exacerbate this supply problem by creating unique dis- incentives for antibiotic development. First, antibiotics are used in smaller quantities than other drugs…Antibiotics yield lower revenues than most drugs. The result is a quandary; Resistance is on the rise while antibiotic discovery and development are on the decline. Summary report on antimicrobials sold or distributed for use in food producing animals. While the manufacturers of these products want you to think triclosan protects you from harmful bacteria, it turns out that it may be doing more harm than good. Another undoubted advantage of extended-release formulation is improved patient compliance. Many antibiotics have short half life values and need to be administered frequently, which also contributes to patient incompliance. The limitation of their application is mainly caused by the high cost and unsatisfactory drug loading…[it is hoped that] ‘nanoparticle- based’ extended-release antibiotic delivery…will come to sight in the future. The potential role of concentrated animal feeding operations in infectious disease epidemics and antibiotic resistance. These have reduced the effectiveness of several classes of antibiotics for treating infections in humans and livestock. We also agree that all therapeutic antimicrobial agents should be available only by prescription for human and veterinary use. In Zika epidemic, a warning on climate change: Mosquitoes will thrive in a warming world. These include the spread of malaria into the highlands of eastern Africa, the rising incidence of Lyme disease in North America, and the spread of a serious livestock ailment called bluetongue into parts of Europe that were once too cold for it to thrive. That creature adapted long ago to live in human settlements, and developed a concomitant taste for human blood. Proceedings of the 12 meeting of the Association of Island Marine Laboratories of the Caribbean Curaivo (Netherlands Antilles). Outpatient antibiotic use in Europe and association with resistance: A cross-national database study. Antibiotic resistance is an emerging threat to public health: An urgent call to action at the Antimicrobial Resistance Summit 2011. We believe that the window for overcoming antimicrobial resistance is still open, but we must act decisively now – Australia cannot bury its head in the sand any longer and hope that the problem will just go away. The method, which extracts drugs from bacteria that live in dirt, has yielded a powerful new antibiotic, researchers reported in the journal Nature on Wednesday. We describe determinants likely to influence the future epidemiology and health impact of antimicrobial-resistant infections. Antibiotic contamination and occurrence of antibiotic-resistant bacteria in aquatic environments of northern Vietnam. Emerging substances of concern in biosolids: concentrations and effects of treatment processes. Carbamazepine, anti- depressants, psycho-stimulants and mood altering drugs are also included. Occurrence and elimination of pharmaceuticals during conventional wastewater treatment. However, this type of treatment has been shown to have limited capability of removing pharmaceuticals from wastewater. These data warrant use of prudence in the administration of antibiotics that could aggravate the growing battle with emerging antibiotic-resistant pathogenic strains. It is generally acknowledged that the use of antibiotics causes selection for and enrichment of antimicrobial resistance, but it has also been believed until recently that the commensal microbiota is normalized a few weeks following withdrawl of the treatment. In the last decade hypervirulent strains have emerged and been associated with increased severity of disease, high recurrence and significant mortality. Although surveillance in Europe is now a 59 requirement of the European Commission, reporting is not standardised or mandatory. Here we review the current literature, guidelines on diagnosis and treatment and conclude by highlighting a number of areas where further research would increase our understanding. Transition metal diamine complexes with antimicrobial activity against staphylococcus aureus and methicillin- resistant S. In the last decade hypervirulent strains have emerged and been associated with increased severity of disease, high recurrence and significant mortality. Although surveillance in Europe is now a requirement of the European Commission, reporting is not standardised or mandatory. Here we review the current literature, guidelines on diagnosis and treatment and conclude by highlighting a number of areas where further research would increase our understanding. Fighting antibiotic resistance: Marrying new financial incentives to meeting public health goals. However, such strategies directly conflict with the clear need to reduce unnecessary antibiotic prescriptions and could actually increase prescription use. Agricultural use of antibiotics and the evolution and transfer of antibiotic-resistant bacteria. These uses promote the selection of antibiotic resistance in bacterial populations.

Corticosteroids buy procardia 30mg on-line, such as prednisone purchase 30 mg procardia with amex, help reduce inflammation and suppress the activity of the immune system buy procardia 30 mg lowest price. They can cause serious side effects, including osteo- porosis, weight gain, 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.