Mark Corson

By F. Musan. Fielding Graduate University. 2018.

The last communication from Captain Sullenberger to the tower advised of the eventual outcome: We’re going to be in the Hudson order valtrex 1000mg mastercard. The crew kept the passengers calm as women order 1000 mg valtrex overnight delivery, children trusted valtrex 1000 mg, and then the rest of the passengers were evacuated onto the boats of the rescue personnel that had quickly arrived. Captain Sullenberger then calmly walked the aisle of the plane to be sure that everyone was out before joining the 150 other rescued survivors (Levin, 2009; National Transportation [1] Safety Board, 2009). Affect is an essential part of the study of psychology because it plays such an important role in everyday life. As we will see, affect guides behavior, helps us make decisions, and has a major impact on our mental and physical health. Because they involve arousal, emotions and motivations are “hot‖—they “charge,‖ “drive,‖ or “move‖ our behavior. When we become aroused, the sympathetic nervous system provides us with energy to respond to our environment. The liver puts extra sugar into the bloodstream, the heart pumps more blood, our pupils dilate to help us see better, respiration increases, and we begin to perspire to cool the body. An emotion is a mental and physiological feeling state that directs our attention and guides our behavior. Whether it is the thrill of a roller-coaster ride that elicits an unexpected scream, the flush of embarrassment that follows a public mistake, or the horror of a potential plane crash that creates an exceptionally brilliant response in a pilot, emotions move our actions. Emotions normally serve an adaptive role: We care for infants because of the love we feel for them, we avoid making a left turn onto a crowded highway because we fear that a speeding truck may hit us, and we are particularly nice to Mandy because we are feeling guilty that we didn‘t go to her party. But emotions may also be destructive, such as when a frustrating experience leads us to lash out at others who do not deserve it. But there are a variety of other personal and social motivations that can influence behavior, including the motivations for social approval and acceptance, the motivation to achieve, and the [2] motivation to take, or to avoid taking, risks (Morsella, Bargh, & Gollwitzer, 2009). As predicted by basic theories of operant learning, motivations lead us to engage in particular behaviors because doing so makes us feel good. Motivations are often considered in psychology in terms of drives, which are internal states that are activated when the physiological characteristics of the body are out of balance, and goals, which are desired end states that we strive to attain. Motivation can thus be conceptualized as a series of behavioral responses that lead us to attempt to reduce drives and to attain goals by comparing our current state with a desired end state (Lawrence, Carver, & Scheier, [3] 2002). Like a thermostat on an air conditioner, the body tries to maintain homeostasis, the natural state of the body‘s systems, with goals, drives, and arousal in balance. When a drive or goal is aroused—for instance, when we are hungry—the thermostat turns on and we start to behave in a way that attempts to reduce the drive or meet the goal (in this case to seek food). As the body works toward the desired end state, the thermostat continues to check whether or not the end state has been reached. Eventually, the need or goal is satisfied (we eat), and the relevant behaviors are turned off. The body‘s thermostat continues to check for homeostasis and is always ready to react to future needs. In addition to more basic motivations such as hunger, a variety of other personal and social motivations can also be conceptualized in terms of drives or goals. When the goal of studying for an exam is hindered because we take a day off from our schoolwork, we may work harder on our studying on the next day to move us toward our goal. When we are dieting, we may be more likely to have a big binge on a day when the scale says that we have met our prior day‘s goals. And when we are lonely, the motivation to be around other people is aroused and we try to socialize. In many, if not most cases, our emotions and motivations operate out of our conscious Attributed to Charles Stangor Saylor. We begin this chapter by considering the role of affect on behavior, discussing the most important psychological theories of emotions. We will discuss how the experience of long-term stress causes illness, and then turn to research onpositive thinking and what has been learned about the beneficial health effects of more positive emotions. Finally, we will review some of the most important human motivations, including the behaviors of eating and sex. The importance of this chapter is not only in helping you gain an understanding the principles of affect but also in helping you discover the important roles that affect plays in our everyday lives, and particularly in our mental and physical health. The study of the interface between affect and physical health—that principle that “everything that is physiological is also psychological‖—is a key focus of the branch of psychology known as health psychology. The importance of this topic has made health psychology one of the fastest growing fields in psychology. Velocity toward goal attainment in immediate experience as a determinant of affect. The unconscious regulation of emotion: Nonconscious reappraisal goals modulate emotional reactivity. The most fundamental emotions, known as the basic emotions, are those ofanger, disgust, fear, happiness, sadness, and surprise. The basic emotions have a long history in human evolution, and they have developed in large part to help us make rapid judgments about stimuli and to [1] quickly guide appropriate behavior (LeDoux, 2000). The basic emotions are determined in large part by one of the oldest parts of our brain, the limbic system, including the amygdala, the hypothalamus, and the thalamus. Because they are primarily evolutionarily determined, the basic emotions are experienced and displayed in much the same way across cultures (Ekman, 1992; [2] Elfenbein & Ambady, 2002, 2003; Fridland, Ekman, & Oster, 1987), and people are quite accurate at judging the facial expressions of people from different cultures. Video Clip: The Basic Emotions Not all of our emotions come from the old parts of our brain; we also interpret our experiences to create a more complex array of emotional experiences. For instance, the amygdala may sense fear when it senses that the body is falling, but that fear may be interpreted completely differently (perhaps even as “excitement‖) when we are falling on a roller-coaster ride than when we are falling from the sky in an airplane that has lost power. The cognitive interpretations that accompany emotions—known as cognitive appraisal—allow us to experience a much larger and more complex set of secondary emotions, as shown in Figure 10.

What resources might be helpful for Include common factors that disrupt sleep pat- terns purchase valtrex 500mg free shipping, total amount of sleep required 500 mg valtrex for sale, and pos- Mr purchase valtrex 1000 mg otc. Interview individuals who have tried your interventions and evaluate the like- lihood that your teaching tool will resolve sleep problems. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. I used to think my sleep habits were bad at school, but this is a Read the following patient care study and use hundred times worse because there never your nursing process skills to answer the seems to be time to crash. Identify pertinent patient data by placing a nurse, has been in her new position as a criti- single underline beneath the objective data in cal care staff nurse in a large tertiary-care med- the case study and a double underline beneath ical center for 3 months. Complete the Nursing Process Worksheet on of time for other things I want to do, but I’m page 223 to develop a three-part diagnostic not so sure anymore,” she says. Write down the patient and personal nursing it seems I’m always tired and all I think about strengths you hope to draw on as you assist all day long is how soon I can get back to bed. Worst of all, when I do finally get into bed, I often can’t fall asleep, especially if things have Patient strengths: been busy at work and someone ‘went bad. At that time, she “bounced into work” looking fresh each morning, and her features were always animated. Pretend that you are performing a nursing the “brightness” that was so characteristic assessment of this patient after the plan of of her earlier is strikingly absent. 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. Somatic pain endings that are involved in fast-conducting, acute, well-localized pain include which of c. The highest level of integration of sensory which of the following facts about pain? A patient who recently underwent amputation patient to see whether the pain is manu- of a leg complains of pain in the amputated factured or psychogenic before starting part. The pain cannot exist because the leg has istence and nature of her pain, and pain been amputated. Encourage the use of nondrug complemen- tary therapies as adjuncts to the medical 7. Increase and decrease the serum level of without any preparation can be explained by the analgesic as needed. Which of the following groups of opioids are produced at neural synapses at various points d. A patient complains of severe pain following does not mean the pain is a result of an a mastectomy. Your patient is experiencing acute pain but cannot vocalize this pain, which of the following the amputation of a limb. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. After sedating a patient, you assess that he is frequently drowsy and drifts off during con- c. What number on the sedation that sends additional pain stimuli to the scale would best describe your patient’s seda- central nervous system. Which of the following are accurate Multiple Response Questions descriptors of the gate control theory? Which of the following are characteristics of tatory pain stimuli away from the brain. Which of the following statements accurately be processed by the nervous system at any describe the nature of the pain experience? Patients are able to describe chronic pain through the nervous system, cells in the because it is generally localized. Pain that is resistant to therapy is referred person’s interpretation of the pain. Pain in people whose tissue injury is of a stimulus that causes the subject to rec- nonprogressive or healed is termed chronic ognize pain. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Pain that is resistant to therapy and per- sists despite a variety of interventions c. A patient who experiences acute pain following a noxious stimulus is experiencing 6. Pain that is diffuse or scattered and orig- inates in tendons, ligaments, bones, pain. Superficial pain that usually involves the localized following abdominal surgery is most skin or subcutaneous tissue likely experiencing pain. A person who experiences a “head rush” from eating ice cream too fast is experiencing originates in body organs, the thorax,. Pain that is perceived in an area distant arm following a myocardial infarction is from its point of origin experiencing pain. Somatic pain Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition.

Use role-playing to decrease anxiety as client anticipates stressful situations that might occur in relation to the health status change valtrex 500mg. Role-playing decreases anxiety and provides a feeling of security by providing client with a plan of action for responding in an appropriate manner when a stressful situation occurs discount valtrex 1000mg without a prescription. Ensure that client and family are fully knowledgeable re- garding the physiology of the change in health status and its necessity for optimal wellness buy generic valtrex 1000mg on line. Encourage them to ask ques- tions, and provide printed material explaining the change to which they may refer following discharge. Help client identify resources within the community from which he or she may seek assistance in adapting to the change in health status. Examples include self-help or support groups and public health nurse, counselor, or social worker. Encour- age client to keep follow-up appointments with physician, or to call physician’s office prior to follow-up date if problems or concerns arise. Client is able to make independent decisions regarding life- style considering change in health status. Client is able to express hope for the future with consider- ation of change in health status. Long-term Goal Client will be able to verbalize behaviors associated with the normal stages of grief and identify own position in grief process, while progressing at own pace toward resolution. Accurate baseline as- sessment data are necessary to plan effective care for the grieving client. Convey an accepting attitude so that the client is not afraid to express feelings openly. An accepting attitude conveys to the client that you believe he or she is a worthwhile person. Do not become defensive if initial expression of anger is displaced on nurse or therapist. Help client explore angry feelings so that they may be di- rected toward the intended object or person. Verbalization of feelings in a nonthreatening environment may help client come to terms with unresolved issues. Help client discharge pent-up anger through participation in large motor activities (e. Physical exercise provides a safe and effective method for discharging pent-up tension. Explain to client the normal stages of grief and the behaviors associated with each stage. Help client to understand that feelings such as guilt and anger toward the lost entity are appropriate and acceptable during the grief process. Knowl- edge of the acceptability of the feelings associated with nor- mal grieving may help to relieve some of the guilt that these responses generate. With support and sensitivity, point out reality of the situation in areas where misrepresentations are expressed. Client must give up an idealized perception and be able to Adjustment Disorder ● 249 accept both positive and negative aspects about the painful life change before the grief process is complete. Knowledge of cultural influences specific to the client is im- portant before employing this technique. Help client solve problems as he or she attempts to determine methods for more adaptive coping with the experienced loss. Positive reinforcement enhances self-esteem and encourages repetition of desirable behaviors. Encourage client to reach out for spiritual support during this time in whatever form is desirable to him or her. As- sess spiritual needs of client, and assist as necessary in the fulfillment of those needs. Spiritual support can enhance successful adaptation to painful life experiences for some individuals. Client is able to verbalize normal stages of grief process and behaviors associated with each stage. Client is able to identify own position within the grief pro- cess and express honest feelings related to the lost entity. Client will verbalize things he or she likes about self within (realistic time period). 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 worthwhile human being. Unconditional positive regard and acceptance promote trust and increase client’s feelings of self-worth. Help client identify positive aspects of self and to develop plans for changing the characteristics he or she views as neg- ative. Individuals with low self-esteem often have difficulty recognizing their positive attributes. They may also lack problem-solving ability and require assistance to formulate a plan for implementing the desired changes. Encourage and support client in confronting the fear of failure by attending therapy activities and undertaking new tasks. Offer recognition of successful endeavors and positive reinforcement for attempts made.

The ultimate need is to obtain useful predictions A composite prediction matrix will be applied of response in healthy human subjects (phase I rapidly and accurately to the process of synthesis studies) from observed drug effects in animals or of new compounds for phase I testing valtrex 1000 mg without prescription. In the shorter term purchase 1000 mg valtrex otc, what can we now do to What are the strengths and weaknesses of these expedite the drug selection process? The use of intrinsic clearance in vitro represents a flow chart illustrating one form of permits predictions between species for the parti- metabolism/pharmacokinetics input into the drug cular enzyme/route of metabolism concerned 500 mg valtrex amex. Arrows (indicating the flow of humans have qualitatively different routes of work and communication) pointing to the right metabolism for any particular compound, then represent perceived progress, whereas arrows point- this will weaken the predictive value of the in ing tothe leftrepresent ‘disappointments’ (and other vitro observation. The works best for compounds with a high component numbered asterisks indicate continuations. The of nonenzymatic elimination, such as our model ‘flow of time’ is from left to right and from the top compound with approximately 90% excretion as panel to the bottom panel. This prediction weakens as var- tasks that are to be completed, and rectangles in a iations in rates of enzymatic reactions become column within a panel represent work done by more important. If preclinical work identified metabolite(s) to and may not necessarily be based on hard and fast measure in humans, are the pharmacokinetics criteria. Does the relationship between concentration compounds that have the same indication. For example, within the represents the tasks that can be expedited by online box including ‘in vitro intrinsic clearance’, there pharmacokinetic modeling. Among the pharmaco- may be in vitro predictors of oral availability and kinetic questions that will be asked online in the measures of potentially toxic metabolites. The ‘in phase I trial are the following: vivo pharmacokinetics’ in rats may include an increasing number of compartments whose con- 1. As the doses are escalated, do the kinetics of the centrations are measured by microdialysis and may drug appear to be linear or nonlinear over the include measures of a few selected metabolite dose range? However, it does show that the change in kinetics, for example a higher elim- chemists discover new chemical entities with ination rate that might be indicative of autoin- desirable properties. This is not a comprehensive flow diagram for all aspects of drug discovery – it is restricted to the components of the process discussed in this chapter. In this context, phase I serves as the As a chemical series develops, correlations such interface between preclinical research and clinical as that in Figure 8. Eventually, a development, and the validity of the predictions compound or compounds is/are chosen for phase I from animals to humans involved is of paramount studies. In this scheme, phase I is influenced by pharma- We believe that with enhanced integrated study cokinetic and pharmacodynamic modeling. The objective is expe- lism and pharmacokinetics (Welling and Tse, ditious choice of the best compound, with the ever- 1995). The time saved could be used to permit a present limitations on information available. Note larger number of compounds with better pro- that this scheme can involve feedback from phase I spects, from a single research program, to be to renewed chemical synthesis, as well as choice of compared in phase I studies. Typically, after adequate preclinical char- acterization of a candidate drug and 14-day and/or 3-month multiple-dose toxicology studies in two References mammalian species, a very low dose is chosen for the first human exposure to the drug. Doses may be single or short multiple- netics: the dynamics of drug absorption, distribution dose series. PharmacokineticandPha- a-adrenergic receptors and contraction of rat vas rmacodynamic Data Analysis: Concepts and Applica- deferens’. Interspecies scaling and comparisons Pharmacokinetic/Pharmacodynamic Analysis: in drug development and toxicokinetics. Financial pressures, even for the largest pharma- model ceutical companies, are generally much greater than in the past. The technical response is to max- In former times, it was assumed that developmental imize resources, avoiding any and all redundant drugs proceeded in stepwise fashion from phase I, clinical studies. Phase I was conducted in ‘normal volun- the regulatory authorities and from within the teers’ (although some medical students might pharmaceutical companies themselves. After approval, certain stu- earlier stages of drug development when these dies, to find new indications, address special questions are asked, have driven change in patient subpopulations, for marketing purposes or clinical study design. Increasingly sophisticated to otherwise broaden product labeling might or data are now developed at earlier stages of drug might not be conducted. Strategies such as the overlapping of devel- any generally agreed definitions except, perhaps, opment ‘phases’, as well as the use of early dose- that the studies are run by different teams. None of are (and always have been) sound medical or phar- today’s successful companies actually use such a macological reasons for doing so. It would be unreasonable to study the pharma- cokinetics of relatively toxic agents, at poten- 9. Typically, this information can be gained in Bias is a general consideration in clinical trial patients with diseases potentially responsive to design, regardless of the type of trial being con- these agents. Cytotoxic and antiviral drugs are two of the types of study design considered below. This enemy comes from many quarters doses at which tolerability must be confirmed are (Table 9. The clinical trialist must be sufficiently unknown until the exposure of patients can indi- humble to realize that he or she, himself or herself, cate the doses that may be effective. However, the ability to talk to and understand statisticians is There are some diseases which have neither ani- absolutely essential. Sine qua non: Involve a mal model nor relevant pharmacodynamic or sur- good statistician from the moment a clinical trial rogate end point in normal volunteers. This is one of your best defences against migraine, and normal volunteers cannot report an bias.