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Many of the health problems they experience are related in large part to their living situations prostate forum purchase generic rogaine 2 on line. Street life exposes homeless persons to the extremes of hot and cold environments and compounds their health risks prostate cancer 20 rogaine 2 60ml lowest price. Homeless persons have high rates of trauma, tuberculosis, upper respiratory tract infections, poor nutrition and anemia, lice, scabies, peripheral vascular problems, sexually transmitted diseases, dental problems, arthritis, hypothermia, skin disorders, and foot problems. These problems are made more difficult by living on the street and by being discharged to a transitory, homeless situation in which follow-up is unlikely (Hunter, Crosby, Ventura, & Warkentin, 1997; Walker, 1998). Homeless persons who live in shelters frequently encounter overcrowded, unventilated quarters that provide an ideal environment for the spread of communicable diseases such as tuberculosis. Community-based nurses who work with the homeless must be nonjudgmental, patient, and understanding. They must be proficient in dealing with many different kinds of people who have a wide variety of health problems and needs. Nursing interventions are aimed at attempting to obtain health care services for the homeless and evaluating the health care needs of those who reside in the shelters. Collaborative home practice: Nursing and occupational therapy ensure appropriate medication administration. Develop a plan of nursing care for a patient using strategies of critical thinking. Traditionally, nurses have used a problem-solving approach in planning and providing nursing care. Today the decision-making part of problem solving has become increasingly complex and requires critical thinking. I Chapter 3 Critical Thinking, Ethical Decision Making, and the Nursing Process 27 cal thinker must be insightful and have a sense of fairness and integrity, the courage to question personal ethics, and the perseverance to strive continuously to minimize the effects of egocentricity, ethnocentricity, and other biases on the decisionmaking process (Alfaro-LeFevre, 1999). When thinking critically, a person will do the following: Definition of Critical Thinking Critical thinking is a multidimensional skill, a cognitive or mental process or set of procedures. It involves reasoning and purposeful, systematic, reflective, rational, outcome-directed thinking based on a body of knowledge, as well as examination and analysis of all available information and ideas. Critical thinking leads to the formulation of conclusions and the most appropriate, often creative, decisions, options, or alternatives (Ignatavicius, 2001; Prideaux, 2000). Independent judgments and decisions evolve from a sound knowledge base and the ability to synthesize information within the context in which it is presented. Critical thinking enhances clinical decision making, helping to identify patient needs and to determine the best nursing actions that will assist the patient in meeting those needs. As indicated in the above definition, critical thinking is a conscious, outcome-oriented activity; it is purposeful and intentional. The critical thinker is an inquisitive, fair-minded truthseeker with an open-mindedness to the alternative solutions that might surface. Gather as much relevant information as possible to consider as many factors as possible. Validate the information presented to make sure that it is accurate (not just supposition or opinion), that it makes sense, and that it is based on fact and evidence. Analyze the information to determine what it means and to see whether it forms clusters or patterns that point to certain conclusions. Draw on past clinical experience and knowledge to explain what is happening and to anticipate what might happen next, acknowledging personal bias and cultural influences. Maintain a flexible attitude that allows the facts to guide thinking and takes into account all possibilities. Consider available options and examine each in terms of its advantages and disadvantages. The skills involved in critical thinking are developed over time through effort, practice, and experience. Skills needed in critical thinking include interpretation, analysis, evaluation, inference, explanation, and self-regulation (Ignatavicius, 2001). Critical thinking requires background knowledge and knowledge of key concepts as well as standards of good thinking (Prideaux, 2000).

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The defense mechanisms that the body exhibits determine the difference between adaptation and maladaptation- health and disease prostate 07 60ml rogaine 2 for sale. W Chapter 6 Homeostasis man health book order rogaine 2 with american express, Stress, and Adaptation 81 External environment: Family Group Community Society as a whole Humans Stress and Function Physiology is the study of the functional activities of the living organism and its parts. Each different body system performs specific functions to sustain optimal life for the organism. Mechanisms for adjusting internal conditions promote the normal steady state of the organism and ultimately its survival. These mechanisms are compensatory in nature and work to restore balance in the body. An example of this restorative effort is the development of rapid breathing (hyperpnea) after intense exercise in an attempt to compensate for an oxygen deficit and excess lactic acid accumulated in the muscle tissue. An example of a pathophysiologic change is the development of heart failure: the body reacts by retaining sodium and water and increasing venous pressure, which worsens the condition. These pathophysiologic mechanisms give rise to signs that are observed by the patient, nurse, or other health care provider, or symptoms that are reported by the patient. These observations, plus a sound knowledge of physiologic and pathophysiologic processes, can assist in determining the existence of a problem and can guide the nurse in planning the appropriate course of action. Each system is a subsystem of the larger system (suprasystem) of which it is a part. In this figure the cell is the smallest system, being a subsystem of all other systems. Dynamic Balance: the Steady State Physiologic mechanisms must be understood in the context of the body as a whole. The person, as a living system, has both an internal and an external environment, between which information and matter are continuously exchanged. Within the internal environment each organ, tissue, and cell is also a system or subsystem of the whole, each with its own internal and external environment, each exchanging information and matter. The internal milieu was the fluid that bathed the cells, and the constancy was the balanced internal state maintained by physiologic and biochemical processes. Later, Walter Cannon used the term homeostasis to describe the stability of the internal environment, which, he said, was coordinated by homeostatic or compensatory processes that responded to changes in the internal environment. Any change within the internal environment initiated a "righting" response to minimize the change. These biologic processes sought physiologic and chemical balance and were under involuntary control. Rene Jules Dubos (1965) provided further insight into the dynamic nature of the internal environment with his theory that two complementary concepts, homeostasis and adaptation, were necessary for balance. Homeostatic processes occurred quickly in response to stress, rapidly making the adjustments necessary to maintain the internal environment. Dubos also emphasized that acceptable ranges of response to stimuli existed and that these responses varied for different individuals: "Absolute constancy is only a concept of the ideal. When a change or stress occurs that causes a body function to deviate from its stable range, processes are initiated to restore and maintain the dynamic balance. When these adjustment processes or compensatory mechanisms are not adequate, the steady state is threatened, function becomes disordered, and pathophysiologic mechanisms occur. The pathophysiologic processes can lead to disease and may be active during disease, which is a threat to the steady state. Disease is an abnormal variation in the structure or function of any part of the body. As new challenges are met, this ability to cope and adapt can change, thereby providing the individual with a wide range of adaptive ability. Adaptation occurs throughout the life span as the individual encounters many developmental and situational challenges, especially related to health and illness. Because both stress and adaptation may exist at different levels of a system, it is possible to study these reactions at the cellular, tissue, and organ levels. Biologists are concerned mainly with subcellular components or with subsystems of the total body. The desired goals of adaptation for any system are survival, growth, and reproduction.

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In addition man health advice purchase discount rogaine 2 line, proprioceptors in the muscles and joints respond to body movements androgen hormone medication best purchase for rogaine 2, such as exercise, causing an increase in ventilation. Baroreceptors, also located in the aortic and carotid bodies, respond to an increase or decrease in arterial blood pressure and cause reflex hypoventilation or hyperventilation. Gerontologic Considerations A gradual decline in respiratory function begins in early to middle adulthood and affects the structure and function of the respiratory system. The vital capacity of the lungs and respiratory muscle strength peak between ages 20 and 25 and decrease thereafter. With aging (40 years and older), changes occur in the alveoli that reduce the surface area available for the exchange of oxygen and Signs and Symptoms the major signs and symptoms of respiratory disease are dyspnea, cough, sputum production, chest pain, wheezing, clubbing of the fingers, hemoptysis, and cyanosis. These clinical manifestations are related to the duration and severity of the disease. The right ventricle of the heart will be affected ultimately by lung disease because it must pump blood through the lungs against greater resistance. It may also be associated with neurologic or neuromuscular disorders such as myasthenia gravis, Guillain-Barrй syndrome, or muscular dystrophy. In general, acute diseases of the lungs produce a more severe grade of dyspnea than do chronic diseases. Noisy breathing may result from a narrowing of the airway or localized obstruction of a major bronchus by a tumor or foreign body. The presence of both inspiratory and expiratory wheezing usually signifies asthma if the patient does not have heart failure. Therefore, it is important to ask the patient the following questions: · At what time of day or night does the dyspnea occur? The stimulus producing a cough may arise from an infectious process or from an airborne irritant, such as smoke, smog, dust, or a gas. The nurse needs to evaluate the character of the cough- is it dry, hacking, brassy, wheezing, loose, or severe? Pleuritic chest pain accompanying coughing may indicate pleural or chest wall (musculoskeletal) involvement. Study Sample and Design A qualitative study approach was used with a convenience sample of 29 patients recruited from the pulmonary clinic at a large medical center in the midwestern United States. The taped interviews were transcribed and content analysis was performed using open coding methods. Findings the investigators identified the following self-management themes from the data: · Traditional medical care (formal health care and prescription medications) · Self-care wisdom (learned insight regarding the impact of dyspnea on quality of life) · Self-care action (specific strategies for dyspnea relief included exercise, environmental control, cognitive strategies, and controlled breathing, which refers to patient-initiated position and breathing to manage dyspnea). When working with patients with chronic respiratory disorders, nurses should assess all four aspects of dyspnea selfmanagement, which reflect a holistic approach to care. Self-care actions should be encouraged and taught, and self-care resources facilitated. Further research is warranted to determine if the differences in the breathing techniques used by these two populations of patients are also found in a research study with a larger sample size. Coughing at night may herald the onset of left-sided heart failure or bronchial asthma. A cough that worsens when the patient is supine suggests postnasal drip (sinusitis). Coughing after food intake may indicate aspiration of material into the tracheobronchial tree. Violent coughing causes bronchial spasm, obstruction, and further irritation of the bronchi and may result in syncope (fainting). A severe, repeated, or uncontrolled cough that is nonproductive is exhausting and potentially harmful. Sputum pro- duction is the reaction of the lungs to any constantly recurring irritant. A profuse amount of purulent sputum (thick and yellow, green, or rust-colored) or a change in color of the sputum probably indicates a bacterial infection. A gradual increase of sputum over time may indicate the presence of chronic bronchitis or bronchiectasis. Pleuritic pain from irritation of the parietal pleura is sharp and seems to "catch" on inspiration; patients often describe it as "like the stabbing of a knife. Also, it is important to assess the relationship of pain to the inspiratory and expiratory phases of respiration. Analgesic medications may be effective in relieving chest pain, but care must be taken not to depress the respiratory center or a productive cough, if present.

Professionals in ambulatory health care settings may refer patients for home care services to prevent hospitalization prostate cancer vs bph purchase rogaine 2 on line amex. Public health nurses care for patients referred for anticipatory guidance with high-risk families prostate cancer biopsy procedure discount rogaine 2 60ml, for case finding, and for follow-up treatment (eg, patients with communicable diseases). Parish nurses may have patients referred, or they may be contacted directly by members of the parish community who need guidance or referrals related to physical or psychosocial health care concerns (Palmer, 2001). The development of a comprehensive discharge plan requires collaboration with professionals at both the referring agency and the home care agency, public health agency, or other community resource. Community Resources and Referrals Home health nurses and public health nurses act as case managers. They work collaboratively with the health team and the agency or person who referred the patient for service. The nurse should learn about the neighborhood and obtain directions for reaching the expected destination. Chapter 2 Nurses are not expected to disregard their personal safety in an effort to make or complete home visits. If nurses encounter dangerous situations during visits, they should return to their agencies and contact their supervisors or law enforcement officials, or both. Suggested precautions to take when making a home visit are presented in Chart 2-1. They may not understand why the patient was sent home from the hospital before being totally rehabilitated. They may not comprehend what home care is or why they cannot have 24-hour nursing services. It is critical that the nurse try to convey an understanding of what the patient and family are experiencing and how the illness is affecting their lives. During the initial home visit, which usually lasts less than an hour, the patient is evaluated and a plan of care is established to be followed or modified on subsequent visits. If the agency is to be reimbursed for the visit, the nurse asks for insurance information, such as a Medicare or Medicaid card. Identifying possible hazards, such as cluttered walk areas, potential fire risks, air or water pollution, or inadequate sanitation facilities, is also part of the initial assessment. The medical diagnosis and specific detailed information on the functional limitations of the patient are usually part of the documentation. Expected outcomes of the nursing interventions must be stated in terms of patient behaviors and must be realistic and measurable. If the documentation is not done correctly, the agency may not be paid for the visit. To make these judgments, the nurse may find it helpful to consider the following factors: Chart 2-1 · Safety Precautions in Home Health Care · Learn, or preprogram a cellular phone with the telephone numbers of the agency, police, and emergency services. Let the agency know your daily schedule and the telephone numbers of your patients so that you can be located if you do not return when expected. Know where the patient lives before leaving to make the visit and carry a map for quick referral. Carry agency identification and have enough change to make telephone calls in case you get lost or have problems. Most agencies provide cellular phones for their nurses so that the agency can contact the nurse, and so that the nurse can contact the agency in case of an emergency or unexpected situation. When making visits in high-crime areas, visit with another person rather than alone. If a patient or family member is intoxicated, hostile, or obnoxious, reschedule the visit and leave. If a family is having a serious argument or abusing the patient or anyone else in the household, reschedule the visit, contact your supervisor, and report the abuse to the appropriate authorities. Has the patient shown signs of progressing as expected, or does it seem that recovery will be delayed? Does the patient have sufficient energy or is he or she frail and easily fatigued? Level of nursing care needed: What level of nursing care does the patient require?

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