By E. Olivier. Union College, Barbourville KY. 2018.
Self-care confidence discount alendronate 70 mg overnight delivery, though not part of the model buy alendronate 70mg lowest price, is the ability to perform a task comfortably to achieve the desired outcome purchase alendronate 35mg with visa. The management subscale not a significant univariable predictor of medication adherence order alendronate 35mg with amex. However, the authors noted that benefits of self-care, such as lower health care costs, effective relationships with health care providers, and client satisfaction may be evident in some clients with below-average scores on the subscales. Clients who possess knowledge, experience, and skill of their disease process are expertly engaged in self-care (Riegel et al. While it is advantageous for client‘s to have knowledge, experience, and skill to conduct self-care, if the client is not motivated to adhere to the treatment regimen, they are unlikely to improve (Becker, 1985). The literature indicates that many Black clients generally distrust White health care providers because of their historical legacy of slavery and oppression that contributed to perceptions of injustices and discriminatory experiences in various health care situations (Gamble, 1997; Spillers, 1987; "Unequal treatment", 2002; Washington, 2006). This lack of trust in White health care providers may result in a lack of adherence to the treatment regimen (Greer, 2010). Consequently, many Black clients may have a preference for care and treatment from Black health care providers (Flack et al. However, the scarcity of Black health care providers is concerning and limits the Black clients‘ inclination to choose a provider based on race. Also, inappropriate cultural competence and awareness to treat the holistic needs of Black clients by health care 170 providers of other races and ethnicities may further complicate the trust issue and medication adherence outcomes (Barksdale, 2009; Yancy et al. The optimal predictive model in this study revealed that the dynamic variable that had a statistically significant relationship with medication adherence was trust. As trust in the health care provider increased, adherence to medications increased. That is, participants who reported the most trust in their health care providers were more willing to adhere to the prescribed treatment regimen. This finding is congruent to expectations that trust promotes better medication adherence (Benkert et al. Because the sex of participants in the study was not reported, it is unclear whether Black women were included. Although the findings of the current study support currently held beliefs regarding trust and medication adherence, there is reason to consider an alternative viewpoint for clients who may not trust their health care providers. Clients who are distrustful may recognize that their health needs are not satisfied when they are left with superficial directives that are virtually meaningless and impossible to follow. Over time, the clients 171 become symptomatic and gain the label of being nonadherent to the treatment regimen that they may have had no knowledge. In essence, health care providers may not be providing Black clients with the health care information and services necessary to promote healthy lifestyle changes, thus increasing distrust of the health care provider. According to Cox, Sullivan, and Roghmann (1984), multifaceted interventions to manage health problems are required from health care providers. These interventions include combining the client‘s physiological, psychological, sociodemographic, and environmental characteristics to achieve the desired health outcome, such as adherence to antihypertensive medication. Cox (2010, August 4) contends that clients must be involved as participants in the self-care of their health and initially, ample time must be spent to clear up misperceptions, misunderstandings, and misknowledge. Barksdale (2009) concurs and recommends a client-centered approach to delivering health care. Thus, increasing client knowledge, involvement in the treatment process, and devising interventions pertinent to the client‘s needs may be vital to establishing trust and maintaining medication adherence. Stress on the other hand refers to how the body reacts to internal and external experiences. Black women, unlike other racial/ethnic groups, are confronted with the triple jeopardy of racism, sexism, and classism that may overtax coping mechanisms and contribute to insurmountable 172 psychological and physiological stressors (Beal, 1969; Jones & Shorter-Gooden, 2003). Further, 21% of those below the poverty level reported total medication adherence with a perfect Hill-Bone Compliance score. In contrast, two studies showed that coping was associated with mean arterial changes (R. In a study conducted by Shorter-Gooden (2004) on mechanisms to identify coping strategies in Black women, results indicated that those who were resistant to the damaging effects of stress-related health consequences tended to engage in various coping strategies, such as spirituality, social support, and valuing oneself.
Clinical Correlate: Maternal Age best 70mg alendronate, Risk of Down Syndrome generic alendronate 35mg without a prescription, and Prenatal Diagnosis Surveys of babies with trisomy 21 show that approximately 90% to 95% of the time generic 35 mg alendronate free shipping, the extra copy of the chromosome is contributed by the mother (similar figures are obtained for trisomies of the 18th I and 13th chromosomes) buy generic alendronate 35mg. I The risk of bearing a child with Down syndrome is less than 1/1,006 for women younger than 30. The I risk increases to about 1/400 at age 35, 1/100 at age 40, and 3-4% or more after age 45. There is no corresponding increase in risk with advanced paternal age; sperm cells are generated continuously throughout the life of the male. The increased risk of trisomy with advanced maternal age motivates more than half of pregnant women in North America to undergo prenatal diagnosis (most commonly, amniocentesis or chorionic villus sampling, discussed in Chapter 6). Down syndrome can also be screened by assaying maternal serum levels of a-fetoprotein, chorionic gonadotropin, and unconjugated estriol. This so-called triple screen can detect approximately 70% of fetuses with Down syndrome. At During Metaphase 2, each the end of Meiosis 1, each chromosome aligns individually daughter cell has one homolog. In Anaphase 2, sister chromatids migrate to opposite poles and each daughter cell gets one chromatid Figure 11-3-2A. Some alterations may result in a loss or gain of genetic material and are called unbalanced alterations; balanced alterations do not result in a gain or loss of genetic material and usually have fewer clinical consequences. As with other types of mutations, structural alterations can occur either in the germ line or in somatic cells. The latter, although not transmitted to offspring, can alter genetic material such that the cell can give rise to cancer. Translocations Translocations occur when chromosomes are broken and the broken elements reattach to other chromosomes. Translocations can be classified into two major types: reciprocal and Robertsonian. Reciprocal translocation Reciprocal translocations occur when genetic material is exchanged between nonhomologous chromosomes; for example, chromosomes 2 and 8 (Figure 11-3-3). If this happens during game- togenesis, the offspring will carry the reciprocal translocation in all his or her :cells and will be called a translocation carrier. Because this individual has all of the genetic material (balanced, albeit some of it misplaced because of the translocation), there are often no clinical consequences other than during reproduction. A Reciprocal Translocation In a translocation carrier, during gametogenesis and meiosis, unbalanced genetic material can Note be transmitted to the offspring, causing partial trisomies and partial monosomies typically resulting in pregnancy loss. During meiosis 1, the translocated chromosomes may segregate as Alternate Versus Adjacent chromosome 8 or as chromosome 2, producing a variety of possible gametes with respect to Segregation these chromosomes. The diagram in the upper right is used to depict the segregation refer to diagrams possible sperm the father can produce. It acknowledges that the translocated chromosomes can (Figure 11-3-4, upper right) potentially pair with either of the two homologs (2 or 8) during meiosis. These con- quadrants (next to each ceptions are likely to result in pregnancy loss. Fertilization with Normal Egg I Normal Translocation Partial Trisomy 8 Carrier Partial Monosomy 2 Figure 11-3-4. Because these translocations involve only a single cell and the I genetic material is balanced, there is often no consequence. This translocation alters the activity of the abl proto-oncogene (proto- leukemia (retinoid :. More than 100 different chromosome rearrangements involving nearly every chromosome have been observed in more than 40 types of cancer. If alternate segregation occurs, the offspring will inherit either a nor- ~,I mal chromosome complement or will be a normal carrier like the. Consequences of a Robertsonian Translocaton in One Parent (illustrated with a male), I " f Robertsonian Translocation and Down Syndrome. Approximately 5% of Down syndrome cases are the result of a Robertsonian translocation affecting chromosome 14 and chromo- some 21. When a translocation carrier produces gametes, the translocation chromosome can, segregate with the normal 14 or with the normal 21. A diagram can be drawn to represent the six possible gametes that could be produced.
It may be caused by neoplastic disease of the bone marrow order 70mg alendronate mastercard, or more commonly by destruction of the bone marrow by exposure to toxic chemicals order alendronate 35mg with amex, ionizing radiation buy 35mg alendronate visa, or some antibiotics or other medications purchase 35mg alendronate free shipping. Rarely, an idiopathic form of the disease occurs Apnea – temporary or permanent cessation of breathing and therefore, of the body’s intake of oxygen and release of carbon dioxide. It is a serious symptom, especially in patients with other potentially life threatening conditions Apoptosis - cell death as in what happens to the brains in Batten Disease Arrhythmia – irregular heart action caused by disturbances either physiological or pathological Arteriosclerosis – a disease of the arterial vessels marked by thickening, hardening, and loss of elasticity in the arterial walls. Three forms of arteriosclerosis are generally recognized: atherosclerosis, sclerosis of arterioles, and calcific sclerosis of the medial layer of arteries. An increased level in this enzyme in the blood indicates necrosis or disease in these tissues. The episodes may be precipitated by inhalation of allergens or pollutants, infection, vigorous exercise, or emotional stress. Treatment includes 395 elimination of the causative agent, hyposensitization, aerosol or oral bronchodilators, and short term use of corticosteroids. Repeated attacks often result in emphysema and permanent obstructive lung disease Ataxia – a disorder or irregularity, a muscular incoordination especially that manifested when voluntary muscular movements are attempted Atrial fibrillation – irregular and rapid contractions of the heart where the atria and the ventricles are working independently, heart rate can be slow (in the 30’s or very fast in the 200’s), seen when the heart muscle begins to deteriorate. Atropine – used to overcome spasm of involuntary muscles, to help decrease secretions, also used to dilate pupils before testing eyes for glasses to relieve muscle spasm, and to increase heart rate Atypical – deviating from the normal Auditory - pertaining to the sense of hearing Aura – the preepileptic phenomenon where one is aware of a seizure that will be occurring shortly Auscultation – listening for sounds within the body, especially, from the chest, neck, or abdomen. A stethoscope is used, applied to the patient’s skin surface gently but firmly, to eliminate any environmental noises that may be present. They contribute to some of the subconscious aspects of voluntary movement such as accessory movements and inhibiting tremor. They do not initiate movement but rather provide coordination of complex motor circuits. May produce inflammatory lesions of the skin (cutaneous form) or lungs or a generalized invasion of the skin, lungs, bones, central nervous system, kidneys, liver, and spleen Blepharoptosis – drooping of the upper eyelid Blepharospasm – a twitching or spasmodic contraction of the orbicularis oculi muscle due to tics, eyestrain, or nervous irritability Bone marrow – the soft tissue in the marrow cavities of the long bones (yellow marrow) and in the spaces between trabeculae (a cord of tissue) of spongy bone in the sternum and other flat and irregular bones (red marrow). Red marrow produces all the types of blood cells Bowel – the intestine, colon Bradycardia – a normal heart rhythm with a rate of 60 or below in an adult or 70 in a child Bradykinesia – extreme slowness of movement Brain stem – part of the brain at the base of the neck which includes center for regulating and coordinating body activities, perception, the seat of consciousness, thought, memory, reason, judgment and emotion, through reflex centers automatic 397 control of body activities are maintained most important being cardiac, vasomotor, and respiratory centers which regulate circulation and respiration Brompton’s Cocktail – a mixture of cocaine, morphine and antiemetics formerly used to alleviate pain and induce euphoria, especially in patients with cancer Bronchial – a primary division of the trachea, which extends into each lung Bronchitis – inflammation of the bronchial mucous membrane, which a bronchus splits off of the trachea and goes into each lung Bronchodilator – a drug that expand the bronchi by relaxing bronchial muscle. There are three classes of bronchodilators: B2adrenergic-receptor agonists, Methylxanthines and Anticholinergic agents; the B2 adrenergic receptor agonists produce the greatest bronchodilitation in patients with bronchial asthma. The beta2, adrenergic receptor agonists are the best drugs for patients with mild, intermittent asthma and for acute attacks of reactive airway disease Bronchopneumonia – a type of pneumonia marked by scattered consolidation (areas filled with inflammatory exudates) in one or more lobes of the lung. It occurs primarily in infants and in elderly persons, both of whom have decreased resistance to bacterial and viral infections. It is often a complication of bronchitis Broncho-spasm – spasm of the bronchus, which the trachea divides into 2 bronchi, which ends, one in each lung Bruxism – the grinding of the teeth in children especially during sleep. It is a constituent of some kidney stones Calculi – any abnormal concretion, commonly called a stone, within the animal body. A calculus is usually composed of mineral salts, and can be found in the gallbladder, kidneys, ureter, bladder, or urethra Candidiasis – infection of the skin or mucous membrane with any species of Candida. Candida grows in warm moist areas, causing superficial infections of the mouth, vagina, nails, and skin folds of healthy individuals. Sometimes very difficult to get rid of Cardiac arrest – heart stops due to many reasons with the main one being heart attacks Cardiomegaly – enlargement of the heart Cardiomyopathy – any disease that affects the heart muscle, diminishing heart performance Cardiovascular – pertaining to the heart and blood vessels Cardioversion – the restoration of normal sinus rhythm by chemical or electrical means. When preformed mechanically, the procedure relies on or the oral or intravenous administration of antiarrhythmic drugs. Electrical cardioversion relies instead on the delivery of synchronized shock of direct electrical current across the chest wall. It is used to terminate arrhythmias such as atrial fibrillation, atrial flutter, supraventricular tachycardia, and well tolerated ventricular tachycardia. Unlike defibrillation, which is an unsynchronized shock, applied during a dire emergency, electrical cardioversion is timed to avoid the T wave of cardiac repolarization to avoid triggering malignant arrhythmias. A patient will almost always require sedation and analgesia before the procedure Carnitine – a chemical important in metabolizing palmitic and stearic acids. It has been used therapeutically in treating myopathy due to carnitine deficiency. In children that are on Depakote, you need to have their Carnitine levels checked periodically due to the fact that Depakote pulls Carnitine from the body system Carpal tunnel – pain or numbness that affects some part of the median nerve distribution of the hand (the palmer side of the thumb, the index finger, the radial half of the ring finger, and the radial half of the palm) and may radiate to the arms. Patients may have a history of cumulative trauma to the wrist in carpenters, rowers, typists, computer users, or those who regularly use vibrating tools or machinery Cascara – It is the main ingredient in a laxative which is supposed to be fairly good 399 Cataplexy – a sudden brief loss of muscle control brought on by strong emotion or emotional response, such as a hearty laugh, excitement, surprise, or anger.
Before you decide on medication discount alendronate 70 mg amex, ask yourself what you’ve done to alleviate your anxiety buy 35mg alendronate overnight delivery. With a few important exceptions order 35mg alendronate visa, which we review in this chapter generic 70mg alendronate visa, we recom- mend that you try various psychological approaches prior to adding medica- tion. Consider the following: ✓ Some research suggests that certain medications may actually interfere with the long-term effectiveness of the most successful treatments for anxiety. That’s especially true of the techniques designed to confront phobias and fears directly through exposure. Many of our recommended anxiety axes have the potential to cement change for the long haul as well as posi- tively affect your entire life. Many people who take medication alone experience a quick reoccurrence of symp- toms when they discontinue taking medication for any reason. The downside of medications You need to reflect on both sides of any important decision. The negative side of the argument includes: ✓ Addiction: Some medications can lead to physical and/or mental depen- dency. Getting off of those medications can be difficult, or even danger- ous, if not done properly. And some medi- cations can lead to serious problems, such as diabetes and tremors. The potential effects on the baby or fetus are just too risky for most situations. Working with your physician to find the right medication — a drug that alleviates your anxiety and doesn’t cause you overly troublesome side effects — may take some time. Chapter 9: Considering Medications and Other Physical Treatment Options 147 The upside of medications Sometimes medications make good sense. In weighing the pros and cons, we suggest that you take a good look at the benefits that medications can offer: ✓ When serious depression accompanies anxiety, medication can some- times provide faster relief, especially when a person feels hopeless, helpless, or suicidal. Such interferences include: • Panic attacks that occur frequently and cause expensive trips to the emergency room. Traumas that happen to most people at one time or another include • The sudden death of a loved one • An unexpected accident • Severe illness • An unexpected financial disaster • A natural disaster, such as a hurricane or earthquake • Being the victim of a serious crime • Being the victim of terrorism Understanding Medication Options Today, physicians have a wide range of medications for the treatment of anxi- ety disorders. If you decide to ask your doctor about medication, don’t forget to discuss the following critical issues if they apply to you. Communicating with your doctor about these considerations can help prevent a bad outcome. Be sure to tell your doctor if you ✓ Are pregnant or plan to become pregnant ✓ Are breast-feeding ✓ Drink alcohol ✓ Take any other prescription drugs ✓ Take any over-the-counter medications ✓ Take herbs or supplements ✓ Have any serious medical conditions ✓ Have had any bad reactions to medications in the past ✓ Have any allergies ✓ Take birth control pills (some medications for anxiety reduce their effectiveness) Most drugs prescribed for anxiety belong to one of the following categories. In addition to a few intriguing medication options, we discuss the following: ✓ Antidepressants ✓ Benzodiazepines (minor tranquilizers) ✓ Miscellaneous tranquilizers ✓ Beta blockers ✓ Atypical antipsychotics ✓ Mood stabilizers You may notice that some of these categories sound a little strange. For example, antidepressants (typically used to treat depression) and beta blockers (generally prescribed for hypertension) don’t sound like groups of medications for the treatment of anxiety. Antidepressants Antidepressant medications have been used to treat anxiety for many decades. That’s interesting, because anxiety and depression often occur Chapter 9: Considering Medications and Other Physical Treatment Options 149 together. And both problems appear to have some similarity in terms of their biological underpinnings. Antidepressants increase the availability of different neurotransmitters or chemical messengers in the brain. The most frequently prescribed antidepressants increase the levels of serotonin, which helps regulate mood, anxiety, and the ability to control impulses. Be sure to tell your doctor about all medications or over-the- counter supplements you’re taking. Some of these neurotransmitters boost energy and alertness while others affect experiences of pleasure, motivation, and attention. Table 9-2 lists these medications alphabetically within their respective categories. Paradoxically, agita- tion and anxiety are common side effects: Be sure to let your doctor know if you experience increased distress with this medication.