By P. Lester. Arizona State University West.
The role of conscious- notion of health professionals as wounded healers ness with respect to a holographic view of science is acknowledged as part of the necessary growth has been discussed in earlier writings (Watson generic 0.25mcg rocaltrol otc, and compassion called forth within this theory/ 1992 purchase 0.25 mcg rocaltrol mastercard, p cheap 0.25 mcg rocaltrol otc. A caring occasion occurs whenever the nurse and • The one caring and the one being cared for are another come together with their unique life histo- interconnected; the caring-healing process is ries and phenomenal ﬁelds in a human-to-human connected with the other human(s) and with transaction cheap 0.25 mcg rocaltrol overnight delivery. It • The caring-healing-loving consciousness of the becomes transcendent, whereby experience and nurse is communicated to the one being cared perception take place, but the actual caring occa- for. The process goes beyond itself yet arises from through and transcends time and space and can aspects of itself that become part of the life history be dominant over physical dimensions. It transcends clarify where one may locate self within the time, space, and physicality. The Caring Model or Theory can be considered a • Are those involved “conscious” of their caring philosophical and moral/ethical foundation for caritas or noncaring consciousness and inten- professional nursing and is part of the central focus tionally in a given moment, at individual and for nursing at the disciplinary level. It offers to expanding their caring consciousness and a framework that embraces and intersects with art, actions to self, other, environment, nature, and science, humanities, spirituality, and new dimen- wider universe? However, to truly “get it,” one has to experience This work, in both its original and evolving it personally. The model is both an invitation and forms, seeks to develop caring as an ontological- an opportunity to interact with the ideas, epistemological foundation for a theoretical- experiment with and grow within the philosophy, philosophical-ethical framework for the profession and to live it out in one’s personal/professional life. Nursing caring theory-based activi- 2004), provide us with a chance to assess, critique, ties as guides to practice, education, and research and see where or how, or even if, we may locate have developed throughout the United States ourselves within a framework of caring science as a and other parts of the world. The caring model is basis for the emerging ideas in relation to our own consistently one of the nursing caring theories used “theories and philosophies of professional nursing as a guide. Nursing thus ironically is interacting with the caring model to transform now challenged to stand and mature within and/or improve practice? The it mean to be human, caring, healing, becoming, future already reveals that all health-care growing, transforming, and so on? For example, practitioners will need to work within a in the words of Teilhard de Chardin:“Are we hu- shared framework of caring relationships and mans having a spiritual experience, or are we human-environment ﬁeld modalities, pay at- spiritual beings having a human experience? Participants were invited to explore Transpersonal However, nursing’s future holds promises of Human Caring Theory (Caring Theory), as taught caring and healing mysteries and models yet and modeled by Dr. Jean Watson, through experi- to unfold, as opportunities for offering com- ential interactions with caring-healing modalities. Nursing has a critical role to play Returning from the retreat to the preexisting in sustaining caring in humanity and making schedules, customs and habits of hospital routine new connections between caring, love, and was both daunting and exciting. Caring Theory, and not as a remote and abstract philosophical ideal; rather, we had experienced car- ing as the very core of our true selves, and it was the call that led us into health-care professions. Our experiences throughout the re- treat had accentuated caring as our core value. Caring Theory could not be restricted to a single Application of area of practice. Nursing within acute care inpatient hospital set- Theory of tings is practiced dependently, collaboratively, and independently (Bernardo, 1998). Bernardo de- scribes dependent practice as energy directed by Human Caring and requiring physician orders, collaborative prac- Terri Kaye Woodward tice as interdependent energy directed toward activities with other health-care professionals, and independent practice as “where the meaningful role and impact of nursing may evolve” (p. Transpersonal Caring Theory and the caring Although Bernardo’s description of inpatient nurs- model “can be read, taught, learned about, studied, ing captures the composite and fragmented role researched and even practiced: however, to truly ‘get it,’ one has to personally experience it—interact and grow within the philosophy and intention of 1 See Watson,J. This section of Model® integrating theory, evidence and advanced caring-healing the chapter provides a look into Transpersonal therapeutics for transforming professional practice. Watson’s clinical caritas of deep respect for humanity and all life, of wonder processes are listed, as well as an abbreviated ver- and awe of life’s mystery, and the interconnected- sion of her guidelines for cultivating caring-healing ness from mind-body-spirit unity into cosmic throughout the day (Watson, 2002). Gadow (1995) describes written in Caring Theory language, expresses our nursing as a lived world of interdependency and intention to all and reminds us that caring is the shared knowledge, rather than as a service pro- core of our praxis. Caring praxis within this lived world is a Second, a shallow bowl of smooth, rounded praxis that offers “a combination of action and re- river stones is located in a prominent position at ﬂection... A sign posted by the stones iden- and a relationship with the wider community” tify them as “Caring-Healing Touch Stones” invit- (Penny & Warelow, 1999, p.
It is characterized by remission and exacerbation of symptoms; the commonly exacerbating condition is superimposed bacterial infection purchase rocaltrol 0.25mcg on-line. Bacteria that exacerbate chronic bronchitis are: Streptococcus pneumoniae Haempphilus influenzae Mycoplasma pneumoniae Branhamella catarrhalis Laboratory diagnosis: Specimen: Sputum Procedure: Gram staining 0.25mcg rocaltrol visa, culture generic rocaltrol 0.25 mcg free shipping, biochemical and serological test for microbe identification discount rocaltrol 0.25 mcg without a prescription. Clinical features: Sudden onset of fever, chills, sweating, and productive cough of purulent or blood streaking sputum and pleuritic chest pain. Procedure: Gram staining, culture, biochemical and serological test for microbe identification. Giardia lamblia causes diarrhea by physical coverage of the normal absorptive surface. Laboratory diagnosis: Specimen: Stool, rectal swab Wet mount preparation: Pus cells, red blood cells, parasites and ova. Incubation period and severity of disease in food infection is determined by inoculum of micro-organism ingested. Examples of food intoxication Organism Incubation period Clinical findings Related food item Bacillus cereus 1-6 hours Vomiting, cramp Rice, Pasta dishes Staphylococcus aureus 2-4 hours Vomiting Meat, Salads Clostridium botulinum 12-72 hours Flaccid paralysis Meat, Vegetables Table 4. Examples of food infection Organism Incubation period Clinical findings Related food item Bacillus cereus 6-24 hours Watery diarrhea Meat, Vegetables Salmonella spp. These are: Escherichia coli Pseudomonas aeruginosa Klebsiella pneumoniae Proteus spp. Enterobacter aerogens Other important causative agents: Enterococci Staphylococcus saprophyticus 318 Routes of infection 1. Obstruction: Congenital anomalies in youngs and prostatic adenoma, stricture and calculi in olds. Lower urinary tract infection: Infection of urethra and bladder which manifests with frequency of micturition, pain during micturition, blood-stained or cloudy urine, supra pubic tenderness. Gram stain: The presence of one bacterium in Uncentrifuged gram stained urine confirms Urinary tract infection. Culture: Blood agar medium, Mac Conkey agar medium Interpretation of culture results 5 1. Genital tract infection manifests as either genital discharge or genital ulceration with or without inguinal lymphadenitis. Ectoparasites Phthirus pubis Pubic hair louse infestation Sarcoptes scabei Scabies 321 Urethral and vaginal discharge 1. Urethritis It manifests with urethral discharge, pain during urination and frequency of urination. Clinical findings: White mucoid discharge Laboratory diagnosis: Specimen: Urethral discharge or swab (Before urination or antibiotics) Wet mount: T. The organism which causes bacteremia are less virulent and usually cleared from blood with in 3o min. It occurs in normal and abnormal heart valves and tissues with fulminant course resulting in death in six weeks time if not treated. It occurs in acquired or congenitally damaged heart valves with less fulminant course resulting in death after six weeks if not treated. Amount needed is 2ml for a child and 10 ml for an adult to give 1:10 dilution of the specimen. Blood culture bottle should have 18 ml and 90 ml of broth for a child and an adult respectively. Time of incubation of blood culture is 7 days and subculture is done in first, third and seventh day of incubation. If the appearance of blood culture is changed to cloudy, it indicates bacterial growth. Interpretation of results • Positive bacterial growth in three of blood culture broth ----- Definitive diagnosis • Positive bacterial growth in two of blood culture broth----- Probable diagnosis • Positive bacterial growth in one of blood culture broth----- Contamination Common contaminants of blood culture S. In children ----------- Haemophilus influenzae Streptococcus pneumoniae Neisseria meningitidis. In adults ------ Streptococcus pneumoniae Neisseria meningitidis Haemophilus influenzae Clinical features:. Sudden onset of head ache, fever, malaise, vomiting associated with neckand back stiffness, behavioral changes like irritability and drowsiness, convulsions and coma.
Abra- sions exude serum buy cheap rocaltrol 0.25mcg on-line, which progressively hardens to form a scab cheap 0.25mcg rocaltrol mastercard, but they may also bleed because occasionally they are deep enough to breach the vascular papillae that corrugate the undersurface of the epidermis in which case frank bleeding may be present at an early stage generic rocaltrol 0.25mcg otc. More superficial abrasions that barely damage the skin with little or no exudation of serum (and thus little or no scab formation) may be termed brush or scuff abrasions discount 0.25mcg rocaltrol free shipping. Scratches are lin- ear abrasions typically caused by fingernails across the surface of the skin. Pointed but noncutting objects may also cause linear abrasions and to differ- entiate them from fingernail scratches may be termed “point abrasions. Thus they may have a linear appearance, and close examination may show ruffling of the superficial epidermis to one end, indicating the direction of travel of the opposing surface. Thus, a tangential blow could be horizontal or vertical, or it may be possible to infer that the victim had been dragged over a rough surface. The patterning of abrasions is clearer than that of bruises because abra- sions frequently take a fairly detailed impression of the shape of the object causing them and, once inflicted, do not extend or gravitate; therefore, they indicate precisely the area of application of force. In manual strangulation, small, crescent-shaped abrasions caused by the fingernails of the victim or assailant may be the only signs visible on the neck. A victim resisting a sexual or other attack may claw at her assailant and leave linear parallel abrasions on the assailant’s face. Some abrasions may be contaminated with foreign mate- rial, such as dirt or glass, which may have important medicolegal significance. In such cases, consultation with a forensic scientist can ensure the best means of evidence collection and preservation. Lacerations Lacerations are caused by blunt force splitting the full thickness of the skin (see Fig. Boxers classically develop lac- erations when a boxing glove presses on the orbital rim. When inflicted deliberately, the force may cause the assailant and weapon to be contaminated with blood. Lacerations have characteristic features but often mimic incised wounds (or vice-versa), particularly where the skin is closely applied to underlying bone, for example, the scalp. Close examination of the margins of the wound, which are usually slightly inverted, normally resolves the issue. Blood vessels, nerves, and delicate tissue bridges may be exposed in the depth of the wound, which may be soiled by grit, paint fragments, or glass. The shape of the laceration may give some indication regarding to the agent responsible. For example, blows to the scalp with the circular head of a hammer or the spherical knob of a poker tend to cause crescent-shaped lacera- tions. A weapon with a square or rectangular face, such as the butt of an axe, may cause a laceration with a Y-shaped split at its corners. Incisions These wounds are caused by sharp cutting implements, usually bladed weapons, such as knives and razors, but sharp slivers of glass, the sharp edges of tin cans, and sharp tools, such as chisels, may also cause clean-cut incised injuries. Axes, choppers, and other similar instruments, although capable of cutting, usually cause lacerations because the injury caused by the size of the instrument (e. Mixed wounds are common, with some incised element, some laceration, bruising, and swelling and abrasion also present. Machetes and other large-blade implements are being used, pro- ducing large deep cuts known as slash or chop injuries. They Injury Assessment 141 gape, and the deeper tissues are all cut cleanly in the same plane. If the blade of the weapon is drawn across the skin while it is lax, it may cause a notched wound if the skin creases. The direction of travel of the blade of the weapon is not always easy to decide, but usually the deeper part of the wound is near the end that was inflicted first, the weapon tending to be drawn away toward the end of the wound. In an attempt to ward off the assailant, the arms are often raised in a protective gesture and incisions are then often seen on the ulnar borders of the forearms. If the blade of the weapon is grasped, then incised wounds are apparent on the palmar surfaces of the fingers. Incised wounds may be a feature of suicide or attempted suicide (see Subheading 3. They are usually located on the wrists, forearms, or neck, although other accessible areas on the front of the body may be chosen.
Low blood C levels of vitamin E have been linked to increased risk of cataracts and some research shows protective beneﬁts with supplements rocaltrol 0.25 mcg with amex. Consistent and long-term use of antioxidants discount rocaltrol 0.25mcg otc, along with lifestyle changes order rocaltrol 0.25mcg online, are your best defence purchase 0.25mcg rocaltrol overnight delivery. In one study, people who took multivitamins or supplements containing vitamins C or E for more than 10 years had a 60 percent lower risk of devel- oping cataracts (Archives of Ophthalmology, 2000: 118;1556–1563). Complementary Supplements B-complex: Vitamins B2 and B3 protect glutathione in the eye, and some evidence shows protective beneﬁts with supplements. Boost antioxidant and carotenoid intake by eating lots of berries, carrots, peppers, kale, collard greens, spinach, and broccoli. When a person with celiac disease eats gluten-containing food, the immune sys- tem reacts by producing antibodies, which attack the villi in the small intestine, reducing their ability to absorb nutrients. Over time, the reduced absorption of nutri- C ents leads to malnutrition and vitamin, mineral, and essential fatty acid deﬁciencies. This can damage the health of every organ and body system and increase the risk of many diseases, such as osteoporosis and depression. The cause of celiac is not known; however, three factors are typically present in those who develop the disease: genetic predisposition, a diet containing gluten, and a triggering event. Possible triggers include: introduction of grains into a baby’s diet, puberty, pregnancy, menopause, stress, viral or bacterial infection, and trauma (ac- cident, surgery). There is no cure for celiac disease, but the condition can be managed by following a gluten-free diet for life. Those who do not adhere to a gluten-free diet are at greater risk of developing os- teoporosis; cancer of the intestines, mouth, esophagus, or bowel; and neurological diseases (seizures and nerve damage). Once gluten is removed from the diet, the villi start to heal and intestinal inﬂammation subsides. Complete healing and regrowth of the villi may take several months in younger people and as long as two to three years in older people. For severe cases that don’t respond to dietary changes, medications such as prednisone are temporarily used to suppress the immune response. Vitamin, mineral, and essential fatty acid supplements are recommended to correct deﬁciencies and restore health. Dietary Recommendations Read labels carefully; look for products labelled gluten-free. When eating out, ask to speak directly to the chef as service staff may not be familiar with gluten and the many possible hidden sources. Cross-contamination can occur if gluten-free foods are prepared in unwashed bowls previously containing gluten, or cooked in the same pots or deep-fryer. Foods to include: • Lean meats, ﬁsh and poultry, fruits, vegetables, corn, potato, rice, quinoa, and soy. Healthy fats (ﬁsh, nuts, and seeds) are very important to help restore essential fatty acids, which are depleted in those with celiac disease. Foods to avoid: • Foods containing wheat, barley, rye, bulgur, Kamut, spelt, and triticale, such as breads, pasta, cereals, baked goods, crackers, and pies. Note: Dairy should be limited initially as damage to the intestines reduces the ability to di- gest lactose (dairy sugar). These studies used pure oats, free of gluten contamination, and the amount per day was limited. The Canadian Celiac Association has stated that consump- tion of pure, uncontaminated oats is safe in the amount of 50–70 g per day (1/2–3/4 166 cup of dry rolled oats) by adults and 20–25 g per day (1/4 cup of dry rolled oats) by children with celiac disease. Note: Some individuals may not tolerate even pure oats, in which case they should be completely avoided. Lifestyle Suggestions To promote healing and support immune function, it is important to get adequate rest, reduce stress, and strictly adhere to the gluten-free diet. C Top Recommended Supplements Digestive enzymes: May be depleted in those with celiac; they aid proper digestion of food and are particularly important in newly diagnosed individuals. Essential fatty acids: Are highly recommended to correct deﬁciencies, reduce inﬂammation, and promote healing of intestinal cells.