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Maintain adequate fluid intake to avoid dehydration without causing fluid overload, which may lead to cerebral edema. It results in patches of sclerotic tissue that impair the ability of the nervous system to conduct motor nerve impulses. Emphasize the need to avoid stress, infections, and fatigue and to maintain independence by developing new ways of performing daily activities. The client experiences sporadic, progressive weakness and abnormal fatigue of voluntary skeletal muscles. Myasthenia gravis is characterized by a disturbance in transmission of nerve impulses at neuromuscular junctions. Polish up on client care 209 this transmission defect results from a deficiency in release of acetylcholine or a deficient number of acetylcholine receptor sites. Respiratory muscle weakness may be severe enough in myasthenic crisis to require an emergency airway and mechanical ventilation. Respiratory muscle weakness in myasthenic crisis may require an emergency airway and mechanical ventilation. This overgrowth curtails 210 Neurosensory system movement of the stapes in the oval window, preventing sound from being transmitted to the cochlea and resulting in conductive hearing loss. This lack of dopamine impairs the area of the brain responsible for control of voluntary movement. Be alert for and report orthostatic hypotension, irregular pulse, blepharospasm, and anxiety or confusion. Retinal detachment Retinal detachment is the separation of the retina (a thin, semitransparent layer of nerve tissue that lines the eye wall) from the choroid (the middle vascular coat of the eye between the retina and the sclera). It occurs when the retina develops a hole or tear and the vitreous humour seeps between the retina and choroid. Teaching topics · Explanation of the disorder and treatment plan · Medication use and possible adverse effects · Physical therapy 212 Neurosensory system Speaking of seeing, make sure that you have good lighting. Other possible causes include: · alcohol withdrawal · anoxia after respiratory or cardiac arrest · birth trauma (inadequate oxygen supply to the brain) · brain tumor · hypoglycemia · infectious disease, such as meningitis, encephalitis, or brain abscess · ingestion of toxins · inherited disorder such as phenylketonuria · stroke. However, 80% of patients have Drug therapy · For status epilepticus: diazepam (Valium), lorazepam (Ativan), phenytoin · Phenytoin (Dilantin), carbamazepine (Tegretol), gabapentin (Neurontin) for generalized tonic-clonic seizures Polish up on client care 213 Differentiating among seizure types the hallmark of seizure disorder is recurring seizures, which can be classified as partial or generalized. Categories of partial seizures include simple partial seizures (consciousness is intact), complex partial seizures (some loss of consciousness occurs), and partial seizures in which seizure activity may be spread to the entire brain, thereby causing a generalized seizure. Simple partial seizures A simple partial seizure can be present in several ways depending upon the focal point of the seizure in the brain. Complex partial seizures Consciousness becomes impaired with a complex partial seizure. The same symptoms that present during a simple partial seizure are still seen as the seizure develops into a complex partial seizure. Partial seizures evolving to generalized tonic-clonic seizures A partial seizure can be either a simple partial or a complex partial seizure that progresses to a generalized seizure. Loss of consciousness occurs immediately or within 1 to 2 minutes of the start of the progression. Absence (petit mal) seizures An absence seizure occurs commonly in children, but it may also affect adults. It usually begins with a brief change in the level of consciousness, indicated by blinking or rolling of the eyes, or a blank stare, and slight mouth movements. The impairment is so brief that the patient (or parent) is sometimes unaware of it. If not properly treated, these seizures can recur as often as 100 times per day and may result in learning difficulties. Myoclonic seizures A myoclonic seizure is marked by brief bilateral muscular jerks of the body extremities. They may occur in a rhythmic manner and may be accompanied by brief loss of consciousness. Generalized tonic-clonic (grand mal) seizures Typically, a generalized tonic-clonic seizure begins with a loud cry, precipitated by air rushing from the lungs through the vocal cords.
A client withdrawing from cocaine is prone to severe depression (post coke blues) and the nurse needs to assess for this health problem virus 85 order 250mg panmycin. A client who has a long history of alcohol abuse is experiencing cardiac problems bacterial growth 500mg panmycin. A client tells the nurse that he has been using ecstasy every weekend with his friends antibiotic bone penetration order panmycin 250mg. The withdrawal effects of hallucinogens are not clearly established because these drugs are not known to be physically addictive bacteria 4 urinalysis buy 500mg panmycin. When developing a teaching plan for the client and his family, the nurse should stress the importance of including which vitamin in his diet? On the treatment plan for a client diagnosed with schizophrenia, one of the goals is to discuss issues that reinforce reality. Discourage his use of illegal substances and explain how they can cause him to hallucinate. Helping a client to understand that external stressors can provoke hallucinations can assist the client to recognize and avoid these stressors and enhance coping ability. Telling him to look for discrepancies between what he thinks and feels and limiting the number of relationships he has during treatment encourage the client to focus internally on himself and not engage with external reality. Discouraging his use of illegal substances assumes that he abuses substances that can alter his perceptions of reality. A hallucination is a false sensory perception associated without real external stimuli. A client tells the nurse that a voice keeps telling him to crawl on his hands and knees like a dog. A nurse is developing a teaching plan for the client receiving clozapine (Clozaril). Clozapine can cause a potentially fatal blood dyscrasia characterized by decreased white blood cells and severe neutropenia. Clozapine can also cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures. The client may have a difficult time sitting long enough to eat his meal; therefore, finger foods that can be eaten easily are most appropriate. The other foods require the client to sit and eat, a task the client will be unable to achieve at this time. Each time the client tries to go to the day room, she begins to perspire and becomes short of breath. During the night, a 50-year-old Vietnam veteran with posttraumatic stress syndrome wakens shaking and tells you that someone is trying to smother him. Staying with him until he can sleep again or listening to him if he wants to talk is the most appropriate action for the nurse to take in this situation. A client is being taught how to manage the adverse effects of the antipsychotic medication that he has been prescribed. Drink caffeinated beverages throughout the day to handle the feeling of being sleepy. A client taking an antipsychotic medication will commonly experience the adverse effect of dry eyes and should be instructed to use artificial tears. Sedation is a less common adverse effect of antipsychotic drugs and it will resolve itself; the client needs to be reminded to stay active. A client recently prescribed antipsychotic medication comes to the hospital emergency department with a high fever and parkinsonian-type symptoms. The most common extrapyramidal adverse effect, akathisia, is a form of psychomotor restlessness that can usually be relieved by pacing. Haloperidol and the anticholinergic medications that are provided to alleviate its extrapyramidal effects can result in dry mouth. A male client approaches the nurse and says "Hey cutie, can you take me outside for a smoke? Taking the client outside to smoke is inappropriate because the nurse is allowing the client to manipulate her. Offering an abrupt response, such as "You know the rules," may cause the client to act defensively. Knowledge of the physiologic changes that accompany pregnancy and fetal development is essential to understanding client care during the antepartum period. At any time, you can review the major points of this chapter by consulting the Cheat sheet on pages 494 to 496.
If it is given antibiotics for uti pdf safe panmycin 250 mg, and later the confidence is broken antibiotics walgreens cheap panmycin 250 mg, the child is likely to feel betrayed and trust will be jeopardized virus - arrivederci zippy cheap 500mg panmycin. The assessment process is dynamic; that is antibiotics for sinus infection in canada order 250 mg panmycin, it does not stop after a particular number of questions have been asked. It requires active involvement on the part of the mandated reporter to interpret clues, observe non-verbal communication, and develop and test hypothesis. The process of assessment necessitates a willingness and ability on the part of the mandated reporter to inquire further. An assessment can be done in such a way that it naturally evolves into collecting information about neglect and physical, sexual and emotional abuse. It is extremely important not to lead the child to say what they think you want to hear. Assessment With a Verbal Child Two things are noteworthy when interviewing a child who is able and willing to be verbal: first, creating an environment that seems safe to the child; and second, providing opportunities for spontaneous disclosure through verbal and non-verbal messages. If assessing the home environment, ask the child to describe the house and who lives there. Physical Abuse the presence of physical abuse can be evaluated by asking what happens at home when people get angry, drink or take drugs. Sexual Abuse Sexual abuse can be assessed by asking non-leading questions about touching and affection in the family. Particularly in the area of questions about sexual abuse, mandated reporters should use discretion. Detailed questioning about sexual abuse will usually be asked by the investigating agency, such as Child Protective Services. Neglect the two types of neglect are severe neglect and general neglect: · "Severe neglect" means the negligent failure of a person having the care or custody of a child to protect the child from severe malnutrition or medically diagnosed nonorganic failure to thrive. If the child has given information that leads to a reasonable suspicion that he/she is being abused, let the child know you are concerned about what is going on (describe what the child has revealed) and that it is important to get some help now. Do not make any guarantees to the child about what will happen, but let the child know as much as possible. It is helpful to make the referral to the Child Protective Agency while the child can listen. Emotional abuse Emotional abuse is a new addition to the Child Abuse & Neglect Reporting law. It is important to assess abuse based on extreme or persistent behaviors that are consistent with indicators of abuse. A child who is physically abused may be very physically abusive of dolls or other play materials, and have themes of violence or death in his or her play or drawings. Assessment With the Family If the entire family will be meeting with a mandated reporter, the family members may be asked nonthreatening questions about family life similar to those questions asked of a verbal child (see "Assessment with a Verbal Child"). It must be recognized, however, that if abuse is occurring in the family, parents and other family members may not be inclined to discuss this area of concern. Frequently, meeting with the child separately from the parents may be helpful in gathering further information which may be relevant to the abuse situation. These references may indicate that a parent or caretaker is physically abusing a child. Parents sometimes use objects such as belts, bats, pots and pans, or telephone cords to physically punish their children. Some parents who were abused as children may not recognize their behavior as abusive. Other abusive parents may think of their behavior as abusive, and may seek to hide it, making up stories, or getting their children to protect them. The latter are obviously more difficult to assess, but looking at the entire family picture, and interviewing the children alone, may help with data collection. Parents are frequently frightened and angry when the referral is made to the authorities. They may also, either immediately or eventually, feel relief that steps have been taken to protect their children. Giving parents a confidentiality policy (See Appendix C) and being matterof-fact and confident about what abuse is, will help tremendously in undertaking the emotional and difficult task of reporting. Also, the mandated reporter must clearly understand that his/her responsibility is to make the assessment, determine if "reasonable suspicion exists" and then report. When in doubt, call the 13 Emergency Response Unit in the Child Protective Agency and discuss the situation.
Professor Maatman teaches legal writing at Widener University School of Law antibiotics for acne minocycline generic panmycin 250 mg, Wilmington treatment for uti in guinea pigs quality panmycin 250 mg, Delaware low grade antibiotics for acne purchase panmycin 250mg. Category Three: the Theory and Practice Appropriate to the Teaching of Legal Writing Like other teaching areas antibiotics just in case safe 250 mg panmycin, legal writing has been enriched by articles about pedagogy. In fact, the pedagogical conversation among legal writing professors may be more vibrant than that in any other area of the legal academy. Since much of the content of a legal writing course is focused on the teaching of a process, it is natural that legal writing professors would focus scholarly attention on pedagogical issues. Further, many articles about pedagogy take as their starting point a substantive (category one) or theoretical (category two) point. Professor Eichhorn teaches legal writing at the University of South Carolina School of Law. Other articles might present a study of the effectiveness of various academic support techniques 102 or critique present practices of teaching legal research. Professor Seligmann teaches legal writing at the University of Arkansas School of Law, Fayetteville. Professor Stinson teaches legal writing at the Arizona State University College of Law. Professor Zimmerman teaches legal writing at Northwestern University School of Law. New Voices in the Legal Academy An article might analyze the use of the Socratic method in law schools in general and in writing courses in particular. Another article might argue that certain principles of rhetoric and literary criticism might serve as the foundations for a coherent philosophy of law study;110 or use principles of rhetorical criticism to argue that legal writing and firstyear casebook courses should be viewed as one ongoing rhetorical activity;111 or examine possible definitions of legal writing and their impact on the effectiveness of teaching and learning in the academy;112 or identify the rhetorical roots of legal reasoning and advocate that law schools use classical rhetorical concepts and vocabulary to teach deductive and analogical reasoning. Another article might compare the historical development and the pedagogical and jurisprudential foundations of le- 107 Elizabeth Fajans & Mary Falk, Comments Worth Making: Supervising Scholarly Writing in Law School, 46 J. Professor Beazley teaches legal writing at Moritz College of Law at the Ohio State University. Professor Kearney taught legal writing at Vermont Law School until the twoyear cap on her position expired. Professor Cornwell teaches legal writing at the John Marshall Law School in Chicago. Professor Greenhaw formerly taught legal writing and currently teaches Introduction to U. Professor Ramsfield taught legal writing at Georgetown University Law Center for many years, and now teaches legal writing at University of Hawaii at Mnoa, William S. Robbins, Paradigm Lost: Recapturing Classical Rhetoric to Validate Legal Reasoning, 27 Vt. An article might use research in cognitive science, psychology, psychotherapy, composition theory, and critical discourse analysis to explore both the role of student conferences and the institutional and individual constraints that may impede learning. Judge Harry Edwards begins his well-known critique of modern legal scholarship117 with an epigram from Felix Frankfurter: "In the last analysis, the law is what the lawyers are. Romantz, the Truth about Cats and Dogs: Legal Writing Courses and the Law School Curriculum, 52 U. Larry Catб Backer, Defining, Measuring, and Judging Scholarly Productivity: Working toward a Rigorous and Flexible Approach, 52 J. Rosenwald 3 (May 13, 1927) (Felix Frankfurter papers, Harvard Law School library) (quoted in Rand Jack & Dana C. Jack, Moral Vision and Professional Decisions: the Changing Values of Women and Men Lawyers 156 (Cambridge U. Careful analysis of legal pedagogy serves all the identified values of scholarship. It advances knowledge about one of our own professions, the profession of teaching. When we talk about scholarship, we should say what we mean, and we should keep our stories straight. The claim that scholarship enhances teaching is one of the primary justifications for devoting so many institutional and personal resources to the scholarship project. We do not claim that all publications about pedagogy should be considered scholarship. Rather, we claim that articles about pedagogy, like other kinds of articles, should be taken seriously enough to be evaluated according to their merit. In the press of other obligations, most professors struggle to find time to write at all.
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