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At this stage, the drug produces no more depressive effects. Morphine has different effects at various concentrations
The depressive curve is used to show the bad effect of morphine.
It shows the concenrtaion of morphine over time before it becomes toxic to the user. The margin of safety should be large to avoid toxicity / poisoning.
What is a margin of safety?
It is the distance between the desired effect and the toxic effect. Shibamoto and Bjeldanes (2009) defined safety as the freedom from danger.
Why is a bigger margin of safety better than a small one?
A bigger margin of safety is better since it will mean that the drug user would niot easily or accidentally experience the toxic effects of the drug.
Explain why each of the lines flatline at the top and why the second line also flatlines to begin with.
The flat lines that are observed…
Beach, HD (1957).Morphine addiction in ratsCanadian Journal of Psychology/Revue canadienne de psychologie, Vol 11(2), Jun 1957, 104-112.
Jaffe JH, Martin WR. In: Gilman AG et al. (Eds).(1990) Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed. New York: Pergamon Press, 1990, pp 485-521
Mucha, H and Kalan, RF (1981)Naloxone prevention of morphine LDR curve flattening associated with high-dose tolerance
Martin WR, Fraser HF (1961). "A comparative study of physiological and subjective effects of heroin and morphine administered intravenously in postaddicts." Journal of Pharmacology and Experimental Therapeutics 133: 388 -- 99. PMID 13767429. http://jpet.aspetjournals.org/cgi/pmidlookup?view=long&pmid=13767429 .
ISSUES WITH MORPHINE
The importance of the proper management of pain in a patient with a terminal illness cannot be overstated (roglio, 2008). Pain may not be the most common among the symptoms at the end-of-life stage, but it is what patients and their families fear the most. Unrelieved pain reduces the quality of life and of joy in what remains of that life. It triggers anxiety, depression, loss of hope and the sense of usefulness and worth and also obstructs important decision-making efforts. Family members want the final moments of their departing loved one to as peaceful and comfortable as possible. That is as far as possible from the pain of the approaching end. Pharmacotherapy is still the major approach to the management of pain at this stage of life. Opioids are the main category of painkillers used for such patients because of these painkillers' strength, their accompanying…
Broglio, K. (2008). Pain management and terminal illness. Vol 8 # 4, Practical Pain
Management: Vertical Health. Retrieved on March 13, 2015 from http://www.practicalpainmanagement.com/resources/hospice/pain-management-terminal-illness
Fine, R.L. (2007). Ethical and practical issues with opioids in life-limiting illnesses.
Vol. 20 # 1, Journal in the Proceedings of the Baylor University Medical Center:
ANtoher common result of taking the drug would be higher blood pressure (obviously the intent based on the question) but also anxiety (due to the higher blood pressure if it goes too high), chest pain, tingling/pricking (also due to the blood pressure change) and so forth.
2. When monkeys with Kluver-Bucy syndrome pick up lighted matches and snakes, we do not know whether they are displaying an emotional deficit or an inability to identify the object. What kind of research method might help answer this question?
erhaps the best way to decipher that is to use both the objects that the monkeys should not generally be picking up and then comparing it to more docile and inanimate objects such as wood blocks. If the monkeys interact with the objects in much the same manner regardless of the objects in question, there's a good chance that the composition or safety (or…
Perhaps the best way to decipher that is to use both the objects that the monkeys should not generally be picking up and then comparing it to more docile and inanimate objects such as wood blocks. If the monkeys interact with the objects in much the same manner regardless of the objects in question, there's a good chance that the composition or safety (or lack thereof) of the objects is probably not of any concern. Either the monkeys don't care or they don't have the mental faculties to care in the first place.
3. Certain unusual aspects of brain structure were observed in the brain of Albert Einstein ( M.C. Diamond, Scheibel, Murphy, & Harvey, 1985; Witelson, Kigar, & Harvey, 1999). One interpretation is that he was born with certain specialized brain features that encouraged his scientific and intellectual abilities. What is an alternative interpretation?
There is certainly much to be said of genetics informing whether or not a person is intellectually gifted. However, I would diverge from the statement above in one major way. Many people that are autistic, have Down's syndrome and other neurological or brain disorders like ADD/ADHD often have high amounts of raw intelligence. However, this does not mean that the will use it or even that they CAN use those faculties. Through third-party and medical interventions, this potential may be realized. The point is that not all mental acuity born into a person will be used or that it can be used and it's ultimately up to the person to use the gifts they have. Just because a person has good intellectual gifts does not mean they will be biologically or mentally guided by their own brain to use those gifts. Also, even people that are not born with high raw intelligence can get very far through strong education and diligent use of the resources that they do have and possess at any given time even if it's not at birth through physiology.
It was a love-hate situation, and he would be madly kissing her and letting her stir his carnal urges one moment, and the next he would loudly protest and pull away. So from that standpoint, Eben was changed after the death of the baby. He was not changed in a truly intelligent heart-felt way, but in a kind of acceptance that this is how it is (the current cliche, "It is what it is," fits in here perfectly). For Eben, it feels good to have sex with her, and anyway, being hateful and spiteful of his father, this incestuous affair with his father's wife is another way to get back at him.
The bottom line is that even before they are both punished for the crime of murder (not the crime of incest) Eben's naivete in terms of relationships is disgustingly obvious; he returns to Abbie after having bolted away…
American Decades. "Eugene O'Neill." Retrieved May 29, 2012, from Gale Biography.
Contemporary Authors Online. "Eugene (Gladstone) O'Neill." Retrieved May 29, 2012, from Gale Biography.
Mahfouz, Safi Mahmoud. "Tragic passion, romantic eloquence, and betrayal in Eugene O'Neill's
Desire Under the Elms." Studies in Literature and Language, 1.3 (2010): 1-12.
With regard to the medication administration itself, in a life saving circumstance, which this clearly is not the weight of the potential for depression of respiration and cardiac status is clearly indicated, yet it would seem unethical under these circumstances, if the review of the documentation proves its validity and clearly indicates the patients wishes, to deny at least the smallest dosage (2mg) of ordered Morphine to reduce the pain and potentially allow the patient to regain calm, which will clearly improve his status with regard to short-term treatment.
If the fear of doing harm, drives every medical decision, based on the extreme notion that all patients can be saved under all circumstances then bioethical decisions are futile. The observations and communications of others in the immediate vicinity to care, including the family, other nurses, support staff and most importantly the orders of the doctor to administer palliative care for…
Andre, J. (2002). Bioethics as Practice. Chapel Hill, NC: University of North Carolina Press.
Forsythe, C.D. (2005). Protecting Unconscious, Medically-Dependent Persons after Wendland & Schiavo. Constitutional Commentary, 22(3), 475.
Mantz, a. (2002). Do Not Resuscitate Decision-Making: Ohio's Do Not Resuscitate Law Should Be Amended to Include a Mature Minor's Right to Initiate a DNR Order. Journal of Law and Health, 17(2), 359.
Saunders, D.E. (2003). Removing the Mask. The Hastings Center Report, 33(2), 12.
As a new graduate of six months working night shift on a small cancer unit, I am faced with a dilemma. Mr. V has been in and out of the unit several times over the last few months. He has liver cancer and has gone through several episodes of chemotherapy. His wife has been staying with him since his admission. There are two RN's on this unit.
Mr.V recently joined the hospice program. His current admission is for pain control with orders to start a morphine drip to be regulated for pain control.
The only set parameters indicated by hospital policy are to decrease the drip when respirations are less than twelve breaths per minute. Mr. V has requested that the drip be increased several times during my shift. Even though he does not appear to be in any discomfort, I increase the drip. On my final round of…
Strevy, S.S. Myths & facts about pain. RN, 42-45. 1998, February.
C. Junkerman and D. Schiedermayer, Practical Ethics for Students, Interns, and Residents, 2nd Ed, Frederick, MD: University Publishing Group, 1998.
American Nurses Association. Code for Nurses With Interpretive Statements. Kansas City, MO: the Association. 1985.
Strevy, S.S. (1998, February). Myths & facts about pain. RN, 42-45.
Euthanasia Is Illegal
Euthanasia otherwise known as assisted suicide refers to the painless extermination of a patient suffering from terminal illnesses or painful or incurable disease. According to Cavan & Dolan, euthanasia is the practice or act of permitting the death of hopelessly injured or sick individuals in a painless means for the purpose of mercy (Cavan & Dolan 12). The techniques used in euthanasia induce numerous artifacts such as shifts in regional brain chemistry, liver metabolism and epinephrine levels causing death. Advocates of euthanasia trust that sparing a patient needless suffering or pain is a good thing. If an individual is hopelessly hurt or ill with no hope of ever getting well, if such a person is in an unending and unbearable pain and cannot experience the things that make life meaningful, the best option for such patients is euthanasia. Euthanasia raises questions on morals, legal and essence of…
Baird, R. Caring for the Dying: critical issues at the edge of life. New York: Prometeus Books 2003, pp.117
Cavan, Seasmus, Dolan, Sean. Euthanasia: The Debate over the right to die. New York: The Rosen Publishing Group, Oct 1, 2000.
Cohen-Almagor, R. Euthanasia in the Netherlands: The policy and practice of mercy killing. Netherlands: Springer, Aug 3, 2004.
Devettere, Raymond. Practical decision making in health care ethics: Cases and concepts. Georgetown: Georgetown University Press, 2009.
Multisystem Failure in a Geriatric Patient
Multisystem Failure in a Geriatric
eflect on your analysis of the geriatric patient in multisystem failure by doing the following:
Explain key immediate assessments you should make that would help assess the patient's homeostasis, oxygenation, and level of pain.
There are various diagnoses undertaken in assessing the patient's homeostasis, oxygenation, and level of pain. The immediate objective that nurses prioritize on is checking the patient's vital symptoms. Vital symptoms form the baseline of the assessment by providing significant information that illustrates whether the most essential organs function as required.
The assessment may involve checking the health status of the patient in the laboratory (Kane, 2004). In the laboratory, there is an assessment of the patient's capillary tube, urine test and blood pressure. When there is simultaneous malfunctioning of the body organs, nurses refer to this condition as multiple organ dysfunction (MODs).
Multiple organ dysfunction…
Esteban, A., Anzueto, A., Frutos-Vivar, F., Alia, I., Ely, E.W., Brochard, L., et al. (2004).
Outcome of older patients receiving mechanical ventilation. Intensive Care
Medicine, 30(4), 639 -- 646. Evidence Level IV: Nonexperimental Study.
Happ, M.B., Baumann, B.M., Sawicki, J., Tate, J.A., George, E.L., & Barnato, A.E. (2010).
Nursing Case Study
The first concern is that Mrs. Baker is taking a new drug that has side effects such as she is experiencing. Although the other high blood pressure medication has similar side effects (Drugs.com, 2012), she has been taking it for a long period of time and should not be experiencing as much difficulty. It seems germane to ask her how long she has been taking the hydrochlorothiazide though. One of the first thoughts is how well do the two medications work together, which is something her doctor understands, and if she can have an increase in side effects because of the increase in medication. The second question the symptoms, especially the fact that she seemed "confused and beside herself" on the phone, is to determine if there are other symptoms of stroke. Her breathing difficulties could be a symptom of the medication, and so could the confusion,…
Drugs.Com. (2012). The side effect of Lisinopril. Retrieved from http://www.drugs.com/sfx/lisinopril-side-effects.html
young, most of us do not think about making a conscious decision to die. e look forward to years of long and healthy life, and if death ever seems appealing it is as an antidote to depression. It does not often, if ever, occur to us that there will be a time when we look forward to the "good death" promised by euthanasia.
But it is inevitable that for many of us there will come a time in our lives when suicide may indeed seem appealing because we are fighting a losing battle against a certainly fatal disease that fills our remaining days with pain and despair. In such a position many of us may wish to have our doctors help us die by prescribing for us drugs that when we ourselves take them will prove to be fatal. Or we may wish that other people should have this option…
Callahan, Daniel, "Good Strategies and Bad: Opposing physician-assisted suicide," Commonweal, December 3, 1999, sec1. 7+.
Cassel, Christine K. "AMA Guidelines for Caring for Patients in the Last Phase of Life.," CQ Researcher 7 (1997): 774. ( http://www.ama-assn.org/sci-pubs/amnews/amn_97/edit0721.htm )
Humphrey, Derek. Euthanasia: Essays and Briefings on the Right to Die. Los Angeles: Hemlock Society, 1991. http://deathwithdignity.org/euth_us2htm .
Orric, Sarah. "House Judiciary Committee Rationale." Congressional Digest 77 (1998); 263-264.
Social issue alcohol drugs consider a social issue interested. It human freedom, sexuality, deviance, crime, social mobility, poverty, education, aging, similar issues. Select a specific social issue investigate assignment.
Social issue: Drug abuse
The social problem of drug addiction is a long-standing one, yet the causes of addiction and the best way to treat addiction still remain difficult questions to answer. One contentious issue pertains to whether addiction is a 'crime' or an 'illness,' although an increasingly large body of medical research indicates long-term abuse fundamentally rewires addicts' brains and changes their perceptions of reward and punishment. Drugs stimulate dopamine receptors. Dopamine is a chemical in the brain that generates a sense of positive well-being: "Just as we turn down the volume on a radio that is too loud, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number…
Cratty, Carol. (2011). New rules slashing crack cocaine sentences go into effect. CNN.
Drugs and the brain. (2012). National Institute on Drug Abuse (NIDA). Retrieved at:
Patient Overview -- Mr. C. is a 52-year-old business executive with indigestion that an entire roll of TUMS did not help. Initially he blamed this on his lunchtime pizza, but his staff convinced him to go to the E where he presented epigastric pain. An EKG was done indicating ST segment elevation. Additionally, the pain remained unrelieved after three sublingual nitroglycerine tablets. Three doses of morphine sulfate given intravenously relieved the pain enough for a transfer to the cardiac unit. Mr. C's skin is clammy and cool; he has inspiratory crackles, temp of 98.6, 120 pulse, and respiration 24, BP 90/62. The Cardiac monitor showed sinus rhythm with occasional premature ventricular contractions (PVCS). Labs showed elevated isoenzymes, topponis, creatin kinase myocardial bound, and lactic acid dehydrogenase. We find out also that Mr. C has been having dental pain for the past 48 hours.
Part 1 -- The ST segment is…
ST Elevation. (2012). Family Practice Notebook. Retrieved from: http://www.fpnotebook.com/cv/exam/StElvtn.htm
Dains, J., et al. (2012). Advanced Health Assessment & Clinical Diagnosis in Primary Care.
St. Louis, MO: Mosby/Elsevier.
Hudson, K. (2012). Congestive Heart Failure. DynamicNursingEducation.com. Retrieved from: http://dynamicnursingeducation.com/class.php?class_id=130&pid=23
drug use and abuse in the United States and presents differing approaches that are used (or proposed) to get a handle on the problem. There is no doubt that the drug abuse issue is not new and it is not being reduced by any significant amount. This paper presents statistics and scholarly research articles that delve into various aspects of the drug abuse issue in the United States, with particular emphasis on drugs that are abused in eastern Kentucky and generally in the Appalachian communities.
History of Drug Use & Availability
The history of illegal drug use in the United States goes back to the 19th Century, according to the U.S. Drug Enforcement Agency (DEA). The DEA has a Museum in Arlington, Virginia, that illustrates the history of drug discoveries, drug use, and drug abuse through the years. The DEA reports that morphine, heroin, and cocaine were "discovered" in the…
Bureau of Justice Statistics. (2008). Drugs and Crime Facts / Drug Use / Youth. Retrieved November 30, 2012, from http://bjs.ojp.usdog.gov.
Drug Enforcement Agency. (2012). Illegal Drugs in America: A Modern History. Retrieved November 30, 2012, from http://www.deamuseum.org .
Grant, Judith. (2007). Rural women's stories of recovery from addition. Addiction Research and Theory, 15(5), 521-541.
Havens, Jennifer R., Oser, Carrie B., and Leukefeld, Carl G. (2011). Injection risk behaviors
Gonadectomy alters the magnitude of CCS and ICS analgesia and alters the relationship between the gender-specific effects observed in sham-treated rats. Castration significantly decreased the magnitude of CCS analgesia on the tail-flick and jump tests, and the magnitude of ICS analgesia on the jump test. Indeed castration reduced the magnitude of CCS and ICS analgesia in males to that observed for sham-treated female rats.
Given the multitude of CNS substrates and systems underlying both opioid and stress analgesia, and the likelihood that only a little differ amid sexes, we could rationally expect to come across sex differences in opioid analgesic efficacy in some occasions, depending solely on the nature of the ache incentive and opioid involved, as outlined earlier. It is important to also note that sex differences are no defined to opioid drugs in analgesia. Furthermore, commencement of endogenous pain inhibitory mechanisms in reaction to stress also produces…
Islam, Anita K., Madeline L. Cooper, and Richard J. Bodnar. "Interactions among Aging, Gender, and Gonadectomy Effects Upon Morphine Antinociception in Rats." Physiology and Behavior 54 (1993): 45-53. Print.
Romero, Maria-Teresa, et al. "Gender-Specific and Gonadectomy-Specific Effects Upon Swim Analgesia: Role of Steroid Replacement Therapy." Physiology and Behavior 44 (1988): 257-65. Print.
Romero, Maria-Teresa, et al. "Modulation of Gender-Specific Effects Upon Swim Analgesia in Gonadectomized Rats." Physiology and Behavior 40 (1987): 39-45. Print.
Drugs on the Economy
History of drugs in the United States
How drugs affect the United States Economy both positively and negatively
How decriminalization of drugs like marijuana stand to lessen the burden on tax-payers
Wonder drugs like morphine, heroine, and cocaine to mention but a few pose a lot of problems to the entire American society. Americans have had to grapple with the deleterious effects of drug abuse and addiction. estrictions were imposed at the beginning of the 20th Century through domestic and overseas law enforcement to contain the drugs epidemic. Such enforcements were initiated to limit opium and cocoa crops (Drug Enforcement Administration, 2012). This term paper seeks to give a brief history of drugs in the United States of America and subsequently outline how drug use affects the American economy both positively and negatively. The paper also endeavors to list how decriminalization of drugs like marijuana stands…
Bureau of Justice Statistics. (2011). Prisoners in 2010 (revised). Retrieved June 22, 2012 from http://bjs.ojp.usdoj.gov/index.cfm?ty=pbdetail&iid=2230
Drug Enforcement Administration. (2012). Illegal drugs in America: A modern
History. Retrieved June 22, from http://www.deamuseum.org /museum_ida.html
Easton, S. (2009). Legalize Marijuana for Tax Revenue. Retrieved June 22, from http://www.businessweek.com/debateroom/archives/2010/03/legalize_mariju.html
14). Soon, Congress passed the Marijuana Tax Act, which was signed into law in 1937. Like the Harrison Act, the Marijuana Tax Act placed marijuana into the same category as the cocaine and opium drugs. It was now illegal to import marijuana into the United States (McWilliams, 1991). However, this law was ineffective in curbing marijuana use (Brecher, 1986, p. 14).
By the early 1940s narcotic addiction had significantly reduced in the United States (Harrison, Backenheimer and Inciardi, 1999). However, this was not the result of legislative initiatives. Instead, it was because World War II was cutting off the "supplies of opium from Asia and interrupt the trafficking routes from Europe" (Inciardi, 1992, p. 24).
Several other legislative efforts in the supply reduction department served to establish more severe penalties for violations of drug laws, and tighten controls and restrictions over legally manufactured narcotic drugs (Harrison, Backenheimer and Inciardi, 1999).…
1999). Recreational Drug Information. History of Drug Use U.S. Retrieved from the Internet at www.a1b2c3.com/drugs/.
Brecher, E. (1986). Drug Laws and Drug Law Enforcement: A Review and Evaluation Based on 111 Years of Experience,' Drugs and Society 1:1.
Drucker, Ernest. (1999). Harm Reduction: A Public Health Strategy. Current Issues in Public Health, 1: pp. 64-70.
Drug Policy Alliance. (February 17, 2005). Harm Reduction: Options that Work. Retrieved from the Internet at http://www.drugpolicy.org/news/021705harm.cfm .
Offered under the same roof are "consultative, diagnostic, and treatment services" which are stated to be provided "by board-certified practitioners in the fields of pulmonary medicine, otolarngology, family medicine and more." (2006)
Smith reports that the laboratories experiencing the most dramatic growth are two which are located the "farthest from the Hillsboro flagship" as they are located in two areas that were "formerly underserved." (2006) Smith additionally reports that the demand is stronger in the areas where the two fastest growing centers are located which supplies "plenty of fuel for expansion."
Smith states that the Sleep Health & Wellness NW is attempting to "fill a gap so that patients who previously were overlooked or not being reached or who fell through the cracks no longer are," she says. "We have no plans to open centers in areas where there are already quality sleep services programs. We only want to go…
Inspiration! Sleep Study Results & Analysis (2006) Q&a with Ron Richard, senior vice president of strategic marketing initiatives at ResMed HME Business April 2006. Online at http://www.hme-business.com/articles/55305/
Johnson, Duane, PhD (2008) Are you Really Managing Your Sleep Lab? The Business of Sleep. Focus Journal May/June 2008. Online at http://www.foocus.com/pdfs/Articles/MayJune08/Duane.pdf
Kay DC, Pickworth WB, Neider GL. Morphine-like insomnia from heroin in nondependent human addicts. Br J. Clin Pharmacol. 1981;11(2):159-169
MacFarlene, James (2009) the Painful Pursuit of Sleep. Sleep Review Journal Jan/Feb 2009. Online available at http://www.sleepreviewmag.com/issues/articles/2009-01_07.asp
Penington, P., Caminniti, S., Schein, J.R., Hewitt, D.J., & Nelson, W.W. (2009). Patients' Assessment of the Convenience of Fentanyl HCl Iontophoretic Transdermal System (ITS) Versus Morphine Intravenous Patient- Controlled Analgesia (IV PCA) in the Management of Postoperative Pain After Major Surgery, Pain Management Nursing, 10, 124-133
to evaluate patients' assessment of fentanyl ITS and morphine intravenous patient-controlled analgesia (IV PCA)
Two previous studies used Ease of Care questionnaire in order to assess the superiority of ITS over morphine intravenous patient-controlled analgesia. However extensive analysis of the EOC data was not collected. This study intends to do just that, assessing the convenience of each patient modality using the EOC questionnaire form both previous studies.
Review of the literature
There is inadequate management of postoperative pain, which can impact a host of conditions including chronic pain. Patient controlled anesthesia is preferred to clinician-controlled anesthesia. The common analgesic used until now…
NLM (2012). Substance abuse treatment of women. Chapter 4. National Library of Medicine: National Institutes of Health. Retrieved on December 9, 2012 from http://www.ncbi.nlm.nih.gov/books/NK83257
- Screening and assessment. http://www.ncbi.nlm.nih.gov/books.NK83253
rauser, D (2010), Sublingual buprenorphine relieves symptoms of neonatal opioid abstinence syndrome, Medscape: Medscape LLC. Retrieved on December 9, 2012
Fisher, P.A. et al. (2011). The combined effects of prenatal drug exposure and early adversity on neurobehavioral dis-inhibition in childhood and adolescence,
Developmental Psychopathology. Retrieved on December 9, 2012 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335443
Hamdan, a.H. (2012). Neonatal abstinence syndrome, Medscape: Medscape LLC.
Retrieved on December 9, 2012 from http://www.emedicine.medscape.com/article/978763-clinical
Johnson, K et al. (2003). Treatment of neonatal abstinence syndrome, Archive of Disease
in Childhood. Retrieved on December 9, 2012 from http://www.bmj.com/content/88/1/F.2.2.ful
Johnson, K and Leff, M (1999). Children of substance abusers. Pediatrics. American Academy of Pediatrics. Retrieved on December 9, 2012 from http://www.pediatrics.aappublications.org/content/103/Supplement_2/1085.long
Kraft, W.K. et al. (2010). Future trends…
NLM (2012). Substance abuse treatment of women. Chapter 4. National Library of Medicine: National Institutes of Health. Retrieved on December 9, 2012 from http://www.ncbi.nlm.nih.gov/books/NBK83257
- Screening and assessment. http://www.ncbi.nlm.nih.gov/books.NBK83253
Brauser, D (2010), Sublingual buprenorphine relieves symptoms of neonatal opioid abstinence syndrome, Medscape: Medscape LLC. Retrieved on December 9, 2012
Application Quality Improvement Models Organizations Systems, Part I Analysis equired esources eadings Course Text: Applying Quality Management HealthCare: A Systems Approach eview Chapter 9, "Improving Processes Implementing
oot cause analysis
According to Nicolini (2011)
the first step in CA is identifying the incident to be analyzed. This step requires for the problem or incident to be clearly defined and identified. Identifying the problem will assist in determining what caused the incident and how the incident occurred. In the case study, the mother requested for pain medication, and this was within her right. The nurse performed the request, and it was approved by the pharmacist, but the incident occurred when the nurse did not check the IV line correctly. The nurse confused the infants IV line with the mothers, which resulted in the infant been administered with Morphine. This should be an indicator, and it should be recorded as a fact.…
Brown, J.E., Smith, N., & Sherfy, B.R. (2011). Decreasing mislabeled laboratory specimens using barcode technology and bedside printers. Journal of Nursing Care Quality, 26(1), 13-21.
Brunner, L.S., & Suddarth, D.S. (1986). The Lippincott Manual of Nursing Practice. Philadelphia, Pennsylvania J.B. Lippincott Company.
Cooper, M.R., Duquette, C.E., McWilliams, T., Orsini, M., & Klein, A.A. (2009). The unintended consequences of being friendly: A case study. Journal for Healthcare Quality: Promoting Excellence in Healthcare, 31(5), 43-47.
Nicolini, D., Waring, J., & Mengis, J. (2011). Policy and practice in the use of root cause analysis to investigate clinical adverse events: Mind the gap. Social Science & Medicine, 73(2), 217-225.
Aortic dissection is a disease of the wall of the aorta in which the aortic blood bursts into the muscular layer of the great artery, thus forming a blood filled channel along the planes of the muscularis layer. This false lumen can re-rupture back into the true lumen, through a second distal intimal tear, creating a biluminal or double barrelled aorta. Due to weakened walls, there is threat of rupture into the surrounding tissue with fatal consequences. (Boon, , Colledge, Walker, & Hunter, 2010)
The pathophysiology behind the condition is often a spontaneous or iatrogenic tear in the intima. However, in about five to ten percent of patients, these tears are absent. An intimal tear can occur anywhere along the aorta, although a vast majority of tears are found within ten centimeters of the aortic valve. The dissection may extend towards the heart, affecting the coronary arteries, or it may…
Duranki. (n.d.). Type an aortic dissection - the silent killer. Retrieved from http://duranki.hubpages.com/hub/Beware-High-Blood-Pressure-It-will-Kill-You -- You-Wont-See-It-Coming
Erbel, R., Alfonso, F., Boileau, C., & Dirsch, O. (2001). Diagnosis and management of aortic dissection*.European Heart Journal, 22(18), 1642-1681. Retrieved from http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-aortic-dissection-FT.pdf
Multum, C. (2012, Feburary 12). Morphine injection. Retrieved from http://www.drugs.com/pro/morphine-injection.html
Nicholas A. Boon, Nicki R. Colledge, Brian R. Walker, John A.A. Hunter.(2010). Davidson's Principles and Practice of Medicine . India, Elsevier.
This is a 12 lead ECG taken for Mr. Long at the Emergency Department. He presented with a two hour history of chest pain radiating to his left arm. The ECG is suggestive of an antero-septal Myocardial infarction. Further scrutiny of the ECG displays a normal sinus rhythm, with a rate of 75 bpm that is regularly regular. There is no axis deviation with a P interval of 200 ms and normal qrs complexes. Leads I and aVL also show a q wave which may be suggestive of an old high lateral wall MI. Leads I, V1, V2, V3 and aVL show ST segment elevation of greater than 2 mm and ST segment depression in leads II and III. Mr. Long is suffering from a fully evolved ST-segment elevation myocardial infarction.
A correlation can be made with the area of myocardium involved and the vessel involved. The antero-septal…
B, Deborah, Diercks. (2010). Mission Lifeline: Developing a STEMI regonal care. American Heart Association. -. Print.
Jois, P. (2011). Nstemi and stemi: therapeutic updates 2011. The Practical Journal for Emergency Physicians, 32(1), 1-7.
Katzung, B., & Masters, S. (2011). Katzung's pharmacology. (9 ed.). United States of America: Mc-Graw Hill.
Kumar, V., & Robbins, (2007). Basic pathology. (8 ed.). London: Saunders Company.
Drug addiction is a human issue that cultivates biological, psychological, and social consequences, among others. The manifestation of addiction itself is characterized by physical dependence, and is defined by the uncontrollable, compulsive urge to seek and use drugs despite harmful repercussions (Fernandez, odriguez & Villa, 2011). Philologically, drug use affects the reward center, where dopamine receptors are over-stimulated. Ultimately, the repetition of drug use is encouraged to achieve the same, heightened, pleasure response (U.S. DHHS, 2007). Psychological responses to drug use may reflect motivations caused by positive pleasure, anxiety, or protection. The bodily effects of drugs often reflect the drug's class: stimulants, depressants, narcotics, hallucinogen, and cannabis. Each class represents various drugs and causes distinct biochemical responses. In addition to illicit drugs, prescription drugs are also highly abused and are categorized within the drug classes. Drug addiction does not discriminate between gender, race, sexual orientation or creed, and…
Connecticut Department of Mental Health and Addiction Services (CDMHAS). (n.d.). Drugs with addictive potential. Retrieved 08 March 2012 from: http://www.ctclearinghouse.org/topics/customer-files/Drugs-with-Addictive-Potential-071105.pdf
Coon, D., & Mitterer, J. (2009). Psychology: A journey. (1st ed.). Belmont, CA: Wadsworth.
Fernandez, G., Rodriguez, O., & Villa, R. (2011). Neuropsychology and drug addiction. Papeles del Psicologo, 32(2), 159-165.
Hyman, S., & Malenka, R. (2001). Addiction and the brain: The neurobiology of compulsion and its persistence. Neuroscience, 2, 695-703.
Also no pill will change everything. One must be willing to change their lifestyle as well.
hy do some people still need an antihyperlipidemic agent even though they have reduced their dietary intake of cholesterol and saturated fats?
hy is it better to sue selective beta2 agonists, rather than non-selective beta-adrenergic agonists, for a patient who has both asthma and heart disease?
hy is the combination of a glucocorticoid and a beta2 adrenergic agonist used sometimes in treating asthma? hat is the difference in their mechanisms of action?
http://lungusa.org/asthmato answer: (a) what is a peak flow meter and how is it used in asthma clients? (b) Is low or high humidity in the home better for asthma clients? - hat aspects of weather are triggers for asthma?
Based upon your knowledge of the mechanism of action of the following drug classes, explain the rationale for using the following to…
Personal Health History
Yes (Please list medications and reasons for usage below)
eason for usage
Are you taking any vitamins or dietary supplements?
Yes (If yes then please list supplements and reasons for usage below)
I am taking Vitamin C through consuming multitude of fruits in order to fight muscle spasms, fatigue, and joint pain.
Do you now, or have you had in the past: Yes No
History of heart problems, chest pain or stroke?
Increased blood pressure?
Any chronic illness or condition?
Do you ever get dizzy, lose your balance or lose consciousness?
Difficulty with physical exercise?
Advice from physician not to exercise?
ecent surgery (last 12 months)?
History of breathing or lung problems? No
Swollen, stiff, or painful joints? Yes
Foot problems? No
Back problems? Yes
Any significant vision or hearing problems? No
National comprehensive cancer network (NCCN). NCN clinical Practice Guidelines in Oncology: Myeloid growth factors. Version 1. 2006
Combining morphine and Ativan (lorazepam) can be deadly, making the Primary Care Physician (PCP) statement seem contradictory to medical ethics. The specific medical ethical issues addressed in this case include patient autonomy, beneficence, and nonmaleficence. However, there are other ethical issues and dilemmas raised by this case. The nurse faces professional ethical dilemmas in terms of the conflicts between Provision 2 and Provision 8 in the American Nurses Association (ANA) Code of Ethics. Provision 2 indicates that nurses have a primary commitment to the patient, followed by Provision 3, which calls for the professional nurse to actively advocate for and protect the "rights, health, and safety of the patient," (ANA, 2015). However, Provision 8 indicates that the nurse also "collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities," (ANA, 2015). This case shows how the nurse's primary obligation to protect…
American Nurses Association (ANA, 2015). Code of Ethics. Retrieved online: http://www.vcuhealth.org/?id=1220&sid=13
International Council of Nurses (2012). The ICN Code of Ethics for Nurses. Retrieved online: http://www.icn.ch/images/stories/documents/about/icncode_english.pdf
"Patients' Bill of Rights," (n.d.). Retrieved online: http://www.aapsonline.org/patients/billrts.htm
6. Identify the collaborative team members pertinent to the care of the geriatric patient in the scenario, including the emergency room nurse's response to changes in the level of consciousness and increasing respiratory distress.
The collaborative team here would consist of a primary care physician / geriatrician, pain management specialist, laboratory specialists, and x-ray team. Additional consultants may be neurologist, neurosurgeon, gastroenterologist, psychologist, and drug and alcohol detoxification specialist.
In the case of increasing respiratory distress, the nurse is advised to continue or modify the interventions: to continue to teach patient how to breath and cough correctly; to summon a productive cough; to attempt to clear lungs to auscultation; and to achieve symmetric chest excursion of at least 4 cm; also that her respirations and pulse beats should be regular, and that she should inhale a normal volume of air. This is done by encouraging Fowler or semi-Fowler's position; monitoring…
Eliopoulos, C. (2001). Gerontological nursing Philadelphia: Lippincott,
Kandel, J. (2009). The encyclopedia of elder care New York, NY: Facts on File,
Marvin J.A. (1995). Pain assessment vs. measurement. J Burn Care Rehabil 16, 348-357
Melzack R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1, 277-299
When processed by a transglutaminase enzyme, it can interact with immunological cells and produce cytotoxic inflammation. In autism, it is believed that peptides from gluten and casein cross the intestinal microvillus barrier and enter the blood stream. They also cross the blood-brain barrier. In the brain, certain amino acid sequences of these peptides compete with natural peptides, which bind to opioid receptors. These receptors are G-protein receptors in cell membrane surfaces of neurons. inding to these receptors disturbs the neuronal function and ultimately leads to or contributes to autism (Department of Pediatrics Staff).
Limited Reliable Scientific Evidence
UK researchers investigated more than 30 scientific articles on the effectiveness of the gluten-free, casein-free diet on autistic children (astian, 2004). They found one, which provided reliable scientific evidence that the diet works. The particular study, however, was conducted on only 20 children aged 5-10 who had high levels of protein in their…
Atwood, K.C. (2003). Naturopathy: a critical appraisal. 5 (4) Medscape General
Medicine. Retrieved on June 23, 2010 from http://www.medscape.com/viewarticle/465994
Bastian, H. (2010). Can a diet avoiding gluten and milk proteins reduce autism?
Medicine News Today: MediLexicon International Ltd. Retrieved on June 23,
The author mentioned that rather than only tying the drug consumption with unemployment, urban drug culture, and other factors, one needs to view the drug pervasiveness issues in light of distribution channels as well. The author mentioned that South East Asia's Golden Triangle was the hub of opium trade to the world. Thai-Burma border was used by the Yunnan province drug lords to change opium into marijuana and heroin. The long trail from Golden Triangle to New York was managed by Yunnan merchants and they exported the illicit drugs to Thai -- Burma border. After refinement into heroin, the drugs were then carried by the Chiu Chau Chinese drug traders. They transported these drugs to Bangkok, South Asia, America and Europe. ith loose organizational structures, these Chinese networks of drug trade were closely knit clans and fiercely ruthless in their trade practices as were the gangs of Versailles.
Chabat, Jorge. "Mexico's war on drugs: No margin for maneuver." The Annals of the American Academy of Political and Social Science 582.1 (2002): 134-148.
Grayson, George W. Mexico: Narco-violence and a failed state? Transaction Books, 2011.
Positron Emission Tomography (PET)
PET represents a new step forward in the way scientists and doctors look at the brain and how it functions. An X-ray or a CT scan shows only structural details within the brain. The PET scanner gives us a picture of the brain at work. - What is PET?
The epigraph above is reflective of the enthusiasm being generated among clinicians concerning the advent of positron emission tomography and its potential for imaging the human brain. The introduction of sophisticated neuroimaging techniques such as computerized tomography and magnetic resonance imaging has shifted the emphasis of neuropsychology from lesion localization to diagnosing the etiology of diseases (Maruish & Moses, 1997).
Behavioral neurology also benefited from innovations in neuroimaging techniques. The advent of improvements in the imaging of brain anatomy through computed tomography (CT) and magnetic resonance imaging (MI), as well as functional imaging with single photon emission…
Charney, D.S., Hoffer, P.B. & Kosten, T.R. et al. (1995). Opiate Dependence and Withdrawal: Preliminary Assessment Using Single Photo Emission Computerized Tomography. American Journal of Drug and Alcohol Abuse, 21(1), 47.
Imaging Parkinson's. (December 14, 2002). Science News, 162(24), 382.
Jensen, K.B. (1991). Humanistic scholarship as qualitative science: Contributions to mass communication research. In K.B. Jensen & N.W. Jankowski (eds.). A handbook of qualitative methodologies for mass communication research (17-43). New York: Routledge.
Lincoln, Y.S., & Guba, E.G. (1990). Judging the quality of case study reports. Qualitative Studies in Education, 3(1), 53-59.
It is the context of Catholic Ireland (and not so much the Hays Production Code) that allows Ford's characters to enjoy the light-heartedness of the whole situation.
Such context is gone in O'Neill's dramas. O'Neill's Irish-American drinkers have left the Emerald Isle and traded it over for a nation where religious liberty denies the right of any religion to declare itself as true and all others as false. The Constitution, in fact, has been amended to keep government from declaring the truth of any religion. If no religion is true, how can the Tyrone's be expected to know the difference between Baudelaire's "spiritual drunkenness" and "physical drunkenness"?
O'Neill has Edmund quote Baudelaire in Long Day's Journey into Night as an attempt to rationalize his characters' drunkenness: "Be always drunken. Nothing else matters: that is the only question. If you would not feel the horrible burden of Time weighing on your…
O'Neill, Eugene. Long Day's Journey into Night. Yale University Press, 2002. Print.
He liked to show of the luxury than by now he could afford at the expense of the robberies conducted by him and his men and his very influential position. A closer look to Goering's life of luxury shows that he was more than enjoying his success, his arrogance and extravagance being by now well-known.
Goering had good organizational skills and he was appointed in charge of so many different positions because he had the capability to follow the Nazi ideology with more belief than many others. Goering was truly dedicated to the Nazi cause, although not entirely unmotivated.
Goering was the man that stood behind the elimination of the Jewish community from German economic life, as he fined the German Jewish community a billion marks and order their exclusion from economy, their properties, even schools, parks, or forests. Goering was one of the leading figures that planned the "Aryanisation"…
Hermann Goering, available at http://en.wikipedia.org/wiki/Hermann_G%C3%B6ring ;
Hermann Goering, Jewish Virtual Library, available at http://www.jewishvirtuallibrary.org/jsource/Holocaust/goering.html ;
Jagdgeschwader 1 (World War 1), available at http://en.wikipedia.org/wiki/Jagdgeschwader_1_%28World_War_1%29 ;
Manvell, Roger and Franenkel, Heinrich, Goering, Greenhill Books, London UK, 2005;
entrapment' and 'outrageous Governmental conduct'. Entrapment is usually permitted within confines of the law even though it contradicts the fourth and fifth amendments. It refers to entrapping the suspect into a situation where it is clearly seen that he was willing and ready to violate the law. 'Outrageous Government conduct,' on the other hand, refers to cases when the Government's conduct was so egregious that it provoked the accused into committing the transgression. Usually conducted out of undue zeal, particular Government official(s) can be egregious in their 'entrapment' conduct and generally, although not always, consequent in running afoul of the law.
The distinction between 'entrapment' and 'outrageous government conduct' is illustrated by the following fictitious case history, "Alabama vs. Billy Bob," where, on the grounds of 'Outrageous Governmental conduct', I appeal to the Judge to exonerate Mr. Bob.
There is no doubt in my mind that, firstly, Mr.…
Bardhan, P. (1997). Corruption and Development: A Review of Issues Journal of Economic Literature, 3. pp. 1320-1346.
Coleman, Stephen (2004). When Police Should Say "No!" To Gratuities. Criminal Justice Ethics, p. 33-50.
A "drug" is any substance, other than food, that affects our bodies or minds. Since not all drugs are bad, the book uses "substance" to clarify the issue. Substance abuse can cause temporary or long-term problems for the abuser. Dependence, tolerance or addiction can develop.
Depressants: slow the central nervous system (CNS) down. Alcohol is a CNS depressant.
Alcohol: nearly 6% of the U.S. population are heavy drinkers, some as young as 11. Men outnumber women 3:1. Ethyl alcohol is quickly absorbed in stomach and intestine. First it depresses the areas of the brain that control judgments and curbs on behavior. Next, motor control is affected. Alcohol can also interfere with both vision and hearing. As the liver metabolizes the alcohol, the blood levels drop and function gradually returns. Patterns of alcoholism vary among socio-cultural groups and by age. Alcoholism can destroy family life, sink a career, and…
This is a paper on narcotic withdrawal. There are three references used for this paper.
A person who has taken narcotics faces a number of physical difficulties. It is important to look at narcotic withdrawal in order to gain a better understanding of the signs and symptoms associated with it, as well as what the person is experiencing.
Narcotic drug addiction is a "physical and psychological dependence on a specific class of drugs. Narcotics are drugs that produce a change in response to sensations, mood changes, unconsciousness, or deep sleep. Some examples of narcotics are heroin, codeine, morphine and methadone (www.beryl.net/HTL/DrugAbuse/21505.htm)."
A person may experience withdrawal due to a number of reasons such as "shortage of supply, lack of money, deciding to stop taking the drug to break the drug habit, or confinement in a controlled environment, such as jail, hospital, or other institution where…
Unknown. "Even prescription pain killers can cause addiction in patients." St. Louis Post-
Dispatch. (1999): 29 November.
(Drug Withdrawal Symptoms. (accessed 24 November 2004).
Thus Mary loves Tyrone, as when she says, "That was in the winter of senior year. Then in the spring something happened to me. Yes, I remember. I fell in love with James Tyrone and was so happy for a time," in the final act. But Mary and Tyrone's sameness as two people both keeps them together but creates mechanisms, such as addiction, that keep them apart.
This connection through denial, love, and addiction is also seen between mother and sons. At one point, Mary is seen, like Jamie, refilling the liquor bottle with water to keep the level the same. The family 'trick' keeps up appearances for both characters. This sameness in protective mechanisms of addiction seems both touching as well as tragic -- both child and mother protecting one another from one another's knowledge, through the same 'hiding' behavior, as if heredity creates both the hideous and debilitating…
Britannica. "Biography Eugene O'Neil." 2003. EONEILL on the web. http://www.eoneill.com/biography.htm [3 Mar 2005]
O'Neill, Eugene. "Long Day's Journey into Night." Yale University Press, 2002
Shafter, Yvonne. "Review of Long Day's Journey into Night." Plymouth Theatre, New York, New York, May 6-August 31, 2003 production. Review retrieved on O'Neill Website. http://www.eoneill.com/reviews/index.htm .[3 Mar 2005]
How can eliminating abbreviations reduce errors?
In the medical profession, time is everything. To make documentation as expeditious as possible, a series of abbreviations have been accepted in records. This has been considered an acceptable practice as much as calling a registered nurse an "RN." The problems occur when people are unclear about the abbreviations mean or if a set of letters can have more than one meaning. For example, there is the abbreviation "CA" which means cancer and then "Ca" which is calcium. Another example is "a" which can mean both "artery" and "before" (Medical 2011-page 1). It is very easy to misread abbreviations when medical staff is in a hurry. Imagine the problem if a "q.w." which is take weekly was confused for a "q.v." which is take as one wishes. If the terms were written out rather than abbreviated, these potentially dangerous situations could be…
Berman, Jules. (2008). "Specified Life." Biomedical Informatics.
Greenall, Julie (2006). "Safe Medication Practices." Hospital News.
"Medical Abbreviations Glossary." (2011). JD-MD.
mericas Coalition Puts Marijuana Legalization Up for Discussion. Retrieved from the New York Times: http://www.nytimes.com/2013/05/18/world/americas/nations-in-americas-urged-to-consider-legalizing-pot.html?_r=0
Bakalar, N. (2006). Marijuana as Medicine: Consider the Pros and Cons,. The Mayo Clinic .
Lawrence Genen, M.M. (2012). Cannabis Compound buse. Medscape Reference .
National Instritute of Health. (2012, December). DrugFacts: Marijuana. Retrieved from National Institute on Drug buse: http://www.drugabuse.gov/publications/drugfacts/marijuana
Considering the magnitude of the worldwide illicit drug trade and its impact on the United States, take a position on merican enforcement policy in the world. nalyze the impact that merican drug enforcement has had on the international drug trade. Has it been effective?
The countries in which drug plants such as poppy (for opium and heroin) and cannabis (for marijuana), such drugs are smuggled into them. International drug trafficking is a billion-dollar business that grows each year.
Drugs trafficked on an international scale include heroin, cocaine, methamphetamine etc. It has been…
Abuse, N.I. (2009, September). DrugFacts: Treatment Approaches for Drug Addiction. Retrieved from National Institute on Drug Abuse: http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction ic, T.M. (2011, August 23). Intervention: Help a loved one overcome addiction. Retrieved from the Mayo Clinic: http://www.mayoclinic.com/health/intervention/MH00127/METHOD=print
Preidt, R. (2013, May 16). Adult Children of Substance Abusers More Prone to Depression. Retrieved from Mediline Plus- U.S. National Library for Medicine: http://www.nlm.nih.gov/medlineplus/news/fullstory_136922.html
Services, U.D. (n.d.). Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment. Retrieved from SAMHSA: http://store.samhsa.gov/shin/content/SMA07-4292/SMA07-4292.pdf
Palliative care has gone under a lot of changes as the years have progressed. Just like how general care has been advanced for the sick in areas such as pharmacology and medical engineering, palliative care has also been given much importance. Palliative care has been recognized as a specialty in many countries. There has been evidence that a care outlook that takes note of psychosocial, psychological and spiritual support is very effective and holds great importance in the eyes of those who are sick and their families. (Beaver et al., 2000) In simpler terms, palliative care means to relieve the sufferings of the sick and not really to make the treatment effective. (Macpherson, 2002)
Watching the movie Wit, I was truly saddened and affected by the degree of importance that is given to research these days. esearch for a horrible disease like cancer should be carried out but not on…
Beaver, K. et al. (2000) Primary care services received during terminal illness. International Journal of Palliative Nursing; 6, 220 -- 227.
Macpherson, G. (2002) Black's Medical Dictionary. London: A&C Black.
Nursingtimes.net (2009) Palliative care 1: principles of palliative care nursing and end-of-life care. [online] Available at: http://www.nursingtimes.net/nursing-practice/clinical-zones/end-of-life-and-palliative-care/palliative-care-1-principles-of-palliative-care-nursing-and-end-of-life-care/2007480.article [Accessed: 11 Jan 2013].
Wit (2001) [DVD] USA: Mike Nichols.
Ropivacaine in Epidural Pregnancies
hen it comes time for a woman to have her baby, women worry with the different options and what kind of anesthetic she wants to block the pain during the delivery, who go to the hospital once they start going in to labor, will have already decided that they would like to have an epidural. Therefore, at a certain point in her delivery, the anesthesiologist will be notified, and they will come to the birthing unit room that the mother is in to perform the procedure right there while she is either laying on her side or sitting up while the mother is curled tightly over her belly. This position allows the anesthesiologist to have the best view of her spine so he can make sure that he is putting the needle in between the vertebrae and right outside of the membrane outside the spinal nerves…
American Pregnancy Association, "Epidural Anesthesia." American Pregnancy Association. N.p., Aug 2007. Web. 17 Jul 2011. http://www.theannals.com/ >.
Bagdure, D. "Persistent Hiccups Associated with Epidural Ropivacaine in a Newborn" Annals 45.6 (2011): n.p. pag. Web. 17 Jul 2011.
Halpern, S.H., & Walsh, V. (2008, May). Epidural ropivacaine vs. bupivacaine for labor: a meta-analysis. Retrieved from http://www.anesthesia-analgesia.org/content/96/5/1473.full
Litwin, A. "Mode of Delivery Following Labor Epidural Analgesia: Influence of Ropivacaine and Bupivacaine." AANA Journal 69.4 (2001): 259-261. Web. 17 Jul 2011.
Morality and ethics: what are they and why do they matter?
All you need to know about ethics approaches and theories
Means, ends, principles and virtues six step process of ethical decision making for you to follow
Surviving professional life ethically
Ethical dimensions of the professional -patient relationship
Special challenges: "difficult patients" and patients in suicidal crisis
This is a time of great change in our understanding of health, illness, and health care systems. Medical researchers, practitioners, and administrators must realize that these changes are taking place and look to current, valid research for some answers to the questions which come with increasingly complicated technology and better medications. Since knowledge is the basis for effective decision making, one goal for any medical leader should be to attain as much knowledge as possible.
Ethics has been defined as "rules of conduct recognized in respect of a particular class of human actions."…
Dunn, M. (1998). "Knowledge helps health care professionals deal with ethical dilemmas."
AORN Journal. p.1-2.
Eckberg, E. (April, 1998). "The continuing ethical dilemma of t he do not resuscitate order."
AORN Journal. April, 1998.
Mexico faces an array of drug-related problems ranging from production and transshipment of illicit drugs to corruption, violence, and increased internal drug abuse. Powerful and well-organized Mexican organizations control drug production and trafficking in and through Mexico, as well as the laundering of drug proceeds. These organizations also have made a concerted effort to corrupt and intimidate Mexican law enforcement and public officials. In addition, the geographic proximity of Mexico to the United States and the voluminous cross-border traffic between the countries provide ample opportunities for drug smugglers to deliver their illicit products to U.S. markets. The purpose of this study was to develop informed and timely answers to the following research questions: (a) How serious is the trade in illicit drugs between Mexico and the United States today and what have been recent trends? (b) How does drug trafficking fund terrorist organizations in general and trade between Mexico and…
Delaware fact sheet. (2014). Friends of Narconon, International. Retrieved from http://www.friendsof narconon.org/drug_distribution_in_the_united_states/delaware_drug_facts/delaware_fact
Drug threats in Wilmington. (2014). Drug Enforcement Edu.org. Retrieved from http://www.
Strong wheezing, indicative of cardiac asthma, is also probable. Noisy breathing efforts make cardiac auscultation hard. Signs like neck vein distention and peripheral edema may occur and indicate right ventricular failure (Arnold).
Interstitial pulmonary edema is diagnosed when clinical evaluation reveals severe dyspnea and pulmonary crackles (Arnold, 2009). Diagnosis is also made by chest x-ray, serum natriuretic peptide or N-terminal-pro NP, ECG, cardiac markers and other tests for etiology. In most cases, chest x-ray is immediately performed and establishes the diagnosis with marked interstitial edema. If the diagnosis is inconclusive, bedside measurement of serum NP levels will help. ECG, pulse oximetry and blood tests are conducted on severely ill patients. An ECG will help identify the cause of the pulmonary edema and direct the choice of treatment. Possible causes of pulmonary edema may be myocardial infarct, valvular dysfunction, hypertensive heart disease, are dilated cardiomyopathy. Severe hypoxemia may also occur.…
Arnold, M.O. (2009). Pulmonary edema. The Merck Manual Medical Library: Merck & Co., Inc. Retrieved on February 6, 2011 from http://www.merckmanuals.com/professional/sec07/ch074/ch074b.html
- (2008). Heart failure. Retrieved on February 6, 2011 from http://www.merckmanuals.com/home/sec03/ch025/ch025a.html
PONV was not seen at 24 hours significantly lower rates of PONV at four and eight hours were found in the septoplasty group in which pharyngeal packing was not used
Habib, et al. (2010)
prospective, double-blind, randomized study
104 Patients undergoing craniotomy
Patients were randomized to receive oral aprepitant 40 mg (or matching placebo) 1 to 3 hours before induction of anesthesia or ondansetron 4 mg IV (or placebo) within 30 minutes of the end of surgery.
Data were collected at regular intervals by blinded personnel for 48 hours after surgery. Statistical analysis was performed using Wilcoxon's ranked sum test and ?(2) test. P < 0.05 was considered statistically significant.
cumulative incidence of vomiting at 48 hours was 16% in the aprepitant group and 38% in the ondansetron group (P = 0.0149). The incidence of vomiting was also decreased in the aprepitant group at 2 hours…
Nightingale met a friend Richard Monckton Miles in 1842. Then in 1844, Nightingale asked Dr. Howe if she could do a charitable job in a hospital like the catholic nuns, and refused her marriage to her cousin, Henry Nicholson. By 1845, Nightingale started training herself in the nearby Salisbury Hospital, but her parents were not happy about it, seeing nursing as an inappropriate job for a well to do woman like their daughter. In the next year, Nightingale began teaching herself from the government blue books. In the meantime, Monckton Miles wanted to marry her, but soon she travelled to Rome, Italy with friends to avoid him. Britain unlimited, 2009). Finally, after she attended the Herbert's Charmouth convalescent home, her knowledge was recognized. In 1849, after refusing finally to Miles proposal, she decided to go to Egypt while accompanying her friends, the Bracebridges. They then travelled through Europe, and ended…
(Source: Cody, 2006, p. 259).
Differences Between Nightingale's Theory and Emancipatory Knowing -- When Nightingale thought about the benefits of a well-ventilated room, she was not basing her view on previous knowledge. Emancipatory progress is now evident in the way world healthcare approaches a patient's room -- typically well-ventilated and clean (Beck, 2005, pg. 140). Nightingale was born in an era were by women has very little voice most of the work done by women were in-house work so most of Nightingale's major innovation was providing place for women to work with and for women (Selanders, 2005, pg., 83). Today with Emancipatory knowledge we see a more educated workforce of both men and women in nursing. Although in the late 19th century there were still arguments regarding Nightingale's visions, today's theorists use her broad-based knowledge as a best -- practice template for modern conceptions (Attewell, 2005).
The Legacy of Nightingale Part 1 -- Nursing Ethics -- Most modern ethical theorist are based on traditions dating back as far as Ancient Greece. However, medical, and in particular nursing, ethics are clearly a post-Nightingale logical evolution (never a conclusion). The philosophical combination of advocacy and ethics, while still remaining true to the realities of budgets and the need for a medical institution to
Field, Marilyn Jane & Cassel, Christine K. (1997). Approaching Death: Improving Care at the End of the Life. National Academic Press.
This work emphasizes the necessity to improve end of life care as a way to help ease fears about death and reduce anxiety which would create a more negative death experience within the nursing home. Additionally, this work shows the negative impact of over treating symptoms that are relating to oncoming death which cause patients unnecessary stress and pain in their last few days.
anson, Laura C. (2003). Improving Nursing ome Care of the Dying: A Training Manual for Nursing ome Staff. Springer Publishing Company.
This handbook for physicians emphasizes taking a multi-disciplinary approach to caring for the dying, which also encourages nursing home staff to learn from the lessons seen in hospice care. This includes taking a strategy of main management, rather than resuscitation in order to provide…
Hall, Sue; Longhurst, Susan; & Higginson, Irene. (2009). Living and dying with dignity: a qualitative study of the views of older people in nursing homes. Age and Aging. 38(4):411-416.
This study works within the established fact that most older people who reside in nursing homes will eventually die there. Thus, it examines an empirically-based model of dignity, defined through psychotherapy as a way to help increase the individual perceived levels of dignity within individuals in a nursing home setting. Results shows that issues attacking individual dignity is not necessarily related to the perception of death, but more towards illness-related concerns and the decline of their social role when dealing with various illnesses.
Henderson, Lori. (2009). Variables affecting death anxiety. Le Moyne College. Retrieved
It is because policemen may succumb to corruption; especially when their salaries are minimal and the money earned by drug dealers are immense. The legalization of drugs will eliminate such acts of illegality.
The government and elected officials have a significant amount of say and rule as to what passes as a law and what does not. Such representatives are to symbolize and stand for what the people want. However, with so many voices and opinions of how certain issues should be and what should be ruled as legal, conflicts arise. Controversy is heavily shrouded in the dilemma around the legalization of drugs, and whether the government should permit the legal selling, purchase of narcotics like alcohol and tobacco. If such law is passed, the government and its citizens are affected economically, judicially, medically, and socially. Economically, the government is able to receive billions of dollars in revenue and reduce…
Block, W. "Drug Prohibition: A Legal and Economic Analysis." Journal of Business Ethics 12.9 (1993): 689-700. Print.
Cussen, M, and W. Block. "Legalize Drugs Now! An Analysis of the Benefits of the Legalized Drugs." American Journal of Economics and Sociology 59.3 (2000): 525-536. Print.
"Drug War Clock | DrugSense." DrugSense. N.p., n.d. Web. 1 Apr. 2011. .
"Economic Consequences of the War on Drugs." Drug Policy Alliance: Alternatives to Marijuana Prohibition and the Drug War. N.p., n.d. Web. 1 Apr. 2011. .
The term consciousness has been defined as "mental awareness of sensations, perceptions, memories, and feelings" (Brown, et al. 2003, p. 166). Most human beings live in three states of consciousness: waking, sleeping, and dreaming. Two other states of consciousness, meditation and drug-altered consciousness, can be induced. This essay will explore these five states further and will conclude with a discussion on their psychological relevance.
Most of our lives are spent in waking consciousness, that is, a state of clear and organized alertness (Brown, et al., 2003). When we are awake, our perception of time, places, and events are real and often accurate. An electroencephalograph (EEG), a device that monitors the electrical activity of the brain, reveals that a person in the waking state has low-amplitude brain wave patterns that are fast and irregular.
Contrary to popular beliefs, sleep does involve some awareness (Lindsay et al., 2004). The…
Brannon, L. & Feist, J. (2007). Health psychology: an introduction to behaviour and health.
Belton, CA: Wadsworth.
Brown, P., Coon, D., Malik, R., & McKenzie, S. (2003). Psychology: a journey. Scarborough,
ON: Thompson Nelson.
As the film unfolds the couple flirts with other people at a party given by a billionaire. Both are aware of the other's flirtations. When they hear of the death of their friend Tommaso the woman tells her husband that she no longer loves him. But Giovanni reassures her that they are in love and can make their marriage work. La Notte ends with Lydia reading out a love letter that Giovanni wrote to her just before they got married. However, she cannot remember it.
This film leaves one with a feeling of emptiness and a sense of a journey that has led nowhere. There is a strong feeling of existential crises and the breakdown of communications and relationships in the film. This film can perhaps best be understood in terms of mood structure and in the creation of a certain atmosphere, rather than in looking for a conventional narrative…
" According to anuri "...the inference drawn here is that since there are no inherent rules (or 'guiding principles') in the international system, states act upon their natural predatory instincts in order to prove the 'initial impetus' for conflict, and therefore the states that are preyed upon must respond to the predator by defending themselves, or indeed counterattacking them." (2007)
The realist view is such that holds that the outbreak of conflict is supported alone by domestic policies and predatory practices." (anuri, 2007)
Garib (2003) writes in the work entitled: "Realism and Liberalism Reconsidered in Post 9/11 American Foreign Policy" that while the liberalism of former President George W. ush is "ostensibly present in the National Security Council's 2002 National Security Strategy, which speaks of America crating 'a balance of power that favors human freedom' and of a new American international outlook which seeks to create political and economic freedom,…
Ahmed, Nafeez Mossaddeq (2001) Afghanistan, the Taliban and the United States: The Role of Human Rights in Western Foreign Policy. Media Monitors Network. 2 May 2001. Online available at: http://www.mediamonitors.net/mosaddeq2.html#_ednref4
Ali, Noor, U.S.-UN Conspiracy Against the People of Afghanistan, Online Center for Afghan Studies, 21 February 1998 in: Ahmed, Nafeez Mossaddeq (2001) Afghanistan, the Taliban and the United States: The Role of Human Rights in Western Foreign Policy. Media Monitors Network. 2 May 2001. Online available at:
01 (p = 0.32), and the regression predicting number of non-pharmacologic ways produced a change in 2 of 0.02 (p = 0.10)
The research made by Griffin and colleagues (2008) had quite a few number of limitations -- for example, the patient photos were restricted to school-aged children in resembling developmental phases, with high levels of pain and during acute stages of illness; and situations of children in home care and community outpatient settings were not incorporated, circumstances with chronic low levels of pain or pain symptoms not backed up by medical diagnosis were also not included in this study. These characteristics of pain management ought to be examined in future studies.
Griffin and company (2008) suggested that further research is required to assess nurses' decisions in actual clinical situations. There are more information that needs to be learned about the pain management decisions made by nurses and other providers…
Griffin, R.A., Polit, D.F., & Byrne, M.W. (2008 July-August). Nurse Characteristics and Inferences about Children's Pain. Pediatric Nursing, 34, 297-305.
Rush, S.L., & Harr, J. (2001). Evidence-based pediatric nursing: Does it have to hurt? AACN Clinical Issues, 12, 597-605.
The drug is notorious because it contains "morphine, codeine, papaverine, and other alkaloids" (dictionary.com). Heroin is the most popular and addictive derivative of opium. Heroin users use the drug because of its immediate effects of peace, calm, and relaxation. It is also said to eliminate feelings of hunger, pain, fear, and frustration. Opium costs vary - it is much more expensive when it is purchased on the black market.
hile opium is a natural drug treated to ease pain, there is no reason why its use should be tolerated in the United States. This is primarily because it is so highly addictive. A present American epidemic is that of becoming hooked on painkillers. Because there are so many other options for pain that are far less addictive, they should be chosen over opium.
ordNet® 3.0. Princeton University. Dictionary.com. Site Accessed 16 May. 2008. http://dictionary.reference.com/browse/opium.
WordNet® 3.0. Princeton University. Dictionary.com. Site Accessed 16 May. 2008. http://dictionary.reference.com/browse/opium .
These examples highlight that technology is always a tool, a way of enhancing human judgment -- we must not mistake it as a replacement for good nursing practice.
After all, the use of a computer is no substitute for a medical education. Anyone who works in a hospital can see this -- the increased accessibility of information through the Internet also means that patients often come in, convinced that they are suffering from a serious illness, allergy, or condition, based more upon a diagnosis Googled on WebMD, rather than upon the fact that they saw a doctor! If a computer alone was required to diagnose, everyone would have a degree!
Don't get me wrong -- I use technology every day in my life, and thank my lucky stars, and my patient's lucky stars, that it is so ubiquitous. When health care providers wish to communicate, the use of cell phones…
akalar, JD, 'Marijuana as Medicine: a Plea for Reconsideration', 1876
Journal of the America Medical Association, June 21, 1995 - Vol. 273, No. 23, at http://www.calyx.com/~olsen/MEDICAL/lester.html
Policy Analysis: Thinking About Drug Legalization," at http://www.cato.org/pubs/pas/pa121.html
Alternatives to the War on Drugs," at http://www.geocities.com/CapitolHill/4727/alt-wod-faq.html
Frequently Asked Questions," at http://www.paranoia.com/drugs/marijuana/hemp/FAQ-alt.hemp
Americans for Compassionate Use," at http://www.acu.org/~acu/
Ethan a. Nadelmann, "Thinking seriously about alternatives to the drug prohibition," Daedalus v.123:3, at http://www.calyx.com/~mariolap/debate/ethan1.html
NASRO Issue rief, Spring 1995 vol. 1, no.1,"Rethinking the War on Drugs and Crime: New Approaches to Local Polic." http://www.dscc.org/cwa/report.html
Policy Analysis: Thinking About Drug Legalization," at http://www.cato.org/pubs/pas/pa121.html
Fish, Jefferson M, Ed. How to Legalize Drugs. Northvale, NJ: Jason Aronson Inc.. July 1998, 675 pages., pp. 161
Lester Grinspoon, MD, James . akalar, JD, 'Marijuana as Medicine: a Plea for Reconsideration', 1876 Journal of the America Medical Association, June 21, 1995 -- Vol. 273, No. 23, at http://www.calyx.com/~olsen/MEDICAL/lester.html
Alternatives to the War…
Fish, Jefferson M, Ed. "How to Legalize Drugs." Northvale, NJ: Jason Aronson Inc.. July 1998, 675 pages;
Lee P. Brown, "Eight Myths About Drugs," Vital Speeches of the Day, City News Publishing Co. 15 July 1994;
Lester Grinspoon, MD, James B. Bakalar, JD, 'Marijuana as Medicine: a Plea for Reconsideration', 1876
Journal of the America Medical Association, June 21, 1995 - Vol. 273, No. 23, at http://www.calyx.com/~olsen/MEDICAL/lester.html
Discussion about Brain Death and Cerebral Definitions
It has been researched that the human brain collapses at prior to the cessation of the human organs; the collapse of the human brain is attributed to the elimination of the large numbers of redundant neurons, and the aging process i.e. The gradual loss of sensory capacities. It has been reported that the visual acuity decline on linear basis between the age limit of 20-60, and soon after sixty the declination of the visual acuity is exponential. By the age of 45, the depth perception is reported declination in accelerated manner, and the speech comprehension is expected to get affect after the age of 80 due to the quarter loss of the extensive neurons in the superior temporal gyrus of the auditory cortex. The research has observed that significant decrease in the neuron density is expected, as a result of the aging process.…
Robert H. Blank. Technology and Death Policy: Redefining Death. Department of Government, Brunel University. 2001.
Peter Monaghan. The Unsettled Question of Brain Death. The Chronicle of Higher Education Vol. 48, Issue, 24. 2002.
" Long-term use may develop psychoses, like schizophrenia and severe depression. The use of MDMA may produce psychological difficulties, like confusion, depression, sleep problems, drug craving, severe anxiety and paranoia, even weeks after the use of the drug. MSMA develops symptoms, such as muscle tension, nausea, blurred vision, rapid eye movements, faintness, chills, sweating, and increased heart rate and blood pressure. it, therefore, poses a special risk for those with heart disease. Overuse can lead to death (Kurtzweil).
West Africans used ibogaine as a stimulant and aphrodisiac in the early 1900s (Kurtzweil 1995). Native Americans used mescaline from peyote cactus in religious rituals. LSD was first synthesized in 1938. Throughout history, it was considered a source of many types of medications. Its psychedelic effects were first discovered in 1943. Two decades after World War II, LSD was used to determine its effects on patients with schizophrenia and other mental disorders.…
Kotler, Steven. Drugs in Rehab. Psychology Today: Sussex Publishers, Inc., April 2005
Klotter, Jule. End-of-Life and Psychedelic Research. Townsend Letter for Doctors and Patients: The Townsend Group, July 2005
Kurtzweil, Paula. Medical Possibilities for Psychedelic Drugs. FDA Consumer: U.S. Government Printing Office, September 1995
Luke, David P. And Marrios Kottenis. A Preliminary Survey of Paranormal Experiences with Psychoactive Drugs. Journal of Parapsychology: Parapsychology Press, 2005
Lastly, both of the novels impart a common moral lesson to the readers. "There is more to it than meets the eye"... this is just one of the lessons that can be achieved from the said novels. Many of the characters in the novels are not what they truly seem to be. Like for example, most would write off Boo adley as a reclusive madman, Miss Dubose as a mean spirited old woman, and Dolphous aymond as a social deviant. These people are loathed by most, but these are not fair judgments (http://www.ezinearticles.com/?to-Kill-a-Mockingbird-a-Book-eview&id=78097,2006).
In both novels, it is also the characters that are able to ascertain the true nature of the other people's personality. Jem hates Ms. Dubose so much for what she says that he destroys her bushes. But when forced to spend time with her, he finds her a more acceptable person. And when Atticus points out that…
Lee, Harper (1998) "To Kill a Mocking Bird." (Reissue Edition). Warner Books.
To Kill a Mocking Bird." 2006. http://www.homework-online.com/tkamb/themes_racism-acceptance.asp
To Kill a Mocking Bird." 2006. http://www.ezinearticles.com/?to-Kill-a-Mockingbird-a-Book-Review&id=78097
Drug addiction is not merely a failure of will or weakness in character, however having this 'brain disease' does not absolve the addict of responsibility for his or her behavior, but it does explain why an addict feels compelled to continue using drugs (Leshner 2001). Environmental cues that surround an individual's initial drug use and development of the addiction, actually become "conditioned" to the drug use and thus are critical to the problem of addiction (Leshner 2001).
Therefore, when those cues are present at a later time, "they elicit anticipation of a drug experience and thus generate tremendous drug craving" (Leshner 2001). This type of cue-induces craving is one of the most frequent causes of drug use relapses, independently of whether drugs are available and even after years of abstinence (Leshner 2001).
In March 2006, it was reported that researchers from Liverpool, England discovered a gene that directly affects the…
Changeux, Jean-Pierre. (1998 March 22). Drug use and abuse. Daedalus. Retrieved November 06, 2006 from HighBeam Research Library.
Eaves, Lindon J. (2005 July 01). Familial influences on alcohol use in adolescent female twins: testing for genetic and environmental interactions. Journal of Studies on Alcohol. Retrieved November 06, 2006 from HighBeam Research Library.
Goldman, Erik. (2005 July 01). Genetic tests could improve future drug abuse treatment. Family Practice News. Retrieved November 06, 2006 from HighBeam Research Library.
Heroin Addiction Cuts Across All Social Boundaries, Caron Foundation Study Reports.
sound rationale(s) for each component of the primary survey that the egistered Nurse will undertake.
The geriatric male patient was admitted to the Emergency Department under triage supervision. Primary survey assessment (Considine, 2011) determines the patient's immediate physical condition pertinent to life or death. These include the patient's Airway, Breathing, Circulation, Disability, Discomfort. The patient scores a 14/15, which indicates his eyes are open, appears oriented with succinct and clear verbal responses, and displays exacting and swift motor response and coordination.
Patient respiration is accelerated with shallow yet painful breathes. Lung capacity appears to be compromised, unsure of whether the left or the right is specifically effected but perhaps the onset of pneumonia is the thought. Blood pressure is low, rapid and painful breathing coupled with low blood pressure are symptomatic and are important to monitor for further changes.
Pulse of 90 bpm is somewhat rapid and irregular with 90%…
Considine D. (2011) Patient assessment Primary and secondary survey. Deakin University-Northern Health Clinical Partnership
Danger ith Serving the Self in Anna Karenina and Madam Bovary
It is a classic human trait to make life more difficult than it needs to be. e live in a me-centered society and those with their focus turned inward usually generate enough drama in the world for the rest of the population. hile reality shows like American Idol and America's Got Talent increase the need for money and fame, the need for more has always been around. The old adage that the grass in greener on the other side of the fence is true because it is human to think something is missing and that something will make life better. Two authors that explore this concept are Leo Tolstoy and Gustave Flaubert. In the novel, Anna Karenina, we have a wealthy woman who senses something is wrong with her life and is bent on finding out what that something…
Flaubert. Gustave. Madame Bovary. New York: Brentanos. 1919. Print.
Melfi, Mary Ann. "Keeping secrets in Anna Karenina." Journal of Evolutionary Psychology.
25.1-2 .2004. Gale Literature Resource Center. Web. 12 July 2011.