By G. Roland. Arkansas Tech University.
The ﬁndings of this groups attain purchase 5 mg fincar with mastercard, maintain purchase fincar 5mg on line, and regain a national survey provided some information about healthy state buy fincar 5mg without a prescription. The terms nursing, envi- ronment, and interpersonal relations did not differ nursing situations where life and health goals signiﬁcantly, which indicated a few commonalities are inﬂuenced by a severe illness, nurses give in those three programs. My statements of philosophy imply differences in cur- systems framework has described a holistic view of ricula, which in turn provide different kinds of the complexity in nursing within various groups, education for different kinds of nursing practice. This This study, done over 15 years ago, raised the ques- framework differs from other conceptual schema tions, What is the philosophy of nursing education? They determined The use of my conceptual system and Theory of that nurses could identify the published nursing di- Goal Attainment in family health was suggested agnoses in 1990 with the concepts in the frame- (King, 1983). Nurses in Canada, in social environment in which individuals grow and which two hospitals were involved at a distance develop and learn through interactions to set from each other, used the conceptual framework to goals. Nurses work with families and with individ- design a system for delivery of nursing care ual family members. The of nursing research and education in a large mu- family is also viewed as an interpersonal system. Congruence in ment used my framework and Theory of Goal perceptions of nurse and family members helps in Attainment (Benedict & Frey, 1995). The Theory of assessing a situation to identify concerns and/or Goal Attainment was used in adult orthopedic problems in the interpersonal system. Two cases were presented and the use Sneed (1991) stated that my interactive systems ap- of the Theory of Goal Attainment was described in proach of goal attainment is an ideal basis for each situation. This group used Community Health my theory with inpatient juvenile sexual offenders, offenders in maximum security, and community Community health nursing involves a variety of parolees. For example, school nurses must understand the edu- Continuous Quality Improvement cation system. Occupational health nurses must Continuous quality improvement in nursing and understand the political system, the economic sys- health care is a reality. Structure provides an overall organi- health programs as they interact and set goals with zation of the program. Process relates to nursing interdisciplinary teams to manage health care activities. Outcomes are separate from but related (Hampton, 1994; Sowell & Fuszard, 1989; Sowell & to performance criteria for evaluation of nursing Lowenstein, 1994). In this sense, they system provides structure for a continuous quality- are relating to the interpersonal systems in the improvement program (King, 1994). This is done within a variety of social action Process Model in my Theory of Goal systems in the community. Although the focus is Attainment gives a process that leads to goal attain- groups, nurses work with individuals for whom ment that represents outcomes. An example was given to 16–1) shows the interactions of the three systems in document effectiveness of nursing care if one uses community health. The record system is an information system based on Use in Hospitals my Theory of Goal Attainment. The record system Two case studies were presented to demonstrate can be designed and adapted to most health-care nurses’ use of the transaction process and knowl- systems. For nurses, it was designed to gather data edge of the concepts of perception, communica- from assessments of the patient, make a nursing tion, interaction, and role (King, 1986b). King’s Theory of Goal Attainment 243 nursing care, and write mutually agreed-upon goals twentieth century to the science of nursing in the and means to attain them. Elements in the goal-oriented nursing record are: (1) data base, (2) goal list, (3) nursing orders, (4) ﬂow sheets, (5) progress notes, and (6) discharge summary. My conceptual Several nurses have tested the theory in research on system and transaction process in the Theory aging, parenting, psychiatric-mental health, and of Goal Attainment provides one approach to ambulatory care (Alligood et al. For interaction between nurses and health- ducted studies in their cultures to test the Theory of care professionals and between health- Goal Attainment (Coker et al. For common discourse among health pro- and responses to professional nursing care that fessionals and between nurses and nursing resulted in an instrument that measures patient personnel. Direct measure of outcomes resulting in My vision for the future of nursing is that nursing quality care and cost-effective care; that is, will provide access to health care for all citizens. One valid and reliable assessment instru- are directed to the right place in the system for ment to assess activities of daily living as a nursing care, medical care, social services informa- basis for goal-setting. For continuity of care within and between tion process will be used by every practicing nurse health-care agencies. Theory of Goal Attainment, and Transaction Process Model will continue to serve a useful pur- When knowledge of the concepts and the pose in delivering professional nursing care. The transaction process has been used in hospi- ideas have been tested in research and in practice, tals, homes, nursing homes, and community and nurses in education and practice have used the health agencies, nurses have been motivated knowledge of the concepts. The relevance of to seek additional knowledge in formal edu- evidence theory–based practice, using my theory, cational programs. Publications, including Frey & Sieloff (1995), identiﬁed from a review of the literature, will be summarized and brieﬂy discussed. Finally, of King’s recommendations will be made for future knowl- edge development in relation to King’s Interacting Systems Framework and midrange theory, par- Theory of Goal ticularly in relation to the importance of their application within an evidence-based practice environment. Attainment Christina Leibold Sieloff, Maureen Application of Interacting Frey, & Mary Killeen Systems Framework In conducting the literature review, the authors began with the broadest category of application— application within the Interacting Systems Frame- Application of Interacting Systems work to nursing care situations. Because a con- Framework In conducting the literature review, the Concept Development Within the authors began with the broadest category Framework of application—application within the Interacting Systems Framework to nursing Theory of Goal Attainment care situations. Recommendations for Knowledge Development Related to King’s ceptual framework is, by nature, very broad and Framework and Theory abstract, it can only serve to guide, rather than prescriptively direct, nursing practice. Summary King’s Interacting Systems Framework has been used to guide nursing practice in several References ways. Fawcett, Vaillancourt, and Watson (1995) used the frame- Since the ﬁrst publication of Dr. Imogene King’s work to guide nursing practice in a large tertiary work (1971), nursing’s interest in the application of care hospital. The fact that she the framework to guide nursing practice with spe- was one of the few theorists who generated both a ciﬁc patient populations. Doornbos (2002) ex- framework and a midrange theory further ex- plored family health in families with chronically panded her work.
Other physical signs of anger in- toward the use of animals in research and scientific ex- clude scowling cheap fincar on line, teeth grinding discount fincar 5 mg line, glaring order fincar online from canada, clenched fists, perimentation have changed considerably. Ironically, this chills and shuddering, twitching, choking, flushing or knowledge of the close genetic bond between species paling, and numbness. People use a number of defense mechanisms to Nevertheless, evidence of animals as “sentient” beings, deal with anger. They may practice denial, refusing to capable of a wide range of emotions and thought recognize that they are angry. Such repressed anger often processes, has led scientists and animal activists to finds another outlet, such as a physical symptom. Anoth- search for alternative ways to study behavior without er way of circumventing anger is through passive ag- victimizing animals. Although most psychology research gression, in which anger is expressed covertly in a way does not involve deadly disease or experimental patholo- that prevents retaliation. Both sarcasm and chronic late- gy, it often involves unrelenting or quantitative mental, ness are forms of passive aggression. In the classroom, a physical, and psychological stress—all of which animals passive aggressive student will display behavior that is are capable of experiencing. In the late nineteenth The majority of all animal research in the field of psy- century, Ivan Pavlov’s experiments in the development chology is conducted on various rodent species (rats, of “conditioned” responses in dogs (salivation) helped to mice, hamsters, etc. The contemporary human treat- Australian philosopher Peter Singer made the case ment regimen known as behavior modification is fash- for an end to animal experimentation with his 1975 ioned from parallels drawn on these early experiments in book, Animal Liberation. Still, tions, including love, sorrow, jealousy, humor, and de- behaviorist thinking at that time denied animals any psy- ceit. Academic journals described animal be- humans by using over 300 learned signs in American havior only in terms of physiologic response to stimuli, Sign Language. Studies with other species produced with no mention of any psychological consequence. During the late 1990s, an African gray In later years, the behaviorist theories were over- parrot named Alex, who was being studied at the Arizona shadowed by the development and spread (from Europe State University, fell ill and was required to spend the to the United States) of ethology which concerns itself night alone at a veterinary clinic. When his keeper at- with genetic predisposition, or innate/instinctive behav- tempted to leave the room at the clinic, Alex cried out, ior and knowledge. Current trends Animal experimentation is still widely used in psy- Anorexia chological research. Animals are used in projects of An eating disorder where preoccupation with diet- many types from alcohol-induced aggression to pain ing and thinness leads to excessive weight loss medication. A 1999 medical study questioned whether while the individual continues to feel fat and fails animal experimentation on the neuroendocrine mecha- to acknowledge that the weight loss or thinness is a problem. However, the trend in academia seems to be following the popular distaste for Symptoms of anorexia, or anorexia nervosa, include animal experimentation. A British study of undergradu- significant weight loss, continuation of weight loss de- ate students enrolled in psychology classes during the spite thinness, persistent feeling of being fat even after 1990s showed that students in psychology were less in weight loss, exaggerated fear of gaining weight, loss of favor of animal testing than students in medicine, and menstrual periods, preoccupation with food, calories, nu- second-year students were less in favor of such research trition and/or cooking, dieting in secret, compulsive ex- than first-year students. Several articles have been pub- ercising, sleep disorders, and a pattern of binging and lished which address the general lack of acknowledg- purging. This estimate does not include animal subjects used for cross-over medical ex- The great majority of anorexics (about 95 percent) perimentation, such as in the related field of neuropsy- are women. Best estimates for the total number of animal history of alcoholism and/or depression, early onset of subjects in all medical/psychological research is about puberty, tallness, perfectionism,lowself-esteem, and 20 million per year. Of great promise in this re- anorexia often involves issues of control; the typical gard is computer simulation technology. As early as anorexic is often a strong-willed adolescent whose aver- 1996, psychology students were able to study “shaping” sion to food is a misdirected way of exercising autonomy and partial reinforcement in operant conditioning, by to compensate for a lack of control in other areas of his using a computer-created “virtual rat” named Sniffy. Commensurate with such technological developments Medical consequences of anorexia may include in- and their refinements, statistics have shown a slow but fertility, osteoporosis, lower body temperatures, lower consistent yearly decline in animal experimentation blood pressure, slower pulse, a weakened heart, lanugo through 1999. Anorexics also have been found to have abnormal levels of several neurotrans- Further Reading mitters, which can, in turn, contribute further to depres- Baluch, Bahman; and Baljit Kaur. People suffering from anorexia often must be hospi- nal of Psychology (July 1995): 477. Treatment and cure for anorexia are possible through skilled psychiatric intervention that includes medical evaluation, psychotherapy for the individual and family group, nutritional counseling, and possibly medication and/or hospitalization. With treatment and the passage of time, about 70 percent of anorexics eventually recover and are able to maintain a normal body weight. The American Anorexia and Bulimia Association is the principal and oldest national non-profit organization working for the prevention, treatment, and cure of eating disorders. It also organizes a referral network which in- cludes educational programs and public information ma- terials, professional services and outpatient programs, patient and parent support groups, and training of recov- ered patients as support group facilitators. American Psychiatric Association estimates that mor- National Association of Anorexia Nervosa and Associated Dis- tality rates for anorexia may be as high as 5 to 18 percent. The peak times of onset are ages 12 to 13 and Medications used to treat depression. In adults with resistant depression,several types of slowly adjusting the dose of the drug. Antisocial behavior can be broken down into two components: the presence of antisocial (i. Some, however, may exhibit Several studies have reported 70-90% response rate to low levels of both types of behaviors; for example, the fluoxetine or sertraline for the treatment of adolescents withdrawn, thoughtful child. High levels of antisocial with major depressive disorder, but the results of these behavior are considered a clinical disorder. Young chil- studies are not conclusive because they have methodologi- dren may exhibit hostility towards authority, and be di- cal limitations. A recent, large, well-performed investiga- agnosed with oppositional-defiant disorder. Older chil- tion showed that fluoxetine was more effective for the dren may lie, steal, or engage in violent behaviors, and treatment of depressed children and adolescents than a be diagnosed with conduct disorder. Despite the significant response to fluoxetine, professionals agree, and rising rates of serious school many patients had only partial improvement. The most common side effects in- Thirty to 70% of childhood psychiatric admissons are clude nausea, stomachache, diarrhea, headaches, mild for disruptive behavior disorders, and diagnoses of be- tremors, sweating, sleep disturbance, sedation, restless- havior disorders are increasing overall.
Tomatis developed a that stress is the greatest single factor causing low- sound therapy to help repattern a child’s auditory ered immune function and the recurrence of cancer cost of fincar. The French physician spontaneous healing 145 Guy Berard also developed a sound therapy purchase 5mg fincar overnight delivery, the relate to physical buy on line fincar, emotional, genetic, and nutri- Berard Method, using music to improve impaired tional conditions. Rebalancing the frequency energy pat- supposed to train the auditory system to process terns supports the individual being tested in a way sound normally and thus foster normal speech, lan- that helps them heal themselves. By providing a Another sound therapy is toning, which requires an constant external input into the biological system individual to stand with eyes closed and a relaxed at a frequency where it is deﬁcient, it eventually jaw and repeat certain vowel sounds in order to rebalances as it learns to resonate at that frequency. All “The audio waveform is analyzed for frequencies matter, including herbs, pharmaceuticals, and even in stress which are then compared to our experi- food with its accompanying vitamins, minerals and mental frequency assignments of vitamins, minerals, other nutrients could be examined from a fre- amino acids, bones, muscles and all manner of sub- quency perspective that may explain their biologi- stances, including drugs and toxins. This is obvious if you consider that quencies in stress are identiﬁed, Bio-Resonance electrons are always moving and vibrating. All Therapy utilizes low-frequency waveforms generated healing interventions inﬂuence the body by some- with a small, “Walkman”-style tonebox and deliv- how altering its frequency resonance. Computer ered through headphones, sub-woofer or a vibration technology such as Bio-Resonance Therapy can transducer. Each tonebox can be programmed for up measure the specific frequency imbalances in much to 12 tracks, with up to 4 very accurate frequencies the same way as one would measure brain wave on each track. The voice is a holographic blueprint of the non-invasively delivered to the body, often resulting whole body. Research indi- subjective since it does not depend on the skill or cates that low-frequency waveforms seem to activate orientation of the practitioner. After the assess- vitamins, minerals, amino acids and other biologic ment, appropriate suggestions can be made and substances, and show promise at being able to detox- actions taken with respect to the identiﬁed ener- ify frequencies that correlate with dangerous sub- getically stressed issues. The voice is an accurate map or holograph spontaneous healing The abatement of symp- of the body energetics. Every individual has a toms or disappearance of disease without apparent unique voice energy print that may be charted with cause. When charted, the called spontaneous remission, to an act of God or a voice often reveals patterns of sound frequency remarkable change of attitude or events in a per- energy imbalance. In his article “Spontaneous Remission 146 Steiner, Rudolf and the Placebo Effect,” Stephen Barrett, M. He did not believe in dis- limiting, and even incurable conditions can have pensing drugs, but as a result of his doctrine, Still’s sufﬁcient day-to-day variation to enable quack future osteopaths incorporated the use of drugs, methods to gain large followings. Taking action vaccines, surgery, and other treatment modalities often produces temporary relief of symptoms (a thought to be appropriate for each case. Thus it is extremely important for consumers vaman, or vamankarm (therapeutic vomiting), an to understand the concepts of spontaneous remis- Ayurvedic method of emptying the stomach of sion and the placebo effect. Three Steiner, Rudolf The Austrian philosopher (1861– or four glasses of licorice and honey or calamus 1925) who developed the idea of science of the root tea or two glasses of salt water are to be taken, spirit, which he called anthroposophy. His experi- and afterward one rubs the tongue to induce vom- ence of the reality of the Christ was pivotal in his iting—and the release of emotions—until bile teachings and vision and soon took a central place appears in the vomitus. The stomach wash, a gentler treatment than powers that can be drawn from spiritual vision. In vamankarm, involves drinking salt water and tick- response to World War I (1914–18), Steiner claimed ling the back of the throat with a ﬁnger to induce that with insight into humankind’s nature, a new vomiting until the stomach is empty. His ideas added not recommended for children; elderly, frail, preg- to the body of knowledge in education, agriculture, nant, grieving, menstruating, or emaciated individ- therapy, and medicine. The book Anthroposophical uals; or those with anorexia, heart disease, cavities Medicine (Rochester, Vt. Some stress is considered necessary in order Sweat can also eliminate excessive salts that for biological mechanisms to function optimally. Eustress refers to good stress, and distress Sweat may also draw out lactic acid that causes refers to bad or painful stress. Finnish and German doctors cite studies indicating sweat baths help persons with high blood pressure subclinical symptoms Precursors of symptoms or and heart problems. The heat of a sweat bath and the often “shaking,” the act of shaking an individual in order rapid cooling afterward are said to condition the to hear any internal splashing sounds that indicate body against colds, disease, and infection. Recent the abnormal presence of ﬂuid, particularly in the tests in Finland validate the practice of splashing thoracic area. Succussion also refers to the homeo- water on superheated rocks as a way to produce pathic method of shaking remedy preparations. Spiritual Aspects sweat lodge A Native American healing practice, The Native American sweat lodge is said to offer similar to a steam bath or sauna to induce profuse spiritual as well as physical beneﬁts. Rudolph sweating in order to rid the body of wastes, but with Ballentine, in his book Radical Healing (New York: spiritual aspects geared to healing emotional distur- Harmony Books, 1999, p. Enthusiasts lodge is a tangible expression of the intricate min- claim that pollution, artiﬁcial environments, syn- gling of being tested, of being reduced to the mere thetic clothing, and lack of regular exercise clog bones of your life before being guided into a pores and block the body’s natural ﬂow of perspira- rebirth—a re-creation of yourself—through the tion and can lead to physical and emotional prob- ordeal of the cleansing crisis. Depending on how hot the sweat bath is and humble, yet eloquent way the connection between the climate in which it occurs, a 15-minute sauna or physical healing and the realm of the spirit. What sweat induces the heavy metal excretion that nor- is released in the experience of the sweat lodge is mally takes healthy kidneys 24 hours to accomplish. A sauna is often body in a form that can only express such a con- 148 sweat lodge stricted consciousness. The arrival of glowing rocks is a constant shaman used the sweat lodge to move beyond the reminder of One-Above’s penetrating goodness limited consciousness of the ego to a place where and radiance. Sakim, Creek spiritual leader, con- he could seek guidance for those who were suffer- stantly reminds us that Silence is the voice of Cre- ing, to transport himself to other dimensions of ator, One Above. Sometimes, a ﬂute is played; this reality where he could retrieve the spirits of those represents bird song, Creator’s ﬁrst speciﬁc gift to who were lost, or even to call forth a vision of the the newly created. To sum up, the subject of cleansing is of cru- Story, birds received songs for their part in drying cial importance, but is widely ignored. People fast while working on the items, and ﬁre, which represents various concepts lodge to help their intent remain pure, and prayer according to the nation. For Creeks, for example, and tobacco are offered as willow (the wood of ﬁre is a piece of the Sun and perfect symbol of Cre- choice) or other saplings are cut, as holes are dug ator. Saunas and sweat lodges exist throughout the for the placement of saplings and as the pit for the world, largely in North and Central America, Ire- hot rocks is excavated.
An- other general reason for drug resistance is the down-regulation of receptors (Appendix 5) purchase fincar cheap. Down-regulation occurs when repeated stimulation of a receptor results in the receptor being broken down discount fincar 5 mg. This results in the drug being less effective because there are fewer receptors available for it to act on purchase cheap fincar. Drug resistance may also be due to the appearance of a significantly high proportion of drug resistant strains of microorganisms. These strains arise naturally and can rapidly multiply and become the currently predominant strain of that microorganism. For example, antimalarial drugs are proving less effective because of an increase in the proportion of drug resistant strains of the malaria parasite. New drugs are constantly required to combat drug resistance, even though it can be minimized by the correct use of medicines by patients. These products, obtained from animal, vege- table and mineral sources, were sometimes very effective. Information about these ancient remedies was not readily available to users until the invention of the printing press in the 15th century. This invention led to the widespread publication and circulation of herbals and pharmacopoeias. This resulted in a rapid increase in the use, and misuse, of herbal and other remedies. However, improved communications between practitioners in the 18th and 19th centuries resulted in the progressive removal of preparations that were either ineffective or too toxic from herbals and pharmacopoeias. Initially this development was centred around the natural products isolated from plant and animal material, but as knowledge increased a wider range of pharmaceutically active compounds were used as the starting point for the development of drugs. The compounds on which a development is based are now known as lead compounds, while the synthetic compounds developed from a lead are referred to as its analogues. The work of the medicinal chemist is centred around the discovery of new lead compounds with specific medical properties. It includes the devel- opment of more effective and safer analogues from both these new and existing lead compounds. This usually involves synthesizing and testing many hundreds of compounds before a suitable compound is produced. It is currently estimated that for every 10 000 compounds synthesized one is suitable for medical use. The first rational development of synthetic drugs was carried out by Paul Ehrlich and Sacachiro Hata, who produced the antiprotozoal arsphemamine in 1910 by combining synthesis with reliable biological screening and evaluation procedures. Ehrlich, at the begining of the 20th century, had recognized that both the beneficial and toxic properties of a drug were important to its evaluation. He realized that the more effective drugs showed a greater selectiv- ity for the target microorganism than its host. However, in practice index values can only be used as a limited guide to the relative usefulness of different compounds. One of its most successful uses has been in the development in the 1970s of the antiulcer agents cimetidine and ranitidine. In 1905 he proposed that so called receptive substances in the body could accept either a stimulating compound, which would cause a biological response, or a non-stimulating compound, which would prevent a bio- logical response. It is now universally accepted that the binding of a chemical agent, referred to as a ligand (see also section 7. Furthermore, a drug is most effective when its structure or a significant part of its structure, both as regards molecular shape and electron distribution (stereo- electronic structure), is complementary with the stereoelectronic structure of the receptor responsible for the desired biological action. The section of the structure of a ligand that binds to a receptor is known as its pharmacophore. Furthermore, it is now believed that side effects can arise when the drug binds to either the receptor responsible for the desired biological response or to different receptors. The mid- to late 20th century has seen an explosion of our understanding of the chemistry of disease states, biological structures and processes. This increase in knowledge has given medicinal chemists a clearer picture of how drugs are distributed through the body and transported across membranes and their mode of operation and metabolism. It has enabled medicinal chemists to place groups that influence absorption, stability in a bio-system, distribution, metabol- ism and excretion in the molecular structure of a drug. For example, the intro- duction of a sulphonic acid group into the structure of a drug will increase its water solubility. However, because of the complex nature of biological systems, there is always a degree of uncertainty in predicting the effect of structural changes on the activity of a drug. As a result, it is always necessary to carry out extensive testing to determine the consequences of modifying a structure. Furthermore, changing a group or introducing a group may change the nature of the activity of the compound. For example, the change of the ester group in procaine to an amide (procainamide) changes the activity from a local anaesthetic to anti-rhythmic. This is because drugs normally have to cross nonpolar lipid membrane barriers (Appendix 3) in order to reach their site of action. Consequently, as the polar nature of the drug increases, it usually becomes more difficult for that drug to cross these barriers. For example, quaternary ammonium salts, which are permanently charged, can be used as an alternative to an amine in a structure in order to restrict the passage of a drug across a membrane. The structure of the anticholinesterase neostigmine, developed from physostig- mine, contains a quaternary ammonium group, which stops the molecule from crossing the blood–brain barrier (Appendix 11). However, modern techniques such as computer modelling (Chapter 5) and combinatorial chemistry (Chapter 6) introduced in the 1970s and 1990s respectively are likely to reduce the number of intuitive discoveries. Computer modelling has reduced the need to synthesize every analogue of a lead compound. It is also often used retrospectively to confirm the information derived from other sources. Combinatorial chemistry, which originated in the field of peptide chemistry, has now been expanded to cover other areas. The term covers a group of related techniques for the simultaneous production of large numbers of compounds for biological testing. Consequently, it is used for structure action studies and to discover new lead compounds. It originally started with drugs and lead compounds derived from natural sources, such as animals, plants, trees and microorganisms.
As a general rule buy fincar 5mg on line, every effort is made to encourage the patient to take the medica- tion buy fincar 5mg amex. Healthcare providers should avoid speaking in medical terminology and discount 5mg fincar visa, instead, use common words and expressions that are familiar to the patient—and always in the language that the patient speaks. The patient provides feedback that he or she understands everything about the medication. It is common for the healthcare provider to ask the patient to tell in his or her own words what was told to them about the medication. The list should have the name of the medication, dose, time the medication is to be taken and the name and phone number of the prescriber who ordered the medication. Summary Pharmacology is the study of drug effects on living tissue and how drugs cure, prevent, or manage diseases. Drugs are derived from plants, animals, miner- als, and are synthesized in the laboratory. These are the chemical name, the generic name that is considered the official name for the drug, and the brand name, which is used by the manufacturer to market the drug. There are two general classifications of drugs: prescription and over-the- counter drugs. Prescription drugs are also known as legend drugs and must be prescribed by an authorized healthcare provider. Drugs have three effects: these are the therapeutic effect to fight or prevent a disease; a side effect that isn’t harmful; and an adverse effect that is harmful to a varying degree. Healthcare providers must know about these effects before administering the med- ication to the patient. Clinical studies determine the therapeutic effect, adverse effect, and side effects the drug has on humans. A drug is prescribed to a patient by writing a drug order or medical prescrip- tion. A drug order specifies, among other things, the name of the drug, the dose, route of administration, and frequency. These are to give the right patient the right drug, in the right dose, at the right time, by the right route. Patients also have the right to refuse medication and the right to education about the medication. With this overview of pharmacology under your belt, let’s take a closer look at how drugs work by exploring the principles of drug action and drug inter- actions in the next chapter. A brand name of a drug is (a) the non-trademarked name given by the original drug manufacturer. A drug order that requires the drug to be given immediately is called a (a) one-time order. The number of times a drug is given to a patient can be determined by the half-life of the drug. You might have even reached the point when you’d welcome an injection of a miracle drug if it would get you back on your feet quickly. Drugs aren’t miracles and have nothing to do with magic although you might think differently when your nose is running, eyes watering, and you feel rotten all over. In this chapter, you’ll be introduced to the scientific principles that describe how drugs interact with cells in your body to bring about a pharmaceutical response that either directly attacks the pathogen that is causing your sniffles or stimulates your body’s own defense mechanism to stamp them out. This occurs when an antihypertensive (high blood pressure) drug interferes with the process that constricts blood vessels and may cause blood pressure to rise. A drug action begins when the drug enters the body and is absorbed into the bloodstream where the drug is transported to receptor sites throughout the body (see Pharmacokinetics, in this chapter). Once the drug hooks onto a receptor site, the drug’s pharmacological response initiates. The pharmacological response is the therapeutic effect that makes the patient well. The desirable effect is what makes the patient well or prevents the disease or disorder. Some side effects are desirable and others are undesirable (see Side Effects, in this chapter). The strength of a drug action is determined by how much of the drug is given, (the dose) and how often the drug is given (the frequency). For example, a patient who has a sore throat can be given a large dose of an antibiotic—a loading dose— on the first day of treatment and a normal or maintenance dose for the next five days. These are: • Pharmaceutic Phase: This phase occurs after the drug is given and involves disintegration and dissolution of the dosage form. The inactive ingredient, called excipient, is the substance that has no pharmaceutical response but helps in the delivery of the drug. The coating around tiny particles of a capsule that causes a timed-release action of the drug is an inactive ingredient. The time necessary for the drug to disintegrate and dissolve so it can be absorbed is called the rate limiting time. A drug has a higher rate limiting time (Table 2-1) if it is absorbed in acidic fluids rather than alkaline fluids. Some drugs are more effective if absorbed in the small intestine rather than the stomach. Therefore, pharmaceutical manufacturers place an enteric coating around the drug that resists disintegration in the stomach. Enteric coating is also used to delay the onset of the pharmaceutical response and to prevent food in the stomach from interfering with the dissolution and absorption of the drug. Tip: Never crush a capsule that contains enteric release beads or is coated for timed-release. Drug molecules move to the intended site of action in the plasma but sometimes this journey can be limited because they have to get into the interior of a cell or body compartment through cell membranes. These membranes could be in the skin, the intestinal tract, or the intended site of action.
She should be started on calcium and vitamin D supplements and a bisphosphonate to try to reduce her bone loss purchase fincar us. Oestrogen-based hormone replacement therapy is only used for symptoms associated with the menopause because of the increased incidence of thromboembolism and endometrial carcinoma discount generic fincar canada. She has had an irregular bowel habit with periods of increased bowel actions up to four times a day and periods of constipation best 5 mg fincar. Opening her bowels tends to relieve the pain which has been present in both iliac fossae at different times. She thinks that her pains are made worse after eat- ing citrus fruits and after some vegetables and wheat. She has tried to exclude these from her diet with some temporary relief but overall there has been no change in the symptoms over the 6 years. One year previously she was seen in a gastroenterology clinic and had a sigmoidoscopy which was normal. She found the procedure very uncomfortable and developed similar symptoms of abdominal pain during the procedure. She is anxious about the continuing pain but is not keen to have a further endoscopy. She has a history of occasional episodes of headache which have been diagnosed as migraine and has irregular periods with troublesome period pains but no other relevant medical history. This is a very common condition accounting for a large number of refer- rals to gastroenterology clinics. Under the age of 40 years with a history of 6 years of similar problems, it would be reasonable to accept the diag- nosis and reassure the patient. However, the family history of carcinoma of the colon raises the possibility of a condition such as familial polyposis coli. The family history, the circumstances of the grandmother’s death and the patient’s feelings about this should be explored further. Anxiety about the family history might contribute to the patient’s own symptoms or her presentation at this time. If any doubt remains in this woman it would be sensible to proceed to a barium enema or a colonoscopy to rule out any significant problems. In older patients, sigmoidoscopy and bar- ium enema or colonoscopy should be performed. The symptoms tend to be persistent and are not helped by repeated normal investigations looking for an underlying cause. Her headaches have developed over the past 3 weeks and have become progressively more severe. Her friend who accompanies her says that she has lost 10 kg in weight over 6 months and has recently become increasingly confused. Examination of her cardiovascular, respiratory and gastrointestinal systems is normal. Neurological examination prior to her fit showed her to be disorien- tated in time, place and person. This condition is caused by the protozoan Toxoplasma gondii which primarily infects cats but can also be carried by any warm blooded animal. In the West, 30–80 per cent of adults have been infected by ingesting food or water contaminated by cat faeces, or by eating raw meat from sheep or pigs which contain Toxoplasma cysts. After ingestion by humans the organ- ism divides rapidly within macrophages and spreads to muscles and brain. The primary infec- tion is generally asymptomatic, but can cause an acute mononucleosis-type illness with generalized lympadenopathy and rash. It may leave scars in the choroid and retina and small inflammatory lesions in the brain. If the host then becomes immunocompromised the organism starts proliferating causing toxoplasmosis. Cerebral toxoplasmosis usually presents with a subacute illness comprising fever, headache, confusion, fits, cognitive dis- turbance, focal neurological signs including hemiparesis, ataxia, cranial nerve lesions, visual field defects and sensory loss. The clinical and radiological differential diagnoses include lymphoma, tuberculosis and secondary tumours. Anti-toxoplasma anti- body titres should be measured, but are not always positive. The headaches and papilloedema are caused by raised intracranial pressure from the multiple space-occupying lesions. Treatment is started with high-dose sulfadiazine and pyrimethamine together with folinic acid to pre- vent myelosuppression. In cases that have not responded within 3 weeks, a biopsy of one of the lesions should be considered. Cerebral toxoplamosis is uniformally fatal if untreated, and even after treat- ment neurological sequelae are common. She should be advised to contact her previous sexual partners so that they can be tested and started on antiretroviral therapy. She should also tell her occupational health department so that the appropriate advice can be taken about contacting, testing and reassuring patients. Her mother says that her daughter has been behaving increasingly strangely, and has been hearing voices talking about her. She has also complained of night sweats and flitting joint pains affecting mainly the small joints of her hands and feet. She smokes 5–10 cigarettes per day and consumes about 10 units of alcohol per week. Examination of her cardio- vascular, respiratory and abdominal systems is otherwise normal. Investigations show low haemo- globin, white cells and platelets with impaired renal function and blood, protein and cells in the urine. It varies in severity from a mild illness caus- ing a rash or joint pains, to a life-threatening multisystem illness. Glomerulonephritis is another common manifestation of lupus and may present with microscopic haematuria/proteinuria, nephrotic syndrome or renal failure. Arthritis commonly affects the proximal interphalangeal and metacarpophalangeal joints and wrists, usually as arthralgia without any deformity. Differential diagnosis of the combination of headaches/psychiatric features/fits • Meningitis/encephalitis • ‘Recreational’ drug abuse, e.
Chapter 2 examines changes in the causes of death over the twentieth century and why this shift suggests an increasing role for beliefs and behaviours generic fincar 5 mg without a prescription. The chapter then assesses theories of health beliefs and the models that have been developed to describe beliefs and predict behaviour cheap fincar online master card. Chapter 3 examines beliefs individuals have about illness and Chapter 4 examines health professionals’ health beliefs in the context of doctor– patient communication trusted fincar 5mg. Chapters 5– 9 examine health-related behaviours and illustrate many of the theories and constructs which have been applied to speciﬁc behaviours. Chapter 5 describes theories of addictive behaviours and the factors that predict smoking and alcohol con- sumption. Chapter 6 examines theories of eating behaviour drawing upon develop- mental models, cognitive theories and the role of weight concern. Chapter 9 examines screening as a health behaviour and assesses the psychological factors that relate to whether or not someone attends for a health check and the psychological consequences of screening programmes. Health psychology also focuses on the direct pathway between psychology and health and this is the focus for the second half of the book. Chapter 10 examines research on stress in terms of its deﬁnition and measurement and Chapter 11 assesses the links between stress and illness via changes in both physiology and behaviour and the role of moderating variables. Chapter 12 focuses on pain and evaluates the psycho- logical factors in exacerbating pain perception and explores how psychological interven- tions can be used to reduce pain and encourage pain acceptance. Chapter 13 speciﬁcally examines the interrelationships between beliefs, behaviour and health using the example of placebo eﬀects. Chapter 16 explores the problems with measuring health status and the issues surrounding the measurement of quality of life. Finally, Chapter 17 examines some of the assumptions within health psychology that are described throughout the book. My thanks again go to my psychology and medical students and to my colleagues over the years for their comments and feedback. For this edition I am particularly grateful to Derek Johnston and Amanda Williams for pointing me in the right direction, to David Armstrong for conversation and cooking, to Cecilia Clementi for help with all the new references and for Harry and Ellie for being wonderful and for going to bed on time. Take advantage of the study tools oﬀered to reinforce the material you have read in the text, and to develop your knowledge of Health Psychology in a fun and eﬀective way. Study Skills Open University Press publishes guides to study, research and exam skills, to help under- graduate and postgraduate students through their university studies. Get a £2 discount oﬀ these titles by entering the promotional code app when ordering online at www. The chapter highlights differences between health psychology and the biomedical model and examines the kinds of questions asked by health psychologists. Then the possible future of health psychology in terms of both clinical health psychology and becoming a professional health psychologist is discussed. Finally, this chapter outlines the aims of the textbook and describes how the book is structured. This chapter covers: ➧ The background to health psychology ➧ What is the biomedical model? Darwin’s thesis, The Origin of Species, was published in 1856 and described the theory of evolution. This revolutionary theory identiﬁed a place for Man within Nature and suggested that we were part of nature, that we developed from nature and that we were biological beings. This was in accord with the biomedical model of medicine, which studied Man in the same way that other members of the natural world had been studied in earlier years. This model described human beings as having a biological identity in common with all other biological beings. The biomedical model of medicine can be understood in terms of its answers to the following questions: s What causes illness? According to the biomedical model of medicine, diseases either come from outside the body, invade the body and cause physical changes within the body, or originate as internal involuntary physical changes. Such diseases may be caused by several factors such as chemical imbalances, bacteria, viruses and genetic predisposition. Because illness is seen as arising from biological changes beyond their control, individuals are not seen as responsible for their illness. The biomedical model regards treatment in terms of vaccination, surgery, chemotherapy and radiotherapy, all of which aim to change the physical state of the body. Within the biomedical model, health and illness are seen as qualitatively diﬀerent – you are either healthy or ill, there is no continuum between the two. According to the biomedical model of medicine, the mind and body function independently of each other. From this perspective, the mind is incapable of inﬂuencing physical matter and the mind and body are deﬁned as separate entities. The mind is seen as abstract and relating to feelings and thoughts, and the body is seen in terms of physical matter such as skin, muscles, bones, brain and organs. Changes in the physical matter are regarded as independent of changes in state of mind. Within traditional biomedicine, illness may have psychological consequences, but not psychological causes. These developments have included the emergence of psychosomatic medicine, behavioural health, behavioural medicine and, most recently, health psychology. These diﬀerent areas of study illustrate an increasing role for psychology in health and a changing model of the relationship between the mind and body. Psychosomatic medicine The earliest challenge to the biomedical model was psychosomatic medicine. This was developed at the beginning of the twentieth century in response to Freud’s analysis of the relationship between the mind and physical illness. At the turn of the century, Freud described a condition called ‘hysterical paralysis’, whereby patients presented with paralysed limbs with no obvious physical cause and in a pattern that did not reﬂect the organization of nerves. Freud argued that this condition was an indication of the individual’s state of mind and that repressed experiences and feelings were expressed in terms of a physical problem. This explanation indicated an interaction between mind and body and suggested that psychological factors may not only be consequences of illness but may contribute to its cause. Behavioural health Behavioural health again challenged the biomedical assumptions of a separation of mind and body. Behavioural health was described as being concerned with the main- tenance of health and prevention of illness in currently healthy individuals through the use of educational inputs to change behaviour and lifestyle. The role of behaviour in determining the individual’s health status indicates an integration of the mind and body.