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During auscultation buy altace online from canada pulse pressure response to exercise, the first heart sound is heard as the “lub” of “lub-dub” and is b purchase altace cheap online blood pressure 40 over 0. Bruits buy altace online pills arterial insufficiency, which are normal heart sounds simi- lar to murmurs, are heard over the major blood vessels. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Locate the following list of internal structures Malleus of the ear and place your answers on the lines Tympanic membrane provided on the illustration below. Stapes and footplate Incus Cochlear and vestibular branch Facial nerve Oval window Cochlea Eustachian tube Semicircular canals Round window c. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Yellow color provide the taste sensation of the ante- rior two thirds of the tongue 14. Purplish discoloration “aaah” as the upward movement of the soft palate is observed 17. The knees are both bent, with the ing hearing ability uppermost leg at a more acute angle. A sensory nerve whose function is The position is used to assess the rectum vision. A sensorimotor nerve that is assessed position with the buttocks at the edge of by observing the facial muscles for devi- the examining table and feet supported ation of the jaw to one side and by pal- in stirrups. This position is used to assess pating facial muscles for tone while the the female rectum and genitalia. A motor nerve that affects the movement on the side of the examining table or and strength of the tongue bed. It is used to take vital signs sense of smell and assess the head, neck, posterior and 26. Motor nerves that control the movement anterior thorax and lungs, breasts, heart, of the eyes through the cardinal fields of and upper extremities. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Nasal speculum: thorax and lungs, breasts, heart, extrem- ities, and peripheral pulses. The patient lies flat on the back with legs together but extended and slightly bent at the knees. Tuning fork: assess the head and neck, anterior thorax and lungs, breasts, heart, abdomen, extremities, and peripheral pulses. The patient lies on the abdomen, flat on the bed, with the head turned to one side. Otoscope: four assessment techniques; give a brief description of each technique and the types of assessments made. Auscultation: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. During auscultation of the heart, the first heart sound heard is the (a) _______________ of “lub-dub. Accommodation: (b) _______________ and (c) _______________ valves close and corresponds with the onset of (d) _______________ contraction. This sound is called (e) _______________ and is heard best in the (f) _______________ area. Convergence: The second heart sound, (g) _______________, occurs at the end of (h) _______________ and represents the closure of the (i) _______________ and (j) _______________ 9. List the equipment you would do to prepare the patient, the room, and would assemble before performing the assess- the environment for an examination. In what position would your patient why would you modify these preparations for be placed? A small child Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Write a definition of each instrument and how it is to be used dur- ing the assessment.

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Fears purchase genuine altace on line prehypertension pubmed, phobias order 10 mg altace otc pulse pressure 99, and preparedness: Toward an evolved module of fear and fear learning altace 5 mg visa blood pressure water pill. Neurobiological basis of failure to recall extinction memory in posttraumatic stress disorder. Explain how learning can be shaped through the use of reinforcement schedules and secondary reinforcers. In classical conditioning the organism learns to associate new stimuli with natural, biological responses such as salivation or fear. The organism does not learn something new but rather begins to perform in an existing behavior in the presence of a new signal. Operant conditioning, on the other hand, is learning that occurs based on the consequences of behavior and can involve the learning of new actions. Operant conditioning occurs when a dog rolls over on command because it has been praised for doing so in the past, when a schoolroom bully threatens his classmates because doing so allows him to get his way, and when a child gets good grades because her parents threaten to punish her if she doesn‘t. In operant conditioning the organism learns from the consequences of its own actions. How Reinforcement and Punishment Influence Behavior: The Research of Thorndike and Skinner Psychologist Edward L. Thorndike (1874–1949) was the first scientist to systematically study [1] operant conditioning. In his research Thorndike (1898) observed cats who had been placed in a “puzzle box‖ from which they tried to escape (Note 7. But eventually, and accidentally, they pressed the lever that opened the door and exited to their prize, a scrap of fish. The next time the cat was constrained within the box it attempted fewer of the ineffective responses before carrying out the successful escape, and after several trials the cat learned to almost immediately make the correct response. Observing these changes in the cats‘ behavior led Thorndike to develop hislaw of effect, the principle that responses that create a typically pleasant outcome in a particular situation are more likely to occur again in a similar situation, whereas responses that produce a typically [2] unpleasant outcome are less likely to occur again in the situation (Thorndike, 1911). The essence of the law of effect is that successful responses, because they are pleasurable, are “stamped in‖ by experience and thus occur more frequently. Unsuccessful responses, which produce unpleasant experiences, are “stamped out‖ and subsequently occur less frequently. Video Clip: Thorndike’s Puzzle Box When Thorndike placed his cats in a puzzle box, he found that they learned to engage in the important escape behavior faster after each trial. Thorndike described the learning that follows reinforcement in terms of the law of effect. Skinner (1904–1990) expanded on Thorndike‘s ideas to develop a more complete set of principles to explain operant conditioning. Skinner created specially designed environments known as operant chambers (usually called Skinner boxes) to systemically study learning. A Skinner box (operant chamber) is a structure that is big enough to fit a rodent or bird and that contains a bar or key that the organism can press or peck to release food or water. The most basic of Skinner‘s experiments was quite similar to Thorndike‘s research with cats. A rat placed in the chamber reacted as one might expect, scurrying about the box and sniffing and clawing at the floor and walls. Eventually the rat chanced upon a lever, which it pressed to Attributed to Charles Stangor Saylor. The next time around, the rat took a little less time to press the lever, and on successive trials, the time it took to press the lever became shorter and shorter. Soon the rat was pressing the lever as fast as it could eat the food that appeared. As predicted by the law of effect, the rat had learned to repeat the action that brought about the food and cease the actions that did not. Skinner studied, in detail, how animals changed their behavior through reinforcement and punishment, and he developed terms that explained the processes of operant learning (Table 7. Skinner used the termreinforcer to refer to any event that strengthens or increases the likelihood of a behavior and the term punisher to refer to any event that weakens or decreases the likelihood of a behavior.

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She states that the pain began suddenly and is asso- ciated with nausea and vomiting purchase altace with paypal hypertension pregnancy. This is the second time this month that she experienced pain in this location buy altace heart attack arena, however cheap altace 10 mg amex arrhythmia ecg interpretation, never with this severity. He states that he underwent a routine colonoscopy yester- day and was told “everything is fine. Her lungs are clear to auscultation and you do not appreciate a murmur on cardiac examination. An ultrasound reveals dilation of the common bile duct and stones in the gallbladder. She has a history of ovarian cysts and is sexually active but always uses condoms. Observe her abdominal pain, if it resolves discharge her with a diagnosis of menstruation 88 Emergency Medicine 92. His past medical history is significant for hypertension, peripheral vascular disease, peptic ulcer disease, kidney stones, and gallstones. An abdominal radiograph reveals normal loops of bowel and curvilinear calcification of the aortic wall. A 51-year-old man describes 1 week of gradually worsening scrotal pain and dysuria. Send a urethral swab for culture and administer 125-mg ceftriaxone intramus- cularly and 1-g azithromycin orally. Have him follow-up immediately with a urologist to evaluate for testicular cancer. About 2 weeks ago she experienced intermittent diar- rhea with blood-streaked mucus. A 44-year-old woman is undergoing a diagnostic evaluation for 3 hours of abdominal pain. As part of this evaluation, a diagnos- tic ultrasound is performed and is shown below. Start treatment with ciprofloxacin and metronidazole and plan for an emergent barium enema. Start treatment with ciprofloxacin and metronidazole and prep for an emergent colonoscopy. He states that the pain first began as a dull feeling around his umbilicus and slowly migrated to his right side. On abdominal examination you notice an old midline scar the length of his abdomen that he states was from surgery after a gunshot wound as a teenager. The abdomen is distended with hyperactive bowel sounds and mild tender- ness without rebound. Begin fluid resuscitation, bowel decompression with a nasogastric tube, and request a surgical consult. Begin fluid resuscitation, administer broad-spectrum antibiotics, and admit the patient to the medical service. Begin fluid resuscitation, give the patient stool softener, and administer a rectal enema. Begin fluid resuscitation, administer broad-spectrum antibiotics, and observe the patient for 24 hours. He states that he had this same pain 1 week ago and that it got so bad that he passed out. Physical examination reveals a bruit over his abdominal aorta and a pulsatile abdominal mass. Which of the follow- ing is the most appropriate initial test to evaluate this patient? On physical examination, the patient appears uncomfortable, not moving on the gurney. Pelvic examination reveals a normal sized uterus and moderate right-sided adnexal tenderness.

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