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Family members are able to discuss feelings regarding client’s diagnosis and prognosis cheap cyclophosphamide 50mg fast delivery medicine 8 discogs. Family members are able to make rational decisions re- garding care of their loved one and the effect on family functioning purchase 50 mg cyclophosphamide otc symptoms rsv. Possible Etiologies (“related to”) Cognitive limitation Information misinterpretation Lack of exposure [to accurate information] Defining Characteristics (“evidenced by”) Verbalization of the problem Inappropriate or exaggerated behaviors Inaccurate follow-through of instruction [Inaccurate statements by client and family] Goals/Objectives Short-term Goal Client and family verbalize understanding about disease pro- cess cyclophosphamide 50mg visa symptoms 8 days after iui, modes of transmission, and prevention of infection. Shaking hands, hugging, social (dry) kissing, holding hands, or other nonsexual physical contact. Touching unsoiled linens or clothing, money, furniture, or other inanimate objects. Teach client to protect self from infections by taking the following precautions: a. Pets require extra infection control precautions because of the opportunistic organisms carried by animals. Avoid touching animal feces, urine, emesis, litter boxes, aquariums, or bird cages. Vaccination with live organisms may be fatal to severely immunosuppressed persons. Do not share personal items, such as toothbrushes, razors, or other implements that may be contaminated with blood or body fluids. Do not eat or drink from the same dinnerware and utensils without washing them between uses. Engage in only “safer” sexual practices (those not involv- ing exchange of body fluids). Avoid sexual practices medically classified as “unsafe,” such as anal or vaginal intercourse and oral sex. Wash hands thoroughly with liquid antibiotic soap before and after each client contact. Wear a mask: (1) When client has a productive cough and tuberculosis has not been ruled out. Dispose of the following in the toilet: (1) Organic material on clothes or linen before laundering. When house cleaning, all equipment used in care of the client, as well as bathroom and kitchen surfaces, should be cleaned with a 1:10 dilute bleach solution. Mops, sponges, and other items used for cleaning should be reserved specifically for that purpose. Studies have produced a variety of statistics related to age of the homeless: 39% are younger than 18 years; indi- viduals between the ages of 25 and 34 comprise 25%; and 6% are ages 55 to 64. Families with children are among the fastest grow- ing segments of the homeless population. Families comprise 33% of the urban homeless population, but research indicates that this number is higher in rural areas, where families, single mothers, and children make up the largest group of homeless people. The homeless population is estimated to be 42% African American, 39% white, 13% Hispanic, 4% Native American, and 2% Asian (U. The ethnic makeup of homeless populations varies according to geographic location. Other prevalent disorders include bipolar affective disorder, substance abuse and dependence, depression, person- ality disorders, and organic mental disorders. Deinstitutionalization is frequently implicated as a contributing factor to homelessness among persons with mental illness. Deinstitutionalization began out of expressed concern by mental health professionals and oth- ers who described the “deplorable conditions” under which mentally ill individuals were housed. Some individuals be- lieved that institutionalization deprived the mentally ill of their civil rights. Not the least of the motivating factors for deinstitutionalization was the financial burden that these cli- ents placed on state governments. Cuts in various government entitlement programs have depleted the allotments available for individuals with severe and persistent mental illness living in the community. The job market is prohibitive for individuals whose behavior is incomprehensible or even frightening to many.

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The scientist/practitioner seeks out to explore a into a descriptive portrait of the phenome- life situation buy discount cyclophosphamide 50mg on-line symptoms white tongue, phenomenon purchase cyclophosphamide 50 mg overnight delivery medications peripheral neuropathy, or concern from a non cyclophosphamide 50mg with amex medications grapefruit interacts with. Describe the endeavor with the aim of appreciat- and accurate aesthetic rendition of the univer- ing the wholeness, uniqueness, and essence sal patterns, qualities, features, and themes of the particular situation, phenomenon, or exemplifying the essence of the dynamic kalei- concern. Approach participants as partners in a coequal preted from the perspective of the Science of participative appreciative endeavor. Information is collected in the form of dialogue, evolutionary interpretation to create a theoret- discussion, interview, observation, or any prac- ical unitary field pattern portrait of the phe- tice that illuminates the underlying human life nomenon. Documentation of the experience, perceptions, retical structure of the phenomenon from the and expressions can be accomplished through perspective of Rogers’ nursing science. Engagement with participants is negotiated Rogerian science to practice and research. Construct a pattern profile using synopsis that disease and cellular biological processes, the meaningfully represents the person’s experi- Science of Unitary Human Beings focuses on ences, perceptions, and expressions of partici- human beings as irreducible wholes insepa- pants and captures the wholeness, uniqueness, rable from their environment. The profile may be created For 30 years, Rogers advocated that nurses by the scientist/practitioner, the participants, should become the experts and providers of or as a joint venture. If nursing ory by seeking universals that may exist across continues to be dominated by biomedical cases while acknowledging the individual frameworks that are indistinguishable from differences. If nurs- offers nursing a distinguishable and new ing’s content and contribution to the better- way of conceptualizing health events con- ment of the health and well-being of a society cerning human well-being that is congru- is not distinguishable from other disciplines ent with the most contemporary scientific and has nothing unique or valuable to offer, theories. Thus, nursing’s survival rests on its ability to make a difference in promoting References the health and well-being of people. Well-being and ing care is distinguishable from the services of high-risk drug use among active drug users. The consciousness nursing a distinguishable and new way of rainbow: An explication of Rogerian field pattern manifesta- conceptualizing health events concerning tion. Personalized nurs- human well-being that is congruent with the ing: A science-based model of the art of nursing. New York: National League for worldview, new terminology is needed to cre- Nursing. Unpublished dissertation, New York a new understanding of the experiences, per- University, New York. Crystallizing the processes of the unitary The relationship of human field motion and power. Nursing Science Quarterly, 9, porary society: Issues, trends, and transition to practice (pp. Instrument development and the meas- derings related to the power as knowing participation in urement of unitary constructs. Unitary perspectives on methodological prac- harmony: A theory of Rogerian nursing practice. Turbulent mirror: An illustrated Theoretical issues, methodological challenges, and research guide to chaos theory and the science of wholeness. Spirituality as integrality: A Rogerian Visions: The Journal of Rogerian Nursing Science, 11, 7–20. Spirituality: A pattern manifestation of doctoral dissertation, New York University, New York. The relationship of time experience, cre- Journal of Rogerian Nursing Science, 2, 12–18. Governing Council of the Society for the Advancement of Rogers: Her life and her work. Rogers: Her life and of dying, the experience of paranormal events, and creativity her work (pp. Developing an effective pattern ap- and human field pattern, risk taking, and time experience: An praisal to guide nursing care of children with heart variations investigation of Rogers’ principles of homeodynamics. Rogers: tice-level theory of sleeping, waking, and beyond waking Her life and her work (pp.

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Heart and lungs have been B = termed middle sphincter (at the removed; the costal margin remains in place cyclophosphamide 50mg visa symptoms adhd. During inspiration the diaphragm moves downwards and the lower part of the thoracic cage expands forward and laterally order on line cyclophosphamide medicine daughter lyrics, causing the costodiaphragmatic recess (R) to enlarge (cf purchase 50 mg cyclophosphamide medicine cards. Diaphragm 283 1 Azygos venous arch 2 Right pulmonary artery 3 Superior vena cava 4 Right pulmonary vein 5 Fossa ovalis 6 Hepatic veins 7 Inferior vena cava 8 Right crus of lumbar part of diaphragm 9 Medial arcuate ligament 10 Psoas major muscle 11 Left brachiocephalic vein 12 Terminal crista 13 Right atrium 14 Right auricle 15 Central tendon of diaphragm 16 Esophagus 17 Celiac trunk and superior mesenteric artery 18 Aorta 19 Costal part of diaphragm 20 Costal margin 21 Transversus abdominis muscle Diaphragm. Paramedian section to the right of the median plane through thoracic and upper abdominal cavities. The plane passes through the superior and inferior vena cava just to the right of the vertebral bodies. Most of the heart remains in situ to the left of this plane (viewed from the right side). Ductus venosus between umbilical vein bypass of liver 4 Superior vena cava (of Arantius) and inferior vena cava circulation 5 Ascending aorta 6 Right auricle 2. Foramen ovale between right and left bypass of pulmonary 7 Pulmonary trunk atrium circulation 8 Left primary bronchus 9 Left auricle 3. Ductus arteriosus between pulmonary trunk 10 Right ventricle (Botalli) and aorta 11 Left ventricle 12 Left common carotid artery 13 Trachea 14 Superior lobe of right lung 15 Left subclavian artery 16 Aortic arch 12 17 Ductus arteriosus (Botalli) 18 Inferior lobe of right lung 2 14 19 Left pulmonary artery with branches to the 15 left lung 3 20 Descending aorta 21 Left pulmonary veins 5 18 22 Inferior vena cava 23 Foramen ovale 7 17 24 Right atrium 25 Opening of inferior vena cava 8 19 26 Valve of inferior vena cava (Eustachian valve) 23 27 Opening of coronary sinus 21 28 Anterior papillary muscle of right ventricle 9 20 11 Heart of the fetus (schematic drawing). Fetal Circulatory System 289 1 Internal jugular vein and right common carotid artery 2 Right and left brachiocephalic vein 3 Aortic arch 4 Superior vena cava 5 Foramen ovale 6 Inferior vena cava 7 Ductus venosus 8 Liver 9 Umbilical vein 10 Small intestine 11 Umbilical artery 12 Urachus 13 Trachea and left internal jugular vein 14 Left pulmonary artery 15 Ductus arteriosus (Botalli) 16 Right ventricle 17 Hepatic arteries (red) and portal vein (blue) 18 Stomach 19 Urinary bladder 20 Portal vein 21 Pulmonary veins 22 Descending aorta 23 Placenta Thoracic and abdominal organs in the newborn (anterior aspect). The greater omentum partly fixed to the transverse colon covers the small intestine. The liver, stomach, and superior part of 1 the duodenum are connected to the lesser omentum covering the omental bursa, the entrance of which is the epiploic foramen. The hepatoduodenal ligament contains 2 the portal vein, the common bile duct, and the hepatic arteries. The heart is in contact with the diaphragm (from Lütjen-Drecoll, Rohen, Innenansichten des menschlichen Körpers, 2010). Transverse section through the abdominal cavity at the level of the second lumbar vertebra (from below). Anterior Abdominal Wall 293 1 Left ventricle with pericardium 2 Diaphragm 3 Remnant of liver 4 Ligamentum teres (free margin of falciform ligament) 5 Site of umbilicus 6 Medial umbilical fold (containing the obliterated umbilical artery) 7 Lateral umbilical fold (containing inferior epigastric artery and vein) 8 Median umbilical fold (containing remnant of urachus) 9 Head of femur and pelvic bone 10 Urinary bladder 11 Root of penis 12 Falciform ligament of liver 13 Rib (divided) 14 Iliac crest (divided) 15 Site of deep inguinal ring and lateral inguinal fossa 16 Iliopsoas muscle (divided) 17 Medial inguinal fossa 18 Supravesical fossa 19 Posterior layer of rectus sheath 20 Transversus abdominis muscle 21 Umbilicus and arcuate line 22 Inferior epigastric artery 23 Femoral nerve 24 Iliopsoas muscle 25 Remnant of umbilical artery 26 Femoral artery and vein 27 Tendinous intersection of rectus abdominis Anterior abdominal wall with pelvic cavity and thigh (frontal section, male) muscle (internal aspect). The peritoneum and parts of the posterior layer of rectus sheath have been removed. Parasagittal section through upper 30 Intervertebral disc part of left abdominal cavity 3. Stomach 295 1 2 9 10 4 9 11 1 2 3 5 12 10 4 6 6 11 8 7 13 8 14 Muscular coat of stomach, outer layer (ventral aspect). Stomach and transverse colon have been removed, liver elevated; superior mesenteric vein is slightly enlarged. Parasagittal section through the left side of the abdomen 2 cm lateral to median plane. Liver 299 1 Fundus of gallbladder 2 Peritoneum (cut edges) 3 Cystic artery 4 Cystic duct 5 Right lobe of liver 6 Inferior vena cava 7 Bare area of liver 8 Notch for ligamentum teres and falciform ligament 9 Ligamentum teres 10 Falciform ligament of liver 11 Quadrate lobe of liver 12 Common hepatic duct 13 Left lobe of liver 14 Hepatic artery proper 15 Common bile duct Portal triad 16 Portal vein 17 Caudate lobe of liver 18 Ligamentum venosum 19 Ligament of inferior vena cava 20 Appendix fibrosa (left triangular ligament) 21 Coronary ligament of liver 22 Hepatic veins Liver (inferior aspect). It should be noted that the anatom- ical left and right lobes of the liver do not reflect the internal distribution of the hepatic artery, portal vein, and biliary ducts. With these structures, used as criteria, the left lobe includes both the caudate and quadrate lobes, and thus the line dividing the liver into left and right functional lobes passes through the gallbladder and inferior vena cava. The three main hepatic veins drain segments of the liver that have no visible external Liver (ventral aspect) (transparent drawing illustrating margins of peritoneal folds). In this case the accessory pancreatic duct represents the main excretory duct of the pancreas. Vessels of the Abdominal Organs: Portal Circulation 303 1 2 3 7 8 9 4 5 10 11 6 Tributaries of portal vein (blue) and branches of superior mesenteric artery (red) (anterior aspect). Stomach and transverse 33 Superior rectal artery colon have been removed and the liver elevated.

There are many different ways one can present a nursing situation generic cyclophosphamide 50mg line medications 73, such as case presentations buy discount cyclophosphamide line medicine 5513, poems discount 50mg cyclophosphamide symptoms 97 jeep 40 oxygen sensor failure, projects, and various other art forms. When one shares a nursing situation with others, new possibilities for knowing other unfold exponentially. First, I will present it in the traditional medical model, and then I will present the same story in a nursing perspective grounded in the nursing as caring theory. Through comparison, the lived experience of both of these models will make clearer the difference between practice per- spectives. She remarked that she did not like going to the doctor and had neglected to have any checkups in quite a few years. I ordered blood tests, all of which were unremarkable with the ex- ception of the Ca125, which was 625, well above normal parameters. Three days after our initial visit, I asked her to return to the office so we could discuss the results. She said I had done so much for her in our visit, she wanted to share with me a precious gift the Lord had given her—her voice. There, in the office, I sat with her labs in my lap as she serenaded me with a song. I don’t remember the name of the song, but the verse told me Jesus was calling her home and she was not afraid. I advised her that although the blood test was not diagnostic, the pos- sibility of cancer did exist and she needed to see an oncological gynecologist. After a month of invasive testing at the family’s prompting, exploratory surgery and biopsies confirmed the diagno- sis of ovarian cancer with extensive metastasis. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy with debulking, and she died shortly thereafter. There is a lot one can learn from a case presentation such as this one, but it does not reflect the essence of what occurred between the nurse and the one nursed. The reader is left wondering what the nurse did that prompted such a special present in return. Nursing as Caring Case Presentation As the morning rolled along, I began to dream. My arms outstretched, reached for the sun, found the sky, and in it, a gentle breeze that surrounded and calmed me. I stood in awe of the sun’s beauty as its rays poured over me and warmed my spirit. I saw a glow on the horizon, unlike the sun and different from the moon and stars. An ember, the residual of a fire that has burned through the night, tirelessly, to provide warmth. I reached upward, grasping for the restoration of harmonious interconnectedness, but in the sky, there is nothing to grab onto. You may grow into it, enjoy its beauty, bask in its breezes, and breathe in its life-giving oxygen, but you cannot hold on to it or possess it. My arms grew weary, my leaves were wilted, so I drank from the spring beneath my foundation. I began to feel stronger and reached toward the sky, hoping to catch one last glimpse of her ember and saw her reflection in the sun. It demonstrates the perspective of enhancing other as one lives and grows in caring, which subsequently results in the enhancement of self as the nurse lives and grows in caring. Boykin and Schoenhofer encourage nurses to choose var- ious art forms as media for sharing and reflection. It is the artful integration of all the ways of knowing to create a meaningful, caring moment that is born in a nursing situation. Personal knowing is that which is known intuitively by encountering self and other. Authentic presence is a key component for my intuitive experiences when I just know. The patient trusted me and humbled herself to ask me to validate her concern that the mass in her belly was of grave concern.

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