Therefore 200mg red viagra overnight delivery, it is crit- ical that the nurse assess the patient’s age before administering medication and carefully monitor very young and elderly patients afterwards for adverse side effects 200mg red viagra for sale. Body Weight ° The prescriber might order medication given at the recommended dose purchase red viagra 200 mg online. However buy discount red viagra 200mg on-line, the recommended dose is typically for a patient whose body weight is within the average range (70 kg for an adult). The medication might have a different effect if the patient’s body weight falls outside this range. For example, the recommended dose might be too strong for a very thin patient resulting in a toxic effect. Likewise, the recommended dose might be too low for an obese patient and never reach the therapeutic level. This is particularly important to assess when administering medications such as antineoplastics (anti-cancer drugs) where a low therapeutic level can have a non-therapeutic effect for the patient—resulting in an undesirable outcome. Pharmacogenetic ° Genetic factors might have a serious influence on the response to a drug. Depending on the medication, a patient might have a genetically based adverse reaction to the drug. Therefore, in assessing the patient, the nurse must determine if parents, siblings, or other close relatives have had an adverse reaction to the medication. Some drugs are effective only if taken with meals while other medication cannot be taken with meals. Food-drug interaction ° Certain types of foods can adversely effect the drug’s therapeutic effect by increasing absorption, delaying absorption, and even preventing absorption of the medication. Nardil cannot be given with foods that use bacteria or molds in their prepa- ration or for preservation of those that contain tyramine, such as cheese, sour cream, beer, wine, figs, raisins, bananas, avocados, etc. The nurse must assess if the drug has a contraindication with food and educate the patient about this food-drug interaction. Drug-drug interaction ° The nurse should be aware that the combination of drugs administered to the patient may have a negative effect. Some drugs when administered together might increase or decrease the therapeutic effectiveness of either or both medications by competing for the same receptor sites in the body. Furthermore, a combination of some medications produce toxicity or a fatal condition such as anaphylaxis. The prescribers should be notified before medica- tions are administered if there is a possibility of a drug-drug interaction. Drug History, Tolerance, and the Cumulative Effect ° Continued use of a medication might lessen the therapeutic effect of the drug because the patient’s body becomes tolerant of the medication. The nurse must assess the patient’s drug history and monitor the patient for signs and symptoms that the drug is having a therapeutic effect. One such example would be the absence of seizures if the patient is taking phenytoin (Dilantin), an antiseizure medication. The patient may be unable to metabolize and excrete the medication as fast as new doses are administered. For example, ataxia (muscular incoordination), nystagmus (rhythmic oscilla- tion of eyes), and double vision are signs of toxic levels of Dilantin. It is crit- ical for the nurse to review all medications and not just those that will be given on the nurse’s shift because previous medications may still be active in the patient’s body. Remember that some drugs have a long half-life making them still a potential conflict with other medication days after it was administered to the patient. Sometimes the patient may not have recalled any allergies when the patient’s history was taken, but will recall an allergy after being questioned again by the nurse. It is best to create a medication administration worksheet that schedules both medication and the patient’s other activities so there is one schedule for the patient. Make sure that all of the patient’s medications that will be administered during the shift are in the patient’s medication drawer. Always look up the medication in the drug manual if you do not recognize the name of the drug. Check the name of the medication three times: 1) when you remove it from the drawer; 2) when you prepare the medication; and 3) before returning the medication to the drawer or disposing of the wrapper or container. In doing so, the nurse must follow precautions to assure that the medication is administered safely. The patient may be aware of food allergies such as shellfish, but unaware of allergies to medication. However, patients who are allergic to shellfish are also allergic to some medications. Ask the patient if he/she knows about the medication and why the med- ication is being administered. The patient’s response provides insight into knowledge the patient has about his/her condition and treatment. This gives the nurse a perfect opportunity to educate the patient about his/her condition, treatment and medication. Stop immediately if the patient doesn’t recognize the medication as the drug the patient received previously. The dose may have changed, a different medication was substituted, or there is an error in the medication. Make sure you have baseline vital signs, labs, and other patient data before administering the medication. To determine the patient’s reaction to the drug, the baseline can be compared to vital signs, labs, and other patient data taken after the patient receives the medication. Instruct the patient about side effects of the medication and take pre- cautions to assure the patient’s safety such as raising the side rails and instructing the patient to remain in bed until the side effects subside. Properly dispose of the medication and supplies used to administer the medication. Don’t leave the medication at the patient’s bedside unless required by the medication order. You can minimize this adverse effect by giving the patient ice chips prior to administering the medication. The patient is left with the taste of the pleasant tasting medication in his/her mouth. Use the liquid form of the medication where possible because patients find it easier to ingest a liq- uid. Administer medication to a patient who needs extra assistance taking the medication after you give medication to your other patients. In this way, you can devote the necessary time to assist this patient without being pressured to admin- ister medication to your other patients. It is therefore critical that the nurse avoid situations that frequently result in med- ication errors. If an error occurs, assess the patient and notify the nurse in charge and the physician.

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Pathogens enter our body in a variety of ways such as a cut or in food that we ingest cheap red viagra 200mg overnight delivery. Our body reacts with an inflammatory response that dilates blood ves- sels so they become permeable purchase red viagra 200mg free shipping. Nerve endings are stimulated and send a message to your brain that there is something wrong generic 200mg red viagra mastercard. You know when this happens because the infected area turns red cheap 200mg red viagra visa, swollen, and it hurts. Other infections affect an organ or entire system of your body, which is referred to as a systemic infection or septecemia. Medication—A Formidable Defender Your natural defense against bacteria is a phagocytic response. Cells in your body engulf a pathogen, basically eat it and remove the injured tissue. For example, an antibiotic used to kill bacteria that causes a urinary tract infection will also kill the flora in your intestine that are used to help digest food. Patients are also treated with medication that eases the symptoms of inflam- mation but doesn’t kill microbials. Prostaglandins are chemical mediators that bring about the inflammatory response by vasodilatation, relaxing smooth muscle, making capillaries perme- able, and sensitizing nerve cells within the affected area to pain. It is also an antipyretic to lower body temperature and it is an anticoagulant that inhibits the formation of platelets. Sulfonamides are bacteriostatic, which means they stop the growth of bacteria, but do not kill bacteria. Penicillin, the first antibiotic, is a bacteriocidal and kills bacteria using lysis, which explodes the bacteria into parts. Today there are many synthetic and semi-synthetic antimicrobials on the mar- ket that stop some bacteria from growing and kill other bacteria. For example, chloramphenicol is bacteriostatic and stops most bacteria from growing while it is bacteriocidal and kills S pneumoniae and H influenza in cerebral spinal fluid. Tetracycline is also bacteriostatic and bacteriocidal; in small concentrations it stops the growth of bacteria and in high concentration it kills bacteria. Sulfonamides and penicillin are administered orally, topically as an ointment or cream, or parenterally and are absorbed into the body and distributed by the circulatory system. In severe infections, they can be administered directly at the site of the infection such as in the eye or rubbed on the skin. The membrane is within the cell wall and is used to let nutrients into the cell and send waste out of the cell. Medications that stop the growth of bacteria interrupt steps in protein syn- thesis. They inhibit the bacteria’s capability to make (synthesize) essential metabolites. A metabolite is a component necessary for bacteria’s metabo- lism to function properly. Medication used to stop the growth of microbials or kill them outright have side effects, some of which can adversely affect the patient. Some cause an aller- gic reaction while others lead to an exaggerated immune response. Here are a few common ones that you probably recognize: • Rash • Fever • Urticaria (hives) with pruritis (itching) • Chills, general erythema (redness) • Anaphylaxis (circulatory collapse) These side effects are usually treatable by using other medication such as: • Antihistamines (Benadryl) • Epinephrine (adrenalin) • Steroids for anti-inflammatory response Superinfections Antibiotics are a good thing—and a not so good thing. This is a greater risk when large doses of anti- biotics are used, when more than one antibiotic is used at a time, or when broad- spectrum drugs are used. For example, the overuse of cephalosporins may cause pseudomonas and the overuse of tetracycline may cause candida albicans. Pseudomonas and candida albicans are then considered to be a superinfection in response to the use of cephalosporins and tetracycline. Culture and sensitivity studies should be performed on all infections in order to determine which antibiotics will work for the microorganism that is causing the infection. The test can be performed on blood or wound drainage to identify the bacteria and help identify which antibiotic will be effective. Other times, the prescriber may underprescribe an antibiotic by giving the patient a lower-than-effective dose or order the antibiotic for a short period of time. At first this seems like a logical way to prevent the bacterium from becom- ing resistant to the antibiotic. However, a low dose may not completely kill the bacterium resulting in a recurrence of symptoms that requires additional doses of antibiotics. It is very important to choose the right antibiotic, in the right dose, for the right amount of time. Preparing to Administer Antimicrobial Medication Antimicrobial medication requires the nurse to follow the same general admin- istration procedures that are required for any type of medication. The most critical step is to determine if the patient has allergies to drugs, food, environ- mental stimuli, and a family history of allergies to antibiotics. There is also a high incidence of cross sensitivity between some antibiotics such as penicillin and cephalasporins. Even if the patient’s record indicates that the patient doesn’t have allergies, always ask the patient each time you administer the antimicrobial medication. Always have emergency medications such as epinephrine, Benadryl, and steroids handy so they can be given to counteract any adverse side effect of the antimicrobial medication. Be sure to carefully monitor the patient for a half hour after the medication is given to determine if the patient experiences an adverse reaction. During treatment, you’ll need to monitor the therapeutic effect of the med- ication by monitoring the signs and symptoms of the disease and by obtaining the patient’s white blood cell count. Although you can monitor the antimicro- bial serum level to determine if the medication has achieved a therapeutic level, this is only done in cases where the therapeutic range is narrow resulting in pos- sible toxicities (i. It is important to administer antimicrobials at the times described in the pre- scriber’s order in order to maintain a therapeutic blood level of the medication. Sometimes a double dose of an antibiotic is administered as the first dose to quickly achieve a therapeutic level. Intramuscular injections of antibiotics should be given deep into the muscle and sites should be rotated if more than one injection is prescribed. Stop orders and the need for renewal orders will depend on the healthcare agency policy. However, it is common that antibiotic orders are for 72 hours only until the results of a culture and sensitivity test can be obtained. This is an effort to limit the opportunity for the micro- bial to become resistant to the medication. In severe cases, aggressive treatment is necessary to control the growth and destroy the microbial quickly.

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One such society was the Zuni Indians of mistake discount red viagra 200mg otc, however order 200mg red viagra free shipping, not to recognize the effect competition Arizona discount red viagra 200 mg on line, and they purchase red viagra 200 mg with amex, Mead found, valued cooperation far has in the areas of academics, work, and many other more than competition. Psychologists disagree as to whether competition is a learned or genetic component of human behavior. Natural concepts are often learned through the use Conditioned responses develop in a process called of prototypes, highly typical examples of a category— acquisition, in which the natural or unconditioned stimu- like the robin cited above. Some re- concept learning is through the trial-and-error method of sponses develop more quickly than others; similarly, testing hypotheses. The nature of certain item is an instance of a particular concept; they the conditioned response depends on the circumstances then learn more about the concept when they see in which acquisition occurs. This People learn simple concepts more readily than process is called “delayed conditioning” because the un- complex ones. For example, the easiest concept to learn conditioned stimulus is delayed relative to the condi- is one with only a single defining feature. The response is weaker if the condi- est is one with multiple features, all of which must be tioned and unconditioned stimuli begin together, and be- present in every case, known as the conjunctive concept. For example, the concept square is defined by four conditioned response resembles the unconditioned re- sides and four 90-degree angles. People also learn response is not identical to the unconditioned response concepts more easily when they are given positive rather and may be very different. An animal usually produces a conditioned response to stimuli that resemble the conditioned stimulus, a Further Reading process called stimulus generalization. Studies in Cognitive Growth: A Collabora- a complementary tendency not to respond to anything tion at the Center for Cognitive Studies. Piaget’s Theory of Intel- nation of generalization and discrimination leads to ap- lectual Development. The Growth of Logical In classical conditioning, a stimulus leads to a Thinking from Childhood to Adolescence. In Ivan Pavlov’s experimentations with classical Chicago: University of Chicago Press, 1991. After the powder and the sound had co-occurred a few times, the dog salivated when the sound occurred, even when the meat powder was not ad- Conditioned response ministered. Although most research in classical condi- In classical conditioning, behavior that is learned tioning has involved reflexive behaviors that are typical- in response to a particular stimulus. The effects of the condi- Reflexive behaviors occur when an animal encoun- tioned stimulus can vary widely in different circum- ters a stimulus that naturally leads to a reflex. For example, if the unconditioned stimulus is ple, a loud noise generates a fright response. If an initial- more intense, the conditioned stimulus will have a ly neutral stimulus is paired with the noise, that neutral greater effect. On the other hand, if the conditioned stim- or conditioned stimulus produces a fright response. Further, if an animal has associated a particu- lar conditioned stimulus with a certain unconditioned stimulus and a new conditioned stimulus is presented, the animal will typically not develop a response to the new conditioned stimulus. The conditioned stimulus seems to exert its effect by providing information to the animal. If the animal has al- ready gained information through an initial conditioned stimulus, the second one will not be very useful. Similar- ly, if the potential conditioned stimulus does not always occur with the unconditioned stimulus, the information provided by the conditioned stimulus is less useful to the animal. If the conditioned stimulus occurs without the unconditioned stimulus, extinction will occur; that is, the conditioned stimulus will no longer have an effect. The reflex can be conditioned more easily the second time around if the two are again paired. Sometimes, after extinction has taken place, the conditioned stimulus will produce the reflexive behavior without the uncondi- tioned stimulus, a process called spontaneous recovery. For example, people with allergies may rely on drugs that have unwanted side effects. Their allergies have been alleviated by pairing a unique odor (the conditioned stimulus) with the drug (the unconditioned stimulus). Over time, presentation of the odor by itself may alleviate the allergic symptoms. During potty training, children are conditioned to associate the urge to urinate with sitting on the toilet. He reasoned that the presence of the animal caretakers led the animals to an- ticipate the meat powder, so they began to salivate even Psychology has often been defined as the study of without the food. As such, psychologists have developed a di- verse array of methods for studying both human and ani- When classical conditioning occurs, an animal or mal activity. Two of the most commonly used techniques person initially responds to a naturally occurring stimulus are classical conditioning and operant conditioning. They have been used to study the process of learning, Then the food is systematically paired with a previously one of the key areas of interest to psychologists in the neutral stimulus (e. With repeated pairings, the natur- siderable significance to conditioning because it has al response occurs when the neutral stimulus appears. In his Nobel States, John Watson,the first widely known behaviorist, Prize-winning research on the digestive processes, he used the principles of classical conditioning in his research. On the other nant Russian model for the study of behaviorism, anoth- hand, when something positive is removed, this is called er form of conditioning took hold in the United States. In both forms of punishment, an This version, which became known as operant or instru- undesired behavior results in a negative consequence. As mental conditioning, initially developed from the ideas a result, the undesired behavior is less likely to recur in of the psychologist Edward Thorndike. Based on the problem solving of ment with punishment because the word “negative” con- these animals, he developed the Law of Effect,which in jures up the idea of punishment. In reality, a situation in- simple form states that a behavior that has a positive out- volving negative reinforcement involves the removal of a come is likely to be repeated. Similarly, his Law of Exer- negative stimulus, leading to a more satisfying situation. Beginning with Watson and Skinner, psychology in Operant conditioning was popularized by the psy- the United States adopted a behavioral framework in chologist B. His research and writings influ- which researchers began to study people and animals enced not only psychologists but also the general public. From the 1920s through the 1960s, Operant conditioning differs from classical conditioning many psychologists performed conditioning experiments in that, whereas classical conditioning relies on an or- with animals with the idea that what was true for animals ganism’s response to some stimulus in the environment, would also be true for humans. Psychologists assumed operant conditioning relies on the organism’s initiating that the principles of conditioning were universal.

Assess client’s sexual history and previous level of satisfac- tion in sexual relationship discount 200 mg red viagra amex. This establishes a database from which to work and provides a foundation for goal setting cheap 200mg red viagra free shipping. Help client determine time dimension associated with the onset of the problem and discuss what was happening in his or her life situation at that time cheap 200 mg red viagra free shipping. Depression and fatigue decrease desire and enthusiasm for participation in sexual activity purchase red viagra 200 mg. Evaluation of drug and individual response is important to ascertain whether drug may be contributing to the problem. Encourage client to discuss disease process that may be con- tributing to sexual dysfunction. Ensure that client is aware that alternative methods of achieving sexual satisfaction exist and can be learned through sex counseling if he or she and partner desire to do so. Client may be unaware that satis- factory changes can be made in his or her sex life. Encourage client to ask questions regarding sexuality and sexual functioning that may be troubling him or her. In- creasing knowledge and correcting misconceptions can decrease feelings of powerlessness and anxiety and facilitate problem resolution. Complex problems are likely to require assistance from an in- dividual who is specially trained to treat problems related to sexuality. Support from a trusted nurse can provide the impetus for them to pursue the help they need. Client is able to correlate physical or psychosocial factors that interfere with sexual functioning. Client is able to communicate with partner about their sexual relationship without discomfort. Client and partner verbalize willingness and desire to seek assistance from professional sex therapist or 4. Client verbalizes resumption of sexual activity at level satis- factory to self and partner. Client will verbalize aspects about sexuality that he or she would like to change. Client and partner will communicate with each other ways in which each believes their sexual relationship could be improved. Take sexual history, noting client’s expression of areas of dis- satisfaction with sexual pattern. Knowledge of what client perceives as the problem is essential for providing the type of assistance he or she may need. Assess areas of stress in client’s life and examine relationship with sexual partner. Variant sexual behaviors are often as- sociated with added stress in the client’s life. Relationship with partner may deteriorate as individual eventually gains sexual satisfaction only from variant practices. Note cultural, social, ethnic, racial, and religious factors that may contribute to conflicts regarding variant sexual prac- tices. Client may be unaware of the influence these factors exert in creating feelings of discomfort, shame, and guilt regarding sexual attitudes and behavior. The client is more likely to share this information if he or she does not fear being judged by the nurse. Assist therapist in plan of behavior modification to help cli- ent who desires to decrease variant sexual behaviors. Indi- viduals with paraphilias are treated by specialists who have Sexual and Gender Identity Disorders ● 211 experience in modifying variant sexual behaviors. Nurses can intervene by providing assistance with implementation of the plan for behavior modification. If altered sexuality patterns are related to illness or medi- cal treatment, provide information to client and partner re- garding the correlation between the illness and the sexual alteration. Explain possible modifications in usual sexual patterns that client and partner may try in an effort to achieve a satisfying sexual experience in spite of the limi- tation. Client and partner may be unaware of alternate possibilities for achieving sexual satisfaction, or anxiety associated with the limitation may interfere with rational problem solving. Explain to client that sexuality is a normal human response and does not relate exclusively to the sex organs or sexual be- havior. Sexuality involves complex interrelationships among one’s self-concept, body image, personal history, and family and cultural influences; and all interactions with others. If client feels “abnormal” or very unlike everyone else, the self-concept is likely to be very low—he or she may even feel worthless. To increase the client’s feelings of self-worth and desire to change behavior, help him or her to see that even though the behavior is variant, feelings and motivations are common. Client is able to verbalize fears about abnormality and inap- propriateness of sexual behaviors. Client expresses desire to change variant sexual behavior and cooperates with plan of behavior modification. Client and partner verbalize modifications in sexual activi- ties in response to limitations imposed by illness or medical treatment. Client expresses satisfaction with own sexuality pattern or a satisfying sexual relationship with another. Gender Identity Disorders Gender identity is the sense of knowing to which gender one belongs—that is, the awareness of one’s masculinity or femininity. Gender identity disorders occur when there is incongruity be- tween anatomic sex and gender identity. An individual with gen- der identity disorder has an intense desire to be, or insists that he or she is of, the other gender. Intervention with adolescents and adults with gender identity disorder is difficult. Adolescents commonly act out and rarely have the motivation required to alter their cross-gender roles. Treatment of children with the disorder is aimed at helping them to become more comfortable with their assigned gender and to avoid the possible development of gender dissatisfaction in adulthood. Studies of genetics and physiological alterations have been conducted in an attempt to determine whether or not a biological predisposition to gender identity disorder exists. Family Dynamics: It appears that family dynamics plays the most influential role in the etiology of gender disor- ders. Sadock and Sadock (2007) state, “Children develop a gender identity consonant with their sex of rearing (also known as assigned sex). Although “temperament” may play a role with certain behavioral characteristics being present at birth, mothers usually foster a child’s pride in their gender. Sadock and Sadock (2007) state: The father’s role is also important in the early years, and his presence normally helps the separation- individuation process. For a girl, the father is normally the prototype of future love objects; for a boy, the father is a model for male identification” (p.