By R. Zakosh. University of Michigan-Dearborn.
The thyrohyoid muscle also elevates the larynx’s thyroid cartilage zudena 100 mg low price, whereas the sternothyroid depresses it to create different tones of voice zudena 100mg low price. Muscles That Move the Head The head purchase zudena 100mg amex, attached to the top of the vertebral column buy 100mg zudena with mastercard, is balanced, moved, and rotated by the neck muscles (Table 11. This muscle divides the neck into anterior and posterior triangles when viewed from the side (Figure 11. Muscles That Move the Head Target motion Movement Target Prime mover Origin Insertion direction Temporal Rotates and Individually: rotates bone tilts head to the Skull; head to opposite side; Sternocleidomastoid Sternum; clavicle (mastoid side; tilts head vertebrae bilaterally: flexion process); forward occipital bone Individually: laterally Transverse and Rotates and Skull; flexes and rotates articular processes Occipital tilts head Semispinalis capitis vertebrae head to same side; of cervical and bone backward bilaterally: extension thoracic vertebra Temporal Rotates and Individually: laterally Spinous processes bone tilts head to the Skull; flexes and rotates Splenius capitis of cervical and (mastoid side; tilts head vertebrae head to same side; thoracic vertebra process); backward bilaterally: extension occipital bone Table 11. The back muscles stabilize and move the vertebral column, and are grouped according to the lengths and direction of the fascicles. From the sides and the back of the neck, the splenius capitis inserts onto the head region, and the splenius cervicis extends onto the cervical region. The erector spinae group forms the majority of the muscle mass of the back and it is the primary extensor of the vertebral column. It controls flexion, lateral flexion, and rotation of the vertebral column, and maintains the lumbar curve. The erector spinae comprises the iliocostalis (laterally placed) group, the longissimus (intermediately placed) group, and the spinalis (medially placed) group. The iliocostalis group includes the iliocostalis cervicis, associated with the cervical region; the iliocostalis thoracis, associated with the thoracic region; and the iliocostalis lumborum, associated with the lumbar region. The three muscles of the longissimus group are the longissimus capitis, associated with the head region; the longissimus cervicis, associated with the cervical region; and the longissimus thoracis, associated with the thoracic region. The third group, the spinalis group, comprises the spinalis capitis (head region), the spinalis cervicis (cervical region), and the spinalis thoracis (thoracic region). The transversospinales muscles run from the transverse processes to the spinous processes of the vertebrae. Similar to the erector spinae muscles, the semispinalis muscles in this group are named for the areas of the body with which they are associated. The semispinalis muscles include the semispinalis capitis, the semispinalis cervicis, and the semispinalis 464 Chapter 11 | The Muscular System thoracis. Important in the stabilization of the vertebral column is the segmental muscle group, which includes the interspinales and intertransversarii muscles. The scalene muscles include the anterior scalene muscle (anterior to the middle scalene), the middle scalene muscle (the longest, intermediate between the anterior and posterior scalenes), and the posterior scalene muscle (the smallest, posterior to the middle scalene). The muscles of the vertebral column, thorax, and abdominal wall extend, flex, and stabilize different parts of the body’s trunk. The brain sends out electrical impulses to these various muscle groups to control posture by alternate contraction and relaxation. Muscles of the Abdomen There are four pairs of abdominal muscles that cover the anterior and lateral abdominal region and meet at the anterior midline. These muscles of the anterolateral abdominal wall can be divided into four groups: the external obliques, the internal obliques, the transversus abdominis, and the rectus abdominis (Figure 11. On the flanks of the body, medial to the rectus abdominis, the abdominal wall is composed of three layers. The external oblique muscles form the superficial layer, while the internal oblique muscles form the middle layer, and the transverses abdominus forms the deepest layer. The external oblique, closest to the surface, extend inferiorly and medially, in the direction of sliding one’s four fingers into pants pockets. Perpendicular to it is the intermediate internal oblique, extending superiorly and medially, the direction the thumbs usually go when the other fingers are in the pants pocket. The deep muscle, the transversus abdominis, is arranged transversely around the abdomen, similar to the front of a belt on a pair of pants. This arrangement of three bands of muscles in different orientations allows various movements and rotations of the trunk. The three layers of muscle also help to protect the internal abdominal organs in an area where there is no bone. The linea alba is a white, fibrous band that is made of the bilateral rectus sheaths that join at the anterior midline of the body. These enclose the rectus abdominis muscles (a pair of long, linear muscles, commonly called the “sit-up” muscles) that originate at the pubic crest and symphysis, and extend the length of the body’s trunk. Each muscle is segmented by three transverse bands of collagen fibers called the tendinous intersections. This results in the look of “six-pack abs,” as each segment hypertrophies on individuals at the gym who do many sit-ups. The posterior abdominal wall is formed by the lumbar vertebrae, parts of the ilia of the hip bones, psoas major and iliacus muscles, and quadratus lumborum muscle. If you injured your shoulder while you were kayaking, the first thing a physical therapist would do during your first visit is to assess the functionality of the joint. The first step in physical therapy will probably be applying a heat pack to the injured site, which acts much like a warm-up to draw blood to the area, to enhance healing. You will be instructed to do a series of exercises to continue the therapy at home, followed by icing, to decrease inflammation and swelling, which will continue for several weeks. Muscles of the Thorax The muscles of the chest serve to facilitate breathing by changing the size of the thoracic cavity (Table 11. Muscles of the Thorax Target motion Prime Movement Target Origin Insertion direction mover Sternum; ribs Inhalation; Thoracic Compression; expansion Diaphragm 6–12; lumbar Central tendon exhalation cavity vertebrae Rib superior to Rib inferior to Elevation (expands thoracic External Inhalation;exhalation Ribs each intercostal each intercostal cavity) intercostals muscle muscle Movement along superior/ Rib inferior to Rib superior to Internal Forced exhalation Ribs inferior axis to bring ribs each intercostal each intercostal intercostals closer together muscle muscle Table 11. Defecating, urination, and even childbirth involve cooperation between the diaphragm and abdominal muscles (this cooperation is referred to as the “Valsalva maneuver”). You hold your breath by a steady contraction of the diaphragm; this stabilizes the volume and pressure of the peritoneal cavity. When the abdominal muscles contract, the pressure cannot push the diaphragm up, so it increases pressure on the intestinal tract (defecation), urinary tract (urination), or reproductive tract (childbirth). The inferior surface of the pericardial sac and the inferior surfaces of the pleural membranes (parietal pleura) fuse onto the central tendon of the diaphragm. To the sides of the tendon are the skeletal muscle portions of the diaphragm, which insert into the tendon while having a number of origins including the xiphoid process of the sternum anteriorly, the inferior six ribs and their cartilages laterally, and the lumbar vertebrae and 12th ribs posteriorly. The diaphragm also includes three openings for the passage of structures between the thorax and the abdomen. The inferior vena cava passes through the caval opening, and the esophagus and attached nerves pass through the esophageal hiatus. The Intercostal Muscles There are three sets of muscles, called intercostal muscles, which span each of the intercostal spaces. The principal role of the intercostal muscles is to assist in breathing by changing the dimensions of the rib cage (Figure 11. The 11 pairs of superficial external intercostal muscles aid in inspiration of air during breathing because when they contract, they raise the rib cage, which expands it. The 11 pairs of internal intercostal muscles, just under the externals, are used for expiration because they draw the ribs together to constrict the rib cage. The innermost intercostal muscles are the deepest, and they act as synergists for the action of the internal intercostals. Muscles of the Pelvic Floor and Perineum The pelvic floor is a muscular sheet that defines the inferior portion of the pelvic cavity.
Doing so will not only give the student a better idea of surgical procedures order zudena 100mg, but it will also help in understanding the client’s feelings and apprehensions discount 100mg zudena with visa. Duties include handling instruments to the surgeon cheap zudena 100mg, threading needles cheap zudena 100 mg, cutting sutures, assisting with retraction and suction, and handling specimen. Duties include opening sterile packs, delivering supplies and instruments to the sterile team, delivering medications to sterile nurse, labeling specimens, and keeping records during the surgical procedure. This person acts as a client advocate by monitoring the situation and maintaining safety in the operating room. Post- operative Care Purpose • To prevent any complication from anesthesia • To detect any sign of post- operative complications 333 • To rehabilitate the patient. Equipment • Anesthetic bed • Oxygen • Sphygmomanometer • Stetoscope • Suction machine (as needed) • Extra rubber sheet (as needed) • I. V stand • Emergency drugs (to be ready in wards) • Bed blocks (as needed) for shock Procedure • Prepare anesthetic bed (see section on bed making) • Assist operating room nurse in placing patient in bed. Charting • Time of return • General condition and appearance ⇐ State of consciousness ⇐ Color of skin ⇐ Temperature of skin to touch ⇐ Skin- moist or dry ⇐ Blood pressure, plus and respiration ⇐ Any unusual condition such as bleeding drainage, Vomiting etc. Generals Instructions • If patient shows any signs of shock immediate action should be taken and then be reported to the doctor. The head of the bed should be lowered (If no gatches on bed, bed blocks may be used) • Do not leave unconscious patient alone. Breast Surgery • Encourage deep breathing often, because of danger of pneumonia • Special arm exercises should be given Abdominal Surgery • Encourage deep breathing • Turn from side to side often st • Sit patient on edge of bed 1 day postoperatively and • Start walking second day post operatively (unless contra- indicated) • Intake and output should be recorded 336 • If gastric suction is present make sure it is working properly • Frequent mouth care for patients who are not allowed to drink. Eye Surgery • Must lie very still because the incision and sutures can be damaged by pulling on the eye muscles. This will make it easier to breathe since the pressure of dressing and swelling may give choking feeling. Key terminology Autopsy Cheyne-Stkes respiration postmortum examination Brain death Kussmal’s breathing A. Spirituality and Death Death often forces people to consider profaned questions: the meaning of life, the existence of the soul, and the possibility of an after life. Individuals faced with death, their close friends, and family often relies on a spiritual foundation to help them meet these challenging concepts. For those whose spirituality does not include beliefs rooted in organized religion, support may take the form of compassionate care and the acceptance of personal beliefs. Meeting basic human needs is an expression of caring that dying individuals will appreciate even if they can no longer communicate with you verbally. As a person learns of his or her own impending death, he or she experiences grief in relation to his or her own loss. The denial may be partial or complete and may occur not only during the first stages of illness or confrontation but later on from time to time. This initial denial is usually a temporary defense and is used as a buffer until such time as the person is able to collect him or herself, mobilize his or her defenses, and face the inevitability of death. This emotion may be directed toward persons in the environment or even projected into the environment at random. Ross discusses this reaction and the difficulty in handling it for those close to the person by explaining that we should put ourselves in the client’s position and consider how we might feel intense anger at having our life interrupted abruptly. The person attempts to strike a bargain for more time to live or more time to be without pain in return for doing something for God. Usually, when people have completed the processes of denial, anger, and bargaining, they 341 move into depression. In this form of depression, the person is reacting against the impending loss of life and grieves for him or herself. This occurs when the person has worked through the previous stages and accepts his or her own inevitable death. With full acceptance of impending death comes the preparation for it; however, even with acceptance, hope is still present and needs to be supported realistically. Personal values and beliefs about life; views of personal successes, both financial and emotional; the way they look physically when experiencing the dying process; their family and friends and their families’ attitudes and reactions; their past experiences in coping with difficult or traumatic situations; and, finally, the health care staff who are caring for them during this process – all affect an individual’s attitude toward dying. Notify the charge nurse if there is an impending crisis and perform emergency actions until help arrives. Encourage dying clients to do as much as they can for themselves so that they do not just give up-a state that only reinforces low self-esteem. Recognize that your physical presence is comforting by staying physically close to the client if he or she is frightened. Respect the client’s need for privacy and with draw if the client has a need to be alone or to disengage from personal relationships. Be tuned into client’s cues that he or she wants to talk and express feelings, cry, or even intellectually discuss the dying process. Understand that different family members react differently to the impending death and support the different reactions. Be aware that demonstrating your concern and caring assists the family to cope with the grief process. Explore your own feelings about death and dying with the understanding that until you have faced the subject of death you will be inadequate to support the client or the family as they experience the dying process. Share your feelings about dying with the staff and others; actively work through them so that negativity does not get transferred to the client. To show kindness to the family Equipment • Basin for water, wash cloth and towel • Cotton • Gauze • Dressings and tape if necessary • Clean sheet • Stretcher • Forceps • Name tag • Gloves, if necessary Procedure • Note the exact time of death and chart it • If the doctor is present call him to pronounce death • If the family members are not present, send for them 347 • Wash hands and wear clean gloves according to agency policy • Close doors of the room or pull curtain • Raise bed to comfortable working level (when necessary) • Arrange for privacy and prevent other patients from seeing in to room. Airborne precaution precaution taken when a person has an illness that can be carried in the air or in the dust particles. Apex lower point of the heart, formed by the tip of the left ventricle Apical pulse pulse normally heard at the heart’s apex, which usually give the most accurate assessment of pulse rate Aspiration Inhalation of foodstuff, vomitus or saliva into the lungs. Asphyxia A condition produced by prolonged lack of oxygen 350 Asepsis Absolute freedom from all microorganisms Antiseptic Harmless chemicals that can kill microorganisms or prevent them from multiplying. Blood pressure The force exerted by the heart to pump the blood around the body Bradycardia Abnormally slow heartbeat. Brand name copyright name assigned by a company that makes the medication; also called the trade name. Brain death irreversible cessation of brain and brain stem function to the extent that 351 cardiopulmonary function must be mechanical maintained. Capsule a small gelatinous case for holding a dose of medicine; a membranous structuring enclosing another body structure, as the articular capsule in a joint. Center of gravity the center of one’s weight; half of one’s body weight is below and half above, and half to the left and half to the right of the center of gravity. Cheyne-Stkes respiration: breathing characterized by deep breathing alternating with very slow breathing or apnea often precedes death. Contact precaution precaution taken against disease that can be transmitted through direct contact between a susceptible host’s body surface and an infected or colonized person.
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Screening and assessing mental health and substance use disorders among youth in the juvenile justice system: A resource guide for practitioners. Practical implications of current domestic violence research: For law enforcement, prosecutors and judges. Occupational employment statistics: Occupational employment and wages, May 2011: 21-1011 Substance abuse and behavioral disorder counselors. Interim final rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. Confidentiality and the Employee Assistance Program: A question and answer guide for federal employees. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: Recommendation statement. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U. Before prohibition: Images from the preprohibition era when many psychotropic substances were legally available in America and Europe. 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In the same way if a child receives from its parents genes B and O it will belong to group B only if it receives gene O from both its parents will it belong to group O buy zudena 100 mg on-line. Every individual contains alcohol soluble antigens in body tissues and on the red cells discount zudena 100mg amex, whether secretor or non-secretor zudena 100 mg on line, but secretors buy zudena 100mg line, in addition to this, possess the water soluble (glycoprotein) form of antigen, which appears in most body fluids. Individual who are homozygous for se (sese) do not secrete H,A, or B antigens regardless of the presence of H,A or B genes. The Se gene does not affect the formation of A,B or H antigens on the red cells or in hematopoietic tissue, which are alcohol soluble and which are not present in body secretions. What was the reason for the failure of attempted intra and inter species blood transfusions (relate this with the discovery of blood group by Karl Landsteiner). The immunogenicity of a substance (relative ability of a substance to stimulate, the production of antibodies when introduced in to a subject lacking the substance) is influenced by a number of characteristics: Foreignness: The substance should present, at least in part, a configuration that is unfamiliar to the organism. The greater the degree the antigenic determinant is recognized as non- self by an individual’s immune system, the more antigenic it is. The larger the molecule, the greater is its likelihood of possessing unfamiliar antigenic determinant on its surface, and hence the better the molecule functions as an antigen. Molecules with a molecular weight of less than 5000 fail to act as antigen, with 14,000 are poor antigens unless conjugated with adjuvant and with 40,000 or more are good antigens. Structural stability: Structural stability is essential characteristic; structurally instable molecules are poor antigens, eg. Structural complexity: The more complex an antigen is, the more effective it will be complex proteins are better antigens than large repeating polymers such as lipids, carbohydrates, and nucleic acid, which are relatively poor antigens. Route of administration: In general, intravenous (in to the vein) and intraperitoneal (into the peritoneal cavity) routes offer a stronger stimulus than subcutaneous (beneath the skin) or intramuscular (in to the muscle) routes. Five major immunoglobulin (Ig) classes exist; which are called IgG, IgA, IgM, IgD and IgE, with heavy chains gamma (γ) alpha (α), mu (µ) delta(δ ) , and epsilon(Є) respectively. Four sub classes of IgG have been recognized on the basis of structural and serological differences and are known as IgG1, IgG2, IgG3 and IgG4. IgG subtype characteristics Characteristic IgG1 IgG2 IgG3 IgG4 % of total lgG in 65 25 6 4 serum Complement 4+ 2+ 4+ +/- fixation Half-life in days 22 22 8 22 Placental Yes Yes Yes Yes passage Some Immune Immune specificities Anti-Rh Anti-A Anti-Rh Anti-A Anti-B Anti-B IgM: - Accounts for about 10% of the immunoglobulin pool, with a concentration of about 1. Natural antibodies: are red cell antibodies in the serum of an individual that are not provoked by previous red cell sensitization. But, it is believed that these antibodies must be the result of some kind of outside stimulus and the term naturally occurring gives an inaccurate connotation, so they are called non- red cell or non- red cell immune antibodies. Characteristics - Exhibit optimum in vitro agglutination when the antigen bearing erythrocytes are suspended in physiologic saline (0. Immune antibodies: are antibodies evoked by previous antigenic stimulation either by transfusion or pregnancy, i. Characteristics - Do not exhibit visible agglutination of saline- suspended erythrocytes, and called incomplete antibodies 0 - React optimally at a temperature of 37 C, and are so called warm agglutinins. These antibodies obviously have more serious transfusion implications than the naturally occurring ones. Classification of the blood group was based on his observation of the agglutination reaction between an antigen on erythrocytes and antibodies present in the serum of individuals directed against these antigens. The antibody that reacted with the A antigens was known as anti A, and the antibody that reacted with the B antigen was known as anti B. According to 20 the theory of Bernstein the characters A,B and O are inherited by means of three allelic genes, also called A,B and O. The O gene is considered to be silent (amorphic) since it does not appear to control the development of an antigen on the red cell. This four allelic genes give rise to six phenotypes: A1, A2, B, O, A1B and A2B and because each individual inherits one chromosome from each parent, two genes are inherited for each characteristic and these four allelic gene give rise to ten possible genotypes (table 3. In serological testing, individuals of this type have a weaker B antigen and possess some kind of anti- B in the serum. For example, it can be seen that for the matings A1xB, A2 and A2 B children never occur in the same family as B or O children. However, the finding of, for instance, a group O child in a family where other children are A2 and A2 B would not be possible if they all had the same parents. The antiserum has two be specific: does not cross react, and only reacts with its own corresponding antigen, avid: the ability to agglutinate red cells quickly and strongly, stable: maintains it specificity and avidity till the expiry date. It should also be clear, as turbidity may indicate bacterial contamination and free of precipitate and particles. Agglutination: is the clumping of particles with antigens on their surface, such as erythrocytes by antibody molecules that form bridges between the antigenic determinants. When antigens are situated on the red cell membrane, mixture with their specific antibodies causes clumping or agglutination of the red cells. In hemagglutination the antigen is referred to as agglutinogen and the antibody is referred to as agglutinin. In the first stage- sensitization, antibodies present in the serum become attached to the corresponding antigen on the red cell surface. In the second stage, the physical agglutination or clumping of the sensitized red cells takes place, which is caused by an antibody attaching to antigen on more than one red cell producing a net or lattice that holds the cells together. Agglutination reaction is interpreted as a positive (+) test result and indicates, based on the method used, the presence of specific antigen on erythrocytes or antibody in the serum of an individual. No agglutination reaction produces a negative (-) test indicating the absence of specific antigens on erythrocytes or antibody in the serum of an individual. The maximum span of IgG molecules is 14 nanometer that they could only attach the antigens, coating or sensitizing the red cells and agglutination can not be effected in saline media. On the other hand, IgM molecules are bigger and because of their pentameric arrangement can bridge a wider gap and overcome the repulsive forces, causing cells to agglutinate directly in saline. Temperature: The optimum temperature for an antigen- antibody reaction differs for different antibodies. Most IgG 0 antibodies react best at warm temperature(37 C) while IgM antibodies, cold reacting antibodies react best at room 0 temperature and coldest temperature(4 to 22 C). Ionic strength: lowering the ionic strength of the medium increases the rate of agglutination of antibody with antigen. IgM antibodies, referred to as complete antibodies, are more efficient than IgG or IgA antibodies in exhibiting in vitro agglutination when the antigen - bearing erythrocytes are suspended in physiologic saline. Centrifugation: centrifugation at high speed attempts to over come the problem of distance in sensitized cells by physically forcing the cells together. Trypsin, ficin, bromelin, papain) removes surface sialic acid residue- by which red cells exert surface negative charge, thereby reducing the net negative charge of the cells, thus lowering the zeta potential, and allowing the cells to come together for chemical linking by specific antibody molecules. Colloidal media: certain anti-D sera especially some IgG antibodies of the Rh system would agglutinate Rh positive erythrocytes suspended in colloid (bovine albumin) if the zeta potential is carefully adjusted by the addition of the colloid. Ratio of antibody to antigen: There must be an optimum ratio of antibody to antigen sites for agglutination of red cells to occur. In prozone phenomena (antibody excess), a surplus of antigens combining site which are not bound to antigenic determinants exist, producing false- negative reactions. It is also important to ensure that the red cell suspension used in agglutination test must not be too week or too strong, as heavy suspension might mask the presence of a weak antibody. Red cell suspension can be prepared directly from anticoagulated blood or from packed red cell (after separating the serum or plasma).