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By T. Grompel. Mt. Sierra College.

The pia mater cheap citalopram 20mg line symptoms after flu shot, a thin inner membrane, lies close along the surface of the central nerv- ous system. The pia mater and arachnoid may adhere to each other and are considered as one, called pia-arachnoid. There are spaces or cavities between the pia mater and the arachnoid where major regions join, for instance where the medulla oblongata and the cerebellum join. Spaces or cavities between the arachnoid layer and the dura mater layer are referred to as subdural. Two types of solid material make up the inside of the cord, which you can see in Figure 15-2: gray matter (which is indeed grayish in color) containing unmyelinated neurons, dendrites, cell bodies, and neuroglia; and white matter, so-called because of the whitish tint of its myelinated nerve fibers. At the cord’s midsection is a small central canal surrounded first by gray matter in the shape of the letter H and then by white matter, which fills in the areas around the H pattern. The legs of the H are called anterior, posterior, and lateral horns of gray matter, or gray columns. Posterior (dorsal) Lateral white column root of spinal nerve Posterior (dorsal) Posterior gray horn root ganglion Posterior median sulcus Spinal nerve Posterior white column Anterior (ventral) root of spinal nerve Gray commissure Central canal Axon of sensory neuron Figure 15-2: A cross- Anterior gray horn Cell body of sensory neuron section of Anterior white column Lateral gray horn the spinal Anterior white cord, show- commissure Dendrite of sensory neuron ing spinal Cell body of motor neuron nerve con- nections. Anterior median fissure Axon of motor neuron Illustration by Imagineering Media Services Inc. The white matter consists of thousands of myelinated nerve fibers arranged in three funiculi (columns) on each side of the spinal cord that convey information up and down the cord’s tracts. Ascending afferent (sensory) nerve tracts carry impulses to the brain; descending efferent (motor) nerve tracts carry impulses from the brain. Each tract is named according to its origin and the joint of synapse, such as the corti- cospinal and spinothalmic tracts. Thirty-one pairs of spinal nerves arise from the sides of the spinal cord and leave the cord through the intervertebral foramina (spaces) to form the peripheral nervous Chapter 15: Feeling Jumpy: The Nervous System 245 system, which we discuss in the later section “Taking Side Streets: The Peripheral Nervous System. In this section, we review six major divisions of the brain from the bottom up (see Figure 15-3): medulla oblongata, pons, midbrain, cerebellum, diencephalon, and cerebrum. Medulla oblongata The spinal cord meets the brain at the medulla oblongata, or brainstem, just below the right and left cerebellar hemispheres of the brain. In fact, the medulla oblongata is con- tinuous with the spinal cord at its base (inferiorly) and back (dorsally) and located anteriorly and superiorly to the pons. All the afferent and efferent tracts of the cord can be found in the brainstem as part of two bulges of white matter forming an area referred to as the pyramids. Many of the tracts cross from one side to the other at the pyramids, which explains why the right side of the brain controls the left side of the body and vice versa. Along with the pons, the medulla oblongata also forms a network of gray and white matter called the reticular formation, the upper part of the so-called extrapyramidal pathway. With its capacity to arouse the brain to wakefulness, it keeps the brain alert, directs messages in the form of impulses, monitors stimuli entering the sense recep- tors (accepting some and rejecting others it deems to be irrelevant), refines body movements, and effects higher mental processes such as attention, introspection, and reasoning.

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Several areas of assessment in which the clinical forensic nurse specialist in trauma care may become involved include: 1 generic 10mg citalopram with visa symptoms vs signs. Evidence from both crime- related and self-inflicted traumas must be safeguarded in a 358 Forensic Nursing ● 359 manner consistent with the investigation. Evidence such as clothing, bullets, bloodstains, hairs, fibers, and small pieces of material such as fragments of metal, glass, paint, and wood should be saved and documented in all medical accident in- stances that have legal implications. Sharp-Force Injuries: Sharp-force injuries including stab wounds and other wounds resulting from penetration with a sharp object. Blunt-Force Injuries: Includes cuts and bruises resulting from the impact of a blunt object against the body. Dicing Injuries: Multiple, minute cuts and abrasions caused by contact with shattered glass (e. Patterned Injuries: Specific injuries that reflect the pattern of the weapon used to inflict the injury. Defense Wounds: Injuries that reflect the victim’s attempt to defend himself or herself from attack. Hesitation Wounds: Usually superficial, sharp-force wounds; often found perpendicular to the lower part of the body and may reflect self-inflicted wounds. Fast-Force Injuries: Usually gunshot wounds; may reflect various patterns of injury. When deaths oc- cur in the emergency department as a result of abuse or acci- dent, evidence must be retained, the death must be reported to legal authorities, and an investigation is conducted. It is therefore essential that the nurse carefully document the appearance, condition, and behavior of the victim upon ar- rival at the hospital. The information gathered from the cli- ent and family (or others accompanying the client) may serve to facilitate the postmortem investigation and may be used during criminal justice proceedings. The critical factor is to be able to determine if the cause of death is natural or unnatural. A death is deemed natural if it occurs because of a congenital anomaly or a disease process that interferes with vital organ functioning (Lynch, 2006). Those that are considered natural most commonly involve the cardiovascular, respiratory, and central nervous sys- tems. Deaths that are considered unnatural include those from trauma, from self-inflicted acts, or from injuries inflicted by an- other. Legal authorities must be notified of all deaths related to unnatural circumstances. Possible Etiologies (“related to”) Physical and/or psychosocial abuse Tragic occurrence involving multiple deaths Sudden destruction of one’s home or community Epidemics Disasters Rape Serious accidents (e.

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It is always a good idea to give the patient and family members material that they can take home and review at their leisure effective citalopram 10 mg medicine 513. It is very important that written information be at a reading level that can be understood by the patient and family. For example, show the proper injection techniques if the patient requires insulin injections or the correct use of bronchodilator inhalers for asthma. Make sure to have the patient and family members show you how they plan to give the medication. This is especially critical when medication is given using a syringe, topical drugs, and inhalers. The patient and the caregiver must have visual acuity, manual dex- terity, and the mental capacity to prepare and administer medication. Prompt the patient and family members to give you feedback from your les- son and demonstration by asking: • What things help you take your medicine? It is very important that the patient and family members be informed about the signs and symptoms of an allergic response to the medication such as urticaria (hives), swollen lips, hoarse voice, difficulty breathing, and shortness of breath—an indication of life threatening anaphylaxis. In addition to the signs and symptoms of an allergic response, you must also discuss side effects and toxic effects of the medication and any dietary consid- erations the patient must follow while on the medication. Therefore, the nurse needs to de- velop a medication plan to help the patient manage the medication schedule. These influences include the patient’s belief about health such as: • What healthcare can do for the patient • The patient’s susceptibility to disease • The benefits of taking steps to prevent disease • What makes a patient seek healthcare • What makes a patient follow healthcare guidelines For example, a patient who is a coal miner may believe that all coal miners will eventually have lung cancer. Another patient may avoid taking pain medication for fear that they might become addicted. For example, although garlic does lower blood pressure, taking garlic as an herbal cure might be dangerous if the patient is also taking antihypertensive medication because the patient’s blood pressure could be lowered too much. Herbal reme- dies are preferred by some cultures over traditional Western medicine and some patients continue herbal treatment even when a mild illness progresses to a crit- ical level. A patient may refuse any treatment because of the sole belief in the healing power of prayer. Healthcare providers must be nonjudgmental and tolerate alternative beliefs in healthcare even if those beliefs are harmful to the patient. When con- fronted with cultural differences that can result in an adverse effect to the patient, healthcare providers can educate the patient about the benefits of medications and treatment and the risk that the patient is exposed to by not following rec- ommended treatment. This information is sometimes best given while the health- care provider is assessing the patient. The nurse should be careful to remain nonjudgmental about the patient’s decisions. Cultural beliefs can also influence who makes healthcare decisions for the family.

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The researcher and the researcher-into are inte- are the best judges of the authenticity and va- gral: The principle of integrality implies that lidity of their own experiences purchase citalopram 10 mg without prescription medicine 770, perceptions, the researcher is inseparable and in mutual and expressions. Participatory action designs process with the environment and the partici- and focus groups conceptualized within pants in the study. Each evolves during the re- Rogerian science may be ways to enhance mu- search process. The researcher’s values are also tual exploration, discovery, and knowing par- inseparable from the inquiry. Evolutionary interpretation: The researcher in- and environmental field are integral to each terprets all the findings within the perspective other. Purposive sampling: The researcher uses pur- the findings are understood and presented posive sampling to select participants who within the context of Rogers’ postulates of en- manifest the phenomenon of interest. Recogni- ergy fields, pandimensionality, openness, pat- tion of the integrality of all that is tells us that tern, and the principles of integrality, reso- information about the whole is available in in- nancy, and helicy. There is be explored is participatory action and cooperative strong support for the appropriateness of phenom- inquiry (Reason, 1994), because of their congru- enological methods in Rogerian science. Reeder ence with Rogers’ notions of knowing participation (1986) provided a convincing argument demon- in change, continuous mutual process, and inte- strating the congruence between Husserlian phe- grality. Cowling (1998) proposed that a case- nomenology and the Rogerian science of unitary oriented approach is useful in Rogerian research, human beings: because case inquiry allows the researcher to attend to the whole and strives to comprehend his or her [G]iven the congruency between Husserlian phenom- enology and the Rogerian conceptual system, a essence. Husserlian flows from the postulates, principles, and concepts phenomenology as a rigorous science provides just relevant to the conceptual system. Creativity, mystical experiences, tran- the findings in a way that is consistent with Rogers’ scendence, sleeping-beyond-waking experiences, notions of unpredictability, integrality, and nonlin- time experience, and paranormal experiences as earity. Emerging interpretive evaluation methods, they relate to human health and well-being are also such as Guba and Lincoln’s (1989) Fourth of interest in this science. Feelings and experiences Generation Evaluation, offer an alternative means are a manifestation of human/environmental field for testing for differences in the change process patterning and are a manifestation of the whole within and/or between groups more consistent (Rogers, 1970); thus, feelings and experiences rele- with the Science of Unitary Human Beings. Discrete stages of theory development, designs that generate particularistic biophysical phenomena are usually descriptive and explanatory knowledge are relevant not an appropriate focus for inquiry because to the Science of Unitary Human Beings. New concepts with power have been found with anxiety, chronic that describe unitary phenomena may be devel- pain, personal distress, and hopelessness (Caroselli oped through research. For example, the metaphor (Butcher, 2002b), caring (Smith, 1999), and energy “I feel at one with the universe” reflects a high de- (Leddy, 2003; Todaro-Franceschi, 1999) are exam- gree of awareness of integrality; “I feel like a worn- ples of concepts that have been reconceptualizied in out shoe” reflects a more restricted perception of one’s potential (Johnston, 1994; Watson et al. Future research may focus on developing an Researchers need to ensure that concepts understanding of how human field image changes and measurement tools used in the inquiry in a variety of health-related situations or how are defined and conceptualized within a human field image changes in mutual process with unitary perspective. Diversity is inherent in the evolution of the a way congruent with Rogers’ principles and postu- human/environmental mutual field process. Researchers need to ensure that concepts and evolution of the human energy field is character- measurement tools used in the inquiry are defined ized by the creation of more diverse patterns re- and conceptualized within a unitary perspective.