...Volume 2, No. 1, 2006 Trichotillomania: Behavioral Assessment and Treatment Interventions Brandy L. Kell & Victoria E. Kress Abstract This article examines the behavioral treatment of Trichotillomania. A brief overview of the diagnosis and assessment of Trichotillomania is provided. Guidelines for a structured clinical evaluation when working with people diagnosed with Trichotillomania are supplied. The most effective behavioral interventions and treatments for working with client’s diagnosed with Trichotillomania are discussed. Keywords: Trichotillomania, Behavioal Assessment,Behavior Treatment Introduction The reported incidence of Trichotillomania is rising with an estimated prevalence rate of 1%, suggesting that nearly 2.5 million people in the United States have this disorder (Diefenbach, Reitman, & Williamson, 2000). Increased attention should be given to the assessment and treatment of Trichotillomania to fulfill the escalating needs of those dealing with this mental disorder. There is a tendency for the severity of this disorder to be overlooked due to the underestimation of prevalence, and high rate of comorbidity with other psychological disorders (Mulinari-Brenner & Bergfeld, 2001). This article will provide suggestions for the behavioral assessment and treatment of Trichotillomania. It is helpful for individuals to become familiar with the diagnostic features of Trichotillomania to establish the proper assessment and treatment of this disorder. The disorder was introduced...
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...Health History and Examination Health Assessment of the Head, Neck, Eyes, Ears, Nose, Mouth, Throat, Neurological System, and the 12 Cranial Nerves Skin, Hair, Nails, Breasts, Peripheral Vascular System, Lymphatics, Thorax, Heart, Lungs, Musculoskeletal, Gastrointestinal, and Genitourinary Systems Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include relevant data for your client. |Student Name: xx |Date: 03/22/2015 | |Client/Patient Initials: I.F |Sex: Female |Age: 76 | |Occupation of Client/Patient: Stay at home | | |Health History/Review of Systems | | |(Complete and systematic review of systems) | | |Neurological System (headaches, head injuries, dizziness, convulsions, tremors, weakness, numbness, tingling, difficulty speaking, | | |difficulty swallowing, etc., medications): | | |dizziness once in a while. ...
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...Health Assessment of the Head, Neck, Eyes, Ears, Nose, Mouth, Throat, Neurological System, and the 12 Cranial Nerves Skin, Hair, Nails, Breasts, Peripheral Vascular System, Lymphatics, Thorax, Heart, Lungs, Musculoskeletal, Gastrointestinal, and Genitourinary Systems Save this form on your computer as a Microsoft Word document. You can expand or shrink each area as you need to include relevant data for your client. Student Name: | Date: | Client/Patient Initials: | Sex: | Age: | Occupation of Client/Patient: | Health History/Review of Systems(Complete and systematic review of systems) | Neurological System (headaches, head injuries, dizziness, convulsions, tremors, weakness, numbness, tingling, difficulty speaking, difficulty swallowing, etc., medications): Patient is oriented x3. No major memory deificit was noted or reported. Patient if forgetful at times due to the aging. Has BLE muscle weakness and pain due to the disease process. No history of tremors or seizures was reported. No numbness or tingling was reported. Patient speech is clear; no difficulty in swallowing was reported or observed. Patient takes Aspirin 81mg PO daily prophylactically. | Head and Neck (pain, headaches, head/neck injury, neck pain, lumps/swelling, surgeries on head/neck, medications): Per patient “I get occasional headaches but is relived with the pain medication. I have LBP less often then daily but is relieved with the medications”. On assessment no swelling...
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...Tinnitus can intrude with listening to but doesn’t cause listening to loss Tinnitus is a symptom associated with many ear disorders. A common purpose of tinnitus is inner ear damage. Tiny, sensitive hairs for your inner ear pass with the stress of sound waves. That movement triggers the cells in your ear to release an electrical sign. The sign travels from your ear, via the auditory nerve and into your brain. Your mind interprets the sign as sound. If the hair cells interior your inner ear are broken, bent or otherwise damaged, they may spark random electrical impulses in your brain, inflicting tinnitus. some of the ear conditions that may cause tinnitus consist of exposure to loud sound, age-related listening to loss, earwax buildup and adjustments...
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...Types and Sources of Loss Throughout life, individuals form countless attachments and in turn experience losses. Loss is experienced in numerous situations; from the loss of a loved one to the loss of a meaningful possession. There are different types of loss: Loss of possessions or objects, loss of a known environment, loss of a significant other, loss of an aspect of self, and loss of life (Potter, 2013, pg. 709). Necessary loss is a loss that everyone experiences and is the result of simply moving forward in life. Further, a maturational loss is a form of necessary loss and includes all losses normally expected as a person progresses through life. A sudden, unexpected external event may cause a situational loss. A situational loss results from a change in a life situation. This could be the loss of a person, object, physical/mental quality. In addition, losses can be actual or perceived (Potter, 2013, pg. 709). Ambiguous loss, is a type of disenfranchised grief that occurs when the lost person is still physically present but their personality or mental status is lost such is in severe dementia or brain injury(Potter, 2013, pg. 710). Nursing interventions and rationales for caring for the body after death The RN is responsible for providing safe and appropriate nursing care following death. Depending on the state and/or facility, different events may occur after death. Organ and tissue donation, and autopsy, may or may not occur depending on the circumstances...
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...Adult Health History and Examination RN Health Assessment and Screening NRS 434-V Health History and Examinati Client/Patienton Initials: LH Sex: F Age: 47 Occupation: Registered Nurse Health History/Review of Systems Neurological System headaches, head injuries, dizziness, convulsions, tremors, weakness, numbness, tingling, difficulty speaking, and difficulty swallowing etc., medication): Neurologically JP is intact. Alert ox3 clear speech with no hesitations, c/o headaches and dizziness occasionally, upon arising in the am. She admits being “little stressed to family situations” and rotating shifts (DAYS/NIGHTS). Suggested to seek EAP (Employee Assistance Program) at work Head and Neck (pain, headaches, head/neck injury, neck pain, lumps/swelling, surgeries on head/neck, medications: LH has full ROM to neck and head, closes her eyes and able to hold her arms and hands out without swaying. LH takes Motrin 800mg for headaches. Motrin (ibuprofen) is a no steroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body. This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking Motrin, especially in older adults. Nursing Drug Handbook (2013) Eyes (eye pain, blurred vision, history of crossed eyes, redness/swelling in eyes, watering, tearing, injury/surgery to...
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...A comprehensive assessment of the geriatric patient is very important for many reasons and the first being a baseline if nothing else. Today when we use the term geriatric or elderly this does not mean that this person is in a wheelchair or walking with a walker, it is in regards to where they are in their lifespan. Therefore a comprehensive assessment for one may be totally different for another. The healthcare provider needs to keep in mind that this could make the geriatric patient have feelings of hopelessness and helplessness. Comprehensive geriatric assessment (CGA) should being with collecting a health history by interviewing the patient and their family members if needed. The healthcare provider wants to promote an efficient exchange of information and build a rapport with the patient and family. The healthcare provider needs to speak clearly and minimize distractions, give a brief overview of what you will be doing (Lynder, 2011). The CGA can also be done with an interdisciplinary team (Hirth, 2003). The healthcare providers are looking for current and past medical history. A list of current prescription and non-prescription medications are to be recorded. Next we can move to the physical examination, head-to-toe assessment. The healthcare provider would start by assessing: * The skin, looking for moles that are dark or irregular in size, bruising and elasticity of the skin. Checking for pressure ulcers or sores that are not healing properly (Lynder, 2011). ...
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...Adult Health History and Examination ND Health Assessment and Screening NRS 434-V Health History and Examination LH Client/Patient Initials: LH Sex: F Age: 47 Occupation: Registered Nurse Health History/Review of Systems Neurological System headaches, head injuries, dizziness, convulsions, tremors, weakness, numbness, tingling, difficulty speaking, and difficulty swallowing etc., medication): Neurologically JP is intact. Alert ox3 clear speech with no hesitations, c/o headaches and dizziness occasionally, upon arising in the am. She admits being “little stressed to family situations” and rotating shifts (DAYS/NIGHTS). Suggested to seek EAP (Employee Assistance Program) at work Head and Neck (pain, headaches, head/neck injury, neck pain, lumps/swelling, surgeries on head/neck, medications: LH has full ROM to neck and head, closes her eyes and able to hold her arms and hands out without swaying. LH takes Motrin 800mg for headaches. Motrin (ibuprofen) is a no steroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body. This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking Motrin, especially in older adults. Nursing Drug Handbook (2013) Eyes (eye pain, blurred vision, history of crossed eyes, redness/swelling in eyes, watering, tearing, injury/surgery...
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...tone. Dermis - The dermis, beneath the epidermis, contains tough connective tissue, hair follicles and sweat glands. Hypodermis - The deeper subcutaneous tissue (hypodermis) is made of fat and connective tissue. Skin serves several functions such as: Regulation of body temperature. In response to high environmental temperature or strenuous exercise, the evaporation of sweat from the skin surface helps lower an elevated body temperature to normal. In response to low environmental temperature, production of sweat is decreased, which helps conserve heat. Changes in the flow of blood to the skin also help regulate...
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...hypertension, who is admitted to the nursing home 2 weeks ago because of memory loss that disrupts his daily life, especially forgetting recently learned information. He is disoriented to place, time and person. He has trouble to understand something if it is not happening immediately. His communication is not clear, so he is unable to follow the interview and has difficulties finding the right words during assessment. Skin was cool to touch with normal color according to age, but we notice a breakdown of the skin at the level of his calf muscle (left leg). His family complaints about his constant need to urinate, and he is unable to delay going to the toilet. He also complaint about muscle weakness at the level of his lower extremities evidenced by inability to perform what he wants to do with his legs every time he tries. In addition, a Braden Scale was performed to determine whether this patient is at high risk for pressure ulcers. He has a total risk score of 17, which places him at mild risk for the development of wounds. Next, a...
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...1. Using the Rule of Nines, A.N. sustained burns to 45% of her body when combing A&P sites. 2. Criteria to assess includes burns on the face and neck, singed nasal hair, hoarse, dry cough, bloody/sooty sputum, labored respirations. Additionally, edema, blisters, and ulcerations along the mucosal lining of the oorpharyngeal and laryngeal sites. The edema may continue to increase for 24-48 hours post injury, so close pulmonary assessment is pertinent. Asses initially for need of intubation with mechanical ventilation, continuous O2 saturation monitoring, pulmonary toilet, and CXR. Careful assessment in the order of respiratory distress and airway obstruction is essential. Assess for deep facial and neck burns, stridor, accessory muscle use, hypoxia, blistering/edema to the oropharyngeal airway, continuous ABG assessment in the order of intubation and mechanical ventilation need. 3. H&G 20 and 51 increase during the first 24-48 hours post inhalation injury secondary to hemoconcentration related to intravascular fluid volume loss. This is proportional to the level of fluid volume. As fluid returns to the intravascular space, H&H levels return to normal. H&H should decrease with adequate hydration. Serum potassium of 4.9 initially is expected to increase secondary to cellular lysis and fluid shifts to extracellular...
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...Tan, Lecluyse, McFerran and Meddis conducted a study comparing cochlear function between individuals with hearing-impairment with tinnitus, hearing-impairment without tinnitus, and a control group of individuals without hearing-impairment or tinnitus. The specific pathophysiology of tinnitus is unclear, some believe it is associated with outer hair cell damage. Outer hair cell damage as a cause is questionable since some patients continue to have tinnitus sensations “after cochlear ablation or auditory nerve section” (Tan, Lecluyse, McFerran & Meddis, 2013, p. 275). This study found that both groups had a similar average hearing loss, but “tinnitus patients were observed to have better frequency selectivity and compression than those without...
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...Neurological System (Headaches, head injuries, dizziness, convulsions, tremors, weakness, numbness, tingling, difficulty speaking, difficulty swallowing, etc., medications): Patient denies any head injuries, headaches, convulsions, tremors, numbness, tingling, difficulty speaking or swallowing. Patient denies taking any medication in correlation to her neurological system. Patient states, “When I get up sudden I have to wait a moment because I get dizzy.” Head and Neck (Pain, headaches, head/neck injury, neck pain, lumps/swelling, surgeries on head/neck, medications): Patient denies any problems in the head and neck but states, “When I travel I bring a special pillow because my neck gets sore on the wrong pillows.” Patient denies taking medication. Eyes (eye pain, blurred vision, history of crossed eyes, redness/swelling in eyes, watering, tearing, injury/surgery to eye, glaucoma testing, vision test, glasses or contacts, medications): Patient states she has a history of dry macular degeneration and it is being well controlled. Patient uses special eye drops for her eye disease. Patient wears corrective lenses at all times for both reading and sighting with blurred vision occasionally. Negative glaucoma testing 02/15/2014Eye surgery in relation to the macular degeneration 08/13/2013 Ears (Earache or other ear pain, history of ear infections, discharge from ears, history of surgery, difficulty hearing, environmental noise exposure, vertigo, medications): Patient...
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...Physical Assessment Mental Status: My patient is alert and knows his orientation. He is coherent and is able to recall recent and remote events. He appears healthy and shows no signs of distress or anxiety. Skin & Nails: His skin appears to be tanned in color. There is no bleeding or a rash present but has a dime size contusion on right bicep. No signs of puffiness or pitting on the skin. The skin has a smooth texture with a warm touch and doesn’t appear too dry or moist. Patient doesn’t show any signs of dehydrations which means turgor is great along with skin mobility. The nails are pink in color and well cleaned. The branch test shows great capillary refill and no signs of nail clubbing and has an angle of 150 degrees. Head: The patient’s hair is brown with little gray in it. No signs of hair loss and appears clean and shiny. He has no lesions, lice, or lumps present. The scalp appears to have normal distribution of hair on it. Face shows symmetry with appropriate facial movements and CN VII is intact. The patient has sensation in all six locations which indicates CN V is intact. The contraction of the masseter and temporal muscle feel normal and appear symmetrical and has no signs of temporomandibular joint disorder. Neck: The patient had no difficulties completing range of motion. He has no masses/scars present and symmetry appears great. All nodes feel within normal range and no signs of swelling or inflammation. The trachea is mid-line, thyroid gland is normal without...
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...What Is the Use of Elephant Hair? Conor L. Myhrvold1, Howard A. Stone2, Elie Bou-Zeid1* 1 Department of Civil and Environmental Engineering, Princeton University, Princeton, New Jersey, United States of America, 2 Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, New Jersey, United States of America Abstract The idea that low surface densities of hairs could be a heat loss mechanism is understood in engineering and has been postulated in some thermal studies of animals. However, its biological implications, both for thermoregulation as well as for the evolution of epidermal structures, have not yet been noted. Since early epidermal structures are poorly preserved in the fossil record, we study modern elephants to infer not only the heat transfer effect of present-day sparse hair, but also its potential evolutionary origins. Here we use a combination of theoretical and empirical approaches, and a range of hair densities determined from photographs, to test whether sparse hairs increase convective heat loss from elephant skin, thus serving an intentional evolutionary purpose. Our conclusion is that elephants are covered with hair that significantly enhances their thermoregulation ability by over 5% under all scenarios considered, and by up to 23% at low wind speeds where their thermoregulation needs are greatest. The broader biological significance of this finding suggests that maintaining a low-density hair cover can be evolutionary purposeful...
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