...Chapter 1 1.1 Introduction By synthesizing the data from various studies and research, this dissertation will aim to systematically review the current literature of evidence for therapeutic hypothermia (TH) post cardiac arrest. The research question is as follows: does therapeutic hypothermia treatment present positive neurological outcomes for post cardiac arrest victims? 1.1a Rationale: Whilst working in the Intensive Care Unit, I had the opportunity to witnessed a patient being cooled (therapeutic hypothermia concept) after experiencing out of hospital post cardiac arrest. I was intrigued to learn more about the concept as I had never heard or seen it done before. This prompted me to research further on the evidence based practice pertinent to TH treatment on post cardiac arrest victims. Patients who have suffered post cardiac arrest are usually cared for in a critical care environment such as the intensive care unit (ICU), and the survival rate for in hospital incidents is considered to be poor (Gwinnut et al 2000). Furthermore, according to Becker (1993) and Rea (2004), approximately 0.04% to 0.19% of out of hospital cardiac arrest incidence occur each year in industrial countries. Around 14% to 40% of these victims regain Return of Spontaneous circulation (Giraud 1996, Finn 2001, Fischer 1997), and only 7% to 30% were able to attain good neurological outcomes on discharge (Jennings 2001, Westfal 1996, Weston 1997). By critically reviewing the literature of evidence...
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...can exacerbate the degree of permanent neurological damage following cardiac arrest. Each degree Celsius higher than 37C can cause cerebral destruction through increased metabolic expenditure, excitatory neurotransmitters resulting in calcium cellular reflux and accumulation of oxygen free radicals (Busto et al., 1987). To improve the outcome of patients who survive cardiac arrest requires not only reducing the ischemic process as quickly as possible, caused by cardiac arrest, but also preventing post resuscitation syndrome caused from reperfusion (Safar, 1993). Cerebral reperfusion after successful resuscitation can trigger harmful chemical cascades such as oxygen free radical production which can result in multifocal brain damage. Therapeutic hypothermia (TH) is considered as an effective method for reducing the deleterious neurological outcomes in patients who have out-of-hospital cardiac arrest. Clinical and animal studies have shown that TH following cardiac arrest reduces both the cerebral metabolic rate and oxygen demand and it is thought to attenuate reperfusion injury, global inflammation and endothelial dysfunction, all consequences of cerebral ischemia. Over the...
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...of why acknowledging your own biases may be helpful when working with clients. As a future mental health professional being in the position of a client, that is seeing a therapist whose background is different from mine whether by ethnicity, linguistics or even sexuality I would crave for them to be understanding, non-judgmental and respectful of my beliefs and values. In reflecting an understanding attitude, it would be very important for me that the therapist displays keen listening skills; as these attitudes of listening can either assist in promoting a free flowing dialogue between myself and the therapist or build a wall which may prevent me from expressing my feelings on the challenges and issues I am currently facing. In the therapeutic relationship, it is important that the client feels that the therapist is not critical and judgmental towards them and displays a high level of "caring and compassion toward the client even if they have confessed their deepest secrets and hidden desires" (Brew and Kottler, 2008; p.115). Another aspect of being understanding on the part of the therapist is the therapist's body language. Especially with the therapist's cultural differences certain actions in relation to body language may have differing meaning and thus depending on the action may be construed as being offensive. With body language being so important Ivey, Ivey and Zalaquett (2010) noted that if the therapist faces the client squarely, leans forward slightly, has a positively...
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...the nurse to carry out safe medication administration, monitor medication actions, educate patients, and act legally and ethically within the pharmacological parameters. This knowledge is also vital for the nurse practititioner in their role of nurse prescribing. Pharmacology plays a huge part in these roles for the nurse. This essay below will elaborate on the importance of pharmacology for the five reasons of safe medication administration, monitoring of medication actions, patient education, legal and ethical aspects of pharmacology and the nurse practitioner. Firstly, safe medication administration. To administer drugs safely it is the nurse’s responsibility to have knowledge of the prescribed medications as well as their therapeutic and non therapeutic effects. Knowledge of the medications include, knowing its approved drug name and classification, correct dose and route of administration. A medication may have as many as three different names- a chemical name, a generic (proprietary) name and a trade name (Crisp & Taylor, 2011). A chemical name refers to the chemical makeup of a drug, a generic name is the drug name listed in official publications such as the MIMS annual, and the trade name is the name manufacturers have registered the medication as. In a clinical setting medication is normally dispensed using the generic name to avoid confusion, but because medications may come under a number of different names nurses must be able to identify the exact name and spelling so...
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...Therapeutic Touch By Chelsie Boyce Let me begin by saying that after watching several videos (including those provided by you) and reading even more articles, I am more mixed about my acceptance of therapeutic touch. Before this assignment I would have said I was strongly against this practice, but now I am more open to the idea. However, I still believe that therapeutic touch is not a true form of medical healing. To begin with, the Merriam-Webster's Medical Desk Dictionary states that this alternative medicine is a practice where the nurse or practitioner treats a patient by passing his or her hands over a person’s body to promote relaxation, pain reduction and or healing. I must say that the thought of someone’s hands hovering over my body kind of makes me giggle. I keep replaying a scene from Karate Kid over and over again in my head and thinking “yea right” if only it were that easy. After reviewing my resources, I am still very skeptical. Yes, some stated that patients believed they were doing better. But to me that was just it… a belief. Those who had a strong faith in this technique did show signs of relaxation and possible improvement, but I am not sure if the technique caused the reaction or the patient themselves invited the result. Just like Emily Rosa’s experiment supported, as nurses or practitioners we want to believe we can feel the energy being given off and that we are interacting with our patient. Yet, more times than not we are wrong. Along...
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...Name ____________________________________________________________ NVCC Pharm HW 9 summer 2015 (chap 31) 1. Why is the pituitary called the ‘master gland’? 2. What is a common use of clomiphene(Clomid) for women? How is a dose of Clomid likely to make the woman feel (side effects)? What adverse reaction to Clomid did Octomom experience? 3. What is a common use of chorionic gonadotropin in little boys? * In grown men? * How might it make the patient feel? 4. What does somatropin (Humatrope) to to children (the therapeutic effect)? 5. 2 serious hormonal conditions might result for growth hormone therapy: what are they? 6. Cosyntropin may be used for inflammatory conditions when _____________________________ wasn’t successful. When you look at the long list of adverse reactions (p 316) you notice that they are the same as __________________________________________ drugs. 7. What drug may be used to treat diabetes insipidus? Does diabetes insipidus have ANYTHING to do with diabetes mellitus? 8. What is a post op use of vasopressin? What should be taken before a dose of vasopressin? 9. We have talked about glucocorticoids (steroid drugs). Recall adverse effects on: Fluids and electrolytes: Bones: Stomach: Immune system: Skin: Knowing all that, what kind (s) of patient is at a lot of risk for dangerous complications of steroid therapy? 10. fludrocortisone (Florinef) is...
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...The Placebo Effect For years, scientists have sought to find an explanation for the placebo effect. Although many hypotheses exist, there is no one reason defining why or how the placebos work. Some researchers argue that the phenomenon doesn't even occur; that the placebo effect is merely random mistake and that any improvement said to be caused by a placebo is only a spontaneous recovery in the patient's condition. Other scientists argue that Pavlovian conditioning supports an explanation for the effect: If patients have previously shown improvement from being in a medical setting or from taking medicine, they are conditioned to experience positive effects every time they are in the same situation. A second explanation for the placebo effect is that any drug (or placebo) given to a patient will reduce their stress levels. Because many illnesses begin under high-stress circumstances, or exhibit more extreme symptoms under stressful situations, many of the patient's symptoms are likely to improve. The first question that must be answered before researching into the expectations behind the placebo effect is whether or not the wonder even exists. Certain physicians and scientists claim that "positive effects" of a placebo are, in reality, just the body's natural ways of healing itself and the immune system's defenses kicking in soon after the placebo is taken. Basically, these researchers argue that improvement in a patient's condition after being administered a placebo...
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...J Clin Epidemiol Vol. 50, No. 12, pp. 1311–1318, 1997 Copyright © 1997 Elsevier Science Inc. 0895-4356/97/$17.00 PII S0895-4356(97)00203-5 The Powerful Placebo Effect: Fact or Fiction? Gunver S. Kienle* and Helmut Kiene ¨ Institut fur Angewandte Erkenntnistheorie und Medizinische Methodologie, D-79112 Freiburg, Germany ABSTRACT. In 1955, Henry K. Beecher published the classic work entitled ‘‘The Powerful Placebo.’’ Since that time, 40 years ago, the placebo effect has been considered a scientific fact. Beecher was the first scientist to quantify the placebo effect. He claimed that in 15 trials with different diseases, 35% of 1082 patients were satisfactorily relieved by a placebo alone. This publication is still the most frequently cited placebo reference. Recently Beecher’s article was reanalyzed with surprising results: In contrast to his claim, no evidence was found of any placebo effect in any of the studies cited by him. There were many other factors that could account for the reported improvements in patients in these trials, but most likely there was no placebo effect whatsoever. False impressions of placebo effects can be produced in various ways. Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena...
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...Technique Identifier Aphasic Technique 1 Selected Option/ Result Nontherapeutic Result: Correct Rationale Dismissive behavior is an ineffective style of interpersonal communication because the nurse indicates that another person’s opinions or presence is not wanted or needed. Technique 2 Selected Option/ Result Therapeutic Result: Correct Rationale Displaying a caring attitude supports the establishment of a therapeutic relationship by conveying genuine concern and a feeling of emotional closeness, which results in the nurse’s ability to achieve a greater level of communication and understanding with the client. Technique 3 Selected Option/ Result Therapeutic Result: Correct Rationale Clarifying is a therapeutic communication technique because it allows the nurse to validate the message received to ensure that both the nurse and client have a mutual interpretation of the message. Page 1 of 3 Report Created on: 10/19/2015 06:47 PM EDT REP_NTIndv_CommModuleReport_1_0 Technique 4 Selected Option/ Result Therapeutic Result: Correct Rationale Focused questions are a therapeutic communication technique because they allow the nurse to clarify a message, collect data, encourage feedback, and confirm the client’s ideas and beliefs. Technique 5 Selected Option/ Result Nontherapeutic Result: Correct Rationale Shaming is an ineffective style of interpersonal communication because the nurse mistreats...
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...sufficiently. The lungs become over saturated with blood and the pressure from the right side causes a shift of fluid from the intravascular space into the lungs causing increased respiratory rate and impaired gas exchange. The patient’s symptoms are shortness of breath and cough, swollen ankles due to the excess fluid build up and fatigue. X-ray shows congestion in the middle and lower lungs. The patient was also taking digoxin on admission which is a drug commonly used for treating patients with CHF (Figueroa & Peters, 2006). 2. Digoxin toxicity, Digoxin toxicity is caused by high levels of digoxin in the body a drug Mr Marshall is currently prescribed. His digoxin levels are 2.4 ng/mL and the therapeutic range is 0.6 to 1.3 ng/mL showing increased levels beyond the therapeutic range (Chan, Bradley & Harrigan, 2002). Mr Marshall’s irregular pulse as well as his nausea and vomiting are clinical symptoms of digoxin toxicity (Ehle, Patel, Chandni & Giugliano, 2011). Question 1.2 Explain why Mr Marshall is prescribed the following medications in relation to his past medical history. Include in your response the related medical condition, drug action and category. Digoxin; this medication is prescribed to Mr Marshall to treat atrial fibralation a past condition of the patient....
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...Equine Therapy November 2014 Equine assisted therapy is a means to promote personal, physical, emotional, and mental growth in a child that is otherwise therapy resistant. In an Autistic child who is non-verbal, has poor social skills, and is inflexible with routines and schedules, Equine assisted therapy is a big step towards personal growth. When a child participates in Equine therapy they learn a sense of responsibility by learning how to properly care for and clean up after the horses. They develop a sense of belonging, of feeling like they finally fit in somewhere because they are constantly surrounded by the same people, who don't make fun of them, and are in a way just like them. Gradually and continuously participating in this type of therapy gives a child a humongous self-esteem boost because once they are able to conquer the ability to control an animal that is ten times their size, in their mind they are able to conquer and overcome anything that's thrown in front of them. It has been proven that when a child who is autistic or has disabilities engages in Equine assisted therapy, their communication, overall physical and behavioral skills increase dramatically. For example, for a child who has physical disabilities, riding a horse tremendously improves balance, coordination, sensory motor skills and posture. "Being on the horse has improved her sense of balance tremendously. At one time she had to think about sitting up, and if she relaxed she would begin to...
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...Equine Assisted Therapy By: Ashley M. Lorenc An ancient Greek sage once said, "The outside of a horse is the best thing for the inside of man." Hippocrates echoed that sentiment when he spoke of "ride rhythm" (Bliss). I have found there is an unspoken magic that horses posses when it comes to healing human beings. This experience is something that could never be taught or reached in a “talk” therapy session. The primary objective of Equine Assisted Therapy at Helping Hands Therapeutic Riding Center is rehabilitation, but it is also there to provide mental, physical, and social stimulation. The children love coming out to ride. It is amazing seeing an unresponsive child get on a horse and 45 minutes later have a totally different personality. Some of the children are more challenging to work with than others. Their attention spans can be short so keeping them focused and entertained can be difficult. One patient we had was a girl about age 12. While on the horse she would talk in song, in a soft tone. She loved being on the horse. When the therapist would tell her left and right she would start to respond and move the reigns. Every child has their own personalities and their own needs. Each child is matched with a horse depending on those needs. This takes great patience for all the participants. Safety is essential. That is why I am there. I volunteer to walk next to the horse, to control the horse, and to monitor the rider through the lesson. The therapist...
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...case, which got to be known as "the waterworks". Next would be the therapeutic part: did the chemicals cause the wounds to the offended parties; emulated by the cure stage harm appraisal. The Trial: Phase I Stage one of the trial started in March, 1986. A jury of six with two exchanges was chosen. Among the legal hearers was Jean Coulsey, a medical caretaker, and low maintenance fork lift administrator. Nobody on the jury had aptitude with the investigative issues that were in Phase...
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...Equine Therapy for Trouble kids and Handicapped Children Equine riding is not just for a person owning a horse. There is one type of therapy that usually contains people or animals, it is animal-supported therapy is a therapeutic approach that brings animals and individuals with physical and/or emotional needs together to perform the therapy. Today there are programs out there that help kids that are in trouble with the law, or come from broken homes, or even children that have autism or even Down syndrome. Horses are a great source for therapy and bonding. There are many types for programs out there to help these children. Lots of them are non-profit organizations and relay on donations. Therapeutic riding programs for disabled children has been around for a while. Some of these programs are ran from charities and are non-profit organizations. These programs help kids build muscle and balance. Equestrian therapy is particularly applied to children with Attention Deficit Disorder, a delay in mental development, autism, or anxiety, or even dementia. Genetic syndromes and Down syndrome, trauma from brain injuries, and other health issues. Muscle tone is one physical aspect of a disabled child that needs to be corrected and learning to ride a horse can provide the needed healing for this muscle defect. There for riding a horse would teach the child to balance his or her body while enjoying the experience of riding a horse. The lack of having coordination...
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...a slave to his or her psychological makeup. In turn, profilers use their knowledge of which the typical offender is that bears these characteristics and then predicts not only how the investigators can expect the offender to behave in the future, but also what their physical appearance will likely be. While profiling may seem very exciting, few psychologists are ever involved in this field. Psychological knowledge has been applied to many more areas of investigative police work, from the police interrogation to the police line-up. Both of these areas have prospered greatly from psychological research. Outside of the "front-end" operations of police work there is numerous opportunities for the application of forensic psychology. In the court system, Forensic Psychologists are frequently used for both criminal and civil cases. In the criminal realm, the forensic psychologist is often asked to assess competency. Competency assessments can serve a number of purposes. First, a defendant can be assessed for the ability to stand trial and/or make legal decisions on their own behalf. These types of decision have been frequent in the news. These evaluations are carried out when the defendant appears to suffer from a mental defect, such...
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