By O. Tuwas. University of Pittsburgh.

Rather buy 0.25mg digoxin fast delivery, this process of inquiry is evolution- eight essential aspects in the method buy discount digoxin 0.25mg line, as described centered and focuses on changing configurations of here generic digoxin 0.25 mg online. Each aspect is described The flow of the inquiry starts with a summation here in relation to the essential processses cheap 0.25 mg digoxin with amex. Initial engagement is a passionate search for a re- purpose and researcher’s understanding of search question of central interest to under- Rogerian science 0.25 mg digoxin sale. Next, the researcher focuses on standing unitary phenomena associated with becoming familiar with the participants and the human betterment and well-being. A priori nursing science identifies the Science of field perspectives are identified through observa- Unitary Human Beings as the researcher’s per- tions and discussions with participants and spective. It guides all processes of the research processed through mutual exploration and discov- method, including the interpretation of findings. Immersion involves becoming steeped in the re- the Healing Human Field–Environmental Field search topic. The researcher may immerse him- Relationship Creative Measurement Instrument self or herself in any activity that enhances the (Carboni, 1992) as a way to identify, understand, integrality of the researcher and the research and creatively measure human and environmental topic. Pattern manifestation knowing and appreciation figurations of the pattern manifestations emerg- includes participant selection, in-depth dialogu- ing from the human/environmental mutual field ing, and recording pattern manifestations. The Participant selection is made using intensive dialogue is taped and transcribed. Patterning manifestation searcher maintains observational, methodologi- knowing and appreciation occurs in a natural cal, and theoretical field notes, and a reflexive setting and involves using pandimensional journal. Any artifacts the participant wishes to modes of awareness during in-depth dialoguing. Unitary field pattern profile is a rich descrip- process section of the practice method are used tion of the participants’ experiences, percep- in this research method. All the tion and knowing is on experiences, percep- information collected for each participant is tions, and expressions associated with the synthesized into a narrative statement reveal- phenomenon of concern. The researcher also ing the essence of the participant’s descrip- maintains an informal conversational style while tion of the phenomenon of concern. Mutual processing involves constructing the thereby lifting the unitary field pattern por- mutual unitary field pattern profile by mutu- trait from the level of description to the level ally sharing an emerging joint or shared pro- of unitary science. Scientific rigor is main- file with each successive participant at the end tained throughout processes by using the cri- of each participant’s pattern manifestation teria of trustworthiness and authenticity. For exam- findings of the study are conveyed in a ple, at the end of the fourth participant’s Unitary Field Pattern Report. The joint construction (mutual Cowling (2001) recently explicated the processes unitary field pattern profile) at this phase of Unitary Appreciative Inquiry as a method would consist of a synthesis of the profiles of grounded in Rogerian science for “uncovering the the first three participants. After verification wholeness and essence of human existence to in- of the fourth participant’s pattern profile, the form the development of nursing science and guide profile is folded into the emerging mutual the practice of nursing” (p. Pattern manifes- may be used with individuals, groups, or commu- tation knowing and appreciation continues nities and includes appreciative knowing, partici- until there are no new pattern manifestations patory, synoptic, and transformative processes. If it is not possible to either share the dinary and extraordinary forces characterized by pattern profile with each participant or create unknowable mystery. The researcher and partici- a mutually constructed unitary field pattern pant are equals in a participatory mutual process profile, the research may choose to bypass the where outcomes are not imposed and change un- mutual processing phase. The unitary field pattern portrait is created by amines all pattern information synoptically by identifying emerging unitary themes from viewing all experiences, perceptions, and expres- each participant’s field pattern profile, sorting sions as interrelated in a way that reflects the inher- the unitary themes into common categories ent wholeness of a phenomenon or situation. The and creating the resonating unitary themes of elements of the approach in unitary appreciative human/environmental pattern manifestations inquiry (Cowling, 2001) include: through immersion and crystallization, which involves synthesizing the resonating themes 1. The scientist/practitioner seeks out to explore a into a descriptive portrait of the phenome- life situation, phenomenon, or concern from a non. Describe the endeavor with the aim of appreciat- and accurate aesthetic rendition of the univer- ing the wholeness, uniqueness, and essence sal patterns, qualities, features, and themes of the particular situation, phenomenon, or exemplifying the essence of the dynamic kalei- concern. Approach participants as partners in a coequal preted from the perspective of the Science of participative appreciative endeavor. Information is collected in the form of dialogue, evolutionary interpretation to create a theoret- discussion, interview, observation, or any prac- ical unitary field pattern portrait of the phe- tice that illuminates the underlying human life nomenon.

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If bradycardia becomes symptomatic best digoxin 0.25mg, treat as above (atropine cheap digoxin 0.25mg mastercard, adrenaline digoxin 0.25 mg with mastercard, pacing) order digoxin 0.25mg mastercard. Formerly type 1 was named Mobitz type 1 or Wenkebach phenomenon; type 2 was called Mobitz type 2; these names buy digoxin 0.25 mg without prescription, although technically obsolete, still persist in practice. Drugs used include: ■ atropine ■ isoprenaline (when unresponsive to atropine) If symptoms persist pacing may be needed. Intrinsic ventricular rates are slow (about 40 beats every minute); cardiac output is severely impaired, causing hypotension. Bundle branch block This is delayed partial intraventricular conduction (Figure 21. The Bundle of His divides into left and right branch bundles, the left branch further dividing between anterior and posterior fascicles. Ventricular dysrhythmias Ventricular ectopics These originate from ventricular foci outside normal conduction pathways, and so lack P waves and are conducted (slowly) from muscle fibre to muscle fibre. Ectopics originating near the ventricular apex are conducted downwards, giving positive complexes; those originating near the base have retrograde conduction through ventricular muscle, giving negative complexes. Complexes from a single focus (‘unifocaP) look alike; ectopics with different shapes originate from different foci (‘multifocal’). Treatment is usually initiated if it is ■ persistent (more than six ectopics every minute) ■ bigeminy/trigeminy ■ multifocal ■ occurring in vulnerable phases of electrical impulse conduction (R on T). Premature ventricular ectopics may be reversed by overpacing (Hillel & Thys 1994). Intensive care nursing 210 Bigeminy and trigeminy These are sinister extensions of ventricular ectopics, occurring regularly (Figure 21. Bigeminy is one ventricular ectopic every other complex; trigeminy is one ventricular ectopic every third complex. Rates vary from 100–250 (Cohn & Gilroy-Doohan 1996), usually nearer the upper end of this range. Inadequate ventricular filling time causes very poor stroke volumes and systemic hypotension; significantly increased myocardial workload with inadequate oxygen supply rapidly aggravates myocardial ischaemia, with imminent cardiac arrest. Unless patients are asymptomatic, help should be summoned urgently (‘crash’ call). The 1997 resuscitation policy includes a single precordial thump ‘if appropriate’ for witnessed arrests between basic life support and attaching the defibrillator. Like atrial fibrillation, ventricular fibrillation is totally irregular, with no significant cardiac output. Defibrillation is not recommended for asystole (there is no rhythm to defibrillate, and shocks interrupt cardiac massage). Drugs include: ■ adrenaline (1 mg) ■ atropine (3 mg) If P waves are present, external or transvenous pacing may be used. Causes of electromechanical dissociation can be summarised as ‘4Hs and 4Ts’: ■ Hypoxia ■ Hypovolaemia ■ Hyper/hypokalaemia and metabolic disorders (e. An arrest call should be initiated and the Resuscitation Council guidelines followed, with especial focus on correcting and treating underlying causes. Justify your choice in relation to cardiac physiology and note expected waveform pattern. What other strategies can be used to reduce life-threatening tachycardia in emergency situations? The value of various invasive modes remains debatable; this chapter reviews means and implications of invasive neurological monitoring, with especial emphasis on intracranial pressure monitoring. The skull is rigid and filled to capacity with essentially noncompressible contents (the Monro-Kellie hypothesis) so that increasing one component necessarily compresses others. Sustained intracranial pressure over 60 mmHg causes ischaemic brain damage and is usually fatal (Hudak et al. Progressive cellular damage (see Chapter 23) causes: ■ release of vasoactive chemicals (e. A head injury, together with the resulting intracranial hypertension, cause widespread neurological dysfunction, including Intensive care nursing 218 ■ Figure 22.

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Symptoms of amphetamine withdrawal develop within a few hours to several days and include fatigue; vivid buy generic digoxin 0.25 mg online, unpleasant dreams; insomnia or hypersomnia; increased appetite; and psychomotor retardation or agitation order 0.25 mg digoxin with amex. It is commonly regarded incorrectly to be a substance with- out potential for dependence cheap digoxin 0.25mg. Abuse is evidenced by participation in hazardous activities while motor coordination is impaired from cannabis use buy digoxin 0.25 mg low cost. Physical symptoms of cannabis intoxication include conjuncti- val injection generic 0.25mg digoxin free shipping, increased appetite, dry mouth, and tachycardia. Chronic daily (or almost daily) use usually results in an increase in dosage over time to produce the desired effect. Episodic use often takes the form of binges, followed by an in- tense and unpleasant “crash” in which the individual experiences anxiety, irritability, and feelings of fatigue and depression. Cocaine abuse and dependence lead to tolerance of the substance and subsequent use of increasing doses. Continued use appears to be related to a “craving” for the substance, rather than to prevention or alleviation of with- drawal symptoms. Symptoms of cocaine intoxication develop during, or shortly after, use of cocaine. Symptoms of cocaine intoxication include euphoria or affective blunting, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, anger, stereo- typed behaviors, impaired judgment, and impaired social or occupational functioning. Physical symptoms of cocaine intoxication include tachycar- dia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, cardiac arrhythmias, con- fusion, seizures, dyskinesias, dystonias, or coma. Symptoms of withdrawal occur after cessation of, or reduc- tion in, cocaine use that has been heavy and prolonged. Symptoms of cocaine withdrawal include dysphoric mood; fatigue; vivid, unpleasant dreams; insomnia or hypersomnia; increased appetite; psychomotor retardation or agitation. The cognitive and perceptual impairment may last for up to 12 hours, so use is generally episodic, because the individual must organize time during the daily schedule for its use. Dependence is rare, and most people are able to resume their previous lifestyle, following a period of hallucinogen use, without much difficulty. These episodes consist of visual or auditory misperceptions usually lasting only a few seconds but sometimes lasting up to several hours. Hallucinogens are highly unpredictable in the effects they may induce each time they are used. Symptoms include marked anxiety or depression, ideas of reference, fear of losing one’s mind, paranoid ideation, and impaired judgment. Other symptoms include subjective intensification of percep- tions, depersonalization, derealization, illusions, hallucina- tions, and synesthesias. Effects are induced by inhaling the vapors of volatile sub- stances through the nose or mouth. Examples of substances include glue, gasoline, paint, paint thinners, various cleaning chemicals, and typewriter correc- tion fluid. Use of inhalants often begins in childhood, and considerable family dysfunction is characteristic. Tolerance has been reported among individuals with heavy use, but a withdrawal syndrome from these substances has not been well documented. Symptoms of intoxication develop during, or shortly after, use of, or exposure to, volatile inhalants. Symptoms of inhalant intoxication include belligerence, assaultiveness, apathy, impaired judgment, and impaired social or occupational functioning. The effects of nicotine are induced through inhaling the smoke of cigarettes, cigars, or pipe tobacco and orally through the use of snuff or chewing tobacco. Nicotine is commonly used to relieve or to avoid withdrawal symptoms that occur when the individual has been in a situ- ation where use is restricted. Continued use despite knowledge of medical problems related to smoking is a particularly important health problem. Symptoms of withdrawal develop within 24 hours after abrupt cessation of (or reduction in) prolonged nicotine use. Symptoms of nicotine withdrawal include dysphoric or depressed mood, insomnia, irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, decreased heart rate, and increased appetite. Various forms are taken orally, intravenously, by nasal inha- lation, and by smoking.

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