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By Q. Tufail. Pacific College of Oriental Medicine.

Cerebrovascular Disease • Demonstrate your knowledge of this chapter by Seizure Disorders completing the learning and medical record Parkinson Disease activities buy alfuzosin 10mg without a prescription. It senses physical and chemical changes in Despite its complexity order 10mg alfuzosin with amex, the nervous system is com- the internal and external environments buy 10mg alfuzosin visa, processes posed of only two principal types of cells: neurons them 10mg alfuzosin, and then responds to maintain homeostasis buy alfuzosin 10mg with mastercard. Neurons are cells that transmit Voluntary activities, such as walking and talking, impulses. They are commonly identified by the and involuntary activities, such as digestion and direction the impulse travels as afferent when the circulation, are coordinated, regulated, and inte- direction is toward the brain or spinal cord or effer- grated by the nervous system. The entire neural ent when the direction is away from the brain or network of the body relies on the transmission spinal cord. Nervous impulses are elec- rons and bind them to other neurons or other tis- trochemical stimuli that travel from cell to cell as sues of the body. Although they do not transmit they send information from one area of the body impulses, they provide a variety activities essential to another. Along with almost instantaneous, thus providing an immedi- neurons, neuroglia contitute the nervous tissue of ate response to change. Anatomy and Physiology Key Terms This section introduces important nervous system terms and their definitions. Axons are long, The three major structures of the neuron are the single projections ranging from a few millimeters cell body, axon, and dendrites. Axons transmit The (1) cell body is the enlarged structure of the impulses to dendrites of other neurons as well as neuron that contains the (2) nucleus of the cell and muscles and glands. Its branching cytoplasmic pro- Axons in the peripheral nervous system and the jections are (3) dendrites that carry impulses to the central nervous system possess a white, lipoid cov- cell body and (4) axons that carry impulses from ering called (5) myelin sheath. Dendrites resemble tiny branches on as an electrical insulator that reduces the possibility (3) Dendrites (1) Cell body (6) Schwann cell A. Schwann cell nucleus (2) Nucleus (7) Neurilemma (4) Axon (4) Axon (5) Myelin sheath (8) Node of Ranvier (10) Axon terminal (10) Axon terminal Mitochondrion Synaptic bulb (11) Neurotransmitter (9) Synapse Dendrite of receiving neuron B. The neurilemma When sufficient receptor sites are occupied, it sig- does not disintegrate after an axon has been crushed nals an acceptance “message” and the impulse pass- or severed, as does the axon and myelin sheath, but es to the receiving neuron. This intact sheath provides a pathway immediately inactivates the neurotransmitter, and for possible neuron regeneration after injury. The myelin sheath covering the axons in the cen- tral nervous system is formed by oligodendrocytes Neuroglia rather than Schwann cells. Oligodendrocytes do not The term neuroglia literally means nerve glue produce neurilemma, thus injury or damage to neu- because these cells were originally believed to serve rons located in the central nervous system is irrepara- only one function: to bind neurons to each other ble. They are now known to segments of myelin sheath are called (8) nodes of supply nutrients and oxygen to neurons and assist Ranvier. They also play an impulses down the axon because an impulse jumps important role when the nervous system suffers across the nodes at a faster rate than it is able to trav- injury or infection. They provide three-dimensional Impulses must travel from the (10) axon terminal mechanical support for neurons and form tight of one neuron to the dendrite of the next neuron or sheaths around the capillaries of the brain. Anatomy and Physiology 429 sheaths provide an obstruction, called the blood- of the brain and spinal cord. The brain is protect- brain barrier, that keeps large molecular substances ed by the bony skull and the spinal cord is protect- from entering the delicate tissue of the brain. Researchers must take the the body, the brain is highly complex in structure blood-brain barrier into consideration when and function. Microglia, the smallest of • cerebellum the neuroglia, possess phagocytic properties and • diencephalon may become very active during times of infection. Ependyma are ciliated cells that line fluid-filled cavities of the central nervous system, especially Cerebrum the ventricles of the brain. Nervous System Divisions The fissure does not completely separate the The nervous system consists of two main divisions: hemispheres. A structure called the (2) corpus cal- the central nervous system and the peripheral nerv- losum joins these hemispheres, permitting com- ous system. Its nervous tissue is classi- The cerebral surface consists of numerous folds, fied as white matter or gray matter.

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Metabolic acidosis Loss of sodium depletes fixed base; relative carbon dioxide content increases purchase 10mg alfuzosin visa. Wound cleaning • Hydrotherapy (whirl pool) –Antiseptics added to the water –Temp kept between 37-38º C –Warmth allow for easier movement of joints which will prevent contracture –Movement of water will remove dead tissue order alfuzosin 10 mg amex. Dressing the Burn Wound • After burn wounds are cleaned and debrided purchase alfuzosin 10mg on line, topical antibiotics are reapplied to prevent infection 306 • Standard wound dressings are multiple layers of gauze applied over the topical agents on the burn wound Wound Débridement 1 order alfuzosin 10mg without prescription. Surgical Débridement Wound Grafting • coverage of the burn wound is necessary until coverage with a graft is possible order alfuzosin 10mg amex. A combination of these approaches • The main areas for skin grafting include the face (for cosmetic and psychological reasons); functional areas, such as the hands and feet; and areas that involve joints. Homografts (or allografts): skin obtained from living or recently deceased humans or amniotic membrane. Heterografts (or xenografts): skin taken from Autografts • Graft taken from the same person • Graft care (goal: not to dislodge the graft) –Immobilize graft area (use splint) –Occlusive dressing, first dressing removed by Dr (usually after 2-5 days in there is no infection. Other care during acute phase • Pain management • Nutrition –Metabolic rate is very high because of anabolism –High caloric high protein diet. Disorders of Wound Healing • hypertrophic scars: characterized by an overabundant formation of matrix, especially collagen, in wounds that heal by granulation • Keloids: A large, heaped-up mass of scar tissue, a keloid, may develop and extend beyond the wound surface. Assess breath sounds, and oxygen provides dyspnea respiratory rate, rhythm, moisture to Respiratory depth, and symmetry. These signs within normal respiratory indicate possible limits secretions inhalation injury 4. Monitor arterial blood gas and risk of values, pulse oximetry respiratory readings, and dysfunction. Report labored respirations, and decreasing decreased depth of PaO2 and O2 respirations, or signs of saturation may hypoxia to physician indicate need for immediately. Monitoring 310 allows early detection of decreasing respiratory status or complications of mechanical ventilation. Nursing Diagnosis: Ineffective airway clearance related to edema and effects of smoke inhalation Goal: Maintain patent airway and adequate airway clearance 1. A patent airway Patent airway through proper patient is crucial to Respiratory positioning, removal of respiration. Nursing Diagnosis: Fluid volume deficit related to increased capillary permeability and evaporative losses from the burn wound Goal: Restoration of optimal fluid and electrolyte balance and perfusion of vital organs 1. Hypovolemia is a Serum (including central venous major risk electrolytes pressure or pulmonary immediately after within normal artery pressure, if indicated) the burn injury. Monitor urine output at weight provide Blood least hourly and weigh information pressure patient daily. Adequate fluids sensorium serum sodium, potassium, are necessary to Voids clear calcium, phosphorus, and maintain fluid yellow urine bicarbonate. Rapid shifts in immediately of decreased fluid and urine output, blood electrolyte status pressure, central venous, are possible in pulmonary artery, or the postburn pulmonary artery wedge period. Because of the rapid fluid shifts in burn shock, fluid deficit must be detected early so that distributive shock does not occur. Nursing Diagnosis: Hypothermia related to loss of skin microcirculation and open wounds Goal: Maintenance of adequate body temperature 1. A stable Body environment through use of environment temperature heat shield, space blanket, minimizes remains 36. Nursing Diagnosis: Pain related to tissue and nerve injury and emotional impact of injury Goal: Control of pain 1. Pain level States pain assess pain level (ie, 1 to provides baseline level is 10). Differentiate for evaluating decreased restlessness due to pain effectiveness of Absence of from restlessness due to pain relief nonverbal hypoxia. Observe for signs and must be respiratory depression in ruled out before the patient who is not analgesic mechanically ventilated. Emotional support is essential to reduce fear and anxiety resulting from burn injury. Explain all procedures to allows planning answer simple the patient and the family in of individualized questions clear, simple terms. Such signs reflect Arterial blood dyspnea, stridor, changes in deteriorating gas values respiratory patterns. Such signs reflect acceptable arterial blood gas values for decreased limits: PaO2 decreasing PaO2 and oxygenation >80 mm Hg, oxygen saturation, and status.

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Here we tell you how to avoid foods or drinks that may worsen problems with anxiety generic 10mg alfuzosin otc. Whenever you feel out of sorts or especially anxious for no particular reason discount 10mg alfuzosin amex, ask yourself what you’ve eaten in the past couple hours buy cheap alfuzosin 10 mg on-line. Although food sensitivities aren’t generally a major cause of anxiety cheap alfuzosin 10 mg on-line, some people have adverse reactions to certain foods buy cheap alfuzosin 10 mg, such as nuts, wheat, dairy, shellfish, or soy. For many In addition, psychotherapy that teaches relax- years, doctors told most of their patients that ation techniques, biofeedback, and techniques irritable bowel syndrome was caused by stress, for coping with anxiety and stress also improves worry, and anxiety. Alcohol may relax you in small quantities, so many people try to self-medicate by imbibing. For example, after a night of heavy drinking, alcohol can leave you feeling more anxious because it clears the system quickly and the body craves more. Some people seem to thrive on triple espres- sos, but others find themselves up all night with the jitters. Caffeine lurks in most energy drinks as well as chocolate, so be careful if you’re sensitive to the effects of caffeine. Speaking of energy drinks, these sometimes contain unusually large quanti- ties of not only caffeine but also other stimulants. You’ll see herbal stimulants such as taurine, guarana (loaded with caffeine), ginseng, and ginkgo biloba, among others. Reported adverse effects include nervousness, sleeplessness, abnormal heart rhythms, and seizures. If you have excessive anxiety, you don’t want to be chugging down these concoctions. Furthermore, sugar is bad for your body in a variety of ways, such as spiking blood glucose levels and contributing to metabolic syndrome (a condition that often leads to high blood pressure and diabetes). That’s why we strongly recommend that you visit your doctor, especially if you’re experiencing significant anxiety for the first time. Your doctor can help you sort out whether you have a physical problem, a reaction to a medication, an emotionally based anxiety problem, or some combination of these. For example, if you receive a serious diag- nosis of heart disease, cancer, or a chronic progressive disorder, you may develop anxiety about dealing with the consequences of what you’ve been told. The techniques we give you for dealing with anxiety throughout this book can help you manage this type of anxiety as well. Table 3-2 Medical Imposters Medical What It Is Anxiety-Like Symptoms Condition Hypoglycemia Low blood sugar; sometimes Confusion; irritability; trembling; associated with other disor- sweating; rapid heartbeat; weak- ders or can occur by itself. Lupus An autoimmune disease in Anxiety, poor concentration, which the patient’s immune irritability, headaches, irregular system attacks certain types of heartbeat, impaired memory its own cells. Mitral valve The mitral valve of the heart Palpitations, shortness of breath, prolapse fails to close properly, allowing fatigue, chest pain, difficulty blood to flow back into the left breathing atrium. Ménière’s An inner ear disorder that Vertigo that includes abnormal syndrome includes vertigo, loss of hear- sensations associated with ing, and ringing or other noises movement, dizziness, nausea, in the ear. If so, you should know that sometimes people start on the path to change with the best inten- tions, but as they move along, they suddenly encounter icy conditions, lose traction, spin their wheels, and slide off the road. This chapter gives you ways to throw salt and sand on the ice and keep moving forward. When you understand the origins of anxiety, you can move from self-blame to self- acceptance, thus allowing yourself to direct your energy away from self-abuse and toward more productive activities. We give you effective strategies to keep you safely on the road to overcoming anxiety. And finally, if you need some outside support, we give you suggestions on how to find professional help. Digging Out the Roots of Anxiety Anxiety doesn’t come out of nowhere; rather, it typically stems from some combination of three major contributing factors. The primary villains under- lying anxiety are ✓ Genetics: Your biological inheritance ✓ Parenting: The way that you were raised ✓ Trauma: Horrific events that sometimes happen 48 Part I: Detecting and Exposing Anxiety Studies show that of those people who experience an unanticipated trauma, only a minority end up with severe anxiety. That’s because anxiety stems from a combination of causes — perhaps genes and trauma, trauma and par- enting, or even all three factors may gang up to induce anxiety. Some people seem almost immune to developing anxiety, yet it’s possible that life could deal them a blow that challenges their coping abilities in a way they couldn’t expect. In the story that follows, Bonnie shows how someone can show resil- ience for many years yet be tipped over the edge by a single traumatic event. Bonnie manages to grow up in a drug war zone without developing ter- ribly distressing symptoms. Surely, she must have some robust anti-anxiety genes and perhaps some pretty good parents in order to successfully endure such an experience.

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