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Health psychology emphasizes the role of psychological factors in the cause generic 10mg alfuzosin amex prostate problems symptoms, progression and consequences of health and illness alfuzosin 10mg on-line prostate frequent urination. The aims of health psychology can be divided into (1) understanding, explaining, developing and testing theory and (2) putting this theory into practice. For example: s Coronary heart disease is related to behaviours such as smoking, food intake, lack of exercise. For example: s Smoking, alcohol consumption and high fat diets are related to beliefs. For example: s The experience of stress relates to appraisal, coping and social support. For example: s Understanding the psychological consequences of illness could help to alleviate symptoms such as pain, nausea and vomiting. For example: s If psychological factors are important in the cause of illness they may also have a role in its treatment. For example: s Understanding the role of behaviour in illness can allow unhealthy behaviours to be targeted. For many students this involves taking a health psychology course as part of their psychology degree. For some students health psychology plays a part of their studies for other allied disciplines, such as medicine, nursing, health studies and dentistry. However, in addition, to studying health psychology at this preliminary level, an increasing number of students carry out higher degrees in health psychology as a means to develop their careers within this field. This has resulted in a range of debates about the future of health psychology and the possible roles for a health psychologist. To date these debates have highlighted two possible career pathways: the clinical health psychologist and the professional health psychologist. The clinical health psychologist A clinical health psychologist has been defined as someone who merges ‘clinical psychology with its focus on the assessment and treatment of individuals in distress. A trained clinical health psychologist would tend to work within the field of physical health, including stress and pain management, rehabilitation for patients with chronic illnesses (e. A professional health psychologist A professional health psychologist is someone who is trained to an acceptable standard in health psychology and works as a health psychologist. Although still being considered by a range of committees, it is now generally agreed that a professional health psychologist should have competence in three areas: research, teaching and consultancy. In addition, they should be able to show a suitable knowledge base of academic health psychology normally by completing a higher degree in health psychology. Having demonstrated that they meet the required standards, a professional/chartered health psychologist could work as an academic within the higher education system, within the health promotion setting, within schools or industry, and/or work within the health service. The work could include research, teaching and the development and evaluation of interventions to reduce risk-related behaviour. Health psychology is an expanding area in terms of teaching, research and practice. Health psychology teaching occurs at both the undergraduate and postgraduate level and is experienced by both mainstream psychology students and those studying other health- related subjects. Undergraduates are often expected to produce research projects as part of their assessment, and academic staff and research teams carry out research to develop and test theories and to explore new areas. Such research often feeds directly into practice, with intervention programmes aiming to change the factors identified by research. This book aims to provide a com- prehensive introduction to the main topics of health psychology. In addition, how these theories can be turned into practice will also be described. This book is now supported by a compre- hensive website which includes teaching supports such as lectures and assessments. A note on theory and health psychology Health psychology draws upon a range of psychological perspectives for its theories. Further, it utilizes many key psycho- logical concepts such as stereotyping, self-identity, risk perception, self-efficacy and addiction. This book describes many of these theories and explores how they have been used to explain health status and health related behaviours.
Impaired cough and swallowing reflexes may cause aspiration of saliva and gastric secretions cheap 10 mg alfuzosin with mastercard prostate cancer early stages. Seals are usually incomplete; cuffs often develop slow leaks purchase 10mg alfuzosin with mastercard prostate cancer 40s, usually from external valves, but sometimes from cuff permeability to gases or chemicals. If excessive cuff volumes or pressures are needed, the tube probably needs replacing. While cuff pressure should be sufficient to minimise risks from aspiration, excessive pressure on tracheal epithelium may occlude capillary perfusion causing tracheal ulcers; unlike pressure sores on skin, these are not directly visible. Assessing cuff pressures by squeezing the external balloon is unreliable, but commercially available manometers are available and reliable, and so nurses should, as part of their individual accountability, check cuff pressures at least once each shift, and whenever cuff volume is changed. Nasal intubation and tracheostomy prevent hypersalivation, but tracheal secretions may still accumulate. Like cuff pressure sores (above), pressure from tubes can damage any surrounding tissue (lips, gums, nostril). Sympathetic nervous stimulation from intubation and suction initiates stress responses (see Chapter 3); suction-induced stress responses can cause intracranial hypertension (Brucia & Rudy 1996). Direct vagal nerve stimulation (anatomically close to the trachea) can cause bradycardic dysrhythmias and blocks, especially during intubation. Patients’ inability to speak due to intubation through their vocal cords should be explained. Humidification Nasal epithelium has a rich venous supply covering the nasal conchae; air turbulence maximises exposure for heat and moisture exchange, inspired air normally reaching body temperature just below the carina (Jackson 1996); thus the human airway (a) warms, (b) moistens, and (c) filters inspired air. Endotracheal intubation bypasses these normal physiological mechanisms, necessitating artificial replacement. Hot air transports more water vapour than cold air and so fully saturated room air/gas (100 per cent relative humidity) will not be fully saturated once warmed to body temperature. Gas not fully saturated absorbs moisture from airway surfaces, causing dehydration, making mucus more viscid. Viscid mucus increases: ■ risk of chest infection ■ risk of airway encrustation/obstruction ■ airway resistance and work of breathing ■ surfactant dysfunction Gas should therefore be heated and fully saturated exogenously; tracheal gas temperature should be 32–36°C. Heated water baths provide an ideal medium for bacterial incubation, particularly pseudomonas. Water bath humidifiers may cause overhumidification, mucosal burns, hyperthermia and water intoxification (Jackson 1996). Where exogenous heat is used, temperature of inspired air should be continuously monitored. Current dilemmas between humidification and infection control lack an ideal solution. Saline lavage to remove encrusted secretions can cause various problems (discussed below). However pulmonary oedema from increased capillary permeability may limit hydration of critically ill patients. Airway management 43 Suction Intubation bypasses non-specific mucus and cilial defences, while impaired cough reflexes from critical illness, antitussives and sedation, enable accumulation of lower respiratory tract secretions, reducing/obstructing airway patency (increasing work of breathing) and providing media for bacterial growth. Endotracheal suction can remove accumulated secretions, but can also cause: ■ infection ■ trauma ■ hypoxia ■ atelectasis Post-discharge surveys consistently identify patient anxiety and discomfort from suction (e. Puntillo 1990), and so it should never be a ‘routine’ procedure (Ashurst 1997); nurses should evaluate benefits against dangers. The changes made in endotracheal suction practice in the 1980s necessitate caution when reading older literature. Indications for suction include: ■ rattling/bubbling on auscultation ■ sudden increases in airway pressure ■ audible ‘bubbling’ from the back of the throat ■ sudden hypoxia (e. Disconnecting ventilation (inevitable unless closed-circuit suction systems are used) causes arterial desaturation, especially when patients are dependent on high levels of oxygen; preoxygenating all patients (3–5 minutes of 100 per cent oxygen) minimises risks. Although intended to remove bacteria, suction catheters can introduce/displace bacteria into lower airways. Respiratory pathogens sprayed into the environment through patients’ coughing or from suction catheters can infect others (e. Gowns, gloves, masks and goggles may protect staff, but efficacy of each needs evaluation, and their use delays suction procedures. Negative (suction) pressure damages delicate tracheal epithelium, causing possible ■ haemorrhage ■ oedema ■ stenosis ■ metaplasia. Negative pressure should be sufficient to clear secretions, but low enough to minimise trauma.
Protein is restricted in the presence of hepatic encephalopathy purchase 10mg alfuzosin free shipping man healthxnet, and should be of high quality to pro- Uses vide an adequate supply of essential amino acids 10 mg alfuzosin with mastercard prostate icd 10. High energy More importantly than its diuretic effect, acetazolamide intake from carbohydrate minimizes catabolism of body pro- inhibits carbonic anhydrase in the eye and thereby decreases tein. Salt restriction is combined with moderate water restric- the rate of secretion of the aqueous humour and lowers intra- tion monitored by daily weighing. Treatment of glaucoma is currently the major precipitate renal failure: loss of approximately 0. Thiazides or loop diuretics exacerbate potassium depletion Carbonic anhydrase in the choroid plexus participates in the and alkalosis and can precipitate hepatic encephalopathy. Some diuretics have additional distinct Unwanted effects therapeutic roles because of additional effects on the kidney As a consequence of increased urinary elimination of bicarbon- (e. They act from within the tubular fluid to Diuretics inhibit a co-transporter in the thick ascending limb of the Diuretics are classed by their site of action. They cause a large effect and are used especially It is 95% bound to plasma protein and elimination is mainly in heart failure and oedematous states. These drugs are sometimes the renal Na K 2Cl cotransport mechanism, as opposed to combined with thiazide or loop diuretics to prevent hypokalaemia. They are weak diuretic insensitivity in nephrotic syndrome, where heavy 3 diuretics, cause metabolic acidosis and are used to treat albuminuria results in binding of furosemide to albumin glaucoma, rather than for their action on the kidney. Hypokalaemia – inhibition of K reabsorption in the loop reduced filtered load of this ion, so less bicarbonate is available of Henle and increased delivery of Na to the distal for reabsorption from proximal tubular fluid. The diuretic nephron (where it can be exchanged for K ) results in effect of acetazolamide is therefore self-limiting. Otoxicity with hearing loss is associated with excessive Hypersensitivity reactions and blood dyscrasias are a problem, peak plasma concentrations caused by too rapid as with other sulphonamides. It may be related to inhibition of Na K 2Cl cotransporter in the ear, which is involved in the formation of endolymph. Metabolic alkalosis – the increased water and chloride excretion caused by loop diuretics results in contraction Uses alkalosis. Furosemide is also useful in patients with chronic renal failure who are suffering from fluid overload Drug interactions and/or hypertension. Large doses may be needed to produce Loop diuretics increase the nephrotoxicity of first-generation diuresis in patients with severe renal impairment. Lithium reabsorption is reduced by loop diuret- times produces diuresis, and may prevent the development of ics and the dose of lithium carbonate often needs to be established failure, although this is difficult to prove. This is exploited in the treatment of hyper- calcaemia when furosemide is given after volume replacement with 0. The presence of a substantial aldosterone: spironolactone, eplerenone; quantity of a poorly absorbable solute opposes this, because as 2. Na /K exchange antagonists that do not compete with water is reabsorbed the concentration and hence the osmotic aldosterone: amiloride, triamterene. Mannitol is poorly absorbed from the intes- ful when there is hyperaldosteronism, whether primary tine and is given intravenously in gram quantities. Unlike other diuretics, osmotic diuretics increase the plasma in cirrhosis with ascites). High doses of spironolactone causes volume (by increasing the entry of water to the circulation as a gynaecomastia and breast tenderness in men and menstrual result of increasing intravascular osmolarity), so they are unsuit- irregularity in women – oestrogenic side effects. Eplerenone is able for the treatment of most causes of oedema, especially car- more selective and lacks these oestrogenic effects. It is possible that, if used early in the course of more expensive but has been shown to improve survival fol- incipient acute renal failure, osmotic diuretics may stave off the lowing myocardial infarction (Chapter 29). Osmotic diuretics are mainly used for reasons uncon- combination tablets with loop or thiazide diuretics as a means nected with their ability to cause diuresis. Hypokalaemia is important if drugs enter cells or some anatomical areas, such as the eye and brain, such as digoxin (Chapters 31 and 32) or sotalol (Chapter 32) they cause water to leave cells down the osmotic gradient. This are co-prescribed, because their toxicity is increased by ‘dehydrating’ action is used in two circumstances: hypokalaemia. Their main diuretic salt and water overload, but occurs when antidiuretic hor- action is exerted on the proximal tubule.
