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Impulses Neuron membranes are semi-permeable (meaning that certain small molecules like ions can move in and out but larger molecules can’t) buy epivir-hbv 100 mg low cost medications breastfeeding, and they’re electrically polarized (meaning that positively charged ions called cations rest around the outside mem- brane surface while negatively charged ions called anions line the inner surface; you can find more about ions in Chapter 1) buy 150 mg epivir-hbv amex internal medicine. A neuron that isn’t busy transmitting an impulse is said to be at its resting potential. But the nerve impulse theory, or membrane theory, says that things switch around when a stimulus — a nerve impulse, or action potential — moves along the neuron. A stimulus changes the specific permeability of the fiber membrane and causes a depolarization due to a reshuffling of the cations and anions. It’s called an all-or-none response because each neuron has a specific threshold of excitation. After depolarization, repolarization occurs followed by a refractory period, during which no further impulses occur, even if the stimuli’s intensity increases. Intensity of sensation, however, depends on the frequency with which one nerve impulse follows another and the rate at which the impulse travels. That rate is deter- mined by the diameter of the impacted fiber and tends to be more rapid in large nerve fibers. The cyto- plasm of the axon or nerve fiber is electrically conductive and the myelin decreases the capacitance to prevent charge leakage through the membrane. Depolarization at one node of Ranvier is sufficient to trigger regeneration of the voltage at the next node. Therefore, in myelinated nerve fibers the action potential does not move as a wave but recurs at successive nodes, traveling faster than in nonmyelinated fibers. This is referred to as saltatory conduction (from the Latin word saltare, which means “to hop or leap”). Chapter 15: Feeling Jumpy: The Nervous System 241 Synapses Neurons don’t touch, which means that when a nerve impulse reaches the end of a neuron, it needs to cross a gap to the next neuron or to the gland or muscle cell for which the message is intended. An electric synapse — generally found in organs and glial cells — uses channels known as gap junc- tions to permit direct transmission of signals between neurons. But in other parts of the body, chemical changes occur to let the impulse make the leap. The end branches of an axon each form a terminal knob or bulb called a bouton terminal (that first word’s pro- nounced boo-taw), beyond which there is a space between it and the next nerve path- way. Synaptic vesicles in the knob release a transmitter called acetylcholine that flows across the gap and increases the permeability of the next cell mem- brane in the chain. An enzyme called cholinesterase breaks the transmitter down into acetyl and choline, which then diffuse back across the gap. An enzyme called choline acetylase in the synaptic vesicles reunites the acetyl and choline, prepping the bouton terminal to do its job again when the next impulse rolls through. Capacity to record, store, and relate information to be used to determine future action 6. The terminal structure of the cytoplasmic projection of the neuron cannot be a(n) a. Contains storage vesicles for excitatory chemical Minding the Central Nervous System and the Brain Together, the brain and spinal cord make up the central nervous system. The spinal cord, which forms very early in the embryonic spinal canal, extends down into the tail portion of the vertebral column. But because bone grows much faster than nerve tissue, the end of the cord soon is too short to extend into the lowest reaches of the spinal canal. In an adult, the 18-inch spinal cord ends between the first and second lumbar vertebrae, roughly where the last ribs attach. The cord continues as separate strands below that point and is referred to as the cauda equina (horse tail). A thread of fibrous tissue called the filum terminale extends to the base of the coccyx (tailbone) and is attached by the coccygeal ligament. Part V: Mission Control: All Systems Go 244 Spinal cord An oval-shaped cylinder with two deep grooves running its length at the back and the front, the spinal cord doesn’t fill the spinal cavity by itself.
Several applications have tar- theories have been developed from within King’s geted high-risk infants (Frey & Norris buy discount epivir-hbv 100 mg treatment bulging disc, 1997; Norris Interacting Systems framework discount epivir-hbv 150 mg with visa medicine in the 1800s. Hanna (1993) investigated the effect of systems (the nursing staff and hospital environ- nurse-client interactions on oral-contraceptive ad- ment). Interestingly, these theory is their utility in encompassing complex set- studies considered personal systems (infants), in- tings and situations. Kenny (1990) also studied the 1988), and renal procedures (Hanucharurnkui role of the elderly in their care. Gender-specific work in- ied the “impact of information on the health be- cluded Sharts-Hopko’s (1995) use of concepts haviors of older adults” (p. Clearly, focus of care (client system) and/or focus of health these applications, and others, show how the problem (phenomenon of concern). The focus of complexity of King’s framework and midrange the- care, or interest, can be an individual (personal sys- ory increases its usefulness for nursing (refer to tem) or group (interpersonal or social system). Thus, application of King’s work, across client sys- tems, would be divided into the three systems iden- Client Systems tified within King’s Interacting Systems Framework A major strength of King’s work is that it can (1981): personal (the individual), interpersonal be used with virtually all client populations. Frey addition, applications proposed the Theory of and Norris (1997) used both the Interacting Sys- Goal Attainment as the practice model for case tems Framework and Theory of Goal Attain- management (Hampton, 1994; Tritsch, 1996). The earliest 1995a) and revised into a Theory of Group Power applications involved the use of the framework and within Organizations (2003). Educational settings, theory to guide continuing education (Brown & also considered as social systems, have also been Lee, 1980) and nursing curricula (Daubenmire, the focus of application of King’s work (Bello, 1989; Gulitz & King, 1988). Table 16–9 sum- marizes applications related to clients’ phenomena Phenomena of Concern to Clients of concern; the table also groups these applications, Within King’s work, it is critically important for the primarily identified by disease or medical diagno- nurse to focus on, and address, the phenomenon of sis, as illness management. Without this emphasis on the Health is one area that certainly binds clients client’s perspective, mutual goal-setting cannot and nurses. Hence, a client’s phenomena of concern was end point, or outcome, of nursing care and selected as neutral terminology that clearly demon- something to which clients aspire. In addition, Frey applications, tends to support the goal of improved (1996) expanded her research to include risky health directly and/or indirectly, as the result of the behaviors. Health status is explic- As stated previously, diseases or diagnoses are itly the outcome of concern in practice applica- often identified as the focus for the application of tions by Smith (1988). For example, Kohler (1988) conducted research with patients with broncho- focused on increased morale and satisfaction, and pneumonia, while patients with end-stage renal DeHowitt (1992) studied well-being. In Health promotion has also been an emphasis for addition, clients with chronic inflammatory bowel the application of King’s ideas. The experience of parenting was studied by concerns have also been the focus of work, using Norris and Hoyer (1993), and health behaviors King’s conceptualizations (Murray & Baier, 1996; were Hanna’s (1995) focus of study. Clients’ concerns ranged from King (1981) stated that individuals act to main- psychotic symptoms (Kemppainen, 1990) to fami- tain their own health. Although not explicitly lies experiencing chronic mental illness (Doornbos, stated, the converse is probably true as well: 2002) to clients in short-term group psychotherapy Individuals often do things that are not good for (Laben, Sneed, & Seidel, 1995). Accordingly, it is not surprising that eates applications related to clients’ phenomena the Interacting Systems Framework and related of concern. Frey (1997), Frey and Denyes (1989), and Frey and Fox Multicultural applications of King’s Interact- (1990) looked at both health behaviors and illness ing Systems Framework and related theories are management behaviors in several groups of chil- many. King’s framework and theory for transcultural Applications of the framework and related theories nursing. Spratlen (1976) drew heavily from King’s have been documented in the following countries framework and theory to integrate ethnic cultural beyond the United States: Canada (Coker et al. Key Sugimori, 1992), Portugal (Moreira & Arajo, 2002; elements derived from King’s work were the focus Viera & Rossi, 2000), and Sweden (Rooke, 1995a, on perceptions and communication patterns that 1995b). In Japan, a culture very different from the motivate action, reaction, interaction, and transac- United States with regard to communication style, tion. Rooda (1992) derived propositions from the Kameoka (1995) used the classification system of midrange Theory of Goal Attainment as the frame- nurse-patient interactions identified within the work for a conceptual model for multicultural Theory of Goal Attainment (King, 1981) to analyze nursing.
For example epivir-hbv 100 mg for sale medicine lookup, medicines such as wild animal faeces and the blood of a gladiator were supposed to increase strength discount epivir-hbv 100mg overnight delivery symptoms 3 days past ovulation, and part of a dolphin’s penis was supposed to increase virility. These so-called ‘medicines’ have been used at different times in different cultures but have no apparent medical (active) properties. In addition, treatments such as bleeding by leeches to decrease fever or travelling to religious sites such as Lourdes in order to alleviate symptoms have also continued across the years without any obvious understanding of the processes involved. Faith healers are another example of inert treatments ranging from Jesus Christ, Buddha and Krishna. The tradition of faith healers has persisted, although our understanding of the processes involved is very poor. Such apparently inert interventions, and the traditions involved with these practices, have lasted over many centuries. In addition, the people involved in these practices have become famous and have gained a degree of credibility. Perhaps, the maintenance of faith both in these interven- tions and in the people carrying out the treatments suggests that they were actually successful, giving the treatments themselves some validity. It is possible that there are medically active substances in some of these traditional treatments that were not understood in the past and are still not understood now (e. It is also possible that the effectiveness of some of these treatments can be understood in terms of modern-day placebo effects. Modern-day placebos Recently placebos have been studied more specifically and have been found to have a multitude of effects. For example, placebos have been found to increase performance on a cognitive task (Ross and Buckalew 1983), to be effective in reducing anxiety (Down- ing and Rickles 1983), and Haas et al. Beecher (1955), in an early study of the specific effects of placebos in pain reduction, suggested that 30 per cent of chronic pain sufferers show relief from a placebo when using both subjective (e. They reported that half the subjects with angina pain were given a sham operation, and half of the subjects were given a real heart bypass operation. The results indicated that pain reduction in both groups was equal, and the authors concluded that the belief that the individual had had an operation was sufficient to cause pain reduction and alleviation of the angina. Since the 1940s, research into the effectiveness of drugs has used randomized controlled trials and placebos to assess the real effects of a drug versus the unreal effects. However, if placebos have a multitude of effects as discussed above, perhaps, rather than being taken out they should be seen as central to health status. If placebos have a multiple number of possible effects, what factors actually mediate these changes? Several theories have been developed to try and understand the process of placebo effects. Non-interactive theories Characteristics of the individual Individual trait theories suggest that certain individuals have characteristics that make them susceptible to placebo effects. Such characteristics have been described as emotional dependency, extraversion, neurosis and being highly suggestible. Research has also suggested that individuals who respond to placebos are introverted. However, many of the characteristics described are conflicting and there is little evidence to support consistent traits as predictive of placebo responsiveness. Characteristics of the treatment Other researchers have focused on treatment characteristics and have suggested that the characteristics of the actual process involved in the placebo treatment relates to the effectiveness or degree of the placebo effect. For example, if a treatment is perceived by the individual as being serious, the placebo effect will be greater. Accordingly, surgery, which is likely to be perceived as very serious, has the greatest placebo effect, followed by an injection, followed by having two pills versus one pill. Research has also looked at the size of the pill and suggests that larger pills are more effective than small pills in eliciting a change. Characteristics of the health professional Research has also looked at the characteristics of the health professional suggesting that the kind of professional administering the placebo treatment may determine the degree of the placebo effect. For example, higher professional status and higher concern have been shown to increase the placebo effect. Problems with the non-interactive theories Theories that examine only the patient, only the treatment or only the professional ignore the interaction between patient and health professional that occurs when a placebo effect has taken place. They assume that these factors exist in isolation and can be examined independently of each other. However, if we are to understand placebo effects then perhaps theories of the interaction between health professionals and patients described within the literature (see Chapter 4) can be applied to understanding placebos.
