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Te prosecution must prove each of the elements to the trier of fact discount 10 mg singulair otc asthma 12 reversibility, in most cases a jury cheap singulair 10 mg asthma severity, beyond a reasonable doubt. While any dentist might be sued by a patient with an allegation of malpractice, forensic dentists are ofen involved in these types of cases as an expert witness for either the defense or plaintif. In order to prevail in a malpractice case, the plaintif must demonstrate by expert testimony that the defendant dentist performed substandard treatment, that is, rendered care that failed to equal or exceed the standard of care. Te defendant dentist’s attorney must counter the allegations by providing the testimony of a dentist stating that the care was at least equal to or exceeded the prevailing standard. A mere prepon- derance of the evidence, 50% plus a little bit, is all that is required for the prevailing side. Either side can appeal the verdict—a successful plaintif can complain that the damage award is insufcient, or an unsuccessful defendant dentist can argue the fnding of liability itself or complain to the appeals court that the damage award is too high. Most dental expert testimony will be given in cases that arise through state courts. A case arising and decided in one state system has no legal impact on how a similar case may be decided in any other state; however, there are similarities. Te district or trial court (local or regional) that enjoys original jurisdiction over civil and criminal cases that arise within a defned geographical boundary is the court in which the case is frst heard, with evidence and testimony being presented. Cases in these venues are usually argued in front of a jury, although a defen- dant or the parties can sometimes agree to forgo a jury and allow the judge to act as the trier of fact and rule on the law. In cases such as divorce and child custody, a jury trial is not allowed in most jurisdictions. Sitting in review of the decisions rendered at this frst level are the intermediate appellate courts, ofentimes known as the circuit court of appeal, although other names may 382 Forensic dentistry be used. Tese courts, comprised of multiple judges, hear the initial appeal sought by parties dissatisfed with decisions from the district courts. No testimony is heard in these courts; rather, an appointed panel of some of the appellate judges receives written arguments from each party citing the errors and mistakes that are alleged to have occurred in the original trial. Tis panel may request oral arguments from the attorneys, but testimony from witnesses is not heard. Te judges meet to discuss the case and render a written decision, which may uphold the original verdict, partially uphold the verdict, reverse the verdict, or order a new lower court trial in the case along with instructions to the district court on how or from whom testimony may be given. A party to the case at this level may, if desired, request that a larger panel of appeals judges rehear the case (ofen referred to as an en banc hearing), or may appeal the case to the fnal state court level—ofen known as the state supreme court. Similar to the original appeal, no testimony is heard, the justices receive only the written briefs (arguments) of the attorneys, and once again an oral argument may be scheduled. Afer discussion, the justices issue a written opinion on the case that constitutes the fnal state action. Te opinion may uphold the original verdict, partially uphold the verdict, reverse the verdict, or order a new trial in the case along with instructions to the district court on how or from whom testimony may be given. A party, as a fnal appeal, can request a rehearing by the state supreme court, an occurrence rarely granted. In some criminal cases, afer a defendant has exhausted his or her appeals in the state courts, he or she may appeal certain matters to the federal court system. Tese federal appeals can take years to conclude, as evidenced by some capital or death penalty cases. District Courts retain original jurisdiction for questions of federal law that arise within their respective district, of which there are currently ninety-four, including locations within the District of Columbia, Puerto Rico, and the territories of Guam, the Virgin Islands, and the Northern Mariana Islands. District Courts of Appeal, of which there are twelve, each usually encompassing all of the district courts in several states. Written arguments are made, oral arguments may be heard, but witness testimony is not heard at the appellate level. As in the state system, a group of judges is empanelled to hear and discuss each case, and a written decision is handed down. Once again, that decision can uphold, reverse, remand, or supplement the district court verdict. A rehearing Jurisprudence and legal issues 383 or an en banc hearing can be requested, or an appeal to the U.
Volatile substance abuse: a review of possible long-term neurological purchase singulair 10 mg without prescription asthma 2015, intellectual and psychiatric sequelae buy cheap singulair 4mg asthmatic bronchitis qvar. Mescaline, lysergic acid diethylamide and psilocybin: comparison of clinical syndromes, effects on color perception and bio- chemical measures. An association between the regular use of 3,4, methylenedioxy-methamphetamine (ecstasy) and excessive wear of the teeth. Acute systemic effects of cocaine in man—a controlled study by intranasal and intravenous routes. Use and abuse of khat (Catha edulis): a review of the distribution, pharmacology, side effects, and a description of psycho- sis attributed to khat chewing. The effects of superphysiologic doses of testosterone on muscle size and strength in normal men. Three cases of nalbuphine hydro- chloride dependence associated with anabolic steroid use. Pharmacokinetics of gamma-hydroxybu- tyric acid in alcohol dependent patients after single and repeated oral doses. Presented at the 49th Annual Meeting of the American Acad- emy of Forensic Sciences, New York, 1997 107. Multistate outbreak of poisonings associated with the illicit use of gammahydroxybutyrate. Saturday night blue—a case of near fatal poisoning from the abuse of amyl nitrite. Biochemistry and physiology of alcohol: applications to forensic science and toxicology. Food-induced lowering of blood-ethanol profiles and increased rate of elimination immediately after a meal. Lack of observable intoxication in humans with high plasma alcohol concentrations. Alcohol and the law: the legal framework of scientific evidence and expert testimony. Eye signs in suspected drinking drivers: clinical examination and relation to blood alcohol. Acute effects of alcohol on left ventricular function in healthy subjects at rest and during upright exercise. Drunken detain- ees in police custody: is brief intervention by the forensic medical examiner fea- sible? The validity of self-reported alcohol consumption and alcohol prob- lems: a literature review. Assessment and management of individuals under the influence of alcohol in police custody. This chapter aims to pro- vide a broad basis for the understanding of the disease processes and the mecha- nisms that may lead to death and also to provide some understanding of the current thinking behind deaths associated with restraint. The worldwide variations in these definitions have caused, and continue to cause, considerable confusion in any discussion of this subject. For the purposes of this chapter, “in custody” relates to any individual who is either under arrest or otherwise under police control and, although similar deaths may occur in prison, in psychiatric wards, or in other situations where people are detained against their will, the deaths specifically associated with police detention form the basis for this chapter. It is important to distinguish between the different types of custodial deaths because deaths that are related to direct police actions (acts of commission) seem to cause the greatest concern to the family, public, and press. It is also important to remember that police involvement in the detention of individuals From: Clinical Forensic Medicine: A Physician’s Guide, 2nd Edition Edited by: M. These acts are considerably harder to define and perhaps sometimes result from the police being placed in, or assuming, a role of caring (e. Police involvement with an individual can also include those who are being pursued by the police either on foot or by vehicle, those who have been stopped and are being questioned outside the environment of a police station, and those who have become unwell through natural causes while in contact with or in the custody of the police. The definitions of “death in custody” are therefore wide, and attempts at simple definitions are fraught with difficulty. Any definition will have to cover a multitude of variable factors, in various circumstances and with a variety of individuals.
Which of the following principles of reflect the aims of patient teaching and coun- teaching–learning is an accurate guideline seling? Patient teaching should occur independent ior while facilitating changes in the knowl- of the nursing process cheap singulair 4mg amex asthmatic bronchitis triggers. Past life experience should not be a factor when helping patients assimilate new b buy singulair 5 mg line asthmatic bronchitis yreatment. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. School-aged children are capable of logical likely be taught to a patient with the aim of reasoning and should be included in the restoring health? Patient and nurse’s expectations of one different from those of adults, so they another require different content and teaching strategies for patient teaching. Most adults’ orientation to learning is that how the patient can participate in care material should be useful immediately 4. Which of the following is an accurate descrip- rather than at some time in the future. Honor the patient as a partner in the help reduce the probability of contracting education process. Patients believe that the threat of taking reflect recommended steps of the teaching– actions against a disease is not as great as learning process? Patients believe that doing nothing is and long-term goals for patient learning preferable to painful treatments. When a nurse and patient establish a relation- ship in which mutual respect and trust are 6. Which of the following statements accurately established, they have developed a(n) describe the way developmental factors affect relationship. A patient who describes how insulin injections change according to developmental stages. Emotional maturity and moral and spiritual development do not affect a person’s learn- 4. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. A nurse shows a diabetic patient how to give herself insulin by injecting an orange. Content that is supported by nursing research and reflects the most accurate and clinically 10. When a nurse assists a patient to decide to quit smoking, the nurse is fulfilling the role of Match the examples of teaching strategies in. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. An older adult who is afraid to learn some- the example of the domain listed in Part B. Psychomotor learning paralysis of his left side and must be taught exercises for rehabilitation. A patient decides to get dressed in constraints place on the nurse when planning the morning following treatment for patient learning. Briefly describe the following types of patients can facilitate the following nursing teaching, and give an example of each: aims. An adult who resists learning because of preconceived ideas about the process and 8. Define the following types of counseling, and your expectations of him/her: give an example of a case in which each type would be used by the nurse. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Give an example of the following teaching strategies that you have experienced in your personal/student life.
It is model is yet to truly come of age in nursing or the Parthenope buy cheap singulair 10mg on line asthma treatment chart, the older sister purchase singulair 4mg without a prescription asthma definition verb, who clutches her fa- health care system. Justice- making is understood as a manifestation of com- passion and caring,“for it is our actions that brings about justice” (p. This chapter reiterates Nightingale’s life from the years 1820 to 1860, delineating the formative influences on her thinking and providing historical context for her ideas about nursing as we recall them today. Part of what follows is a well-known tale; yet it remains a tale that is irresistible, casting an age-old spell on the reader, like the flickering shadow of Nightingale and her famous lamp in the dark and dreary halls of the Barrack Hospital, Scutari, on the outskirts of Constantinople, circa 1854 to 1856. Early Life and Education A profession, a trade, a necessary occupation, some- thing to fill and employ all my faculties, I have always felt essential to me, I have always longed for, con- sciouslyornot.... Nightingales and both daughters made an extended —Florence Nightingale, private note, 1850, cited tour of France, Italy, and Switzerland between the in Woodham-Smith (1983, p. From there, Nightingale vis- By all accounts, Nightingale was an intense and ited Germany, making her first acquaintance with serious child, always concerned with the poor and Kaiserswerth, a Protestant religious community the ill, mature far beyond her years. A few months that contained the Institution for the Training of before her seventeenth birthday, Nightingale Deaconesses, with a hospital school, penitentiary, recorded in a personal note dated February 7, 1837, and orphanage. What that Fleidner, and his young wife had established this service was to be was unknown at that point in community in 1836, in part to provide training for time. This was to be the first of four such experi- women deaconesses (Protestant “nuns”) who ences that Nightingale documented. Nightingale was to return there in The fundamental nature of her religious convic- 1851 against much family opposition to stay from tions made her service to God, through service to July through October, participating in a period of “nurses training” (Cook, Vol. What the make it without”(Nightingale, private note, cited in Kaiserswerth training lacked in expertise it made Woodham-Smith, 1983). It would take 16 long and torturous years, from Florence wrote, “The world here fills my life with 1837 to 1853, for Nightingale to actualize her call- interest and strengthens me in body and mind” ing to the role of nurse. Nightingale took two trips to Paris she turned down proposals of marriage, potentially, in 1853, hospital training again was the goal, this in her mother’s view, “brilliant matches,” such as time with the sisters of St. In August 1853, she accepted her need to serve God and to demonstrate her caring first “official” nursing post as superintendent of an through meaningful activity proved stronger. She “Establishment for Gentlewomen in Distressed did not think that she could be married and also do Circumstances during Illness,” located at 1 Harley God’s will. After six months at Harley Street, Calabria and Macrae (1994) note that for Nightingale wrote in a letter to her father: “I am in Nightingale there was no conflict between science the hey-day of my power” (Nightingale, cited in and spirituality; actually, in her view, science is nec- Woodham-Smith, 1983, p. The development of science allows for the concept of one perfect God who regulates the uni- verse through universal laws as opposed to random Spirituality happenings. Nightingale referred to these laws, or the organizing principles of the universe, as Today I am 30—the age Christ began his Mission. As part of Now no more childish things, no more vain things, no God’s plan of evolution, it was the responsibility of more love, no more marriage. A suc- cessful advance of Russia through Turkey could God lays down certain physical laws. Upon his carry- threaten the peace and stability of the European ing out such laws depends our responsibility (that continent. It was written of that battle that it was a “glorious and bloody vic- Influenced by the Unitarian ideas of her father tory. However, the telegraph enabled war truth, studying a variety of religions and reading correspondents to telegraph reports home with widely. The horror of the battlefields was Nightingale wrote: “I believe that there is a Perfect relayed to a concerned citizenry. Descriptions of Being, of whose thought the universe in eternity is wounded men, disease, and illness abounded. The French Dossey (1998) recasts Nightingale in the mode of had the Sisters of Charity to care for their sick “religious mystic. For Nightingale, service to God was Lord Herbert of Lea, who was the husband of service to humanity (Calabria & Macrae, 1994, p. Herbert had an innovative solution: appoint Miss In Nightingale’s view, nursing should be a search Nightingale and charge her to head a contingent of for the truth; it should be a discovery of God’s laws nurses to the Crimea to provide help and organiza- of healing and their proper application.
Within Cannon’s model cheap 5 mg singulair with mastercard asthma bronchiale bei kindern definition, stress was defined as a response to external stressors 10 mg singulair free shipping asthma treatment stages, which was predominantly seen as physiological. Cannon considered stress to be an adaptive response as it enabled the individual to manage a stressful event. However, he also recognized that prolonged stress could result in medical problems. The initial stage was called the ‘alarm’ stage, which described an increase in activity, and occurred immediately the individual was exposed to a stressful situation. The second stage was called ‘resistance’, which involved coping and attempts to reverse the effects of the alarm stage. They there- fore did not address the issue of individual variability and psychological factors were given only a minimal role. For example, whilst an exam could be seen as stressful for one person it might be seen as an opportunity to shine to another. This response is seen as non specific in that the changes in physiology are the same regardless of the nature of the stressor. This is reflected in the use of the term ‘arousal’ which has been criticized by more recent researchers. Therefore, these two models described individuals as passive and as responding automatically to their external world. Life events theory In an attempt to depart from both Selye’s and Cannon’s models of stress, which emphasized physiological changes, the life events theory was developed to examine stress and stress-related changes as a response to life experiences. These ranged in supposed objective severity from events such as ‘death of a spouse’, ‘death of a close family member’ and ‘jail term’ to more moderate events such as ‘son or daughter leaving home’ and ‘pregnancy’ to minor events such as ‘vacation’, ‘change in eating habits’, ‘change in sleeping habits’ and ‘change in number of family get-togethers’. However, this obviously crude method of measurement was later replaced by a variety of others, including a weighting system whereby each potential life event was weighted by a panel creating a degree of differentiation between the different life experiences. The individual’s own rating of the event is important It has been argued by many researchers that life experiences should not be seen as either objectively stressful or benign, but that this interpretation of the event should be left to the individual. For example, a divorce for one individual may be regarded as extremely upsetting, whereas for another it may be a relief from an unpleasant situation. They reported that a useful means of assessing the potential impact of life events is to evaluate the individual’s own ratings of the life experience in terms of (1) the desirability of the event (was the event regarded as positive or negative); (2) how much control they had over the event (was the outcome of the event determined by the individual or others); and (3) the degree of required adjustment following the event. This methodology would enable the individual’s own evaluation of the events to be taken into consideration. The problem of retrospective assessment Most ratings of life experiences or life events are completed retrospectively, at the time when the individual has become ill or has come into contact with the health profession. This has obvious implications for understanding the causal link between life events and subsequent stress and stress- related illnesses. For example, if an individual has developed cancer and is asked to rate their life experiences over the last year, their present state of mind will influence their recollection of that year. This effect may result in the individual over-reporting negative events and under-reporting positive events if they are searching for a psychosocial cause of their illness (‘I have developed cancer because my husband divorced me and I was sacked at work’). Alternatively, if they are searching for a more medical cause of their illness they may under-report negative life events (‘I developed cancer because it is a family weakness; my lifestyle and experiences are unrelated as I have had an uneventful year’). The relationship between self-reports of life events and causal models of illness is an interesting area of research. Research projects could select to use this problem of selective recall as a focus for analysis. However, this influence of an individual’s present state of health on their retrospective ratings undermines attempts at causally relating life events to illness onset. For example, a divorce, a change of jobs and a marriage would be regarded as an accumulation of life events that together would contribute to a stressful period of time. However, one event may counter the effects of another and cancel out any negative stressful consequences. Evaluating the potential effects of life experiences should include an assessment of any interactions between events. Accordingly, it was assumed that if the life experiences were indeed stressful then the appropriate outcome measure was one of health status. The most straightforward measure of health status would be a diagnosis of illness such as cancer, heart attack or hypertension. Within this framework, a simple correlational analysis could be carried out to evaluate whether a greater number of life experiences correlated with a medical diagnosis. However, such an outcome measure is restrictive, as it ignores lesser ‘illnesses’ and relies on an intervention by the medical profession to provide the diagnosis.
For each question in the matching set generic 4 mg singulair with visa asthma treatment 1 year old, select one lettered option that is most closely associated with the question cheap singulair 10 mg free shipping asthma symptoms and rapid heartbeat. To simulate the time constraints imposed by the qualifying examina- tions for which this book is intended as a practice guide, the student or physician should allot about one minute for each question. After answering all questions in a chapter, as much time as necessary should be spent reviewing the explanations for each question at the end of the chapter. Atten- tion should be given to all explanations, even if the examinee answered the question correctly. Those seeking more information on a subject should refer to the reference materials listed or to other standard texts in emergency medicine. He has a his- tory of hypertension, hypercholesterolemia, and a 20-pack-year smoking history. Give the patient two nitroglycerin tablets sublingually and observe if his chest pain resolves. She was able to fall asleep without difficulty but woke up in the morning with persistent pain that is worsened upon taking a deep breath. Two weeks ago, she took a 7-hour flight from Europe and since then has left-sided calf pain and swelling. He recalls feeling similar episodes of palpitations a few months ago but they resolved. Her daughter states that the patient has been increasingly tired and occasionally confused for the past 3 days and has not been eating her usual diet. A chest radiograph shows a small right-sided (less than 10% of the hemithorax) spontaneous pneumothorax. Perform needle decompression in the second intercostal space, midclavicular line c. He has a known history of alcohol abuse with multiple presentations for intoxication. Today, the patient complains of acute onset, persistent chest pain associated with dysphagia, and pain upon flexing his neck. Which of the following is the preferred study of choice to diagnose this patient’s condition? The patient states he never experienced chest pain in the past when using cocaine. The patient states that the only medication he takes is alprazolam to “calm his nerves. The patient states that she used to work as a convenience store clerk but was fired 2 weeks ago. Order a monospot test and recommend that the patient refrain from vigorous activities for 1 month. A 61-year-old woman was on her way to the grocery store when she started feeling chest pressure in the center of her chest. He describes a gradual onset of chest pain that is worse with activity and resolves when he is at rest. Administer ibuprofen and reassure the patient that he is not having a heart attack. While eating dinner, a 55-year-old man suddenly feels a piece of steak “get stuck” in his stomach. Which of the following is an absolute contraindication to receiving thrombolytic therapy? Her lung examination reveals bilateral crackles and she is beginning to have chest pain. Which of the following is the most appropriate immediate treatment for this patient? Which of the following is the most appropriate first-line medication to lower cardiac preload?
Because the purpose of nursing educa- tion is to study the discipline and practice of nursing cheap 10mg singulair asthma symptoms 8 days, (Schoenhofer & Boykin cheap singulair 5mg amex asthma treatment yahoo, 1998b). Dialogue, descrip- the nursed must be in the circle, and the focus of tion, and innovations in interpretative approaches study must be the nursing situation, the shared lived characterize research methods. Development of experience of caring between nurse and nursed and systems and structures (e. The community created is that of persons living imbursement) to support nursing necessitates caring in the moment and growing in personhood, sustained efforts in reframing and refocusing famil- each person valued as special and unique. In teaching nursing as caring, faculty assist stu- Nurses in research and development roles carry dents to come to know, appreciate, and celebrate out their work facing environmental pressures both self and other as caring persons. Students, as similar to those experienced by the practitioner, well as faculty, are in a continual search to discover the administrator, and the educator. Research greater meaning of caring as uniquely expressed in and development in nursing require disciplinary- nursing. Examples of a nursing education program congruent values and perspectives, free-ranging based on values similar to those of nursing as car- thought, openness, and creativity. Institutional sys- ing are illustrated in the book Living a Caring-based tems and structures often seem to favor values and Program (Boykin, 1994). Researchers and accepting responsibility for summative evaluation developers guided by the assumptions and themes calls for the integrated foundation provided by the of nursing as caring are empowered to create novel guiding intention to know and nurture persons as methods in the search for understanding and mean- caring. This intention helps the nurse to transcend ing and to articulate effectively the value, purpose, limiting historical practices while creatively invent- and relevance of their work (Schoenhofer, 2002). Does this mean that the nurse must like Theory of Nursing as Caring everything about the person, including personal life choices? Perhaps not; however, the nurse as nurse is The following presents several common ques- not called upon to judge the other, only to care for tions—and responses—that nurses ask about nurs- the other. Related to the previous dilemma, this question Mayeroff’s (1971) caring ingredients offer a useful presents the crucible within which one’s commit- starting point for the nurse committed to knowing ment to the assumptions and themes of nursing as self and other as caring persons. The underlying ques- include knowing, alternating rhythm, honesty, tion is, “Does the person to be nursed deserve or courage, trust, patience, humility, and hope. All persons are caring, even when not all cho- dence, conscience, competence, and compassion— sen actions of the person live up to the ideal to offer another conceptual framework that is helpful which we are all called by virtue of our humanness. Coming to know In discussions of hypothetical situations involving self as caring is facilitated by: child molesters, serial killers, and even political fig- • Trusting in self; freeing self up to become what ures who have attempted mass destruction and one can truly become, and valuing self. However, problems, difficulties, in order to remember the when such a person presents to the nurse for care, interconnectedness that enables us to know self the nursing ethic of caring supersedes all other val- and other as living caring, even in suffering and ues. The theory of nursing as caring asserts that it is in seeking relief from suffering. It is only with sustained intentionality, com- for one can only truly understand in another mitment, study, and reflection that the nurse is what one can understand in self. In order ment, and engaging in study and reflection, indi- to know the other as caring, the nurse must find vidually and in concert with caring others. The key point here is the “caring between” that is Process, as it is understood in the term “nursing the nursing creation: When nursing a person who is process,” connotes a systematic and sequential se- unconscious, the nurse lives the commitment to ries of steps resulting in a predetermined, specifi- know the other as caring person. It requires that all ways of knowing nursing by Orlando (1961), is a linear stepwise be brought into action. The nurse must make self as decision-making tool based on rational analysis of caring person available to the one nursed. The full- empirical data (known in other disciplines as the ness of the nurse as caring person is called forth. Proponents of the theory of nursing as and knowing the other directly through authentic caring view nursing not as a process with an presence and attunement; the hope and courage to endpoint, but as an ongoing process; that is, as risk opening self to one who cannot communicate dynamic and unfolding, guided by intentionality verbally; patiently trusting in self to understand the although not directed by a preenvisioned outcome other’s mode of living caring in the moment; hon- or product. Nursing responses of care arise in est humility as one brings all that one knows and aesthetic knowing, in the creative and evolving remains open to learning from the other. The nurse patterns of appreciation and understanding, and in attuned to the other as person might, for example, the context of a shared lived experience of caring. In that vulnerability, the nurse recognizes that which is experienced as valuable arising in and that the one nursed is living caring in humility, evolving through the “caring between” of the nurs- hope, and trust. Much of that value is neither measur- nerability, merely “taking care of” the other, the able nor empirically verifiable. That which is nurse practicing nursing as caring might respond measurable and empirically verifiable is relevant in by honoring the other’s humility, by participating the situation, however, and may be called upon at in the other’s hopefulness, and by steadfast trust- any time to contribute to and through the nurse’s worthiness.
