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Y. Ilja. Warner Pacific College.
In contrast to the predictions of physiognomy advair diskus 250mcg low price asthma pills, the researchers found that these people would have made more accurate judgments about the strangers if they had just guessed purchase advair diskus 100 mcg asthma symptoms clip art, using their expectations about what people in general are like, rather than trying to use the particular facial features of individuals to help them. It seems then that the predictions of physiognomy may also, in the end, find little empirical support. Personality as Traits Personalities are characterized in terms of traits, which are relatively enduring characteristics that influence our behavior across many situations. Personality traits such as introversion, friendliness, conscientiousness, honesty, and helpfulness are important because they help explain consistencies in behavior. The most popular way of measuring traits is by administering personality tests on which people self-report about their own characteristics. Psychologists have investigated hundreds of traits using the self-report approach, and this research has found many personality traits that have important implications for behavior. You can see some examples of the personality dimensions that have been studied by psychologists and their implications for behavior in Table 11. Individualists prefer to engage in behaviors that make them stand out from Individualism- Individualism is the tendency to focus on oneself others, whereas collectivists prefer to collectivism (Triandis, and one‘s personal goals; collectivism is the engage in behaviors that emphasize their 1989) tendency to focus on one‘s relations with others. In comparison to those with an external locus of control, people with an internal locus of control are People with higher internal locus of Internal versus external more likely to believe that life events are due control are happier, less depressed, and locus of control (Rotter, largely to their own efforts and personal healthier in comparison to those with an 1966) characteristics. Those high in need for achievement Need for achievement The desire to make significant accomplishments by select tasks that are not too difficult to (McClelland, 1958) mastering skills or meeting high standards be sure they will succeed in them. Need for cognition The extent to which people engage in and enjoy People high in the need for cognition (Cacioppo & Petty, 1982) effortful cognitive activities pay more attention to arguments in ads. Refers to differences in the motivations that People with a promotion orientation are energize behavior, varying from apromotion more motivated by goals of gaining Regulatory focus (Shah, orientation (seeking out new opportunities) to money, whereas those with prevention Higgins, & Friedman, aprevention orientation (avoiding negative orientation are more concerned about 1998) outcomes) losing money. Self-consciousness The tendency to introspect and examine one‘s People high in self-consciousness spend Attributed to Charles Stangor Saylor. High self-esteem is associated with a Self-esteem (Rosenberg, High self-esteem means having a positive attitude variety of positive psychological and 1965) toward oneself and one‘s capabilities. Sensation seekers are more likely to engage in risky behaviors such as Sensation seeking The motivation to engage in extreme and risky extreme and risky sports, substance (Zuckerman, 2007) behaviors abuse, unsafe sex, and crime. Generalized expectancies of internal versus external locus of control of reinforcement. Performance incentives and means: How regulatory focus influences goal attainment. Example of a Trait Measure You can try completing a self-report measure of personality (a short form of the Five-Factor Personality Test) here. You will receive feedback about your personality after you have finished the test. Some popular measures of personality are not useful because they are unreliable or invalid. One of the challenges of the trait approach to personality is that there are so many of them; there are at least 18,000 English words that can be used to describe people (Allport & Odbert, [6] 1936). Thus a major goal of psychologists is to take this vast number of descriptors (many of which are very similar to each other) and to determine the underlying important or “core‖ traits [7] among them (John, Angleitner, & Ostendorf, 1988). The trait approach to personality was pioneered by early psychologists, including Gordon Allport (1897–1967), Raymond Cattell (1905–1998), and Hans Eysenck (1916–1997). Each of these psychologists believed in the idea of the trait as the stable unit of personality, and each attempted to provide a list or taxonomy of the most important trait dimensions. Their approach was to provide people with a self-report measure and then to use statistical analyses to look for the Attributed to Charles Stangor Saylor. He called them “cardinal traits‖ (the most important traits), “central traits‖ (the basic and most useful traits), and [9] “secondary traits‖ (the less obvious and less consistent ones). Cattell (1990) used a statistical procedure known as factor analysis to analyze the correlations among traits and to identify the most important ones. On the basis of his research he identified what he referred to as “source‖ (more important) and “surface‖ (less important) traits, and he developed a measure that assessed 16 dimensions of traits based on personality adjectives taken from everyday language.
The dose will subsequently is converted to acetoacetate cheap advair diskus 250mcg on-line asthma unspecified, acetone and β-hydroxybutyrate need to be reduced when the infection has cleared advair diskus 500mcg generic asthma bronchitis emphysema difference. These are buffered by plasma bicarbonate, leading to often causes patients incorrectly to stop injecting insulin (for a fall in bicarbonate concentration (metabolic acidosis – with an fear of hypoglycaemia) and this may result in ketoacidosis. This is continued post-operatively until oral feeding and intermittent subcutaneous injections • Sodium and potassium deficit A generous volume of physiological saline (0. When blood glucose levels fall below 17mmol/L, 5% glucose is Type 1 diabetes mellitus and insulin given in place of N-saline. Potassium must be replaced • Type 1 (insulin-dependent) diabetes mellitus is caused and if the urinary output is satisfactory and the plasma by degeneration of β-cells in the islets of Langerhans potassium concentration is 4. Mixtures of soluble metabolic acidosis is controversial, and may paradoxically and longer-acting insulins are used and are given using worsen intracellular and cerebrospinal fluid acidosis. Regular self- monitoring of blood glucose levels throughout the day arterial pH is 7. It is using physiological saline (there is sometimes a place for half- metabolized to inactive α and β peptide chains largely by strength, 0. Insulin from the pancreas is mainly released into the por- mon, contributes to the difficulty of correcting the potassium tal circulation and passes to the liver, where up to 60% is deficit, and should be treated provided renal function is nor- degraded before reaching the systemic circulation (presystemic mal. The kidney is also important in the metabolism of increased and a heparin preparation (Chapter 30) should be insulin and patients with progressive renal impairment often considered as prophylaxis against venous thrombosis. There is no evidence that diabetes ever results from increased hepatic destruction of Mechanism of action insulin, but in cirrhosis the liver fails to inactivate insulin, thus Insulin acts by binding to transmembrane glycoprotein recep- predisposing to hypoglycaemia. Adverse reactions Most type 2 diabetic patients initially achieve satisfactory con- trol with diet either alone or combined with one of these agents. Hypoglycaemia is the most important and severe The small proportion who cannot be controlled with drugs at complication of insulin treatment. Subsequent failure an intravenous injection of glucose in unconscious after initially adequate control (secondary failure) occurs in patients, but sugar is given as a sweet drink in those about one-third of patients, and is treated with insulin. Its bioavailability is affected repeated after a few minutes if necessary) is useful if by smoking and by respiratory infections, and currently should the patient is unconscious and intravenous access is only be used with great caution in patients with asthma/ not achievable (e. Insulin-induced post-hypoglycaemic hyperglycaemia (Somogyi effect) occurs when hypoglycaemia (e. It is used glucagon) that elevate blood glucose (raised blood glucose in type 2 diabetic patients inadequately controlled by diet. The situation can be misinterpreted as anorectic effect aids weight reduction, so it is a first choice drug requiring increased insulin, thus producing further for obese type 2 patients, provided there are no contraindica- hypoglycaemia. Local or systemic allergic reactions to insulin, with is contraindicated in: itching, redness and swelling at the injection site. Lipodystrophy: the disappearance of subcutaneous fat at • renal failure (it is eliminated in the urine, see below); or near injection sites. Fatty tumours occur if repeated injections • cirrhosis; are made at the same site. Insulin resistance, defined arbitrarily as a daily • cardiac failure (because of poor tissue perfusion); requirement of more than 200 units, due to antibodies, is • congenital mitochondrial myopathy (which is often unusual. Changing to a highly purified insulin accompanied by diabetes); preparation is often successful, a small starting dose being • acute myocardial infarction and other serious intercurrent used to avoid hypoglycaemia. They are shorter acting even than function tests should be monitored before and during its use. Biguanides do not produce hypo- The hypoglycaemic effect of these drugs depends on the pres- glycaemia and are effective in pancreatectomized animals. Sulphonylureas, like glucose, Effects of metformin include: depolarize B cells and release insulin. Chlorpropamide, Adverse effects the longest-acting agent, was responsible for many cases. It also causes flushing in susceptible individuals when ethanol is con- Metformin causes nausea, a metallic taste, anorexia, vomiting sumed, and can cause dilutional hyponatraemia (by potentiat- and diarrhoea. Allergic reactions to sulphonylureas tiated and a few patients cannot tolerate even small doses. Treatment is by reversal of hypoxia and circulatory Serious effects other than hypoglycaemia are uncommon. Absorption of vitamin B12 is reduced tract and the major differences between them lie in their rela- by metformin, but this is seldom clinically important.
Caffeine also stimu- lates the cerebral cortex and stimulates respiration by acting on the brain stem and medulla cheap advair diskus 250 mcg with mastercard asthma treatment drug names. Anorexiants inhibit appetite by stimulating the cerebral cortex and the hypothalamus advair diskus 500 mcg for sale asthma 504. Amphetamines, analeptics, and anorexiants are commonly referred to as “uppers” when used to prevent sleep. Anorexiants and amphetamines can pro- duce psychological dependence and the body can become tolerant to its effect if abused. Abruptly discontinuing these medications may result in withdrawal symptoms including depression. Amphetamines are also taken to decrease weight and increase energy enabling the patient to perform work quickly with- out rest. Amphetamines, analeptics, and anorexiants stimulate the release of the neuro- transmitters norepinephrine and dopamine from the brain and from the periph- eral nerve terminals of the sympathetic nervous system. The patient can also experience sleeplessness, restless- ness, tremors, and irritability; cardiovascular problems (increased heart rate, pal- pitations, dysrhythmias and hypertension). Caffeine is found in many drugs including Anacin, Excedrin, Cafergot, Fiorinal, and Midol. The cause of migraines is not clearly understood although research indicates the expansion of blood vessels and the release of certain chemicals—such as dopamine and serotonin—causes inflammation and pain. A migraine can occur if an abnormal amount of these chemicals are present or if the blood vessels are unusually sensitive to them. Patients who have migraines experience intense, throbbing, headache pain which is often accompanied by nausea, photophobia (sensitivity to light), phono- phobia (sensitivity to sound), and temporary disability. Migraines are sometimes preceded by an aura such as a breeze, odor, a beam of light, or a spectrum of colors. Migraines can occur on one side of the head (unilateral) and the pain is frequently reported as pulsating or throbbing. These are blood-vessel constrictors and dilators (see Chapter 26), antiseizure drugs (dis- cussed later in this chapter), antidepressants (discussed later in this chapter), beta-blockers (see Chapter 26), and analgesics (see Chapter 16). Patients are given a selected combination of these medications to prevent migraines. The prescriber determines the most effective combination for each patient based on the patient’s response to these medications. Commonly prescribed medications to prevent migraines are amitriptyline, divaproex sodium, propranol, timolol, topiramate, bupropion, cyproheptadine, diltiazem, doxepin, fluvoxamine, ibuprofen, imipramine, and methysergide. A list of drugs utilized in the treatment of migrane headaches is provided in the Appendix. With increased doses, the patient experiences a hypnotic effect causing the patient to fall asleep. Such is the case of the ultra-short-acting barbiturate thiopental sodium (Pentothal) that produces anesthesia. Sedative-hypnotics and barbituates were first used to reduce tension and anx- iety. Over-the-counter sleep medications such as diphenhydramine con- tain an antihistamine not barbiturates to achieve sedation. Short-acting sedative-hypnotics are ideal for patients who need assistance falling asleep but who must awaken early without experiencing a lingering aftereffect from the medication. The use of sedative-hypnotics for sleep (hypnotic) should be short term or there is a chance that the patient could become dependent on the medication or develop a tolerance. Patients who take high doses of sedative-hypnotics over long periods must gradually discontinue the medication rather than abruptly stopping the drug which can cause withdrawal symptoms. Sedative-hypnotics should not be administered to patients who have severe respiratory disorders or who are pregnant. Before a patient is prescribed a sedative-hypnotic to aid with sleep, the patient should try non-pharmacological methods that promote sleep such as: • Arise at a specific hour in the morning. Barbiturates are clas- sified by duration of action referred to as ultrashort-acting, short-acting, inter- mediate acting, and long-acting.
Coping mechanisms Exposure to stress initiates various coping mechanisms (responses) order advair diskus 250 mcg on line asthma treatment video. The fight and flight response is a simple physiological response advair diskus 250 mcg mastercard asthmatic bronchitis zinc, but there are more complex cognitive responses. When something causes distress we can try and change either the stressor or ourselves. These coping mechanisms may be positive or negative/palliative, so that attempts to escape reality (changing ourselves) with drugs (e. However, taking antidepressants (again, changing ourselves) can be a positive coping mechanism, the problem (depression) being internal. Palliative coping mechanisms include: ■ denial Stress management 435 ■ smoking ■ excessive drinking ■ excessive overeating. Positive coping mechanisms attempt to change stressors, which may require finding out further information about them, just as preoperative information can reduce postoperative pain (Hayward 1975). Permitting and enabling people to express and release their stress may be more beneficial than trying to offer advice (cf. Recognising stress Recognising distress in others is often relatively easy, but recognising signs of stress in ourselves can be harder. The stressors may be common to all, but their responses (types of stress) differ from person to person; in order to recognise stress, therefore, we must recognise how each stressor affects each person by trying to understand experiences from their viewpoint (i. Unrecognised distress can progress, causing multiple problems, such as staff conflict, absenteeism, low morale, inefficient/poor work and (eventually) burn-out (Stechmiller & Yarandi 1993). Problems usually prove increasingly difficult to resolve, possibly causing potentially valuable staff to leave the unit and even, perhaps, nursing. Tyler and Ellison’s (1994) recommendation that nurses should attend stress management study days could be extended to other self-awareness courses, such as time management. Enabling staff to recognise their own (and others’) stress can help to limit crises. Burn-out, ultimate failure of coping mechanisms, causes: ■ decreased energy ■ decreased self-esteem ■ output exceeding input ■ a sense of hopelessness and helplessness ■ the inability to perceive alternative ways of functioning ■ cynicism ■ negativism ■ feelings of self-depletion (Farrington 1997) Intensive care nursing 436 When burn-out is reached, work becomes hard, unrewarding and of poor quality. Burn- out is a form of mental ill-health, potentially ending in suicide (see the opening of this chapter). Being stressed is not a personal failure; recognising and acknowledging our own stress helps us to resolve it. Stress and response to stress are complex effects, which are often not helped by over- simplistic behavioural explanations. Humanistic stress management seeks to identify the motivation underlying apparent behaviour. This necessitates discussion, but to be effective neither person should feel threatened by the other. Anyone seeking to help distressed colleagues should adopt Rogers’ (1967) ‘unconditional positive regard’, respecting the person for whom they are and what they are. Recognising the rights of both yourself and others is fundamental to assertiveness: everyone has the (moral) right to disagree with others and openly state disagreement, but not to deny others the right to their own opinion. By respecting others it becomes easier both to respect oneself (self-esteem) and be respected by others; self- esteem and the esteem of others form the penultimate level of Maslow’s hierarchy of needs (Maslow 1987 [1954]). Positive thinking about ourselves helps us to believe that we can (and should) change harmful stressors rather than change (harm) ourselves. Type A and type B personalities Much of the early literature on stress identifies two types of personalities: type A and type B. Type A describes active, competitive, potentially aggressive people, highly stressed but also seeking out stress (Rentoul et al. Traditional links between the type A personality and coronary disease have been questioned by more recent studies, and Case et al. However, these over-simplistic stereotypes, more appropriate to behaviourist approaches than humanist, are still being used. Time management Lack of time is often a major stressor: managing our time effectively reduces stress, especially when under pressure.
