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Program Director, University of the Virgin Islands

The most appropriate intervention is to refer the client to a member of the multidisciplinary team who has expertise in the area in which the client is having the problem. After 2 weeks, the nurse should obtain further assistance in treating the stoma site. Karaya paste will not be effective in treating the excoriated area; therefore, this is not an appropriate intervention. Mexican American families are close-knit communities and often prefer to care for their own family members; therefore, they would not seek hospice or palliative care. The nurse should attempt to help the client understand the philosophy, the benefits, and the help hospice can give the client and family. The nurse should attempt to help the client and family understand hospice so the client can make an informed decision. The healthcare provider does not need to be contacted to reaffirm the client is dying. Bereavement counseling may include group counseling, but it could also be individual counseling. The nurse is specifically describing the term "durable power of attorney for healthcare. Many nurses follow this practice, but no research has been completed to support this practice. Evidence-based practice is the conscientious use of current best evidence in making decisions about nursing care. Content ­ Medical/Surgical: Category of Health Alteration ­ Gastrointestinal: Integrated Processes ­ Nursing Process: Diagnosis: Client Needs ­ Safe and Effective Care Environment: Safety and Infection Control: Cognitive Level ­ Analysis blueprint includes nursing care based on evidence-based practice. The charge nurse should stop the nurse from recapping the needle, but not in front of the client. The charge nurse should ask the nurse to step into the hall, where the client cannot hear. The staff nurse is not in a position of authority to require the potentially impaired nurse to submit to a drug test. The administrative supervisor should assess the situation and initiate the appropriate follow-up. The nurse is not a counselor, and a staff nurse should not attempt to confront an impaired colleague. The administrative supervisor and the charge nurse are the only staff members who have the authority to send a nurse home. Content ­ Medical/Surgical: Category of Health Alteration ­ Gastrointestinal: Integrated Processes ­ Nursing Process: Implementation: Client Needs ­ Safe and Effective Care Environment: Management of Care: Cognitive Level ­ Application 43. The first action for the administrative supervisor is to make sure the clients receive care. The supervisor cannot allow the on-duty staff to leave until replacement staff members have been arranged. The supervisor should call any staff that can get to the hospital in an attempt to staff the hospital, but this is not the first action to implement. An emergency disaster protocol may be implemented, but the first intervention is to ensure the clients have a nurse on duty. Content ­ Medical/Surgical: Category of Health Alteration ­ Gastrointestinal: Integrated Processes ­ Nursing Process: Implementation: Client Needs ­ Safe and Effective Care Environment: Management of Care: Cognitive Level ­ Application be knowledgeable of emergency preparedness. Concepts of Management is included under the category Safe and Effective Environment and subcategory Management of Care. Pain is expected with a surgical procedure and a less experienced nurse could administer pain medication. The nurse should first assess the cardiac status, then implement other interventions. Content ­ Medical/Surgical: Category of Health Alteration ­ Gastrointestinal: Integrated Processes ­ Nursing Process: Implementation: Client Needs ­ Physiological Integrity: Reduction of Risk Potential: Cognitive Level ­ Analysis which intervention to implement first. Leaving the client after 20 minutes would allow the client time to induce vomiting. The client will be asked to sign the against medical advice form if he insists on leaving, but the charge nurse should attempt to resolve the situation successfully first.

Click Template in the Template Tools section of the Home tab in the ribbon or in the toolbar at the top of the section. This representation provides easy access to the data analysis capabilities of the SoftMax Pro Software. To assign wells to an existing group, select the wells to add to the group, click the group name, and then click Assign. To specify wells as Group Blank, select the wells, click Group Blank, and then click Assign. To remove wells from a group, select the wells to be removed and then click Clear. To save the template in a protocol file for use on future experiments, see Saving Protocol Files on page 55. If a sample descriptor has been defined for the selected group, type an appropriate value in the field for the descriptor. Creating a Series You can define several samples as a series, allowing you to easily enter incremental sample descriptors (for example, dilutions or concentrations) and sample names to the template as long as the increment can be expressed as a mathematical operation. This allows you to work with groups of wells in the Template so that the standard value or dilution factor increases or decreases in specified steps. You can assign the same group or sample definition (same sample name and description within a group) to multiple wells to create replicates. For example, you might want to read standards in replicate to ensure that anomalies can be excluded prior to generating a standard curve. A series is defined in one direction (starting from left, right, top, or bottom) and therefore samples must be arranged sequentially in either ascending or descending order. Click Template Editor in Template Tools on the Home tab in the ribbon or in the toolbar at the top of the active section. In the Template Editor dialog, click and drag the mouse to select one or more wells to be part of the series. If no groups have been defined, you will need to define a group and then define the series. Choose a fill direction to describe how the series fills the wells from the Start From options. For example, if you are filling down from the top and you have chosen a block of wells that is 4 wells wide by 8 wells high, the maximum number of replicates will be four. With the same block of wells selected, filling from the left would allow eight replicates. If the number of replicates you choose does not divide evenly into the number of rows or columns you select, depending on the filling direction, the remaining wells that cannot contain replicates will be labeled as additional individual wells in the series. To create a series that includes all the wells in the microplate, select all the wells, select the fill direction, and then set the replicates to 1. In Sample Information type the name of the first sample in the series in the Starting Sample Name field. Subsequent replicates use this name as a base and either increment the number within the name or append a number to it. If a sample descriptor has been defined for the selected group, type an aopriate value in the Starting Value field for the descriptor. From the Step by list, select the operator for the series (+, -, *, or /) and then enter a value for the increment. If a sample descriptor has been defined for the selected group, clear the check box next to the descriptor. Incrementing with a Constant To increment the names of a series of samples with a constant concentration or dilution: 1. In the Starting Value field for the sample descriptor, type a value for the concentration or dilution. From the Step by list, select the multiplication operator (*) and then enter a value of 1 for the increment. If sample names are set to increment automatically using the Series function, be aware that SoftMax Pro Software automatically truncates the sample name to three or four characters, including the incrementing number if the sample name starts with letters. If sample names are very long, and they must be kept long for reference, you need to set up your replicates manually. Copying and Pasting Template Contents the content of a template can be copied and pasted to another section within the same experiment or between different experiments. Within the Same Experiment Section the destination template is an extension of the original template and all wells on the destination plate are considered replicates of the wells on the source plate, with the same group and sample names.

It is useful in seminal diseases, nervous diseases, general debility, consumption, liver complaints, hemiplegia, epilepsy, chorea, consumption, anaemia, leucorrhoea (svetapradar), hectic fever, old fevers, asthma. Sankha Bhasma (conch shell): Useful in diseases of the stomach, tympanitis, flatulence, colic, asthma, acidity, bronchitis, loose stools, abdominal and pelvic tumours. Svarna Bhasma (gold): Useful in phthisis, asthma, general debility, hysteria, diabetes, chronic fever, spermatorrhoea, impotency. It gives strength to heart, lungs, intestines, brain and keeps them in fit condition. Tamra Bhasma (copper): Useful in leprosy, asthma, bronchitis, cough, consumption, anaemia, piles, liver trouble, blood impurities, diseases of stomach, colic. Wherever the Anupan or vehicle is ghee or honey with milk, the powder should be first mixed with ghee or honey and milk to be taken afterwards. Useful in sexual and general debility, sperma torrhoea, impotency, emaciation of children, nervous diseases, old age. Bhaskar Lavan Choorna: Lord Surya gave this recipe to Aswin Kumars, the celestial physicians. Useful in indigestion, all kinds of stomach diseases, flatulence or wind in the bowels, nausea, constipation, loss of appetite, bowel complaint, diarrhoea, piles (to be taken with butter milk), fistula, enlargement of spleen. Chitrakadi Choorna: Ingredients are Chitrak root, Hing (asafoetida fried), Sonth, Pippali, Pippala mool, Chavya, the five salts viz. All these are powdered and pounded in the mortar along with big lemon juice and then dried in the sun. Diuretic, demulcent, Tridosha prasamak, Pitha prasamak (Keeps bile in normal condition), mutra samsodhak (purifies urine). Very useful in dysuria (mutra krischra), incontinence of urine, Mutra Agad (pain in passing urine). Hinguashtak Choorna: Ingredients are Sonth, Marich, Pippali, Ajwain, Saindhava nimak (red salt), Sveta Jeera, Kala Jeera, Hingu. Gastric stimulant, carminative, Deepak, Pachak, Agnivardhak (increases digestive fire). Very useful in loss of appetite, indigestion, colic, dyspepsia, flatulence, tympanitis, all stomach diseases, constipation. Lavangadi Choorna: Chief ingredients are Lavanga (cloves), Bheemseni Kapur, Chota Ilachi, Dalcheeni, Jeyaphal (Jatiphal), Sonth, Banslochan, Pippali, Jatamansi, Sugandawala, Kankola, sugar. Kantha samsodhak (cleanses the throat and vocal cords), Agni pravardhak, Suruchikar (gives taste to the food), Dhatu vardhak, Tridosha prasamak, sedative, anti spasmodic, carminative, expectorant (Kaphanasak), diaphoretic. Useful in cold, hiccup, diarrhoea, lumbago, whooping cough, flatulence, spermatorrhoea, consumption, urinary diseases like Mutra krischra, Mutra Agad, diarrhoea, dysentery, hridaya rog (heart diseases), fever due to cold. Maha Khandava Choorna: Ingredients are Marich, Nagakesar, Talispatra, five salts, Pippalamool, Dalcheeni, Pippali, Sonth, Nagarmotha, sugarcandy. Useful in anorexia, diarrhoea, dysentery, cholera, piles, cough, worms, vomiting, stomatitis, diseases of stomach. Narayana Choorna: Ingredients are Chitrak root, Triphala, Trikatu, Svet Jeera, Bacha, Pippala mool, Vana Tulasi, Vaividang, five salts, Danti, Pohakar mool. Deepak, Pachak, Agni vardhak, Dastavar (rechak), Svedhak (diaphoretic), Snehak (makes the body shine), Saktivardhak. Useful in indigestion, flatulence, constipation, stomach pain, acid eructation from stomach. Navayas Choorna: Ingredients are Chitrak jada, Triphala, Nagarmotha, Vaividang, Trikatu, Loha Bhasma. Useful in fistula, leprosy, piles, mandagni (indigestion), anaemia, worms, asthma, phthisis. Pippalyadi Choorna: Chief ingredients are Pippali, Bari Katteri, Chhoti Katteri, Javakshara, Indrajava, Chitrak jada, Ananta mool (Sariva), Kachoor, five salts, Patha. Alterative, blood-purifier, tonic, Deepak, Pachak, Vatha prasamak, diuretic, antilithic, antacid. Useful in chronic diarrhoea and chronic dysentery, dyspepsia, sprue, influenza, stones in the kidney.

May respond as if affected side is no longer part of body and need encouragement and active training to "reincorporate" it as a part of own body. Promotes even weight distribution, decreasing pressure on bony points and helping to prevent skin breakdown and pressure ulcer formation. Specialized beds help with positioning, enhance circulation, and reduce venous stasis to decrease risk of tissue injury and complications such as orthostatic pneumonia. Individualized program can be developed to meet particular needs and deal with deficits in balance, coordination, and strength. May assist with muscle strengthening and increase voluntary muscle control, as well as pain control. Administer muscle relaxants and antispasmodics as indicated, such as baclofen (Lioresal) and dantrolene (Dantrium). Ask client to follow simple commands, such as "Shut your eyes," "Point to the door"; repeat simple words or sentences. Aphasia is a defect in using and interpreting symbols of language and may involve sensory and/or motor components, such as inability to comprehend written or spoken words or to write, make signs, and speak. A dysarthric person can understand, read, and write language, but has difficulty forming or pronouncing words because of weakness and paralysis of oral musculature, resulting in softly spoken speech. Client may lose ability to monitor verbal output and be unaware that communication is not sensible. Feedback helps client realize why caregivers are not understanding and responding appropriately and provides opportunity to clarify content and meaning. Provide alternative methods of communication, such as writing or felt board and pictures. Tests for expressive aphasia-client may recognize item but not be able to name it. Identifies dysarthria because motor components of speech (tongue, lip movement, breath control) can affect articulation and may or may not be accompanied by expressive aphasia. Tests for writing disability (agraphia) and deficits in reading comprehension (alexia), which are also part of receptive and expressive aphasia. Allays anxiety related to inability to communicate and fear that needs will not be met promptly. Call bell that is activated by minimal pressure is useful when client is unable to use regular call system. Provides for communication of needs or desires based on individual situation or underlying deficit. Helpful in decreasing frustration when dependent on others and unable to communicate desires. Reduces confusion and anxiety at having to process and respond to large amount of information at one time. As retraining progresses, advancing complexity of communication stimulates memory and further enhances word and idea association. Client is not necessarily hearing impaired and raising voice may irritate or anger client. Forcing responses can result in frustration and may cause client to resort to "automatic" speech, such as garbled speech and obscenities. Enables client to feel esteemed because intellectual abilities often remain intact. Assesses individual verbal capabilities and sensory, motor, and cognitive functioning to identify deficits and therapy needs. Observe behavioral responses such as hostility, crying, inappropriate affect, agitation, and hallucination by using Los Ranchos Scale, as appropriate. Note loss of visual field, changes in depth perception (horizontal or vertical planes), and presence of diplopia. Individual responses are variable, but commonalities, such as emotional lability, lowered frustration threshold, apathy, and impulsiveness, may complicate care. Eight-level Los Ranchos Scale aids in documenting progress during initial weeks following insult. Reduces anxiety and exaggerated emotional responses and confusion associated with sensory overload. Assists client to identify inconsistencies in reception and integration of stimuli and may reduce perceptual distortion of reality. Note inattention to body parts and segments of environment and lack of recognition of familiar objects or persons.