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Since the goals of milieu therapy relate to helping the client learn to generalize that which is learned to other aspects of his or her life generic viagra 75 mg mastercard, the conditions that promote a therapeutic commu- nity in the hospital setting are similar to the types of conditions that exist in real-life situations buy 25 mg viagra with mastercard. Physical facilities that are conducive to the achievement of the goals of therapy cheap 75 mg viagra. The inclusion of community and family in the program of therapy in an effort to facilitate discharge from the hospital. The team includes some, or all, of the following disciplines and may include oth- ers that are not specified here: psychiatrist, clinical psychologist, psychiatric clinical nurse specialist, psychiatric nurse, mental health technician, psychiatric social worker, occupational thera- pist, recreational therapist, art therapist, music therapist, psy- chodramatist, dietitian, and chaplain. They are involved in the assessment, diagnosis, outcome identification, planning, implementation, and evaluation of all treatment programs. During this period, psychiatric inpatient treat- ment provided sufficient time to implement programs of ther- apy that were aimed at social rehabilitation. Currently, care in inpatient psychiatric facilities is shorter and more biologically based, limiting clients’ benefit from the socialization that occurs in a milieu as treatment program. Although strategies for mi- lieu therapy are still used, they have been modified to conform to the short-term approach to care or to outpatient treatment programs. Crises are precipitated by specific, identifiable events and are determined by an individual’s personal perception of the situa- tion. Crises occur when an individual is exposed to a stressor and previous problem-solving techniques are ineffective. They include disposi- tional crises, crises of anticipated life transitions, crises resulting from traumatic stress, maturational or developmental crises, cri- ses reflecting psychopathology, and psychiatric emergencies. Crisis intervention is designed to provide rapid assistance for individuals who have an urgent need. Aguilera (1998) suggests that the “focus is on the supportive, with the restoration of the individual to his precrisis level of functioning or possibly to a higher level of functioning. Nursing process is the vehicle by which nurses assist individuals in crisis with a short-term problem-solving approach to change. A four-phase technique is used: assessment/analysis, planning of therapeutic intervention, intervention, and evalua- tion of crisis resolution and anticipatory planning. Through this structured method of assistance, nurses assist individuals in cri- sis to develop more adaptive coping strategies for dealing with stressful situations in the future. Individuals under stress respond with a physiological arousal that can be dangerous over long periods. Indeed, the stress re- sponse has been shown to be a major contributor, either directly or indirectly, to coronary heart disease, cancer, lung ailments, accidental injuries, cirrhosis of the liver, and suicide—six of the leading causes of death in the United States. Relaxation therapy is an effective means of reducing the stress response in some individuals. The degree of anxiety that an individual experiences in response to stress is related to cer- tain predisposing factors, such as characteristics of temperament with which he or she was born, past experiences resulting in learned patterns of responding, and existing conditions, such as health status, coping strategies, and adequate support systems. Deep relaxation can counteract the physiological and be- havioral manifestations of stress. Various methods of relaxation include the following: Deep-Breathing Exercises: Tension is released when the lungs are allowed to breathe in as much oxygen as pos- sible. Deep-breathing exercises involve inhaling slowly and deeply through the nose, holding the breath for a few seconds, then exhaling slowly through the mouth, pursing the lips as if trying to whistle. Progressive Relaxation: This method of deep-muscle re- laxation is based on the premise that the body responds to anxiety-provoking thoughts and events with muscle tension. Each muscle group is tensed for 5 to 7 seconds and then relaxed for 20 to 30 seconds, during which time the individual concentrates on the difference in sensa- tions between the two conditions. A modified version of this technique (called passive progressive relaxation) involves re- laxation of the muscles by concentrating on the feeling of relaxation within the muscle, rather than the actual tens- ing and relaxing of the muscle. It brings on a special state of consciousness as attention is concentrated solely on one thought or object. During meditation, as the individual becomes totally pre- occupied with the selected focus, the respiration rate, heart rate, and blood pressure decrease. The frame of reference is very personal, based on what each individual considers to be a relaxing environment. The relaxing sce- nario is most useful when taped and played back at a time when the individual wishes to achieve relaxation.

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Increased motility from both disease and drugs causes diarrhoea discount viagra 50 mg visa, vomiting and nausea proven 50mg viagra. Nutrition should therefore be a priority; gut malfunction may necessitate parenteral nutrition (Macallan 1994) cheap 25 mg viagra. Drugs to prevent nausea and diarrhoea help to restore comfort and dignity; mouthcare provides comfort and helps to prevent opportunist infection. Many patients suffer both cognitive and behavioural changes, such as memory loss, apathy and poor concentration. Isolation, whether in side rooms or by hanging signs over beds, merely reinforces stigmatisation (hence the value of universal precautions); however, using side rooms to provide privacy can be valuable for patients and their families and friends. This can cause additional distress following bereavement, but a nurse’s duty of confidentiality to patients is absolute (apart from specific legal requirements), and extends beyond the death of patients. Dilemmas raised through clinical practice can usefully be discussed among unit teams and thus contribute to the professional growth of all involved. Treatments and interventions increase infection risks, but proactive infection control can reduce risks from nosocomial infection. Extreme reactions to the stigma of a fictional killer virus are effectively illustrated in the film Outbreak (Warner Brothers 1995). Clinical scenario Paul Edwards is 24 years old and was admitted to intensive care for invasive ventilation following a respiratory arrest. The infection control nurse has been asked to approach Paul’s girlfriend and flatmates for screening. Although Leah Betts’ death in 1995 from one uncontaminated tablet of Ecstasy (Towers 1997) captured popular media attention, this death was not isolated; nurses working in acute care increasingly admit patients who have taken overdoses. Illegal drugs and popular subculture trends change rapidly, and trends may have already changed by the time studies appear. There is a paucity of material available on these drugs, and unfortunately this means that even relatively recent material is potentially out of date by the time it is published. Trends in drug use often have significant geographical, cultural and social variations, limiting generalisability of studies. Although drug abuse can occur at any age, drugs such as Ecstasy tend to be taken by adolescents and young adults; at the risk of stereotyping, this chapter refers to this group. With illegal drugs, users and friends are often understandably reluctant to seek medical help until dehydration and collapse occur (Cook 1995). When help is sought, friends may be reluctant to share information with hospital staff, fearing anything revealed may be passed on to the police (Jones and Owens 1996). However, users often have greater knowledge about street drugs than nurses, and they may also have different values and beliefs, so that adopting a moralistic or righteous attitude may cause alienation. Abusers may continue to take drugs, but health education can raise awareness of the dangers and suggest safer ways to take drugs so that users can make their own informed decisions. It is listed as a class A drug under the 1971 Misuse of Drugs Act (Wake 1995), so may only be legally possessed if authorised by the Home Office (Dimond 1995). Ecstasy stimulates feelings of euphoria and benevolence (Wake 1995), breaking down social inhibitions and heightening emotional attachment to others (Cook 1995), hence the names ‘Ecstasy’ and ‘love drug’ (ironically, it impairs libido (Cook 1995)). Ecstasy contains amphetamine, causing hypermetabolism, providing energy which enables users to dance continuously for (literally) hours (Cook 1995). Abuse The ‘pleasure centre’ in the hypothalamus is activated by neurotransmitters (e. Exogenous drugs that induce euphoria trap endogenous dopamine in the synapses of the pleasure centre. Constant stimulation of the pleasure centre causes a ‘high’ (Marieb 1995); but exogenous drugs also inhibit production of endogenous dopamine so that, once trapped, dopamine is metabolised and, if the central nervous system cannot meet demand, a ‘low’ follows. Exogenous drugs can restore the ‘high’, and so victims take further doses; progressive damage to endogenous neurotransmitters cause addiction, with addicts taking ever larger doses (Jones & Owens 1996) to prevent the ‘lows’. Different tablets often have dissimilar strengths, so that even users with previous experience of the drugs cannot be sure how each dose will affect them. Hence, an accidental overdose can easily occur, and individual metabolism and tolerance can further influence the effect.

When distracting thoughts occur generic 25mg viagra, try to ignore them by not dwelling upon them and return to repeating “one order 25 mg viagra free shipping. Practice the technique once or twice daily buy 100 mg viagra visa, but not within two hours after any meal, since the digestive processes seem to interfere with the elicitation of the relaxation response. Coining the term “relaxation response,” which the Mayo Clinic calls the “rest and digest” response, Benson identified the body’s physiological reaction that is the exact opposite of, and necessary complement to, the stress (fight-or-flight) response. In the four decades since that initial discovery, Benson and his colleagues have established a therapy to counteract the harmful effects of stress. They have explored how the relaxation response, the power of expectation and belief, and other mind-body phenomena can produce healing in your own body. Benson’s studies of the relaxation response show that the core of meditational practices is the same, and that the pervasive stress of modern life can be counteracted by self-discipline and self-calming. In Relaxation Revolution, Benson and Proctor contend that we have the ability to self-heal diseases, prevent life-threatening conditions, and supplement established drug and surgical procedures with mind-body techniques. In a special “treatment” section, Benson and Proctor describe how these mind body techniques can be applied—and are being applied— to treat a wide variety of conditions, including anxiety and depression. The proof will have to be weighed by others, and the jury is certainly out, but the lack of an identifiable risk of harm may make the question of efficacy moot. The strong correlation between observed brain wave type (alpha, beta, theta) and the way the subject was attending became obvious. Mindfulness practice seeks to cultivate greater awareness of the unity of mind and body, as well as of the ways that unconscious thoughts, feelings, and behaviors can undermine emotional, physical, and spiritual health. The mind is known to be a factor in stress and stress-related disorders, and meditation has been shown to positively affect a range of autonomic physiological processes, such as lowering blood pressure and reducing overall arousal and emotional reactivity. Completed studies have found that activity levels and feelings of self esteem increased for a majority of participants. The abstract expands on the potential significance of the findings: “Previous research indicates that long-term meditation practice is associated with altered resting electroencephalogram patterns, suggestive of long lasting changes in brain activity. Magnetic resonance imaging was used to assess cortical thickness in 20 participants with extensive Insight meditation experience, which involves focused attention to internal experiences. Brain regions associated with attention, interception [perception of sensations from inside the body] and sensory processing were thicker in meditation participants than matched controls, including the prefrontal cortex and right anterior insula. Between-group differences in prefrontal cortical thickness were most pronounced in older participants, suggesting that meditation might offset age-related cortical thinning. These data provide the first structural evidence for experience-dependent cortical plasticity associated with meditation 41 practice. Weil expresses this same radical thought in asserting that “learning to change our ways of 42 thinking and perceiving can actually change the function and structure of our brains. No side effects of meditation have been documented, but lack of skill could cause increased anxiety and is certain to result in boredom and discontinuation of meditation practice. Previous research has shown that aerobic activity is good for the brain, but this study suggests that a more gentle form of exercise is also beneficial. Her research focuses on mind-body practices for reducing the effects of stress and trauma, particularly in survivors of mass disasters, including the Asian Tsunami, 9/11 World Trade Center attacks, 2010 earthquake in Haiti, genocide in Sudan and Rwanda, Gulf Horizon Oil Spill, and veterans. Of the Eight Limbs of Raja Yoga, the two limbs that are emphasized in Hatha Yoga are (3) Asana & (4) Pranayama. Hatha Yoga was intended as a practice to lead one eventually to be fit to practice Raja Yoga. See also the forthcoming Yoga Skills for Therapists: Mood Management Techniques to Teach & Practice (Norton, New York 2012). Org/Wiki/Jon_Kabat-Zinn; See The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness, by J. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be repro- duced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written per- mission of the publisher. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps.

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This separation is reflected in the differences between the disease models and the social learning perspectives viagra 50mg cheap. It is often assumed that the most recent theoretical perspective is an improvement of previous theories discount viagra 25 mg without a prescription. In terms of addictive behaviours generic viagra 100 mg with visa, the moral model is seen as more naïve than the disease model, which is more naïve than a social learning theory perspective. However, perhaps these different models also illustrate different (and not necessarily better) ways of explaining behaviour and of describing the individual. This book examines the different theories of addictive behaviours and in particular outlines the contribution of social learning theory. This book provides a detailed analysis and background to relapse prevention and applies this approach to a variety of addictive behaviours. This book illustrates the extent to which different addictive behaviours share common variables in both their initiation and maintenance and discusses the interrelationship between physiological and psychological factors. This is a very clearly written accessible book which describes physiological and psychosocial reasons for smoking and provides an excellent account of smoking cessation strategies. Three main psychological perspectives which have been used to study food intake are then described. First, the chapter describes developmental models of eating behaviour with their focus on exposure, social learning and associative learning. Second, it examines cognitive theories with their emphasis on motivation and social cognition models. Third, it explores the emphasis on weight concern and the role of body dissatisfaction and restrained eating. Dinner is later described as similar to breakfast with ‘no vegetables, boiled meat, no made dishes being permitted much less fruit, sweet things or pastry. Similarly in the 1840s Dr Kitchener recommended in his diet book a lunch of ‘a bit of roasted poultry, a basin of good beef tea, eggs poached. Nowadays, there is, however, a consensus among nutritionists as to what constitutes a healthy diet (DoH 1991). Food can be considered in terms of its basic constituents: carbohydrate, protein, alcohol and fat. Descriptions of healthy eating tend to describe food in terms of broader food groups and make recommendations as to the relative consumption of each of these groups as follows. Other recommendations for a healthy diet include a moderate intake of alcohol (a maximum of 3–4 units per day for men and 2–3 units per day for women), the consump- tion of fluoridated water where possible, a limited salt intake of 6g per day, eating unsaturated fats from olive oil and oily fish rather than saturated fats from butter and margarine and consuming complex carbohydrates (e. It is also recommended that men aged between 19 and 59 require 2550 calories per day and that similarly aged women require 1920 calories per day although this depends upon body size and degree of physical activity (DoH 1995). Diet is linked to health in two ways: by influencing the onset of illness and as part of treatment and management once illness has been diagnosed. Eating disorders are linked to physical problems such as heart irregularities, heart attacks, stunted growth, osteoporosis and reproduction. Obesity is linked to diabetes, heart disease and some forms of cancer (see Chapter 15). In addition, some research suggests a direct link between diet and illnesses such as heart disease, cancer and diabetes (see Chapters 14 and 15). Much research has addressed the role of diet in health and although at times controversial, studies suggest that foods such as fruits and vegetables, oily fish and oat fibre can be protective whilst salt and saturated fats can facilitate poor health. Diet and treating illness Diet also has a role to play in treating illness once diagnosed. Obese patients are mainly managed through dietary based interventions (see Chapter 15). Patients diagnosed with angina, heart disease or following a heart attack are also recommended to change their lifestyle with particular emphasis on stopping smoking, increasing their physical activity and adopting a healthy diet (see Chapter 15). Dietary change is also central to the management of both Type 1 and Type 2 diabetes. Dietary interventions are also used to improve the self-management of diabetes and aim to encourage diabetic patients to adhere to a more healthy diet. A healthy diet therefore consists of high carbohydrate and low fat intake and links have been found between diet and both the onset of illnesses and their effective management. However, research indicates that many people across the world do not eat according to these recommendations.

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Supplements help improve sleep quality by reducing the time needed to fall asleep and nighttime wakening discount 100 mg viagra otc. While there may be certain symptoms purchase viagra 100 mg with visa, they are usually short-lived and can often be managed effectively with proper lifestyle measures and supplements buy viagra 50mg mastercard. Ensure adequate calcium intake or take a mineral supplement for bone health; consider fish oils for heart health. Having just one of these conditions increases your risk of disease, but having them in combination multiplies the risk significantly. Ac- M cording to research, those who have three features of metabolic syndrome are nearly twice as likely to have a heart attack or stroke and more than three times as likely to develop heart disease as are those with no features. There is a great deal of research focused on this problem as it is affecting a grow- ing number of our population. According to reports, over half of people over age 60 meet the criteria for metabolic syndrome, and overall about 25 percent of the entire population are classified as having metabolic syndrome. Researchers believe that insulin resistance is the key underlying cause of this syn- drome and responsible for the metabolic changes that occur. Insulin is the hormone secreted by the pancreas that takes glucose from your blood and moves it into the cells to be used for energy. In people with insulin resistance, cells don’t respond to insulin and glucose can’t enter the cells. The pancreas reacts by releasing more and more insulin to help glucose get into your cells. High insulin levels also promote fat storage around the belly, lead- ing to abdominal obesity. These combined factors greatly increase one’s risk of heart disease, stroke, diabetes, and other conditions. The key to the management of metabolic syndrome and the prevention of its con- sequences is to address insulin resistance. This can be done effectively with lifestyle strategies (diet, exercise, and supplements). Over half of children who are obese have the features of metabolic syn- drome, putting them at significant risk of heart disease, diabetes, and premature death. Studies have shown, however, that in as little as 12 weeks, regular exercise and healthy eating can facilitate weight loss and improve blood pressure, cholesterol, and blood sugar. Medications can be used to lower blood pressure, cholesterol, triglycerides, and blood sugar and to improve insulin sensitivity. As discussed below, a low-glycemic diet and regular activity can greatly improve insulin sensitivity and the other features of this syndrome. Cinnamon contains com- pounds that work with insulin to reduce blood sugar levels. It is found in brewer’s yeast, whole grains (especially wheat germ), onions, and garlic. Foods to avoid: • Alcohol can cause either high or low blood sugar depending on how much you drink and if you are eating while drinking. M • Saturated fat (animal products such as meat and dairy) and trans fats (hydrogenated margarine) and deep-fried foods can worsen blood glucose control. Lifestyle Suggestions • Exercise regularly as this can help improve insulin sensitivity and help with weight loss. Aim for 30 minutes to one hour of moderate-intensity activity daily such as brisk walking, cycling, or swimming. Muscle burns more calories than fat and helps your body use blood sugar and insulin more efficiently. Try different strength-training exercises that focus on the core muscle groups: chest, back, shoulders, abdominals, and quadriceps.

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