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With children buy cialis extra dosage 200 mg free shipping, this sometimes takes the form of Behaviorism tokens that may be accumulated and later exchanged for A theory of human development initiated by Amer- certain privileges purchase 50mg cialis extra dosage with visa. Just as providing reinforcement ican educational psychologist Edward Thorndike discount cialis extra dosage 100mg visa, strengthens behaviors, withholding it weakens them. For example, a child who ha- Behaviorism is a psychological theory of human de- bitually shouts to attract attention may be ignored unless velopment that posits that humans can be trained, or con- he or she speaks in a conversational tone. The client is exposed to an that humans and animals acquire behaviors through the unpleasant stimulus while engaged in or thinking about association of stimuli and responses. Eventually the behavior itself laws of learning to explain why behaviors occur the way becomes associated with unpleasant rather than pleasant they do: The Law of Effect specifies that any time a be- feelings. One treatment method used with alcoholics is havior is followed by a pleasant outcome, that behavior the administration of a nausea-inducing drug together is likely to recur. The Law of Exercise states that the with an alcoholic beverage to produce an aversion to the more a stimulus is connected with a response, the taste and smell of alcohol by having it become associat- stronger the link between the two. In counterconditioning,amaladaptive 1936) groundbreaking work on classical conditioning response is weakened by the strengthening of a response also provided an observable way to study behavior. A well-known type of coun- though most psychologists agree that neither Thorndike terconditioning is systematic desensitization, which nor Pavlov were strict behaviorists, their work paved the counteracts the anxiety connected with a particular be- way for the emergence of behaviorism. This method is often used in the treatment of The birth of modern behaviorism was championed people who are afraid of flying. Modeling, another treat- early in the 20th century by a psychologist at Johns Hop- ment method, is based on the human tendency to learn kins University named John Watson. A desired behavior is Behaviorism, Watson made the notorious claim that, performed by another person while the client watches. Freudian psychoanalytical theories of development, which many people found threatening. Watson’s scheme rejected all the hidden, unconscious, and suppressed longings that Freudians attributed to behaviors and posit- Bender-Gestalt Test ed that humans respond to punishments and rewards. Be- havior that elicits positive responses is reinforced and Diagnostic assessment test to identify learning dis- ability, neurological disorders, and developmental continued, while behavior that elicits negative responses delay. The complete name of this test is Bender Visual Skinner (1904-1990) who deduced the evolution of Motor Gestalt Test. It is a test used with all age groups to human behavior by observing the behavior of rats in a help identify possible learning disabilities, neurological maze. Skinner even wrote a novel, Walden Two, about a disorders, mental retardation, or developmental delay. Utopian society where human behavior is governed to- Test results also provide information about specific abili- tally by self-interested decisions based on increasing ties, including motor coordination, memory, and organi- pleasure. The test-taker is given a series of nine designs, many to believe that behaviorism could indeed produce each on a separate card, and asked to reproduce them on such a society. The test is In the 1950s, however, the popularity of behaviorism scored by professionals who consider a variety of fac- began to decline. The first sustained attack on its tenets tors, including form, shape, pattern, and orientation on was made by Noam Chomsky (1928-), a renowned lin- the page. Other psychologists soon began to question the role of Further Reading cognition in behavior. Today, many psychologists debate the extent to which cognitive learning and behavioral learning affect the development of personality. See also Behavior modification; Behavior therapy Bestiality Further Reading See Paraphilias Donahoe, John W. Biology and Human Behavior: The Neu- Austrian-born American psychologist known for his rological Origins of Individuality. Children of the Dream (1969) an- alyzes communal childrearing methods on an Israeli kib- butz and their implications for American family life.

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Simple cuboidal epithelium: These cube-shaped cells cheap cialis extra dosage 100 mg visa, found in a single layer that looks like a microscopic mattress discount cialis extra dosage 50mg without prescription, have centrally located nuclei that usually are round order 200mg cialis extra dosage overnight delivery. Found in the ovaries, kidneys, and some glands, this type of epithe- lium functions in secretion, absorption, and tube formation. Simple columnar epithelium: These densely packed cells are taller than they are wide, with nuclei located near the base of each cell. Found lining the digestive tract from the stomach to the anal canal, this type of epithelium functions in secretion and absorption. Simple columnar ciliated epithelium: A close cousin to simple columnar epithe- lium, this type of tissue has hair-like cilia that can move mucus and other sub- stances across the cell. Pseudostratified columnar epithelium: Pay attention to the prefix pseudo– here, which means “false. This type of epithelium is found in the sali- vary glands and some segments of the male reproductive system, including the urethra. Pseudostratified columnar ciliated epithelium: Another variation on a theme, this tissue is nearly identical to pseudostratified columnar epithelium. The differ- ence is that this tissue’s free surface has cilia, making it ideal for lining air pas- sages because the cilia’s uniform waving action causes a thin layer of mucus to move in one direction — toward the throat and mouth — and trap dust particles. Stratified squamous epithelium: This tissue is the stuff you see everyday — your outer skin, or epidermis. This multilayered tissue has squamous cells on the outside plus deeper layers of cuboidal or columnar cells. Found in areas where the outer cell layer is constantly worn away, this type of epithelium regen- erates its surface layer with cells from lower layers. Stratified cuboidal epithelium: This multilayered epithelium can be found in sweat glands, conjunctiva of the eye, and the male urethra. Stratified columnar epithelium: Also multilayered, this epithelium is found lining parts of the male urethra, excretory ducts of glands, and some small areas of the anal mucus membrane. Stratified transitional epithelium: This epithelium is referred to as transitional because its cells can shape-shift from cubes to squamous-like flat surfaces and back again. Chapter 4: The Study of Tissues: Histology 49 Following are some practice questions dealing with epithelial tissue: Q. A tissue that’s one layer thick but appears to be multilayered and is composed of cells taller than they are wide is a. Simple cuboidal Making a Connection: Connective Tissue Connective tissues connect, support, and bind body structures together. Unlike other types of tissues, connective tissues are classified more by the stuff in which the cells lay — the extracellular matrix — than by the cells themselves. The cells that produce that matrix are scattered within it like chocolate chips in ice cream. The load-bearing Chapter 4: The Study of Tissues: Histology 51 strength of connective tissue comes from a fibrous protein called collagen. All connec- tive tissues contain a varying mix of collagen, elastic, and reticular fibers. Following are the primary types of connective tissue: Areolar, or loose, tissue: This tissue exists between and around almost every- thing in the body to bind structures together and fill space. It’s made up of wavy ribbons called collagenous protein fibers, cylindrical threads called elastic fibers, and amorphous ground substance, a semisolid gel. Various cells including lympho- cytes, fibroblasts, fat cells, and mast cells are scattered throughout the ground substance (see Figure 4-2). Dense regular connective tissue: Made up of parallel, densely packed bands or sheets of fibers (see Figure 4-2), this type of tissue is found in tendons as bundles of collagenous fibers attaching muscles to bone and in ligaments as bundles of elastic fibers extending from bone to bone, surrounding a joint, and anchoring organs. Mast cell Fibers of Matrix Collagen fiber clei of fibroblasts Fibroblast Illustration by Imagineering Media Services Inc. Dense irregular connective tissue: Also known as dense fibrous connective tissue, it consists of fibers that twist and weave around each other, forming a thick tissue that can withstand stresses applied from any direction.

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Barrett (1989) stated that identifies that aspect that is unique to nursing and her theory does not value different forms of power cheap cialis extra dosage 200mg overnight delivery, expands nursing practice beyond the traditional but instead recognizes differences in power mani- biomedical model that dominates much of nursing buy cheap cialis extra dosage 100 mg on line. Barrett’s Power Theory is useful with clients acausal buy discount cialis extra dosage 60mg on-line, pandimensional, rhythmical, irreducible, who are experiencing hopelessness, suicidal and unitary context. Unitary pattern-based practice ideation, hypertension and obesity, drug and alco- brings about a new way of thinking and being in hol dependence, grief and loss, self-esteem issues, nursing that distinguishes nursing from other adolescent turmoil, career conflicts, marital dis- health-care professionals and offers new and inno- cord, cultural relocation trauma, or the desire to vative ways for clients to reach their desired health make a lifestyle change. To prevent biased responses, the nurse ories have been developed that are useful in should refrain from using the word “power. The Kaleidoscoping is a way of engaging in a mutual scores are documented as part of the client’s pat- process with clients who are in the midst of expe- tern profile and shared with the client during vol- riencing a turbulent life event by mutually flow- untary mutual patterning. Scores are considered ing with turbulent manifestations of patterning as a tentative and relative measure of the ever- (Butcher, 1993). Flow is an intense harmonious in- changing nature of one’s field pattern in relation to volvement in the human/environment mutual field power. The term “kaleidoscoping” was used be- Instead of focusing on issues of control, the cause it evolves directly from Rogers’ writings and nurse helps the client identify the changes and the conveys the unpredictable continuous flow of pat- direction of change the client desires to make. Rogers client mutually explore choices and options and (1970) explained that the “organization of the liv- identify barriers preventing change, strategies, and ing system is maintained amidst kaleidoscopic al- resources to overcome barriers; the nurse facilitates terations in the patterning of system” (p. For example, asking the questions, “What Life Events is used in conjunction with the do you want? A pattern A wide range of voluntary mutual patterning profile describing the essence of the client’s experi- strategies may be used to enhance knowing par- ences, perceptions, and expressions related to the ticipation in change, including meaningful dia- turbulent life event is constructed and shared with logue, dance/movement/motion, sound, light, the client. Cultivating purpose involves assist- ing clients in identifying goals and developing an Theory of Kaleidoscoping action system. The action system is comprised of in Life’s Turbulence patterning strategies designed to promote harmony Butcher’s (1993) Theory of Kaleidoscoping in Life’s amid adversity and facilitate the actualization of Turbulence was derived from Rogers’ Science of the potential for well-being. Unitary Human Beings, chaos theory (Briggs & In moments of turbulence, clients may want to Peat, 1989; Peat, 1991), and Csikszentmihalyi’s increase their awareness of the complexity of the (1990) Theory of Flow. Creative suspension is a technique that well-being and harmony amid turbulent life events. Guided imagery is human/environmental field characterized by a useful strategy for facilitating creative suspension chaotic and unpredictable change. Any crisis may because it potentially enhances the client’s ability to be viewed as a turbulent event in the life process. Forging the uncertainty of a medical diagnosis, marital dis- resolve is assisting the clients in becoming involved cord, or loss of a loved one. Flow experiences • Love themselves, promote harmonious human/environmental field • Identify concerns, patterns. There are a wide range of flow experiences • Give themselves goals, that can be incorporated into the daily activities: • Have confidence and help themselves, and art, music, exercise, reading, gardening, meditation, • Take positive action. The art of kaleidoscoping with turbulence is a mutual creative expression of Research beauty and grace and is a way of enhancing perse- verance through difficult times. As new practice model has been used by the Personalized Nursing theories and health patterning modalities evolve Corporation, an independent, nurse-owned, nurse- from the Science of Unitary Human Beings, there managed company providing outreach nursing remains a need to test the viability and usefulness care to high-risk and active drug users in Detroit, of Rogerian theories and voluntary health pattern- Michigan. With been reviewed in a number of publications a higher sense of well-being, clients are less likely to (Caroselli & Barrett, 1998; Dykeman & Loukissa, continue to engage in high-risk drug-related be- 1993; Fawcett, 2000; Fawcett & Alligood, 2003; haviors. Drug-addicted behaviors are postulated to Malinski, 1986; Phillips, 1989b; Watson, Barrett, be a painful means to experience an awareness of Hastings-Tolsma, Johnson, & Gueldner, 1997). During the pattern manifestation Rather than repeat the reviews of Rogerian re- knowing and appreciation process, clients are asked search, the following section describes current to name a painful experience, are encouraged to “be methodological trends within the Science of in the moment” in a safe place with the experi- Unitary Human Beings to assist researchers inter- ence/feeling, are asked to identify the choices they ested in Rogerian science in making methodologi- usually make during the painful experience, and are cal decisions. Nursing re- Barrett and Caroselli (1998), Barrett, Cowling, search must be grounded in a theoretical per- Carboni, and Butcher (1997), Cowling (1986), spective unique to nursing in order for the Smith & Reeder (1996), and Rawnsley (1994) have research to contribute to the advance of nursing all advocated for the appropriateness of multiple science. Irreducible human/environmental energy fields sistent with Rogers’ unitary ontology and participa- are the focus of Rogerian inquiry: Energy fields tory epistemology. Later, Fawcett (1996) also are postulated to constitute the fundamental questioned the congruency between the ontology unit of the living and nonliving. Both human and epistemology of Rogerian science and the as- beings and the environment are understood as sumptions embedded in quantitative research de- dynamic energy fields that cannot be reduced to signs; like Carboni (1995) and Butcher (1994), she parts. Pattern manifestations are indicators of change: may be more congruent with Rogers’ ontology and Pattern is the distinguishing characteristic of an epistemology.

Treloar (1995) presents useful criteria (salivary flow generic cialis extra dosage 200 mg online, plaque discount cialis extra dosage 40mg without a prescription, gingiva generic cialis extra dosage 50mg otc, lip Table 10. Oral assessment necessitates viewing the oral cavity, so tongue depressors and torches are helpful (Jenkins 1989). As part of universal precautions (see Chapter 40), protective gloves should be worn. Mouthcare 93 Lotions and potions Many mouthcare solutions and other aids have been marketed, most with little support beyond custom and practice. Few remove or prevent plaque, or provide other significant benefits, and many leave unpleasant tastes (nurses can understand patients’ experiences by tasting non-prescription products themselves). Lemon-flavoured swabs (introduced to stimulate salivary production) can decalcify teeth (Crosby 1989). Glycerine is hypertonic, so causes dehydration and reflex salivary gland exhaustion (Crosby 1989). Insufficient dilution of chemicals such as sodium bicarbonate and hydrogen peroxide can cause mucosal burns (Tombes & Galluci 1993); even chlorhexidine rinse can alter oral flora and stain teeth black. Some mouthwashes are antibacterial: pharmacists can advise which solution is best for each patient. Foam sticks can moisten mucosa between cleaning, but do not remove debris from surfaces or between teeth (Pritchard & Mallett 1992), and so plaque accumulation continues (Pearson 1996). As hard sticks cause oral trauma, they should be used carefully and (when possible) with good light. Toothbrush Toothbrushes (with or without toothpaste) remain the best way to clean patients’ teeth, loosening debris trapped between teeth and removing plaque from tooth surfaces (Pritchard & Mallett 1992). The technique reflects that of brushing one’s own teeth: brush away from the gums to remove, rather than impact, plaque from gingival crevices. Manipulating toothbrushes in other people’s mouths, especially when orally intubated, can be difficult; smallheaded multitufted toothbrushes, with soft, small, nylon heads and hollow-fibred bristles, are best for brushing the teeth of others (Pritchard & Mallett 1992; Jones 1998). Pritchard & Mallett (1992) and Jones (1998) recommend the ‘Bass’ method: placing the toothbrush at 44° to the gingival margin, using very small vibratory movements so bristles reach subgingivally to collect and remove plaque. With trismus (limited mouth opening), an interspace toothbrush will remove plaque (although not clean between teeth) (Pritchard & Mallett 1992). Gentle brushing of gums and tongue can also be useful with endentitious patients (Day 1993). Toothpaste should be removed with mouthwashes (Jenkins 1989) and gentle suction, as residual toothpaste can cause further drying of the mucosa. Vigorous brushing may cause bleeding, especially if patients have coagulopathies (e. Intensive care nursing 94 Lips Lips are highly vascular, with sensitive nerve endings, and are even more closely associated with communication (e. Lipcare can therefore prevent drying and cracking, while providing psychological comfort. Dental decay from plaque and debris occurs after one day (Pritchard & Mallett 1992), and so care should be performed at least daily (Treloar 1995; Burglass 1995), but comfort (e. Pressure sores Any body surface area is susceptible to pressure sore development (see Chapter 12). Endotracheal tubes and tracheostomies place pressure on various tissues, including the mouth and nose. Sores are especially likely when tubes rest on gingival surfaces rather than teeth (Liwu 1990); sides of lips are particularly susceptible to sores. The loosening and moving of tapes and tubes relieves prolonged pressure (Clarke 1993). Dentures Intubation and impaired consciousness normally necessitates removal of any dentures, but property should be checked on admission so that dentures are not lost. Nursing records should include whether patients normally wear partial or complete dentures, and relevant care.

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