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By E. Hengley. Preston University.

These system is that both continuity and change can exist are examples of homeorhetic processes or self- across the life span cialis sublingual 20mg without a prescription. Instead, the issue should be cast in with illness, he or she is subject to biopsychosocial terms of determining patterns of interactions perturbations. The nurse, according to Johnson among levels of the behavioral system that may (1980, 1990), acts as the external regulator and promote continuity for a particular subsystem at a monitors patient response, looking for successful given point in time. If behavioral system balance tinuity is in the relationship of the parts rather than returns, there is no need for intervention. Johnson (1990) noted that at nurse intervenes to help the patient restore behav- the psychological level, attachment (affiliative) and ioral system balance. It is hoped that the patient dependency are examples of important specific be- matures and with additional hospitalizations the haviors that change over time while the representa- previous patterns of response have been assimilated tion (meaning) may remain the same. Adaptation is defined as balance, this pattern of dependence to independ- change that permits the behavioral system to main- ence may be repeated as the behavioral system en- tain its set points best in new situations. To the ex- gages in new situations during the course of a tent that the behavioral system cannot assimilate lifetime. The nurse acts to provide con- respond to contextual changes by either a homeo- ditions or resources essential to help the accommo- static or homeorhetic process. Systems have a set dation process, may impose regulatory or control point (like a thermostat) that they try to maintain mechanisms to stimulate or reinforce certain be- by altering internal conditions to compensate for haviors, or may attempt to repair structural com- changes in external conditions. A behavioral system is embedded in an tion of ability or effort are behavioral homeostatic environment, but it is capable of operating inde- processes we use to interpret activities so they are pendently of environmental constraints through the consistent with our mental organization. Hierarchic Interaction The combination of systems theory and develop- Each behavioral system exists in a context of hier- ment identifies “nursing’s unique social mission archical relationships and environmental relation- and our special realm of original responsibility in ships. Hierarchies, or a pattern of Next, we review the model as a behavioral system relying on particular subsystems, lead to a degree of within an environment. A disruption or failure will not destroy the Person whole system but leads instead to a decomposition to the next level of stability. Johnson conceptualized a nursing client as a behav- The judgment that a discontinuity has occurred ioral system. The behavioral system is orderly, is typically based on a lack of correlation between repetitive, and organized with interrelated and in- assessments at two points of time. For example, terdependent biological and behavioral subsys- one’s lifestyle prior to surgery is not a good fit post- tems. These discontinuities can provide op- subsystems that interrelate to form the behavioral portunities for reorganization and development. Dialectical Contradiction The client is seen as a collection of behav- ioral subsystems that interrelate to form The last core principle is the motivational force for the behavioral system. Johnson (1980) described these as drives and noted that these responses are devel- oped and modified over time through maturation, system. A person’s activities in the plex, overt actions or responses to a variety of stim- environment lead to knowledge and development. Behavioral system balance is restored and a new level of development The parts of the behavioral system are called sub- is attained. They carry out specialized tasks or func- Johnson’s model is unique, in part, because it tions needed to maintain the integrity of the whole takes from both general systems and developmental behavioral system and manage its relationship to theories. She did not consider the seven subsys- in this author’s operationalization of the model, as tems as complete, because “the ultimate group of in Grubbs (1980), I have included eight subsystems. Johnson noted new subsystems or indicated changes in the struc- that these subsystems are found cross-culturally ture, functions, or behavioral groupings in the orig- and across a broad range of the phylogenetic scale. Each subsystem has functions that serve to meet structural components that interact in a specific the conceptual goal. These parts are goal, set, choice, and ac- activities carried out to meet these goals. The goal of a subsystem is defined as the de- haviors may vary with each individual, depending sired result or consequence of the behavior. The on the person’s age, sex, motives, cultural values, basis for the goal is a universal drive whose exist- social norms, and self-concepts. In subsystem goals to be accomplished, behavioral general, the drive of each subsystem is the same for system structural components must meet func- all people, but there are variations among individ- tional requirements of the behavioral system. With drives as the impetus for the behav- tained, it must be protected, nurtured, and stimu- ior, goals can be identified and are considered uni- lated: It requires protection from noxious stimuli versal. The behavioral set tain behavior; and stimulation, which contributes represents a relatively stable and habitual behav- to continued growth of the behavior and counter- ioral pattern of responses to particular drives or acts stagnation. It is learned behavior and is influenced by functional requirements threatens the behavioral knowledge, attitudes, and beliefs. Set contains two system as a whole, or the effective functioning of components: perseveration and preparation. The preparatory Johnson referred to the internal and external envi- set functions to establish priorities for attending or ronment of the system. She also noted that there are forces in dering that serves as the mediating link between the environment that impinge on the person and to stimuli from the preparatory and perseveratory which the person adjusts.

If the zygote is still viable when it completes the journey buy cialis sublingual 20mg low price, it will attach itself to the wall of the uterus, but if it is not, it will be flushed out in the woman‘s menstrual flow. During this time, the cells in the zygote continue to divide: The original two cells become four, those four become eight, and so on, until there are thousands (and eventually trillions) of cells. The earliest differentiation is between the cells on the inside of the zygote, which will begin to form the developing human being, and the cells on the outside, which will form the protective environment that will provide support for the new life throughout the pregnancy. During the embryonic phase, which will last for the next 6 weeks, the major internal and external organs are formed, each beginning at the microscopic level, with only a few cells. The changes in the embryo‘s appearance will continue rapidly from this point until birth. While the inner layer of embryonic cells is busy forming the embryo itself, the outer layer is forming the surrounding protective environment that will help the embryo survive the pregnancy. This environment consists of three major structures: The amniotic sac is the fluid-filled reservoir in which the embryo (soon to be known as a fetus) will live until birth, and which acts as both a cushion against outside pressure and as a temperature regulator. Theplacenta is an organ that allows the exchange of nutrients between the embryo and the mother, while at the same time filtering out harmful material. The filtering occurs through a thin membrane that separates the mother‘s blood from the blood of the fetus, allowing them to share only the material that is able to pass through the filter. Finally, the umbilical cord links the embryo directly to the placenta and transfers all material to the fetus. Thus the placenta and the umbilical cord protect the fetus from many foreign agents in the mother‘s system that might otherwise pose a threat. All the major aspects of the growing organism have been formed in the embryonic phase, and now the fetus has approximately six months to go from weighing less than an ounce to weighing an average of 6 to 8 pounds. The fetus begins to take on many of the characteristics of a human being, including moving (by the 3rd month the fetus is able to curl and open its fingers, form fists, and wiggle its toes), sleeping, as well as early forms of swallowing and breathing. The fetus begins to develop its senses, becoming able to distinguish tastes and respond to sounds. A newborn prefers the mother‘s voice to that of a stranger, the languages heard in the womb over other languages (DeCasper & Fifer, 1980; Moon, Attributed to Charles Stangor Saylor. How the Environment Can Affect the Vulnerable Fetus Prenatal development is a complicated process and may not always go as planned. About 45% of pregnancies result in a miscarriage, often without the mother ever being aware it has occurred [3] (Moore & Persaud, 1993). Although the amniotic sac and the placenta are designed to protect the embryo, substances that can harm the fetus, known as teratogens, may nevertheless cause problems. Teratogens include general environmental factors, such as air pollution and radiation, but also the cigarettes, alcohol, and drugs that the mother may use. Teratogens do not always harm the fetus, but they are more likely to do so when they occur in larger amounts, for longer time periods, and during the more sensitive phases, as when the fetus is growing most rapidly. The most vulnerable period for many of the fetal organs is very early in the pregnancy—before the mother even knows she is pregnant. Cigarette smoking, for example, reduces the blood oxygen for both the mother and child and can cause a fetus to be born severely underweight. One in about every 500 babies in the United States is born with fetal alcohol syndrome, and it is considered [4] one of the leading causes of retardation in the world today (Niccols, 1994). Because there is no known safe level of alcohol consumption for a pregnant woman, the U. Centers for Disease Control and Prevention indicates that a“pregnant woman should not drink alcohol‖ (Centers for [5] Disease Control and Prevention, 2005). Therefore, the best approach for expectant mothers is to avoid alcohol completely. Maternal drug abuse is also of major concern and is considered one of the greatest risk factors facing unborn children. Children born into homelessness or poverty are more likely to have mothers who are malnourished, who suffer from domestic violence, stress, and other psychological problems, and who smoke or abuse drugs. Poverty‘s impact may also amplify other issues, creating substantial problems for healthy child development (Evans & [7] English, 2002; Gunnar & Quevedo, 2007). Mothers normally receive genetic and blood tests during the first months of pregnancy to determine the health of the embryo or fetus. The screenings detect potential birth defects, including neural tube defects, chromosomal abnormalities (such as Down syndrome), genetic diseases, and other potentially dangerous conditions. Early diagnosis of prenatal problems can allow medical treatment to improve the health of the fetus. What behaviors must a woman avoid engaging in when she decides to try to become pregnant, or when she finds out she is pregnant? Do you think the ability of a mother to engage in healthy behaviors should influence her choice to have a child? Given the negative effects of poverty on human development, what steps do you think that societies should take to try to reduce poverty?

Tube dilution agglutination test Used to determine antibody titers in patients with unknown illness 240 Method: • Serial dilutions of unknown serum are tested against antigens from representative salmonella species effective 20 mg cialis sublingual. Slide agglutination test/ Kauffman-White system Used to identify unknown cultures with known sera 241 Required: Salmoella O and H polyvalent antiserum Method:. Pathogenesis and Clinical features: Route of infection is fecal-oral route Inoculum dose: 103 organisms Pathogenicity determinant: Toxins: Endotoxin: irritate the bowel wall Exotoxin: Enterotoxin and neurotoxin S. Complication: Dehydration Electrolyte and acid-base disturbance High prevalence: Poor sanitation Poor personal hygiene Polluted water supply Young children are frequently affected. Laboratory diagnosis: Specimen: Stool,serum Gram reaction: Gram-negative non-motile rods. Laboratory diagnosis: Specimen: Urine, pus, blood, ear discharge Smear: Gram-negative rods Culture: Produce characteristic swarming growth over the surface of blood agar. Indole negative Serology: Cross react with Weil-fellix test Treatment: Based on sensitivity testing. Bubonic plague: Fever, vomiting, painful lymphadenitis(buboes) in the groin or axillae 2. Pneumonic plague: Ip is 1-3 days Profuse mucoid or bloody expectoration with signs of pneumonia 3. Septicemic plague Fever, vomiting, diarrhea, hypotension, altered mentation, renal and heart failure, intra vascular coagulopathy Lab. Formalin-killed vaccine for travellers to hyperendemic areas and high risk persons Yersinia enterocolitica and Yersinia pseudotuberculosis Non-lactose fermenting gram negative rods Urease positive Oxidase negative Y. Human infection occurs by contaminated food and drinks from domestic animals or rodents Y. Human infection results from ingestion of food and drinks contaminated by animalfeces Antigenic structure. Diagnosis: Specimen: Stool, blood, rectal swab Culture: Grow in routine enteric media Biochemical tests for species identification Treatment: Fluid replacement for enterocolitis (Antibiotics not required) rd Cephalosporin (3 generation) + Aminoglycosides for sepsis/ meningitis Prevention and control: Conventional sanitary precautions 2. Found in human and animal intestine, water, soil and moist environment in hospitals. Invasive and toxigenic, produces infections in patients with abnormal host defenses Antigenic characteristic:. Exotoxin A: Cytotoxic by blocking protein synthesis Clinical features: Pathogenic only when introduced into areas devoid of normal defenses eg. Urinary tract infection- chronic, complicated Urinary tract infection and associated with indwelling catheter. Otitis externa- Malignant external ear infection in poorly treated diabetic patients. Laboratory diagnosis: Specimen: pus, urine, sputum, blood, eye swabs, surface swabs Smear: Gram-negative rods Culture:. Obligate aerobe, grows readily on all routine media over O wide range of temperature(5-42 C). Bluish-green pigmented large colonies with characteristic “fruity” odor on culture media. Species of medical importance: Vibrio cholerae-01 Vibrio cholerae Characteristics:. Readily killed by heat and drying; dies in polluted water but may survive in clean stagnant water, esp. All strains possess a distinctive O antigen and belong to subgroup I with subdivision into three serotypes; Ogawa, Inaba, Hikojima. ElTor biotype is more resistant to adverse conditions than Classical diotype of V. Little value in identification Clinical features: Route of infection is fecal-oral route. Laboratory diagnosis: Specimen: Stool flecks Smear: Gram-negative motile curved rods Motility of vibrios is best seen using dark-field microscopy. Presumptive diagnosis: Inactivation of vibrios in a wet preparation after adding vibrio antiserum. Observe for large yellow sucrose-fermenting colonies after 18-24 hrs of incubation. Stricly microaerophilic bactria requiring 5-10% o2 and 10% co2 enriched environment. Species of medical importance: 254 Campylobacter jejuni Campylobacter coli Campylobacter jejuni and Campylobacter coli Characteristics: ƒ Gram-negative non-spore forming motile rods with comma, S or ‘gull-wing’ shapes. Enterotoxin Clinical features: 4 Inoculum dose: 10 organisms Source of infection is contaminated food, drinks,and unpasteurized milk The organism multiply in small intestine, invade the epithellium and produce inflammation Campylobacter enteritis manifests with fever, headache, malaise, crampy abdominal pain and bloody mucoid diarrhea, and usually self-limited enteritis in a week period 255 Laboratory diagnosis: Specimen: Stool Microscopy: Typical ‘gull-wing’ shaped gram-negative rods. Typical darting motility of the bacteria under dark field microscopy or phase contrast microscopy Culture: Grow best at 420c on selective media but can be cultured at 37 oc. Watery and spreading or round and convex colonies on solid media at low oxygen tension.

Growth refers to physical changes led to the conclusion that cognitive development is more that are quantitative proven cialis sublingual 20 mg, such as increases in height or uneven and less systematic than previously thought, and weight. Maturation involves anatomical, neurophysio- that children’s reasoning abilities in a specific situation logical, and chemical transformations that change the may depend on variables—familiarity with certain ob- way a person functions (such as a woman’s passage into jects, language comprehension, and prior experiences— or out of childbearing age). One recent model long-term changes in behavior or performance acquired advances the notion of cognitive development in “pock- through observation, experience, or training. Anoth- er alternative that has been suggested is an information One of the oldest questions in developmental psy- processing model focusing on gradual quantitative ad- chology involves the nature-nurture controversy, vances in memory and other learning abilities rather which asks how and to what degree nature (inherited or than qualitative progress through a series of stages. This issue has been debated for centuries by the entire life span from infancy through old age, in- philosophers, who often argued strenuously for the pre- spired an interest in the continuation of development past dominance of one influence over the other (a famous ex- childhood. Erikson’s work also popularized the concept ample is the British philosopher John Locke’s concept of of the adolescent “identity crisis” (a term he coined). Yet the newborn human being as a blank slate, or tabula another type of development that has gained increased rasa, to be formed by experience). Pioneered by the interest in recent years is moral development, which American psychologist Arnold Gesell, the concept of has been most extensively investigated by Lawrence maturation, which is central to developmental psycholo- Kohlberg. Also, not all individuals reach the final stage, at which following rules and obeying the so- ”Autonomy versus shame” from one-and-a-half to cial order is superseded by the imperative of the individ- three years ual conscience to obey ethical principles that may tran- ”Initiative versus guilt” from three to six years scend the law. The universality of some of Kohlberg’s findings has been challenged in terms of applicability to ”Industry versus inferiority” from six to 12 years. When Carol Gilligan questioned sub- ”Sensorimotor stage” from birth to two years jects about moral conflicts, the reactions of male and fe- male respondents differed significantly, and Gilligan ”Preoperational stage” from two to seven years drew up her own model for women. The Stages of Life: A Groundbreaking Dis- ”Preconventional stage,” where moral decisions covery: the Steps to Psychological Maturity. New York: are based on how they themselves are affected Atlantic Monthly Press, 1995. The Developing Person Through the ”Conventional stage,” where moral judgments are Life Span. Developmental stages, theories of famous theories of developmental psychology was put forth by the psychological theorist Erik Erikson in The various stages developmental psychologists theorize people go through as they develop from 1963 in his important work Childhood and Society. The first of grown adult, focusing mainly on the factors that con- Erikson’s stages is “trust versus mistrust” and occurs tribute to intelligence, personality, morality, and from birth to 1 years. Of special interest are the effects certain stimuli ing or mistrusting relationship to the world around it, have on the development of humans. These genetics pre-program a person to be introverted, or is needs, at this young age, generally have to do with satis- that personality trait the result of specific life events that faction of physical cravings (food, sleep, and comfort) caused him or her to retreat inward? Here, young children learn to Over the past hundred years or so, several promi- be independent and autonomous on the condition that nent psychologists and psychiatrists have devised vari- they are adequately encouraged to explore their world ous theories seeking to quantify the developmental and given the freedom to do so. On the other hand, chil- stages humans pass through, and in doing so, have dren with overly restrictive or anxious parents who wield sought to map out this difficult process. According to Piaget, and to many who Between the ages of three and six, children pass believe in his framework, not everyone reaches this stage through the stage Erikson refers to as “initiative versus of cognitive development. The guilt comes about when there are unexpected culture-based phenomena and that in less technological consequences involved in these initiations. The final societies, almost no one reaches the stage—mainly be- stage of childhood development is called “industry ver- cause such thinking is not valued or even necessary. Here, children seek to become industrious in all areas of life, A final theory dealing with developmental psychol- from school to interpersonal relations. Mastery of these ogy was devised by Lawrence Kohlberg and presented skills, with adequate support at home and in school, in his 1981 book The Philosophy of Moral Development: brings about a sense of overall competence, whereas fail- Moral Stages and the Idea of Justice. He called the earli- Another prominent theorist in developmental psy- est stage the “preconventional. He theorized that people pass Something is “right,” in other words, if they are not like- from one stage to another not just as a matter of course, ly to be punished for doing it. The next level is the “con- but only when they are confronted with the correct type ventional” stage. Piaget believed that in moral judgments on the conventions of society (or of the absence of the correct kinds of stimulation, children family or religion or some other social order). Many people do children are in the “sensorimotor” stage of cognitive de- not pass beyond the conventional level of moral reason- velopment. They also have little or no ability for “post-conventional level,” where moral judgments are what is called symbolic representation, that is, the ability based on personal beliefs. People in this stage of moral to conceive of things existing outside of their immediate development will do what they consider is “right” even vicinity. In this stage, children begin to use lan- guage and other representational systems to conceive of, Further Reading and even discuss, things or people who are not physically Marse, Michele Black.