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No part of the material protected by this copyright may be reproduced or utilized in any form generic flomax 0.4 mg otc prostate cancer veterans, electronic or mechanical cheap 0.4 mg flomax with visa prostate oncology of san antonio, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. Medical and psychosocial aspects of chronic illness and disability / Donna Falvo. Printed in the United States of America 09 08 07 06 05 10 9 8 7 6 5 4 3 2 1 Dedication This book is dedicated to the memory of Dr. Alan Woolf, A man of science, presence, integrity, strength, and honor This page intentionally left blank About the Author Donna Falvo, R. She is a Registered Nurse, Licensed Psychologist, and Certifed Rehabilitation Counselor. A former Professor and Coordinator of Rehabilitation Counseling, Rehabilitation Institute, Southern Illinois University, she was named a Mary Switzer Scholar in 1986, and elect- ed to Sigma XI National Scientific Research Society in 1995. She was elected President of the American Rehabilitation Counseling Association in 1998 and currently serves on the Editorial Board of the Rehabilitation Counseling Bulletin. She is the author of over 40 articles and book chapters and, in addition to authoring the two previous editions of Medical and Psychosocial Aspects of Chronic Illness and Disability, she is author of the book Effective Patient Education: A Guide to Increased Compliance, also in its third edition. Their dedication and com- mitment to individuals with chronic illness and disability is greatly appreciated by the author as well as by the individuals they serve. Eileen Burker, PhD, CRC Stacy Carone, EdD, CRC Fred Price, RN, MBA (c) Associate Professor Assistant Professor Nurse Manager Department of Allied Health Department of Allied Health North Carolina Jaycee Burn Science Science Center Divison of Rehabilitation Division of Rehabilitation University of North Psychology and Psychology and Carolina Hospitals Counseling Counseling Chapel Hill, North Carolina School of Medicine School of Medicine The University of North The University of North Carolina at Chapel Hill Carolina at Chapel Hill Dianne Rawdanowicz Rehabilitation Counselor N. Falvo, PhD Rehabilitation Services CRC Adjunct Professor Department of Health and Rehabilitation Counselor Cell & Molecular Physiology Human Services North Carolina Jaycee Burn School of Medicine Raleigh, North Carolina Center The University of North University of North Carolina at Chapel Hill Carolina Hospitals Stephanie J. Sjoblad, AuD Chapel Hill, North Carolina Clinic Director Ernest Grant, RN, MSN Audiologist/ Assistant Outreach Coordinator Professor Patrick P. Carone, MD North Carolina Jaycee Burn Allied Health Sciences Psychiatrist Center Division of Speech/Hearing Carolina Rehabilitation and University of North School of Medicine Surgical Associates Carolina Hospitals The University of North Cary, North Carolina Chapel Hill, North Carolina Carolina at Chapel Hill Dawn E. Kleinman, MD Dermatologist Alamance Skin Center Burlington, North Carolina vii This page intentionally left blank C HAPTER 1 Preface In its third edition, Medical and Psycho- continues to use a functional approach to social Aspects of Chronic Illness and Disa- understanding a number of medical con- bility has been revised and updated. In an attempt to reinforce this Certain sections, such as those on condi- approach, an Appendix on Functional tions of the nervous system have been Limitations has been added (Appendix E). Added to the Chronic illness and disability impact all end of each chapter are brief case studies areas of individual’s and their family’s to stimulate discussion. Only by understanding an individ- thetical and not based on any specific case ual’s total experience with chronic illness or individual. The focus tle prior medical knowledge but who work of the book is to help professionals and with individuals with chronic illness and students understand medical and psycho- disability and need to have an understand- social aspects of chronic illness and dis- ing of medical conditions, their implica- ability and how they affect an individual’s tions, and need to have an understanding functioning in all areas of life, including of medical terms. It is designed as a refer- psychological and social impact, impact ence book for professionals in the field as on activities of daily living, and on voca- well as a textbook for students. Individuals with chronic ill- The impact of chronic illness and dis- ness or disability who do not fit the socially ability is far-reaching, extending beyond determined norm may find that, regard- the individual to all those with whom the less of their strengths and abilities, they individual has contact. Chronic illness continue to be regarded in the context of and disability affect all facets of life, societal views rather than their own. Consequently, one the extent of impact, every chronic illness must consider the effect of the diagnosis, or disability requires some alteration and symptoms, and treatment on all aspects of adjustment in daily life. The extent of individuals’ lives, specifically on their impact is dependent on: capacity to function within their environ- ment. It also includes sig- sonality nificant events and relationships with • the meaning of the illness or disabil- family, friends, employers, and casual ac- ity to individuals quaintances. No relationship exists in iso- • individuals’ current life circumstances lation. Just as individuals’ reactions to • the degree of family and social sup- illness or disability influence the reactions port of others, so the reactions of others affect Reactions to chronic illness and disabil- individuals’ self-concept and perception of ity vary considerably. Social groups establish their As interactions or capacities change, or as 1 2 CHAPTER 1 PSYCHOSOCIAL AND FUNCTIONAL ASPECTS OF CHRONIC ILLNESS AND DISABILITY they become limited or restricted, roles ed toward meeting specific needs (Shaw, and relationships also change. There some changes and adjustments may be must be an understanding of individuals’ made with relative ease, others can have strengths, resources, and abilities as well repercussions in many areas of daily life. DISEASE AND ILLNESS Acute refers to the sudden onset of symp- toms that are short term and that incapac- Words are powerful conveyers of con- itate individuals for only a short time.

Insomnia purchase flomax 0.4mg online prostate 08, peptic ulcers order flomax 0.4mg prostate cancer research, palpitation of the heart, diarrhea, and constipation are a few symptoms of psychophys- pituitary: L. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 374 Unit 5 Integration and Coordination and medulla oblongata. Within the mid- brain is the mesencephalic aqueduct (aqueduct of Sylvius) (see figs. The corpora quadrigemina (kwad'rı˘-jem-ı˘-na˘) are the four rounded elevations on the posterior portion of the midbrain. The two posterior eminences, the inferior colliculi, are responsible for auditory reflexes. The red nucleus lies deep within the midbrain between Pons the cerebral peduncle and the cerebral aqueduct. It connects the cerebral hemispheres and the cerebellum and functions in re- Brain stem Pneumotaxic area respiratory Apneustic area flexes concerned with motor coordination and maintenance of centers Rhythmicity area posture. Its reddish color is due to its rich blood supply and an iron-containing pigment in the cell bodies of its neurons. The substantia nigra is thought to inhibit forced in- voluntary movements. Describe symptoms that might indicate a tumor in the The pons can be observed as a rounded bulge on the inferior sur- midbrain. It consists of white fiber tracts that course in bellum in controlling posture and movement? The surface fibers extend transversely to connect with the cerebellum through the middle cerebellar pe- duncles. The deeper longitudinal fibers are part of the motor and sensory tracts that connect the medulla oblongata with the tracts METENCEPHALON of the midbrain. The metencephalon contains the pons, which relays impulses, and Scattered throughout the pons are several nuclei associ- the cerebellum, which coordinates skeletal muscle contractions. The cranial nerves that have nuclei within the pons include the trigeminal (V), which trans- Objective 19 Describe the location and structure of the mits impulses for chewing and sensory sensations from the head; pons and cerebellum and list their functions. Two vital structures of the metencephalon vestibular branches of the vestibulocochlear (VIII), which main- are the pons and cerebellum. The two respiratory centers of the pons are called the apneustic and pneumotaxic areas (fig. It is located in the metencephalon and occupies the inferior and posterior aspect of the cranial cavity. The cerebel- lum is separated from the overlying cerebrum by a transverse fis- sure. A portion of the meninges called the tentorium cerebelli extends into the transverse fissure. The cerebellum consists of two hemispheres and a central constricted area called the vermis (fig. The falx cerebelli is the portion of the meninges that partially extends between the hemispheres. Like the cerebrum, the cerebellum has a thin outer layer of gray matter, the cerebellar cortex, and a thick, deeper layer of white matter. Three paired bundles of nerve fibers called cerebellar pe- duncles support the cerebellum and provide it with tracts for communicating with the rest of the brain (fig. The fibers within these peduncles origi- nate primarily from specialized dentate nuclei within the cerebellum and pass through the red nucleus to the thala- mus, and then to the motor areas of the cerebral cortex. Impulses through the fibers of these peduncles provide feedback to the cerebrum. Middle cerebellar peduncles convey impulses of voluntary movement from the cerebrum through the pons and to the cerebellum. Inferior cerebellar peduncles connect the cerebellum with the medulla oblongata and the spinal cord. They contain both incoming vestibular and proprioceptive fibers and outgoing motor fibers. The principal function of the cerebellum is coordinating skeletal muscle contractions by recruiting precise motor units within the muscles. Impulses for voluntary muscular movement originate in the cerebral cortex and are coordinated by the cere- bellum.

The endocytosed proteins are digested Why is the total body water used as the volume of distribu- in lysosomes to amino acids buy flomax 0.2 mg low cost prostate cancer 2 stages, which are returned to the cir- tion of Na discount flomax 0.2mg visa prostate health supplements, even though the administered Na is limited to culation. The liver, which synthe- Why should the hypertonic saline be administered slowly? The endogenous creatinine (CR) clearance (an estimate of Answers to Case Study Questions for Chapter 24 GFR) equals (UCR V)/PCR (60 1. Note that the permeability of with an impaired ability to dilute the urine (note the inap- the glomerular filtration barrier to macromolecules (plasma propriately high urine osmolality), led to severe hypona- proteins) was abnormally high, but permeability to fluid tremia and water intoxication. Addition of 1 L of 308 mEq Na /L to 25 L produces an in- may be significant and may lead to a reduced fluid perme- ability and GFR. The edema is a result of altered capillary Starling forces and used in this calculation because when hypertonic NaCl is added to the ECF, it causes the movement of water out of renal retention of salt and water. The decline in plasma the cell compartment, diluting the extracellular Na. Because the brain is enclosed in a nondistensible cranium, ing fluid movement out of the capillaries into the interstitial compartment. The edema is particularly noticeable in the when water moves into brain cells and causes them to swell, intracranial pressure can rise to very high values. The abdomi- nal distension (in the absence of organ enlargement) sug- This can damage nervous tissue directly or indirectly by im- gests ascites (an abnormal accumulation of fluid in the ab- pairing cerebral blood flow. The neurological symptoms seen in this patient (headache, semiconsciousness, grand dominal cavity). The kidneys avidly conserve Na (note the low urine [Na ]) despite an expanded ECF volume. The in- though the exact reasons for renal Na retention are contro- creased blood pressure and cool and pale skin may be a consequence of sympathetic nervous system discharge re- versial, a decrease in the effective arterial blood volume sulting from increased intracranial pressure. This leads to activation of the renin-angiotensin-aldosterone system restoration of a normal plasma [Na ] can produce serious damage to the brain (central pontine myelinolysis). The physicians wanted to exclude the presence of a bron- chogenic tumor, which is the most common cause of ments of the nephron reabsorb more Na than usual be- cause of an intrinsic change in the kidneys. Rapid development of hyponatremic seizures in a 1998;338:1202–1211 psychotic patient. Goldman MB, Luchins DJ, Robertson GL Mechanisms of al- CASE STUDY FOR CHAPTER 24 tered water metabolism in psychotic patients with polydipsia Water Intoxication and hyponatremia. A 60-year-old woman with a long history of mental ill- ness was institutionalized after a violent argument with CASE STUDY FOR CHAPTER 25 her son. She experiences visual and auditory hallucina- tions and, on one occasion, ran naked through the ward Lactic Acidosis and Hemorrhagic Shock screaming. She refuses to eat anything since admission, During a violent argument over money, a 30-year-old but maintains a good fluid intake. The assailant escaped, day, she complains of a slight headache and nausea and but friends were able to rush the victim by car to the has three episodes of vomiting. The patient is unconscious, with a blood found on the floor in a semiconscious state, confused pressure (mm Hg) of 55/35 and heart rate of 165 and disoriented. The sub- Her pulse rate is 70/min and blood pressure is 150/100 ject is pale, with cool, clammy skin. On admission, about CHAPTER 25 Acid-Base Balance 447 an hour after the stabbing, an arterial blood sample is tilation is stimulated by the low blood pH, sensed by the pe- taken, and the following data were reported: ripheral chemoreceptors. The anion gap is [Na ] [Cl ] [HCO ] 140 103 3 Glucose 125 mg/dL 70–110 mg/dL (3. Considering the (fasting values) history and physical findings, the high anion gap is most Na 140 mEq/L 136–145 mEq/L likely caused by inadequate tissue perfusion, with resultant K 4. The lac- Cl 103 mEq/L 95–105 mEq/L tic acid is buffered by HCO3 and lactate accumulates as the HCO 4 mEq/L 22–26 mEq/L 3 unmeasured anion. Note that tissue hypoxia can occur if BUN 23 mg/dL 7–18 mg/dL blood flow is diminished, even when arterial PO2 is normal. The low hematocrit is a result of absorption of interstitial Creatinine 1.

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