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There is decreased tactile vocal fremitus and the intensity of the breath sounds is reduced over the right side of the chest ceftin 500 mg without a prescription. Pneumothoraces are usually visible on normal inspira- tory films but an expiratory film may help when there is doubt purchase ceftin 250 mg without prescription. There is no mediastinal displacement on examination or X-ray buy ceftin 250 mg overnight delivery, movement of the mediastinum away from the side of the pneumothorax would suggest a tension pneumothorax. Although she had symp- toms initially, these have settled down as might be expected in a fit patient with no under- lying lung disease. A rim of air greater than 2 cm around the lung on the X-ray indicates at least a moderate pneumothorax because of the three-dimensional structure of the lung within the thoracic cage represented on the two-dimensional X-ray. The differential diagnosis of chest pain in a young woman includes pneumonia and pleurisy, pulmonary embolism and musculoskeletal problems. However, the clinical signs and X-ray leave no doubt about the diagnosis in this woman. Pneumothoraces are more common in tall, thin men, in smokers and in those with underlying lung disease. There is a suggestion that she may have had a similar episode in the past but it may have been on the left side. There is a tendency for recurrence of pneumothoraces, about 20 per cent after one event and 50 per cent after two. Because of this, pleurodesis should be con- sidered after two pneumothoraces or in professional divers or pilots. The immediate management is to aspirate the pneumothorax through the second inter- costal space anteriorly using a cannula of 16 French gauge or more, at least 3 cm long. Small pneumothoraces with no symptoms and no underlying lung disease can be left to absorb spontaneously but this is quite a slow process. Up to 2500 mL can be aspirated at one time, stopping if it becomes difficult to aspirate or the patient coughs excessively. If the aspir- ation is unsuccessful or the pneumothorax recurs immediately, intercostal drainage to an underwater seal or valve may be indicated. Difficulties at this stage or a persistent air leak may require thoracic surgical intervention. This is considered earlier than it used to be since the adoption of less invasive video-assisted techniques. In this woman the apical bulla was associated with a persistent leak and required surgical intervention through video-assisted minimally invasive surgery. Marijuana has been reported to be associated with bullous lung disease, and she should be advised to avoid it. He was unable to look after himself at home because of some osteoarthritis in the hips limiting his mobility. Apart from his reduced mobility, which has restricted him to a few steps on a frame, and a rather irritable temper when he doesn’t get his own way, he has had no prob- lems in residential care. He has been trying to get out of his bed and his chair, and this has resulted in a number of falls. Prior to this he had only been incontinent on one or two occasions in the last 6 months. He thinks that there is a conspiracy in the ward and that the staff are having secret meetings and planning to harm him. He is disorien- tated in place and time although reluctant to try to answer these questions. On a routine blood test 8 years ago he was diagnosed with hypothyroidism and thyroxine 100 mg daily is the only medication he is taking. The staff say that he has taken this regularly up to the last 36 h and his records show that his thyroid function was normal when it was checked 6 months earlier. They feel that he has dementia and that the home is not an appropriate place for such patients. Examination There is nothing abnormal to find apart from blood pressure of 178/102 mmHg and limi- tation of hip movement with pain and a little discomfort in the right loin. The acute onset with clouding of consciousness, hal- lucinations, delusions, restlessness and disorientation suggest an acute confusional state, delirium. It can be provoked by drugs, infections, metabolic or endocrine disorders, or other underlying conditions in the heart, lungs, brain or abdomen. There is no record of any drugs except thyroxine, although this should be rechecked to rule out any analgesics or other agents that he might have had access to or that might not be regarded as important. The lack of replacement for 2 days will not have a significant effect and the normal results 6 months earlier make this an unlikely cause of his current problem. Other metabolic causes such as renal failure, anaemia, hyponatraemia and hypercalcaemia need to be excluded. The falls raise the possibility of trauma, and a subdural haematoma could present in this way. There is blood and protein in the urine, he has become incontinent and he has some tenderness in the loin which could fit with pyelonephritis. We are not told whether he had a fever, and the white cell count should be measured. If this does seem the likely diagnosis it would be best to treat him where he is, if this is safe and possible. There is every likelihood that he will return to his previous state if the urinary tract infection is confirmed and treated appropriately, although this may take longer than the response in temperature and white cell count. Treatment should be started on the pre- sumption of a urinary tract infection, while the diagnosis is confirmed by microscopy and culture of the urine. The most likely organism is Escherichia coli, and an antibiotic such as trimethoprim would be appropriate, although resistance is possible and advice of the local microbiologist may be helpful.

It is very important that written information be at a reading level that can be understood by the patient and family buy discount ceftin 500mg line. For example cheap ceftin 500 mg on line, show the proper injection techniques if the patient requires insulin injections or the correct use of bronchodilator inhalers for asthma cheap 250 mg ceftin with amex. Make sure to have the patient and family members show you how they plan to give the medication. This is especially critical when medication is given using a syringe, topical drugs, and inhalers. The patient and the caregiver must have visual acuity, manual dex- terity, and the mental capacity to prepare and administer medication. Prompt the patient and family members to give you feedback from your les- son and demonstration by asking: • What things help you take your medicine? It is very important that the patient and family members be informed about the signs and symptoms of an allergic response to the medication such as urticaria (hives), swollen lips, hoarse voice, difficulty breathing, and shortness of breath—an indication of life threatening anaphylaxis. In addition to the signs and symptoms of an allergic response, you must also discuss side effects and toxic effects of the medication and any dietary consid- erations the patient must follow while on the medication. Therefore, the nurse needs to de- velop a medication plan to help the patient manage the medication schedule. These influences include the patient’s belief about health such as: • What healthcare can do for the patient • The patient’s susceptibility to disease • The benefits of taking steps to prevent disease • What makes a patient seek healthcare • What makes a patient follow healthcare guidelines For example, a patient who is a coal miner may believe that all coal miners will eventually have lung cancer. Another patient may avoid taking pain medication for fear that they might become addicted. For example, although garlic does lower blood pressure, taking garlic as an herbal cure might be dangerous if the patient is also taking antihypertensive medication because the patient’s blood pressure could be lowered too much. Herbal reme- dies are preferred by some cultures over traditional Western medicine and some patients continue herbal treatment even when a mild illness progresses to a crit- ical level. A patient may refuse any treatment because of the sole belief in the healing power of prayer. Healthcare providers must be nonjudgmental and tolerate alternative beliefs in healthcare even if those beliefs are harmful to the patient. When con- fronted with cultural differences that can result in an adverse effect to the patient, healthcare providers can educate the patient about the benefits of medications and treatment and the risk that the patient is exposed to by not following rec- ommended treatment. This information is sometimes best given while the health- care provider is assessing the patient. The nurse should be careful to remain nonjudgmental about the patient’s decisions. Cultural beliefs can also influence who makes healthcare decisions for the family. However, in some cultures, although the female is responsible for providing and obtaining care, the oldest male is seen as the head of the family and the authority figure for making overall decisions such as when to access healthcare. The way the patient communicates with healthcare providers is greatly influ- enced by individual culture. Here are factors to consider when communicating with a patient: • Eye contact might not be appropriate. Always address the patient formally until the patient gives permission to be addressed informally. Other- wise, the patient may be unable to comply with the appropriate medication schedule. In some cultures, patients don’t want anyone standing or sitting too close and they feel uncomfortable if someone touches them. The elderly are revered in some cultures and the family goes to great lengths to care for them. In other cultures, the family leaves the elderly to die peacefully without interference. As you’ll recall from Chapter 2, pharmaco- genetics is the study of the influence genetics have on a drug response. For example children with Reyes Syndrome, which is a liver disease, cannot metab- olize aspirin because of a genetic defect. Likewise, a genetic factor in African-Americans makes them less responsive to beta-blocking agents used in cardiac and antihypertensive medications. Asians have a genetic factor that causes undesirable side effects when given the typical dose of benzodiazepines (diazepam [Valium]) alprazolam [Xanax], tricyclic anti- depressants, atropine, and propranol [Inderal]. Waste products are excreted into the amniotic fluid and then absorbed by the mother or swallowed by the fetus. Alcohol, barbiturates, and narcotics—such as diphenhydramine (Benadryl), amobarbital (Amytal), diazepam (Valium), codeine, heroin, methadone, morphine, propoxyphene (Darvon)—that are used during pregnancy can lead to harmful effects on the newborn. This can result in hyperactivity, crying, irritability, seizures and even sudden death. When taken by the mother during the first trimester, some drugs have a ter- atogenic effect on the fetus resulting in fetal defects. This includes mutagenic (genetic mutation) or carcinogenic (causing cancer) effects. These drugs include Thalidomide, which causes abnormal limb development, and cocaine, which causes miscarriages, fetal hypoxia (lack of oxygen), low-birth-weight infants, tremors, strokes, increase in stillbirth rates, congenital heart disease, skull defects, and other malformations. Adverse side effects of the drug on the fetus can be avoided by carefully checking the Pregnancy Category of the medication before the medication is administered to a pregnant woman. Regardless of the Pregnancy Category of the drug, always carefully observe the pregnant patient after administering medication to assure that the patient doesn’t show any observable adverse response. Pediatrics Special care must be given when administering medication to pediatric patients because their organs are immature and they might have difficulty absorbing, distributing, and excreting the medication. However, because the mother has already metabolized and excreted the medica- tion, less than the original dose is passed into breast milk. These medications include amphetamines, bromocriptine, cocaine, cyclophos- phamide, cyclosporine, doxorubicin, ergotamine, gold salts, lithium, methotrex- ate, nicotine, and phenindione.

A professional health psychologist A professional health psychologist is someone who is trained to an acceptable standard in health psychology and works as a health psychologist cheap ceftin 250mg on-line. Although still being considered by a range of committees ceftin 250 mg sale, it is now generally agreed that a professional health psychologist should have competence in three areas: research generic ceftin 250mg without prescription, teaching and consultancy. In addition, they should be able to show a suitable knowledge base of academic health psychology normally by completing a higher degree in health psychology. Having demonstrated that they meet the required standards, a professional/chartered health psychologist could work as an academic within the higher education system, within the health promotion setting, within schools or industry, and/or work within the health service. The work could include research, teaching and the development and evaluation of interventions to reduce risk-related behaviour. Health psychology is an expanding area in terms of teaching, research and practice. Health psychology teaching occurs at both the undergraduate and postgraduate level and is experienced by both mainstream psychology students and those studying other health- related subjects. Undergraduates are often expected to produce research projects as part of their assessment, and academic staff and research teams carry out research to develop and test theories and to explore new areas. Such research often feeds directly into practice, with intervention programmes aiming to change the factors identified by research. This book aims to provide a com- prehensive introduction to the main topics of health psychology. In addition, how these theories can be turned into practice will also be described. This book is now supported by a compre- hensive website which includes teaching supports such as lectures and assessments. A note on theory and health psychology Health psychology draws upon a range of psychological perspectives for its theories. Further, it utilizes many key psycho- logical concepts such as stereotyping, self-identity, risk perception, self-efficacy and addiction. This book describes many of these theories and explores how they have been used to explain health status and health related behaviours. Some of these theories have been used across all aspects of health psychology such as social cognition models and stage theories. In contrast, other theories and constructs have tended to be used to study specific behaviours. However, as cross-fertilization is often the making of good research, many of these theories could also be applied to other areas. A note on methodology and health psychology Health psychology also uses a range of methodologies. It uses quantitative methods in the form of surveys, randomized control trials, experiments and case control studies. A separate chapter on methodology has not been included as there are many comprehensive texts which cover methods in detail. The aim of this book is to illustrate this range of methods and approaches to data analysis through the choice of examples described throughout each chapter. The contents of the first half of this book reflect this emphasis and illustrate how different sets of beliefs relate to behaviours and how both these factors are associated with illness. Chapter 2 examines changes in the causes of death over the twentieth century and why this shift suggests an increasing role for beliefs and behaviours. The chapter then assesses theories of health beliefs and the models that have been developed to describe beliefs and predict behaviour. Chapter 3 examines beliefs individuals have about illness and Chapter 4 examines health professionals’ health beliefs in the context of doctor–patient communication. Chapters 5–9 examine health-related behaviours and illustrate many of the theories and constructs which have been applied to specific behaviours. Chapter 5 describes theories of addictive behaviours and the factors that predict smoking and alcohol consumption. Chapter 6 examines theories of eating behaviour drawing upon develop- mental models, cognitive theories and the role of weight concern. Chapter 7 describes the literature on exercise behaviour both in terms of its initiation and methods to encourage individuals to continue exercising. Health psychology also focuses on the direct pathway between psychology and health and this is the focus for the second half of the book. Chapter 10 examines research on stress in terms of its definition and measurement and Chapter 11 assesses the links between stress and illness via changes in both physiology and behaviour and the role of moderating variables. Chapter 12 focuses on pain and evaluates the psychological factors in exacerbating pain perception and explores how psychological interventions can be used to reduce pain and encourage pain acceptance. Chapter 13 specifically examines the interrelationships between beliefs, behaviour and health using the example of placebo effects. Chapter 16 explores the problems with measuring health status and the issues surrounding the measurement of quality of life. Finally, Chapter 17 examines some of the assumptions within health psychology that are described throughout the book. Each chapter could be used as the basis for a lecture and/or reading for a lecture and consists of the following features: s A chapter overview, which outlines the content and aims of the chapter. Each ‘focus on research’ section takes one specific paper that has been chosen as a good illustration of either theory testing or practical implications.