By P. Navaras. Georgia College and State University.

Generally cheap 50mcg levothroid overnight delivery thyroid gland underactive symptoms, clients respond by elaborating Clinical psychology further on the thoughts they have just expressed purchase levothroid 100 mcg with visa thyroid gland role in the body. The application of psychological principles to diag- Two primary goals of client-centered therapy are in- nosing and treating persons with emotional and creased self-esteem and greater openness to experience levothroid 50 mcg visa thyroid gland ultrasound images. Some of the related changes that it seeks to foster in clients include increased correspondence between the Clinical psychologists apply research findings in the client’s idealized and actual selves; better self-under- fields of mental and physical health to explain dysfunc- standing; decreases in defensiveness, guilt, and insecuri- tional behavior in terms of normal processes. Most psychologists earn a mental retardation, marital and family issues, criminal Ph. The clinical psy- four- to six-year program offered by a university psy- chologist may also address less serious problems of ad- chology department. The course of study includes a justment similar to those encountered by the counseling broad overview of the field (including courses in such psychologist. A number of clinical psychologists are in private prac- A new training program for psychologists was de- tice, either alone or in group practice with other mental veloped and introduced at the University of Illinois, health professionals. Others may practice in a variety of which offered the first Psychology Doctorate (Psy. This degree program is geared exclusively toward university medical schools, social work departments, the training of clinicians rather than researchers. It centers for the mentally and physically handicapped, stresses course work in applied methods of assessment prisons, state institutions and hospitals, juvenile courts, and intervention and eliminates the dissertation require- and probation offices. The term “clinical psychol- Individuals consult clinical psychologists for treat- ogy” itself was first used at the end of the nineteenth ment when their behaviors or attitudes are harmful to century in connection with the testing of mentally retard- themselves or others. The discipline methods are employed by psychologists, depending on soon expanded with the growing interest in the applica- the setting in which they work and their theoretical ori- tion of assessment techniques to the general population entation. The major types of therapy include psychody- following Robert Yerkes’s revision of the Stanford Binet namic therapies, based on uncovering unconscious Intelligence scales in 1915, creating a widely used point processes and motivations, of which the most well scale for the measurement of human mental ability. Assessment counter between equals, abandoning the traditional doc- may be used to compare an individual with others in a tor-patient relationship; and behavior-oriented therapies reliable way using standardized norms; determine the geared toward helping clients see their problems as type and circumstances of symptomatic behaviors; un- learned behaviors that can be modified without looking derstand how a person functions in a given area (cogni- for unconscious motivations or hidden meanings. These tion, social skills, emotion); or match a patient to a par- therapies, derived from the work of Ivan Pavlov and ticular diagnostic category for further treatment. Skinner, include methods such as behavior modi- While the clinical psychologist does not specialize in fication and cognitive-behavior therapy, which may be research, the two disciplines often overlap. With their var- used to alter not only overt behavior but also the thought ied experiences, clinicians are qualified to participate in re- patterns that drive it. Clinical psychologists overlap in what these professionals do, there are also routinely contribute to the training of mental health profes- specific distinctions between them. As of 1996, clinical sionals and those in other areas of health care, serving on psychologists cannot prescribe drugs to treat psychologi- the faculties of universities and independent institutes of cal disorders, and must work in conjunction with a psy- psychology, where they teach courses, supervise chiatrist or other M. They also carry out administrative appointments way for prescription privileges for psychologists. The which call for them to assist in the planning and implemen- clinical psychologist has extensive training in research tation of health care services and are represented in inter- methods and in techniques for diagnosing, treating, and national groups such as the World Health Organization. Seeing Both Sides: Classic Controversies Most cliques are fairly complex and have a mixture in Abnormal Psychology. Even if a group exerts posi- tive peer pressure, it may also be exerting negative peer pressure by being exclusive on the basis of race, class, religion, sexual orientation, or ethnicity. Cliques A group of people who identify with each other Further Reading and interact frequently. Lockers, Lunch Lines, Chemistry, and people who interact with each other more intensively Cliques. It is used to describe an adolescent social group that excludes others on the basis of superficial differences, exercising greater than average amount of peer pressure upon its mem- Cocaine bers. The numerous terms teenagers use to describe themselves and others—such as jocks, druggies, popu- See Drugs/Drug abuse lars, brains, nerds, normals, rappers, preps, stoners, rock- ers, punks (punx), freaks (phreaks), and skaters—exem- plify both levels of meaning in the word “clique. A term used to describe a person who is intimately A clique consists of a particular group of people involved with a person who is abusing or addicted within a particular location. Joining cliques, having the desire to person involved with the dependent person in any inti- join a particular clique, and being excluded from cliques mate way (spouse, lover, child, sibling, etc.

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Many factors may affect the length of time that a lubricant will persist on skin or in a body orifice purchase levothroid 200 mcg on line thyroid zucchini. Condom lubricant has been detected on a swab taken from an unwashed penis 50 hours after intercourse and purchase levothroid 200mcg overnight delivery thyroid gland location, in a different case levothroid 50mcg mastercard thyroid symptoms vs menopause, on a vaginal swab (also when the complainant had not washed or douched) taken 24 hours after intercourse, but detection after such prolonged periods would appear to be exceptional (Black, R. Reason for Analysis When drugs or alcohol have been consumed or possibly administered before or during a sexual assault, consideration should be given to the need to obtain samples of blood and urine for toxicological analysis. The length of time that a drug or its metabolites remain detectable in blood or urine depends on several factors, including the quantity taken, the individual’s metabolism, and the sensitivity and specificity of the analytical methods employed by the laboratory (196). Although the metabolites of some sub- stances may be excreted for up to 168 hours in the urine (196), many are detectable for only a few hours (see Subheading 12. In general, drugs and their metabolites will be identifiable for longer in urine than in blood. Blood It is good practice to request a sample of blood for drug/alcohol analysis when the incident has occurred in the preceding 4 days. A single sample of 10 mL of venous blood should be placed in a container with an anticoagulant (e. If volatiles are suspected, a portion of blood must be collected into a container with an intrinsic rubber bung to enable the dead space above the blood to be analyzed. Urine It is good practice to request a sample of urine for drug/alcohol analy- sis when the incident has occurred in the preceding 4 days. If the allegation exceeds this time limit, contact the forensic science laboratory for advice on whether a sample is required. Ideally, 20 mL of urine should be placed in a container with a preservative that prevents decomposition and fermentation (e. Complainants should be advised not to dispose of any towels, panty liners, or tampons at this stage. Taylor, members of the toxicology section of the Metropolitan Laboratory of Forensic Science, 2003. Forensic Analysis Forensic science laboratories have the capability of detecting a range of prescribed and illicit substances, but the persistence of different substances or their metabolites in the blood and urine of an individual depends on numerous factors. In some circumstances, the forensic science laboratory may undertake back calculations to estimate the blood alcohol concentration of the individual at the time of the sexual assault (197). Certain information is required to assist the forensic scientist with inter- pretation of the toxicological results. Persistence Data Table 1 provides the approximate detection windows for several pre- scribed/illicit substances. The detection windows depend on a few different factors, including the amount of substance used/administered and the frequency of use. Specialist advice is available for the toxicology section of the forensic laboratory. Medical Treatment The medical facilities should be stocked with the necessary provisions to enable minor injuries to be cleaned and dressed. Practical The examination facilities should incorporate a shower or bath for the complainant to use after the medical is complete, and a change of clothing should be available (preferably the patient’s own garments). Complainants should have access to a telephone so that they can contact friends or relatives and should be encouraged to spend the next few days in the company of some- one that they trust. Whenever any risk is identified, the patient should be counseled regarding the availability of hormonal and intrauterine methods of emergency contracep- tion; the most suitable method will depend on the patient profile and the time since the assault (198). When patients elect for insertion of an intrauterine contraceptive, they should be given prophylactic antibiotics (see Subheading 13. Follow-up appoint- ments should be made at a convenient venue where pregnancy tests are avail- able. Should the patient become pregnant because of the assault, she must be referred for sympathetic counseling. In children who may have been sexually abused, there is a low preva- lence of infections that are definitely sexually transmitted, although other or- ganisms possibly associated with sexual activity may be identified (201). Consequently, it may be more appropriate for the first tests to be deferred until 14 d after the assault. Some centers prescribe antibiotic prophylaxis for all complainants of penile penetrative sexual assaults at the time they present (6,207,208).

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Maintenance 45–60 mg/d Pregnancy category C Deficiency conditions Prevents and treats C deficiency (scurvy); increases wound healing; for burns; sickle cell crisis; deep vein thrombosis; Megavitamin therapy (massive doses) of vitamins are not recommended as it can cause toxicity purchase 100mcg levothroid thyroid cancer cure. Side effects Headaches purchase 50 mcg levothroid mastercard thyroid gland diet, fatigue generic levothroid 50mcg visa thyroid gland itching, drowsiness, nausea, heartburn, vomiting, diarrhea. Vitamin C with aspirin or sulfonamides may cause crystal formation in the urine (crystalluria); it can also cause a false-negative occult (blood) stool result and false-positive sugar result in the urine when tested by the Clinitest method. B2 is used to manage dermatologic prob- lems, such as scaly dermatitis, cracked corners of the mouth, inflammation of the skin and tongue. Vitamin B Complex Dose for treatment Thiamine: 30–60 mg/d of deficiency Riboflavin: 5–25 mg/d Prophylactic: 3 mg/d Nicotinic acid or niacin: Prevention: 5–20 mg/d Deficit: 50–100 mg/d Pellagra: 300–500 mg in 3 divided doses Hyperlipidemia: 1–2 g/d in 3 divided doses Pyridoxine: 25–100 mg/d Isoniazid therapy prophylaxis: 20–25 mg/d Peripheral neuritis: 50–200 mg/d Maintenance Thiamine: Male 1. Folic acid is found in leafy green vegetables, yellow fruits and vegetables, yeast, and meat and is absorbed in the small intestine. The active form of folic acid—called folate—circulates to all tissues in the body. A third of folate is stored in the liver and the remainder is stored in other tissues. Patients taking phenytoin (Dilantin) for seizures should be cautious about taking folic acid because it can increase the risk of seizures. Chronic alcoholism, poor nutrition, pregnancy, and diseases that disrupts absorption by the small intestine can lead to an inadequate amount of folic acid. A patient with low folic acid has nausea and diarrhea and is anorexic, fatigued, and has stomatitis, alo- pecia, and blood dyscrasias (megaloblastic anemia, leucopenia, and thrombo- cytopenia). Symptoms usually do not appear for 2 to 4 months after folic acid storage is depleted. Vitamin B12 Vitamin B12 may be found in liver, kidney, fish, and fortified milk and helps con- vert folic acid into its active form. Vitamin B12 is absorbed in the intestine with the aid of an intrinsic factor produced by gastric parietal cells. Vitamin B12 is stored in the liver for up to three years during which time it is slowly excreted in urine. Vitamin B12 deficiency is common in patients who are strict vegetari- ans and in patients who have malaborption syndromes (cancer, celiac disease), gastrectomy, Crohn’s disease, and liver and kidney diseases. Vitamins and the Nursing Process The nurse must assess the patient for signs and symptoms of vitamin deficiency before beginning vitamin therapy because vitamin therapy could result in a toxic effect if the patient does not have a vitamin deficiency. If so, then the nurse should educate the patient on the importance of maintaining a balanced diet. In many cases, the nurse may reach one of the following diagnoses: • Altered nutrition; less than body requirements • Lack of knowledge related to proper nutrition • Lack of knowledge related to vitamin use Based on these diagnoses, the nurse should develop a plan for having the patient eat a well-balanced diet and to take vitamin supplements as prescribed. The plan should also take into consideration the following interventions: • Administer vitamins with food to promote absorption. Teaching the patient is an important intervention because this gives the patient the knowledge to implement preemptive actions that lower the risk of vitamin deficiency in the future. It is important that the patient understands that vitamin supplements are not necessary if he or she is healthy and eats properly. Hyper- vitaminosis A causes nausea, vomiting, headache, loss of hair, and cracked lips. The nurse should evaluate the patient for proper dietary intake and determine if vitamin therapy is having a therapeutic effect. Minerals Minerals are inorganic compounds that are required by the body for metabolism and to form bones and teeth. Minerals are extracted from ingested food such as meats, eggs, vegetables, and fruits. Iron Iron (ferrous sulfate, gluconate, or fumarate) is used for the regeneration of hemoglobin. The patient requires 5 to 20 mg of iron each day from eating liver, lean meats, egg yolks, dried beans, green vegetables (such as spinach), and fruit. Iron Dose Adult 50 mg/day Infant and child dose of iron, ages 6 months to 2 years old is 1. Life threatening: cardiovascular collapse, metabolic acidosis Contraindications Avoid a megadose in the first trimester because it might cause birth defects. Iron is absorbed in the intestine where it enters plasma as heme or is stored as ferritin in the liver, spleen, and bone marrow.

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