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If you hesitated to choose “all of hemostasis purchase vytorin 30 mg fast delivery cholesterol levels scale, which is the stoppage the above vytorin 20mg discount cholesterol lowering foods and vitamins,” ask yourself this: If you of bleeding or blood flow. Besides support and protection, the skeleton serves other important functions, including a. Divide different body areas Chapter 5: A Scaffold to Build On: The Skeleton 63 Boning Up on Classifications, Structures, and Ossification Adult bones are composed of 30 percent protein (called ossein), 45 percent minerals (including calcium, phosphorus, and magnesium), and 25 percent water. Mineral in the bones increases with age, causing them to become more brittle and easily fractured. Various types of bone make up the human skeleton, but fortunately for memorization purposes, bone type names match what the bones look like. They are as follows: Long bones, like those found in the arms and legs, form the weight-bearing part of the skeleton. Short bones, such as those in the wrists (carpals) and ankles (tarsals), have a blocky structure and allow for a greater range of motion. Flat bones, such as the skull, sternum, scapulae, and pelvic bones, shield soft tissues. Irregular bones, such as the mandible (jawbone) and vertebrae, come in a vari- ety of shapes and sizes suited for attachment to muscles, tendons, and ligaments. Irregular bones include seed-shaped sesamoid bones found in joints such as the patella, or kneecap. Unfortunately for students of bone structures, there’s no easy way to memorize them. So brace yourself for a rapid summary of what your textbook probably goes into in much greater detail. Compact bone is a dense layer made up of structural units, or lacunae, arranged in concentric circles called Haversian systems (also referred to in short as osteons), each of which has a central, microscopic Haversian canal. A perpendicular system of canals, called Volkmann’s canals, penetrate and cross between the Haversian systems. Compact bone tissue is thick in the shaft and tapers to paper thinness at the ends of the bones. The bulbous ends of each long bone, known as the epiphyses (or singularly as an epiphy- sis), are made up of spongy bone or cancellous bone tissue covered by a thin layer of compact bone. The diaphysis, or shaft, contains the medullary cavity and blood cell–producing marrow. A membrane called the periosteum covers the outer bone to provide nutrients and oxygen, remove waste, and connect with ligaments and tendons. Bones grow through the cellular activities of osteoblasts on the surface of the bone, which produce layers of mature bone cells called osteocytes. Osteoclasts are cells that function in the developing fetus to absorb cartilage as ossification occurs and function in adult bone to break down and remove spent bone tissue. There are two types of ossification, which is the process by which softer tissues harden into bone. Both types rely on a peptide hormone produced by the thyroid gland, calci- tonin, which regulates metabolism of calcium, the body’s most abundant mineral. The two types of ossification are Endochondral or intracartilaginous ossification: Occurs when mineral salts, particularly calcium and phosphorus, calcify along the scaffolding of cartilage formed in the developing fetus beginning about the fifth week after conception. The absence of any one of these sub- stances causes a child to have soft bone, called rickets. Next, the blood supply entering the cartilage brings osteoblasts that attach themselves to the cartilage. As the primary center of ossification, the diaphysis of the long bone is the first to form spongy bone tissue along the cartilage, followed by the epiphyses, which form the secondary centers of ossification and are separated from the diaphysis by a layer of uncalcified cartilage called the epiphyseal plate where all growth in bone length occurs. Compact bone tissue covering the bone’s surface is pro- duced by osteoblasts in the inner layer of the periosteum, producing growth in diameter. Intramembranous ossification: Occurs not along cartilage but instead along a template of membrane, as the name implies, primarily in compact flat bones of the skull that don’t have Haversian systems. The skull and mandible (lower jaw) of the fetus are first laid down as a membrane. Osteoblasts entering with the blood supply attach to the membrane, ossifying from the center of the bone out- ward. The edges of the skull’s bones don’t completely ossify to allow for molding of the head during birth. Instead, six soft spots, or fontanels, are formed: one frontal or anterior, two sphenoidal or anterolateral, two mastoidal or posterolat- eral, and one occipital or posterior. Once formed, bone is surrounded by the periosteum, which has both a vascular layer (remember the Latin word for “vessel” is vasculum) and an inner layer that contains the osteoblasts needed for bone growth and repair. A penetrating matrix of connective tissue called Sharpey’s fibers connects the periosteum to the bone; inside the bone, the medullary cavity is lined by a thin membrane called the endosteum (from the Greek endon, meaning “within,” and, of course, that ever-present Greek word osteon). Following are the basic terms used to identify bone landmarks or surface features: Process: A broad designation for any prominence or prolongation Spine: An abrupt or pointed projection Trochanter: A large, usually blunt process Tubercle: A smaller, rounded eminence Tuberosity: A large, often rough eminence Crest: A prominent ridge Head: A large, rounded articular end of a bone; often set off from the shaft by a neck Condyle: An oval articular prominence of a bone Facet: A smooth, flat or nearly flat articulating surface Fossa: A deeper depression Sulcus: A groove Foramen: A hole Meatus: A canal or opening to a canal Chapter 5: A Scaffold to Build On: The Skeleton 65 Q. Remember that description root blast in biological terms refers of the structural part of the bone, to growth or formation, and the the Haversian system? And check Latin root clast refers to breaking out that root osteo, which comes or fragmentation. Blood vessels entering through Volkmann’s canals reach the bone cells through the a. Fill in the blanks to complete the following sentences: Bones are first laid down as 15. The epiphyseal and diaphyseal areas remain separated by a layer of uncalcified cartilage called the 20. Chapter 5: A Scaffold to Build On: The Skeleton 67 Another very large cell that enters with the blood supply is the 21. Later it helps absorb bone tissue from the center of the long bone’s shaft, forming the 22. After ossification, the spaces that were formed by the osteoclasts join together to form 23. Unlike bones in the rest of the body, those of the skull and mandible (lower jaw) are first laid down as 24. In the skull, the edges of the bone don’t ossify in the fetus but remain membranous and form 25. Use the terms that follow to identify the regions and structures of the long bone shown in Figure 5-1. Compact bone tissue Chapter 5: A Scaffold to Build On: The Skeleton 69 Axial Skeleton: Keeping It All in Line Just as the Earth rotates around its axis, the axial skeleton lies along the midline, or center, of the body. Think of your spinal column and the bones that connect directly to it — the rib (thoracic) cage and the skull.
Visual acuity diminishes somewhat order cheap vytorin on-line cholesterol score of 6.6, and many people in their late 30s and early 40s begin to notice that their eyes are changing and they need eyeglasses vytorin 30 mg fast delivery cholesterol msds. Adults in their 30s and 40s may also begin to suffer some hearing loss because of damage to the hair cells (cilia)  in the inner ear (Lacher-Fougëre & Demany, 2005). And it is during middle adulthood that many people first begin to suffer from ailments such as high cholesterol and high blood pressure  as well as low bone density (Shelton, 2006). Corresponding to changes in our physical abilities, our cognitive and sensory abilities also seem to show some, but not dramatic, decline during this stage. Menopause The stages of both early and middle adulthood bring about a gradual decline in fertility, particularly for women. Eventually, women experience menopause,the cessation of the menstrual cycle, which usually occurs at around age 50. Menopause occurs because of the gradual decrease in the production of the female sex hormones estrogen and progesterone, which slows the production and release of eggs into the uterus. Women whose menstrual cycles have stopped for 12 consecutive months are considered to have entered menopause (Minkin & Wright,  2004). Researchers have found that women‘s responses to menopause are both social as well as physical, and that they vary substantially across both individuals and cultures. Within individuals, some women may react more negatively to menopause, worrying that they have lost their femininity and that their final chance to bear children is over, whereas other women may regard menopause more positively, focusing on the new freedom from menstrual discomfort and unwanted pregnancy. In Western cultures such as in the United States, women are likely to see menopause as a challenging and potentially negative event, whereas in India, where older Attributed to Charles Stangor Saylor. Infants have better chances of survival when their mothers are younger and have more energy to care for them, and the presence of older women who do not have children of their own to care for (but who can help out with raising grandchildren) can be beneficial to the family group. Also consistent with the idea of an evolutionary benefit of menopause is that the decline in fertility occurs primarily for women, who do most of the child care and who need the energy of youth to accomplish it. If older women were able to have children they might not be as able to effectively care for them. Most men never completely lose their fertility, but they do experience a gradual decrease in testosterone levels, sperm count, and speed of erection and ejaculation. Social Changes in Early and Middle Adulthood Perhaps the major marker of adulthood is the ability to create an effective and independent life. Whereas children and adolescents are generally supported by parents, adults must make their own living and must start their own families. Although the timing of the major life events that occur in early and middle adulthood vary substantially across individuals, they nevertheless tend to follow a general sequence, known as a social clock. The social clock refers tothe culturally preferred “right time‖ for major life events, such as moving out of the childhood house, getting married, and having children. Marriage is beneficial to the partners, both in terms of mental health and physical health. People who are married report greater life satisfaction than those who are not married and also suffer fewer health problems (Gallagher & Waite, 2001; Liu & Umberson,  2008). In 2003 almost half of marriages in the  United States ended in divorce (Bureau of the Census, 2007), although about three quarters of people who divorce will remarry. Most divorces occur for couples in their 20s, because younger people are frequently not mature enough to make good marriage choices or to make marriages last. Marriages are more successful for older adults and for those with more education (Goodwin,  Mosher, & Chandra, 2010). Parenthood also involves a major and long-lasting commitment, and one that can cause substantial stress on the parents. The time and finances invested in children create stress, which  frequently results in decreased marital satisfaction (Twenge, Campbell, & Foster, 2003). This decline is especially true for women, who bear the larger part of the burden of raising the children and taking care of the house, despite the fact they increasingly also work and have careers. Despite the challenges of early and middle adulthood, the majority of middle-aged adults are not unhappy. These years are often very satisfying, as families have been established, careers have  been entered into, and some percentage of life goals has been realized (Eid & Larsen, 2008). Compare your behavior, values, and attitudes regarding marriage and work to the attitudes of your parents and grandparents. What factors do you think will make it more or less likely that you will be able to follow the timeline? Unintentional and violent injuries among pre-school children of teenage mothers in Sweden: A national cohort study. Father-child relations, mother-child relations, and offspring psychological well-being in adulthood. Parent styles associated with children’s self-regulation and competence in school. Challenges to the study of African American parenting: Conceptualization, sampling, research approaches, measurement, and design. Marital quality, maternal depressed affect, harsh parenting, and child externalising in Hong Kong Chinese families. Parental divorce and adolescent delinquency: Ruling out the impact of common genes. Consequences of cochlear damage for the detection of inter-aural phase differences. Singled out: How singles are stereotyped, stigmatized and ignored, and still live happily ever after. The case for marriage: Why married people are happier, healthier, and better off financially. The times they are a changin’: Marital status and health differentials from 1972 to 2003. Marriage and cohabitation in the United States: A statistical portrait based on Cycle 6 (2002) of the National Survey of Family Growth. Retrieved from National Center for Health Statistics, Centers for Disease Control and Prevention, website:http://www. We have seen that, over the course of their lives, most individuals are able to develop secure attachments; reason cognitively, socially and morally; and create families and find appropriate careers. Eventually, however, as people enter into their 60s and beyond, the aging process leads to faster changes in our physical, cognitive, and social capabilities and needs, and life begins to come to its natural conclusion, resulting in the final life stage, beginning in the 60s, known as late adulthood. Despite the fact that the body and mind are slowing, most older adults nevertheless maintain an active lifestyle, remain as happy or are happier than when they were younger, and increasingly value their social connections with family and friends (Angner, Ray, Saag, & Allison,   2009). Kennedy, Mather, and Carstensen (2004) found that people‘s memories of their lives  became more positive with age, and Myers and Diener (1996) found that older adults tended to speak more positively about events in their lives, particularly their relationships with friends and family, than did younger adults. Cognitive Changes During Aging The changes associated with aging do not affect everyone in the same way, and they do not necessarily interfere with a healthy life. Former Beatles drummer Ringo Starr celebrated his 70th birthday in 2010 by playing at Radio City Music Hall, and Rolling Stones singer Mick Jagger (who once supposedly said, “I‘d rather be dead than singing Satisfaction‘ at 45‖) continues to perform as he pushes 70. The golfer Tom Watson almost won the 2010 British Open golf tournament at the age of 59, playing against competitors in their 20s and 30s. Senator Frank Lautenberg, and actress Betty White, each in their 80s, all enjoy highly productive and energetic lives. For one, research has found that the people who are best able to adjust well to changing situations early in life are also able to better adjust later in life (Rubin, 2007; Sroufe,  Collins, Egeland, & Carlson, 2009).
The cell wall of Gram-negative bac- teria features a porous outer membrane into the outer surface of which the lipopolysaccharide responsible for the pathogenesis of Gram-negative infec- tions is integrated buy vytorin on line amex cholesterol ldl hdl. Its murein layer is thicker and contains teichoic acids and wall-associated proteins that contribute to the pathogenic process in Gram-positive infections buy vytorin toronto cholesterol deposition definition. Many bacteria have capsules made of polysac- charides that protect them from phagocytosis. Foreign body infections are caused by bacteria that form a biofilm on inert surfaces. Some bacteria produce spores, dormant forms that are highly resistant to chemical and physical noxae. Magnifications of 500– 1000Â—close to the resolution limits of light microscopy—are required to obtain useful images of bacteria. Another problem is that the structures of objects the size of bacteria offer little visual contrast. Techniques like phase contrast and dark field microscopy, both of which allow for live cell observa- tion, are used to overcome this difficulty. Gram-positive cocci with capsules (sporulation) in cells of the (pneumococci) genera Bacillus and 4. Gram-positive, clubshaped, Clostridium (spore stain) pleomorphic rods (corynebacteria) a) Central spore, vegetative 5. Gram-negative rods with pointed cell shows no swelling ends (fusobacteria) b) Terminal spore, vegetative 6. Gram-negative curved rods cell shows no swelling (here commashaped vibrios) c) Terminal spore (“tennis 7. Gram-negative diplococci, adjacent racquet”) sides flattened (neisseria) d) Central spore, vegetative 8. Gram-negative straight rods with cell shows swelling rounded ends (coli bacteria) e) Terminal spore 9. Spiral rods (spirilla) and Gram-negative (“drumstick”) curved rods (Helicobacter) 14. Free spores (spore stain) Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Two stains with differing affinities to different bac- teria are used in differential staining techniques, the most important of which is gram staining. Gram-positive bacteria stain blue-violet, Gram-negative bacteria stain red (see p. Three basic forms are observed in bacteria: spherical, straight rods, and curved rods (see Figs. The plasmids of human pathogen bacteria often bear important genes determining the phenotype of their cells (resistance genes, virulence genes). The 4-quinolones, an important group of anti-infection substances, inactivate these enzymes irreversibly. The cytoplasm is also frequently used to store reserve substances (glycogen depots, poly- merized metaphosphates, lipids). Secretion Four secretion systems differing in structure and mode of action system proteins have been described to date. A common feature of all four is the formation of protein cylinders that traverse the cytoplasmic membrane and, in Gram-negative bacteria, the outer cell wall membrane as well. Sensor proteins Transmit information from the cell’s environment into its inte- (also known as rior. The so-called receiver domain extends outward, the trans- signal proteins) mitter domain inward. The transmission activity is regulated by the binding of signal molecules to a receiver module. In two- component systems, the transmitter module transfers the infor- mation to a regulator protein, activating its functional module. This regulator segment can then bind to specificgene sequences and activate or deactivate one or more genes (see also Fig. Aerobic respiration chain enzymes functions according to the same principles as cellular respiration in eurkaryotes. The Cytoplasmic Membrane This elementary membrane, also known as the plasma membrane, is typical of living cells. It is basically a double layer of phospholipids with numerous proteins integrated into its structure. The most important of these membrane Kayser, Medical Microbiology © 2005 Thieme All rights reserved. In electron microscopic images of Gram-positive bacteria, the mesosomes appear as structures bound to the membrane. Cell Wall The tasks of the complex bacterial cell wall are to protect the protoplasts from external noxae, to withstand and maintain the osmotic pressure gradient be- tween the cell interior and the extracellular environment (with internal pres- sures as high as 500–2000 kPa), to give the cell its outer form and to facilitate communication with its surroundings. The most important structural element of the wall is murein, a netlike polymer material surrounding the entire cell (sacculus). The murein sacculus may consist of as many as 40 layers (15–80 nm thick) and account for as much as Kayser, Medical Microbiology © 2005 Thieme All rights reserved. The membrane lipoteichoic acids are anchored in the cytoplasmic membrane, whereas the cell wall teichoic acids are covalently coupled to the murein. Cytokines cause the clinical symptoms of sepsis or septic shock syndrome (see under Lipoid A, p. Within the macroorganism, teichoic acids can activate the alternative complement pathway and stimulate macrophages to secrete cytokines. Examples of cell wall-associated proteins are protein A, the clumping factor, and the fibronec- tin-binding protein of Staphylococcus aureus or the M protein of Streptococcus pyogenes. Cell wall anchor regions in these proteins extending far beyond the murein are bound covalently to its peptide components. Cell wall-associated proteins frequently function as pathogenicity determinants (specific adher- ence; phagocyte protection). Here, the murein is only about 2 nm thick and contributes up to 10% of the dry cell wall mass (Fig. It contains numerous proteins (50% by mass) as well as the medically critical lipopolysaccharide. Its outer layer is made up of closely packed lipopolysaccharide complexes (see Fig. Examples include the LamB proteins for maltose transport and FepA for transport of the siderophore ferric (Fe3+) enterochelin in E. This molecular complex, also known as endo- toxin, is comprised of the lipoid A, the core polysaccharide, and the O-specific polysaccharide chain (Fig. Therefore,theparentmaterialsusedinproductionof parenteral pharmaceuticals must be free of endotoxins (pyrogens).
Good health is achieved by the proper during the healing process is known as balance of yin and yang buy vytorin paypal cholesterol in butter. A is a large group of people who care and may be consulted even if the are members of a larger cultural group but patient is also receiving traditional care buy genuine vytorin on line cholesterol medication overdose. Dieting and extensive use of exercise and group has collectively, based on the group’s exercise facilities are common practices. The idea that one’s own ideas, practices, and beliefs are superior to, or are preferred to, 7. The patient’s illness is viewed as part of break down more rapidly than normal-shaped the whole. Folk healers frequently base treatments ences in cultures and proceeds as though they on humoral pathology (curanderas). Describe how you would advise impoverished as strange are known as and may patients who are not meeting their healthcare result in psychological discomfort or needs due to the following conditions: disturbances. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Living in overcrowded conditions; absence How my beliefs differ: of running water and adequate sanitation: Nursing actions for patient: c. Explain why the following groups of people are at high risk for living in poverty. Families headed by single women: may affect the interaction of a nurse with a patient in this situation: A nurse attempts to perform a nursing history on an Appalachian woman admitted to the hospital with chest pain. Patient refuses to answer questions and refers to her “granny” woman as a source of information. Patient’s extended family is present during the interview and answers each question before the patient has a chance to speak. How would you respond to the individual special herb prepared by her folk healer to nursing needs of the following patients? Using the Transcultural Assessment: Health- abortion earlier but is ready for this new Related Beliefs and Practices located in your baby. How do this English brings his grandfather (who speaks patient’s beliefs differ from yours? The ing actions could you take to help this patient grandfather presents with the warning express and practice his or her beliefs? Interview fellow classmates and friends repre- senting different cultures to determine how they respond to an illness in the family. Identify any risk factors Health-related beliefs: they may have for serious illness, including culturally related diseases. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Use the following expanded scenario from Chapter 2 in your textbook to answer the questions below. Scenario: Danielle Dorvall, a 45-year-old Hait- ian woman, has been in the United States for 3. She recently had a and/or ethical/legal competencies are most surgical repair of a fractured femur and is now likely to bring about the desired outcome? Dorvall’s dressings, she asks that a Haitian folk healer from her neighborhood be allowed to come to the hospital to help heal her broken leg. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Immunizing children against measles is an example of which of the following levels of d. Secondary when a person feels a sense of belonging to a group or community and being loved by c. In which of the following stages of acute illness Multiple Response Questions does the patient decide to accept the diagnosis and follow the prescribed treatment plan? Which of the following are stages of illness behaviors according to Suchman (1965)? Which of the following statements accurately herself as being sick, seeks validation of describe existing models of health and illness? In stage 2, most people focus on their health and illness developed by Leavell symptoms and bodily functions. When help from a healthcare provider is the agent, host, and environment react sought, the person becomes a patient and separately to create risk factors. When a patient decides to accept a diagno- health as a constantly changing state, with sis and follow a prescribed treatment plan, high-level wellness and death being on he or she is in stage 4, achieving recovery opposite ends of a graduated scale. In stage 1, pain is the most signiﬁcant Dunn (1980) described wellness as “good symptom indicating illness, although other health. Which of the following examples of basic believe to be true about themselves in rela- human needs would be considered within the tion to their health. Thinking tics, experiences, and beliefs of generalized populations to motivate health-promoting c. Performing range-of-motion exercises on a alterations in normal anatomy and patient physiology. It is characterized by stages of illness behav- development iors, which may occur rapidly or slowly. Referring a patient with a new colostomy to and lasts only a relatively short time. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Refer to the chart below to determine the type of human dimension that is represented by the 3. The reappearance of symptoms of a chronic Dimensions Needs Examples disease in a patient who has been in remission Physical Dimension Physiologic needs Circulation is known as a period of. A landscaper’s increased risk for developing Environmental Safety and Security Climate Dimension needs skin cancer because of excessive exposure to the sun is considered a(n) risk factor. A Catholic woman refuses treatment for cancer ple fractures after wrecking his car. A pregnant woman has toxemia in her there is a pathologic change in the structure or ﬁfth month. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Physical and cultural inﬂuences: brother who died of heart attacks at an early age. An elderly man fractures a hip and ankle bone when falling down a ﬂight of stairs c. Match the model of health and illness listed in Part A with the correct deﬁnition in Part B. This model views health as a constantly changing state, with high-level wellness b. Describe where you personally ﬁt on the potential while maintaining balance health–illness continuum, and why: and a purposeful direction in the environment. This model, developed by Leavell and Clark for use in community health, is helpful for examining the causes of dis- ease in an individual by looking at and understanding risk factors.