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A 55-year-old woman on estrogen replacement therapy who underwent a total hip replacement procedure 3 days ago c discount lotrisone 10mg online. A 39-year-old man who smokes cigarettes occasionally and underwent an uncom- plicated appendectomy 2 months ago d buy discount lotrisone 10mg online. After 5 minutes of shoveling buy cheap lotrisone 10mg line, he feels short of breath discount lotrisone 10mg with amex, chest pain, and then passes out. While playing a match of tennis, a 56-year-old man with a medical history significant only for acid reflux disease starts to feel substernal chest pain that radiates into his left arm and shortness of breath. His pain feels better after drinking antacid, but since it is not completely resolved, his partner calls 911. You order a chest radiograph and send his blood work to the laboratory for analysis. Relief of symptoms by antacids essentially rules out a cardiac cause of his chest pain. A 22-year-old college student went to the health clinic complaining of a fever over the last 5 days, fatigue, myalgias, and a bout of vomiting and diarrhea. The clinic doctor diagnosed him with acute gastroenteritis and told him to drink more fluids. She is admitted to the hospital and diagnostic testing reveals min- imal coronary atherosclerotic disease. Which of the following is the most appropriate medication to treat this patient’s condition? Prior to pass- ing out, she describes feeling lightheaded and dizzy and next remembers being in the ambulance. While discussing a case presentation with a medical student, a nearby patient who just returned from getting an ankle radiograph done yells out in pain. Physical examination reveals crackles mid- way up both lung fields and a new holosystolic murmur that is loudest at the apex and radiates to the left axilla. The patient does not have hypertension or diabetes mellitus and takes no prescription medications. A friend states that the patient just dropped to the ground shortly after scoring a basket on a fast-break. On examination, you note a prominent systolic ejection murmur along the left sternal border and at the apex. You suspect the diagnosis and ask the patient to perform the Valsalva maneuver while you auscultate his heart. Which of the following is most likely to occur to the intensity of the murmur with this maneuver? The patient complains of acute onset right-sided chest pain that is sharp in character and worse with inspiration. A 57-year-old man complains of chest palpitations and lightheaded- ness for the past hour. Five years ago he underwent a cardiac catheterization with coronary artery stent placement. Which of the following is the most appropriate medication to treat this dysrhythmia? In the past, he experienced chest discomfort after walking 20 minutes that resolved with rest. The episodes of chest pain this morning occurred while he was reading the newspaper. His wife states that he was well until she found him suddenly slump- ing in the chair and losing consciousness for a minute. The patient recalls having some chest discomfort and shortness of breath prior to the episode. As you are examining the patient described in the previous question, he starts to complain of chest discomfort and shortness of breath and has another syncopal episode.

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The volatile oil order 10 mg lotrisone free shipping, tea tree oil purchase 10mg lotrisone, which is extracted from Melaleuca alternifolia lotrisone 10 mg without prescription, is widely promoted as an antiseptic purchase lotrisone 10 mg mastercard, antibacterial and antifungal agent, and is included in numerous cleaning and cosmetic products, as are the oils of many Eucalyptus species. The kangaroo apple bush, Solanum aviculare, is a source of alkaloids related to the steroids produced in the Mexican yam, and which could also become a viable source of the starting materials for oral contraceptive synthesis. These commercial successes, together with the increasing trend in western society to utilise herbal medicines, has revived interest in Australia’s flora and traditional herbal medicine history. A systematic search of infor- mation in Australia’s Northern Territory about Aboriginal use of plants led in 1988 to the compilation of the first Aboriginal pharmacopoeia of the Northern Territories. More recent research has compared the efficacy of certain traditional remedies with western preparations used for the same conditions, and has found them to be at least as effective, especially when used to treat skin problems such as boils and other general surface infections. As traditional remedies are often more acceptable than western ones to some Aboriginal communities, such medi- cines may be used to improve the often very poor general health of people in these communities. It is ironic that a people whose culture is so ancient and who live in a country with a flora that is at least potentially so medicinally active should have such poor health that their life expectancy is almost 20 years less than that of ‘immigrant’ Australians. One of several strategies being employed to help reduce this inequity has been the recent introduction of support for traditional healers and other Aboriginal health workers in Aboriginal communities. The hope is that their use of a combination of traditional and western medicine will help promote a greater sense of ownership, pride and thus self-worth in the people of these communities, and thus ultimately better general health. Fiji It is difficult to determine which of Fiji’s flora are indigenous and which introduced by its human inhabitants. The forest plants seem, however, to be the oldest surviving species while later ones appear to include most of the Traditional medicines in the Pacific | 279 food and medicinally active species. Many of these are not specific to Fiji but are found throughout tropical regions in south-east Asia and the Pacific. Those used by the Indo-Fijian population are generally the ones favoured by the ayurvedic tradition of medicine (discussed in Chapter 7). The health of pre-European Fijians appears to have been generally good, although diseases such as yaws, filariasis, malaria and other fever-producing conditions were recorded. Post-European settlement, however, the Fijians suffered from imported diseases such as gonorrhoea, diphtheria and measles, so much so in fact that it was feared that the population might even die out completely. Early Europeans could obtain little information about plants used as medicines by the local population. One such person writing in the 1860s complained that the women who seemed to have knowledge of medi- cinally useful plants could not be induced to part with this knowledge because it was a source of income for them. Minor problems such as coughs and colds, headaches or earache, other- wise known as mate vayano, were just accidental occurrences that were thus responsive to physical treatments whereas mate ni vanua, ‘diseases of the land’ were due to spirit interference and as such could be treated only much more rigorously, usually with the assistance of sorcerers (dauvakatevoro) as well as those who had knowledge of the medicinal plants required. The cere- monies involved in treating such conditions, similar to many other ceremo- nial occasions in Fiji, usually included the use of infusions of yaqona, a drink prepared from the powdered root of the kava plant (Piper methysticum). This drink is a mild sedative which is said to be effective in the treatment of many different conditions, ranging from coughs and colds to filariasis10 (Figure 10. Leaves and bark were frequently used, generally by soaking in hot or boiling water. Sometimes, as above, the root and stem would be used as the medicine and might be crushed before extraction to provide a stronger preparation. Leaves could be chewed and their ‘juices’ swallowed or the saliva-softened product used as a poultice. Pastes and ointments were also prepared, by mixing powdered plant material with a little water or coconut oil, respectively. Vesi (Intsia bijuga) is a coastal tree that grows to a height of about 12 metres which has spreading branches that were used to make the traditional 280 | Traditional medicine Figure 10. It was considered to be a sacred tree so medicines prepared from it were thought to be very efficacious (against mate ni vanua as well as mate vayano illnesses). Decoctions of powdered bark or the juice expressed from the inner bark is used to treat the aches and pains of rheumatism whereas the steamed and thus softened bark is used to immobilise and heal bone frac- tures.

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This task involves dealing with symptoms such as pain 10 mg lotrisone otc, dizziness cheap lotrisone 10mg without prescription, loss of control and the recognition of changes in the severity of the symptoms lotrisone 10mg visa. This task involves dealing with medical interventions such as mastectomy buy discount lotrisone 10mg, chemotherapy and any related side effects. Becoming ill requires a new set of relationships with a multitude of health professionals. This involves compensating for the negative emotions aroused by illness with sufficient positive ones. This involves maintaining social support networks even when communication can become problematic due to changes in location and mobility. Process 3: Coping skills Following both appraisal and the use of adaptive tasks, Moos and Schaefer described a series of coping skills that are accessed to deal with the crisis of physical illness. These coping skills can be categorized into three forms: (1) appraisal-focused coping; (2) problem-focused coping; and (3) emotion-focused coping (see Table 3. Appraisal-focused s Logical analysis and mental preparation s Cognitive redefinition s Cognitive avoidance or denial Problem-focused s Seeking information and support s Taking problem-solving action s Identifying rewards Emotion-focused s Affective regulation s Emotional discharge s Resigned acceptance Table 3. Three sets of appraisal-focused coping skills have been defined: 1 Logical analysis and mental preparation, involving turning an apparently unmanageable event into a series of manageable ones. Three types of problem-focused coping skills have been defined: 1 Seeking information and support, involving building a knowledge base by accessing any available information. Emotion-focused coping involves managing emotions and maintaining emotional equilibrium. Three types of emotion-focused coping skills have been defined: 1 Affective, involving efforts to maintain hope when dealing with a stressful situation. Therefore, according to this theory of coping with the crisis of a physical illness, individuals appraise the illness and then use a variety of adaptive tasks and coping skills which in turn determine the outcome. However, not all individuals respond to illness in the same way and Moos and Schaefer (1984) argued that the use of these tasks and skills is determined by three factors: 1 Demographic and personal factors, such as age, sex, class, religion. Implications for the outcome of the coping process Within this model, individuals attempt to deal with the crisis of physical illness via the stages of appraisal, the use of adaptive tasks and the employment of coping skills. The types of tasks and skills used may determine the outcome of this process and such outcome may be psychological adjustment or well-being, or may be related to longevity or quality of life (see Chapter 16). According to crisis theory, individuals are motivated to re-establish a state of equilibrium and normality. Crisis theory differentiates between two types of new equilibrium: healthy adaptation, which can result in maturation and a maladaptive response resulting in deterioration. Within this perspective, healthy adaptation involves reality orientation and adaptive tasks and constructive coping skills. Therefore, according to this model of coping the desired outcome of the coping process is reality orientation. Based on a series of interviews with rape victims and cardiac and cancer patients, they suggested that coping with threatening events (including illness) consists of three processes: (1) a search for meaning; (2) a search for mastery; and (3) a process of self-enhancement. They argued that these three processes are central to developing and maintaining illusions and that these illusions constitute a process of cognitive adaptation. Again, this model describes the individual as self-regulatory and as motivated to maintain the status quo. In addition, many of the model’s components parallel those described earlier in terms of illness cognitions (e. This theoretical perspective will be described in the context of their results from women who had recently had breast cancer (Taylor et al. A search for meaning A search for meaning is reflected in questions such as ‘Why did it happen? For example, 41 per cent explained their cancer in terms of stress, 32 per cent held carcinogens such as the birth control pill, chemical dumps or nuclear waste as responsible, 26 per cent saw hereditary factors as the cause, 17 per cent blamed diet and 10 per cent considered a blow to the breast to blame. Taylor (1983) suggested that no one perception of cause is better than any other, but that what is important for the process of cognitive adaption is the search for any cause.

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