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The carbonyl carbon bears a partial positive charge (dþ) order coreg 25 mg amex, while the oxygen bears a partial negative charge (dÀ) generic coreg 12.5mg free shipping. Therefore buy coreg 12.5 mg online, the carbonyl group can function as both a nucleophile and an electrophile order coreg 25mg with visa. Aldehydes and ketones cannot undergo substitution reac- tions, because they do not have a leaving group. Two factors that make aldehydes more reactive than ketones are electronic and steric effects. Because alkyl groups are electron donating, ketones have their effective partial positive charge reduced more than aldehydes. The electrophilic carbon is the site where the nucleophile approaches for reaction to occur. As a result, ketones offer more steric resistance toward the nucleophilic attack than aldehydes. Reactions of aldehydes and ketones: nucleophilic addition Carbonyl compounds are of central importance in organic chemistry because of their unique ability to form a range of other derivatives. Aldehydes and ketones are selectively reduced to alkanes by Clemmensen reduction (see Section 5. H O or H O+ o o 2 3 2 or 3 Alcohol One of the most important reactions of aldehydes and ketones is the Aldol condensation. In this reaction, an enolate anion is formed from the reaction between an aldehyde or a ketone and an aqueous base, e. The enolate anion reacts with another molecule of aldehyde or ketone to give b-hydroxyaldehyde or b-hydroxyketone, respectively (see Section 5. The carboxyl group takes priority over any other functional groups as follows: carboxylic acid > ester > amide > nitrile > aldehyde > ketone > alcohol > amine > alkene > alkyne. Unsaturated acids are named using the name of the alkene with -e replaced with -oic acid. The chain is numbered starting with the carboxyl group, a number designates the location of the double bond and Z or E is used. The root name comes from the longest carbon chain containing both carboxyl groups. The carbon is sp -hybridized, and the OÀÀH bond lies in the plane, eclipsing the CÀÀÀÀO double bond. Strong aqueous bases can completely deprotonate carboxylic acids, and salts of carboxylic acids are formed. Strong aqueous mineral acids readily convert the salt back to the carboxylic acids. H+ Physical properties of carboxylic acids Carboxylic acids are polar molecules due to the polar nature of both the OÀÀH and CÀÀÀÀO functionalities. H Hydrogen bonds to water in aqueous solution Preparation of carboxylic acids Acetic acid, the most important carboxylic acid, can be prepared by catalytic air oxidation of acetaldehyde. H3O 1o Amide Reactions of carboxylic acids The most important reactions of carboxylic acids are the conversions to various carboxylic acid derivatives, e. The reaction is acid catalysed and is known as Fischer esterification (see Section 5. The important acid derivatives are acid chlorides, acid anhydrides, esters and amides. Although nitriles are not directly carboxylic acid derivatives, they are conveniently hydrolysed to carboxylic acids by acid or base catalysts. Moreover, nitriles can be easily prepared through dehydration of amides, which are carboxylic acid derivatives. In general, it is easy to convert more reactive derivatives into less reactive derivatives. Therefore, an acid chloride is easily converted to an anhydride, ester or amide, but an amide can only be hydrolysed to a carboxylic acid. Acid chlorides and acid anhydrides are hydrolysed easily, whereas amides are hydrolysed slowly in boiling alkaline water.

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Which of the following effects of sensory follow which of the following guidelines for deprivation might he be experiencing? Which of the following statements accurately absent functioning in one or more senses? Sensory overstimulation and is independent of stimulation received during childhood buy coreg 12.5 mg overnight delivery. It is recommended that medically fragile Multiple Response Questions infants have greater light and visual and Circle the letters that correspond to the best vestibular stimulation order coreg 6.25 mg fast delivery. Which of the following conditions must be present for a person to receive the data neces- e order coreg 12.5mg free shipping. Which of the following are guidelines that should be followed when caring for visually d 25 mg coreg fast delivery. Orient the person to the arrangement of tastes, and smells the room and its furnishings. Difficulty with memory, problem solving, follow when dealing with patients with hear- and task performance ing impairments? Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Write any ideas that you cannot convey to Match the examples in Part B with the the person in another manner. The sense that perceives the solidity of objects and their size, shape, and texture b. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Give an example of two goals for patients may place a patient at high risk for sensory with impaired sensory functioning. Impaired ability to receive environmental healthcare patient, a 75-year-old woman with stimuli: diabetes living at home with her husband. When you arrive at their home, you notice the drapes are shut, the room is dark and c. Inability to process environmental stimuli: bleak, and there are no pictures, flowers, or the like to visually stimulate the patient. Briefly describe the following effects of sensory slightly disoriented and confused about the deprivation: date and time of day. List three examples of sensory overload you patient to avoid eye injury in the home. Describe the concept of cultural care depriva- mental stimulation and role model appropri- tion, and list an example from your own ate interactional behaviors for children in the experience of a patient who has experienced following areas. Give an example of sensory stimulation that could be provided for each of the following c. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. As an factors may influence the amount and quality item is identified, remove it from the bag. Do you believe using only one sense at a time heightens the awareness of that sense? Explain how you might assess a patient for the exercises above to the special needs of the following sensory experiences. Visually impaired patients: Chapter 44 in your textbook to answer the questions below. Hearing-impaired patients: Scenario: Dolores Pirolla, age 74, comes to the older adult clinic with her 77-year-old hus- band, who was diagnosed with macular degen- c. Pirolla also expresses concerns about her husband’s safety when moving about the 1.

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The Institute of Medicine has set an adequate intake level for linoleic acid for adults 19–50 years of age at 17 g/day for men and 12 g/day for women; alpha-lino- lenic acid at 1 order 6.25 mg coreg mastercard. Diets rich in the omega-3 fatty acids offer cardio protection by lowering blood cholesterol and triglyceride levels purchase 6.25mg coreg with visa, reducing blood clotting generic 12.5mg coreg amex, and reducing the risk of heart attack and sudden death generic coreg 25 mg overnight delivery. These fats also reduce inflammation and are helpful for arthritis and other inflammatory disorders. These fats are high in cholesterol and linked to heart disease, high cholesterol, obesity, and cancers of the breast, colon, and prostate. Most people get 38 percent or more of the day’s calories from fat while health authorities suggest no more than 20–35 percent of which less than 10 percent comes from saturated fat. To cut your intake of saturated fat, trim fat and skin from meat, choose lean poultry over red meat, and low-fat cheese and dairy (cottage cheese, feta, and hard cheeses have less fat). The exception is non-hydrogenated margarines, such as Becel, which contain beneficial plant sterols that can help lower cholesterol. While butter contains saturated fats, they are short-chain saturates, which are easily digested and provide a source of useable energy. Trans fats are cre- ated when oils undergo a chemical process called hydrogenation, which solidifies them. Trans fat is also found in cookies, crackers, french fries, baked goods, and other snack foods. When trans fats were first introduced into our food supply, they were thought to be a healthier alternative to saturated fats. Trans fats elevate cholesterol levels, increasing the risk for heart disease and heart attack, and are also linked to cancer, particularly breast cancer. The Institute of Medicine has stated that there is no safe limit for trans fats in the diet and that we should reduce consumption of these dangerous fats. It is manu- factured in the liver and also obtained from consuming saturated and trans fats. Cholesterol is not all bad—the body requires it to produce sex hormones, maintain cell membranes, and for a healthy nervous system. It is possible for triglycerides to be high even when blood cholesterol is normal, so get your levels checked regularly. These macronutrients provide us with the energy and nutrients needed for proper growth, development, and many body processes. In a later chapter I will outline principles for a healthy diet—my top recommendations for a nutritional plan for optimal health and disease prevention. They assist in energy-producing reactions, growth and development, protect against free radical damage, and perform many vital functions. Micronutrients are essential for health, and a deficiency can lead to health problems and disease. In this chapter I have outlined the essential vitamins, minerals, and trace elements; their functions in the body; their role in disease prevention and treatment; deficiency symptoms; drugs that deplete; and supplement guidelines. The table at the end of this chapter summarizes food sources, recommended in- take levels, and possible side effects and toxicity for the various nutrients. There are many factors that cause nutrient depletion, such as poor diet, stress, exer- cise, use of prescription drugs, environmental toxicity, and excessive alcohol intake. This is why supplements are so important in making up for short- comings in the diet and preventing deficiencies. The B-vitamins and vitamin C dissolve in water and are easily eliminated from the body. Adverse reactions, even with high-dose supplements, are rare with these vi- tamins. Fat-soluble vitamins (A, D, and E) are not readily excreted from the body and have the potential to accumulate in the tissues and cause adverse effects at high doses. Vitamin A • Found in animal foods and converted from beta-carotene in plant foods. To avoid this risk, choose a multivitamin that contains beta-carotene, which is converted to vitamin A in the liver, but is not as- sociated with health risks. Vitamin B1 (Thiamine) • Required for energy production, nerve and muscle function, enzyme reactions, and fatty acid production. Micronutrients | 15 • Drugs that deplete vitamin B1: furosemide, antibiotics, oral contraceptives, and phenytoin.

In addition purchase 6.25mg coreg amex, Butler and Steptoe (1986) reported that although placebos increased lung function in asthmatics buy coreg 6.25 mg cheap, this increase was not related to anxiety cheap coreg 25mg fast delivery. Placebos have been shown to create dependence generic coreg 25mg with visa, withdrawal and tolerance, all factors which are similar to those found in abstinent heroine addicts, suggesting that placebos may well increase opiate release. In addition, results suggest that placebo effects can be blocked by giving naloxone, which is an opiate antagonist. This indicates that placebos may increase the opiate release, but that this opiate release is blocked by naloxone, supporting the physiological theory of placebos. However, the physiological theories are limited as pain reduction is not the only consequence of placebos. In accordance with this, all theories of placebo effects described so far involve the patient expecting to get better. Experimenter bias theory describes the expectation of the doctor, which is communicated to the patient, changing the patient’s expectation. Expectancy effects theory describes directly the patients’ expectations derived from previous experience of successful treatment. Reporting error theory suggests that patients expect to show recovery and therefore inaccurately report recovery, and theories of misattribution argue that patients’ expec- tations of improvement are translated into understanding spontaneous changes in terms of the expected changes. In addition, conditioning theory requires the individual to expect the conditioned stimuli to be associated with successful intervention and anxiety reduction theory describes the individual as feeling less anxious after a placebo treatment because of the belief that the treatment will be effective. Finally, even the physiological theory assumes that the individual will expect to get better. Ross and Olson (1981) summarize the placebo effects as follows: s the direction of placebo effects parallels the effects of the drug under study; s the strength of the placebo effect is proportional to that of the active drug; s the reported side effects of the placebo drug and the active drug are often similar; s the time needed for both the placebo and the active drug to become active are often similar. As a result, they conclude that ‘most studies find that an administered placebo will alter the recipient’s condition (or in some instances self-report of the condition) in accordance with the placebo’s expected effects’ (Ross and Olson 1981: 419). Therefore, according to the above theories, placebos work because the patient and the health professionals expect them to work. This emphasizes the role of expectations and regards placebo effects as an interaction between individuals and between individuals and their environment. For a long time, medicine has regarded adherence (compliance) with medical recom- mendations to be important for recovery: ‘take these drugs and you will get better’. However, this study suggests that simply adhering to medical recommendations to take pills may be beneficial to recovery following a heart attack, regardless of whether the pills taken are active pills or placebo pills. This has implications for understanding the relationship between the mind and body (‘I believe that I have taken my medication’ is related to actually getting better) and for understanding the central role of beliefs and expectations in health and illness. For these trials, subjects are randomly allocated to either the experimental condition (and receive the real drug) or the control condition (and receive the placebo drug). Placebo drugs are used as a comparison point in order to distinguish the ‘real’ effects of the chemically active drug from both the ‘placebo effects’ and changes that may spontaneously happen over time. However, in 1982, data from the Coronary Drug Project was published which suggested that the best predictor of mortality in men who had survived a heart attack was not taking the lipid-lowering drug compared with taking the placebo drug, but adherence to taking any drug at all (whether an active drug or a placebo drug). The results indicated that adherers had lower mortality at five years than the non-adherers in both the experimental and the placebo groups. Subjects The original study included 3837 men and women aged 30–69 years who were reassessed every three months for an average of 25 months. The data from 1082 men in the experimental condition (who had received the beta-blocker) and 1094 men in the placebo condition were analysed (all women and those men who had not completed the psychosocial measures were excluded from the analysis). Design The study was prospective with subjects completing initial measures six weeks after hospital discharge and completing subsequent follow-up measures every three months. Measures Measures were taken of (1) psychosocial factors, (2) adherence and (3) clinical characteristics: s Psychosocial factors. The answers to this were grouped to form four psychosocial variables: levels of life stress, social isolation, depression and type A behaviour pattern. In addition, data were collected concerning their health practices both at baseline and at follow-up (e. For each follow-up interval (three months) adherence was calculated as the amount of medication divided by the amount prescribed.

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