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By B. Kayor. Bob Jones University.

Ectopic pregnancies will not develop normally sive 80mg top avana amex, homozygous buy 80 mg top avana with mastercard, and heterozygous buy 80mg top avana with mastercard. List several dominant and recessive traits inherited in hu- the first trimester purchase 80mg top avana mastercard. Depending on the location and the stage of develop- for color blindness of an XcY male and an XCXc female. In Vitro Fertilization CLINICAL CONSIDERATIONS and Artificial Implantation Pregnancy and childbirth are natural events in human biology Reproductive biologists have been able to fertilize a human and generally progress smoothly without complications. Prenatal oocyte in vitro (outside the body), culture it to the blastocyst development is amazingly precise, and although traumatic, child- stage, and then perform artificial implantation, leading to a full- birth for most women in the world takes place without the aid of term development and delivery. The physician’s is used to aspirate the preovulatory egg from a mature vesicular knowledge of what constitutes normal development and what ovarian follicle. The oocyte is then placed in a suitable culture factors are responsible for congenital malformations ensures the medium, where it is fertilized with spermatozoa. When the zygote embryo and fetus every possible chance to develop normally. In vitro fertilization with what might be referred to as applied developmental biology. During the second trimester, fetal quickening can be de- tected, epidermal features are formed, and the vital body systems Twins occur about once in 85 pregnancies. At the end of the second trimester, two zygotes produced by the fertilization of two oocytes by two fetal length is about equal to the length of an adult’s hand. Monozy- fetus experiences a tremendous amount of growth and refine- gotic (identical) twins form from a single zygote (fig. Dizygotic twins always have two chorions and two am- Many clinical considerations are associated with prenatal nions, but the chorions and the placentas may be fused. Other developmental problems are geneti- cally related and will be mentioned only briefly. Developmental © The McGraw−Hill Anatomy, Sixth Edition Development Anatomy, Postnatal Companies, 2001 Growth, and Inheritance 786 Unit 7 Reproduction and Development Mesentery Small intestine I C D B E A Lumen of uterine tube X Body of F uterus H Ovarian ligament G (Implantation Ovary Fimbriae at isthmus of uterus) H (Cervical implantation) FIGURE 22. The normal implantation site is indicated by an X; the abnormal sites are indicated by letters in order of frequency of occurrence. Monozygotic twins have two amnions but only one chorion and a common placenta. If the embryoblast fails to completely divide, conjoined twins (Siamese twins) may form. Triplets occur about once in 7,600 pregnancies and may be (1) all from the same ovum and identical, (2) two identical and the third from another ovum, or (3) three zygotes from three dif- ferent ova. Fetal Monitoring Obstetrics has benefited greatly from advancements made in fetal monitoring in the last two decades. Before modern techniques became available, physicians could determine the welfare of the unborn child only by auscultation of the fetal heart and palpa- FIGURE 22. Currently, several tests may be used to gain in- erations, including the extraction of a preovulatory ovum. Fetal conditions that can now be diagnosed and evaluated include ge- netic disorders, hypoxia, blood disorders, growth retardation, pla- Monozygotic twins are of the same sex and are genetically cental functioning, prematurity, postmaturity, and intrauterine identical. These tests also help to determine the advisability of caused by environmental factors during morphogenic develop- an abortion. Monozygotic twinning but were found harmful and have been replaced by other meth- is usually initiated toward the end of the first week when the em- ods of evaluation that are safer and more informative. Developmental © The McGraw−Hill Anatomy, Sixth Edition Development Anatomy, Postnatal Companies, 2001 Growth, and Inheritance Chapter 22 Developmental Anatomy, Postnatal Growth, and Inheritance 787 Two Two chorions amnions Implantation of blastocysts Two Two-cell Blastocysts zygotes stage Separate chorionic sacs Separate placentas (a) Two chorions Two fused amnions (b) Fused placentas Fused chorionic sacs (c) FIGURE 22. Twins of this type are fraternal rather than identical and may have (a) separate or (b) fused placentas. Ultrasonic imaging is a reliable way to determine scan the uterus with pulsed sound waves to locate fetal structures, pregnancy as early as 6 weeks after ovulation. Skin samples are taken from to determine fetal weight, length, and position, as well as to diag- the head of the fetus and blood samples extracted from the pla- nose multiple fetuses. The principal advantage of fetoscopy is that external fea- Amniocentesis is a technique used to obtain a small sam- tures of the fetus (such as fingers, eyes, ears, mouth, and genitals) ple of amniotic fluid so that it can be assessed genetically and can be carefully observed.

The anxieties of sick or injured people often act as a lens that greatly magnifies the physician’s body language buy top avana 80 mg low price. In some cases generic 80mg top avana with mastercard, an inno- 70 Gorney cent sigh buy top avana 80mg line, a raised eyebrow top avana 80mg mastercard, or a look of skepticism when evaluating a colleague’s results has triggered a patient’s visit to an attorney. Likewise, remember that a reassuring smile, a comforting touch, and a confident and caring attitude are indispensable ingredients for the development of solid doctor–patient relationships. PROBLEMS OF NURSE–PHYSICIAN COMMUNICATION Case 1 A 39-year-old man was brought to the emergency room (ER) of a large hospital shortly after being struck in the head with a baseball bat. Eleven days later, he returned to the ER because of increasing lethargy. He was hospitalized, and a computed tomography (CT) scan raised the question of a subdural hematoma. It was late in the evening when the CT scan was interpreted, and the patient was alert, so his physician decided to wait until morning to perform further studies. When the patient’s doctor left the hospital at 10 PM, he wrote orders for the nurses to check the patient’s vital signs hourly. However, the doctor did not give specific direction to note the state of the patient’s pupils or his state of consciousness or to call the doctor if any alteration occurred. He later said he felt it was unnecessary to leave such detailed directions because the nurses should have understood their duty in this regard. However, the nurses were not alert to a progressive deterioration that occurred during the night. It was not until the patient was comatose at 4 AM that a neurosurgeon was called. At trial, several negligence issues arose, but the plaintiff’s attorney mainly concentrated on failed communications—failure of the neuro- surgeon to give the nurses sufficiently clear instructions and failure of the nurses to call the physician when the patient obviously was deterio- rating. The jury returned a verdict of $700,000 against the hospital and the neurosurgeon. She was taken to the postoperative recovery room at 9:45 AM,where her blood pressure was noted to be 80/50. A few minutes later, the patient’s blood pressure was Chapter 6 / Communication and Patient Safety 71 70/40. The nurse telephoned the doctor, who said she told him the pulse was strong and that the patient seemed in good condition. Therefore, the doctor said he did not feel it was neces- sary to go to the hospital to evaluate the situation. A few minutes later, the patient was taken to the intensive care unit, where her pressure was found to be 50/30. Therefore, instead of going to the hospital, which was only 5 minutes away, he told the nurse to call his associate, who was 30 minutes away. The defendant then came to the hospital and performed emer- gency surgery. The patient had experienced a massive hemorrhage into the broad ligament resulting from a perforated uterus with injury to the uterine artery. The patient’s residual damage included hemiparesis with recep- tive and expressive aphasia. At trial, the physician testified that the nurse failed to characterize adequately the seriousness of the problem during each of her two calls. If the doctor does not respond appropriately, then the nurse must either persuade the doctor to act or obtain immediate assistance from another source. It is equally incumbent on physicians to ask the right questions to ensure that they have a full understanding of the situation. THE TELEPHONE Despite the sophisticated technology that is now integral to the practice of medicine, the humble telephone can be a dangerous instru- ment of professional liability.

The lower portion of the large intestine receives parasympathetic innervation from spinal nerves in the sacral region generic 80 mg top avana visa. The submucosal plexus and myen- teric plexus are the sites where preganglionic neurons synapse Transverse palatine folds with postganglionic neurons that innervate the smooth muscle of of hard palate the GI tract purchase top avana 80mg otc. Stimulation of the parasympathetic neurons in- creases peristalsis and the secretions of the GI tract buy top avana 80 mg on line. Palatine uvula Postganglionic sympathetic fibers pass through the submu- Pharyngo- cosal and myenteric plexuses and innervate the GI tract safe 80 mg top avana. The ef- palatine arch fects of sympathetic nerve stimulation are antagonistic to those of parasympathetic nerve stimulation. Sympathetic impulses in- hibit peristalsis, reduce secretions, and constrict muscle sphinc- ters along the GI tract. List the four tunics of the GI tract and identify their major tissue types. MOUTH, PHARYNX, The opening of the oral cavity is referred to as the oral orifice, AND ASSOCIATED STRUCTURES and the opening between the oral cavity and the pharynx is called the fauces (faw/se¯z). Ingested food is changed into a bolus by the mechanical action of teeth and by the chemical activity of saliva. Cheeks, Lips, and Palate Objective 6 Describe the anatomy of the oral cavity. They consist Objective 7 Contrast the deciduous and permanent of outer layers of skin, subcutaneous fat, facial muscles that assist dentitions and describe the structure of a typical tooth. The anterior portion Objective 8 Describe the location and histological structures of the cheeks terminates in the superior and inferior lips that sur- of the salivary glands and list the functions of saliva. The lips are fleshy, highly mobile organs whose principal The functions of the mouth and associated structures are to form a function in humans is associated with speech. Lips also serve for receptacle for food, to initiate digestion through mastication, to suckling, manipulating food, and keeping food between the upper swallow food, and to form words in speech. Each lip is attached from its inner surface to the assist the respiratory system in breathing air. Both the mouth and phar- orbicularis oris muscle and associated connective tissue, and are ynx are lined with nonkeratinized stratified squamous epithelium, covered with soft, pliable skin. Between the outer skin and the which is constantly moistened by the secretion of saliva. Lips are red to reddish brown because of blood formed by the cheeks, lips, hard palate and soft palate. The numerous sensory receptors in vestibule of the oral cavity is the depression between the cheeks the lips aid in determining the temperature and texture of food. Digestive System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 18 Digestive System 641 Palatine uvula FIGURE 18. Suspended from the middle lower bor- this activity and even contain blisterlike milk pads that aid in der of the soft palate is a cone-shaped projection called the suckling. During swallowing, the soft palate ple while breathing through its nostrils and palatine uvula are drawn upward, closing the nasophar- ynx and preventing food and fluid from entering the nasal The palate, which forms the roof of the oral cavity, con- cavity. The anterior palatine processes of the maxillae and the horizontal plates of fold is called the glossopalatine arch, and the posterior fold is the palatine bones, is covered with a mucous membrane. These struc- tures serve as friction ridges against which the tongue is placed during swallowing. The soft palate is a muscular arch covered with mucous membrane and is continuous with the uvula: L. Digestive System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 642 Unit 6 Maintenance of the Body Epiglottis form papillae are scattered among the filiform type. The few val- Lingual tonsils late papillae are arranged in a V shape on the posterior surface of the tongue (see fig.

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