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By A. Chris. Oberlin College. 2018.

The nurse is in an excellent position to educate patients and families about nutrition generic super cialis 80 mg with amex. Tremor buy 80 mg super cialis mastercard, weakness, paralysis, and dysphagia can interfere with nutrition. A registered dietitian can determine caloric needs based on activity level. A person with skin breakdown will need increased calories and protein to promote healing. Feeding techniques and education may be required in a person with dysphagia. Referrals to home health programs to relieve the caregiver may be necessary. Adaptive equipment such as weighted utensils, elongated straws, and modified dishes may be helpful. Nutritional supplements may ensure adequate intake in patients with fatigue. Fluid intake in advanced MS: minimum of 8 glasses needed daily (1500–2000 ml/24 hours) UTIs can be reduced with acidification and hydration fluids can be obtained through gelatin and other desserts supplemental tube feedings may be necessaryUrinary tract infections (UTIs) A. Urinary drainage may be accomplished through spontaneous voiding, IC, or indwelling catheter. While IC is the preferred artificial way of emptying the bladder, indwelling catheters are a reality in advanced disease. Attention must be given to keep tubing and drainage bags as clean as possible. Patients must be monitored for signs and symptoms of UTI (fever, U/A, C&S, increased spasticity, etc. Management is a challenge because of intercurrent symptoms such as fatigue and weakness. Medications consist of baclofen, tizanidine, dantrolene, diazepam, and gabapentin. Stretching, positioning, and ROM are important to maintain muscle length and tone. The advent of intrathecal delivery of baclofen is a breakthrough in the management of intractable spasticity. Chapter 16 Psychosocial Implications Objectives: Upon completion of this chapter, the learner will: Describe initial reactions to the diagnosis of MS Discuss the emotional impact of worsening disease Cite therapeutic nursing interventions in support of patients and their familiesReactions to the diagnosis: A. There is a greater understanding of MS with an emphasis on early intervention. There are issues of abuse and neglect, divorce and separation, altered body image. Chapter 17 Financial and Vocational Concerns Objectives: Upon completion of this chapter, the learner will: Describe the provisions of private and public health insurance plans Describe factors that promote and hinder employment of persons with MS Describe the provisions of vocational rehabilitation assistance programsCost of living with MS A. Costs of MS over a lifetime vary from country to country; they may exceed a minimum of $1,000,000 in lost wages, medical costs, and inestimable family expensesHealth insurance programs A. Civilian Health and Medical Program of the VA 87 88 NURSING PRACTICE IN MULTIPLE SCLEROSIS: A CORE CURRICULUM 4. Most people with MS must be assessed by MS specialists for DMAs (not in all provinces) D. Canadian Pension Plan Disability Program (CPP)Importance of employment A. Frequent source of health insuranceFactors that influence unemployment A. Vocational servicesEmployment protection CHAPTER 17: FINANCIAL AND VOCATIONAL CONCERNS 89 A. Public transportation running on fixed schedules must accommodate the disabled person B. Put individuals in touch with agencies for: job counseling job training job placement B. Work incentive programs via SSA, using trial work periods without losing benefitsSummary A.

Nucleus Shortly after the cessation of labor discount 80 mg super cialis, these gap junctions dis- appear and tissue function again becomes less coordinated safe super cialis 80 mg. Electrical coupling among smooth muscle cells is the ba- sis for classifying smooth muscle into two major types: • Multiunit smooth muscle, which has little cell-to-cell Collagen and elastin communication and depends directly on nerve stimula- fibers between cells tion for activation (like skeletal muscle). Its cells form a The contractile system and cell-to-cell con- functional syncytium (an arrangement in which many FIGURE 9. Note regions of association between thick and thin filaments that are anchored by up the bulk of the muscle in the visceral organs. A net- work of intermediate filaments provides some spatial organization (see, especially, the left side). Several types of cell-to-cell me- The Regulation and Control of chanical connections are shown, including direct connections and connections to the extracellular connective tissue matrix. Struc- Smooth Muscle Involve Many Factors tures are not necessarily drawn to scale. In addition to contraction picture represents a consensus from many researchers and in response to nerve stimulation, smooth muscle responds areas of investigation. Note that assemblies of myofila- to hormonal and pharmacological stimuli, the presence or ments are anchored within the cell by the dense bodies and lack of metabolites, cold, pressure, and stretch, or touch, at the cell margins by the membrane-associated dense bod- and it may be spontaneously active as well. The contractile apparatus lies oblique to the long axis ity of controlling factors is vital for the integration of of the cell. When single isolated smooth muscle cells con- smooth muscle into overall body function. Skeletal muscle tract, they undergo a “corkscrew” motion that is thought to is primarily controlled by the CNS and by a relatively reflect the off-axis orientation of the contractile filaments. The control of In intact tissues, the connections to adjacent cells prevent smooth muscle is much more closely related to the many this rotation. It is not sur- Force appears to be transmitted from cell to cell and prising, therefore, that many internal and external path- throughout the tissue in several ways. Many of the mem- ways have as their final effect the control of the interaction brane-associated dense bodies are opposite one another in of smooth muscle contractile proteins. Most smooth muscles There are also areas of cell-to-cell contact, both lateral and have a nerve supply, usually from both divisions of the au- end to end, where myofilament insertions are not apparent tonomic nervous system. There is much diversity in this but where a direct transmission of force could occur. In area; the muscle response to a given neurotransmitter sub- some places, short strands of connective tissue link adjacent stance depends on the type of tissue and its physiological cells; in other places, cells are joined to the collagen and state. Smooth muscle does not contain the highly struc- elastin fibers running throughout the tissue. It serves to connect the cells and to give integrity to which are the sites of release of transmitter substances in re- the whole tissue. In tissues that can resist considerable ex- sponse to nerve action potentials. Released molecules of ex- ternal force, this connective tissue matrix is well developed citatory or inhibitory transmitter diffuse from the nerve to and may be organized into septa, which transmit the force the nearby smooth muscle cells, where they take effect. Since the cells are so small and numerous, relatively few are directly reached by the transmitters; those that are not Electrical Coupling. Smooth muscle cells are also cou- reached are stimulated by cell-to-cell communication, as pled electrically. Neuromuscular transmission in smooth pling is the gap junction (see Chapter 1). Gap junctions in muscle is a relatively slow process, and in many tissues, smooth muscle appear to be somewhat transient structures nerve stimulation serves mainly to modify (increase or de- that can form and disappear over time. CHAPTER 9 Skeletal Muscle and Smooth Muscle 169 Activation of Smooth Muscle Contraction. As a rest- factors that control the function of smooth muscle cells ing membrane potential of 50 mV results in the inactiva- most often have their first influence at the cell membrane. In most cases, it has been shown that the rising (de- ger that diffuses to the interior of the cell, where it causes polarizing) phase of a smooth muscle action potential is further changes (see Chapter 1).

The ventral anterior nucleus is laterally ad- jacent to the mammillothalamic tract order super cialis 80mg online, but does not receive input 19 cheap super cialis 80 mg without prescription. The other choices are nuclei located more caudally in stantia nigra by only a thin layer of myelinated fibers; these two the diencephalon. Damage to the sub- thalamic nucleus gives rise to hemiballistic movements (described in this question) while loss of cells in the substantia nigra results in 14. Answer A: Many of the fibers contained in the optic tract ter- the motor deficits seen in Parkinson’s disease. Some of these fibers by- globus pallidus, and the medial geniculate nucleus are all lateral to pass this nucleus to traverse the brachium of the superior collicu- the internal capsule; the subthalamic nucleus is medial. The medial tromedial nucleus is separated from the subthalamic nucleus by geniculate nucleus receives input via the brachium of the inferior other thalamic nuclei. Answer B: The column of the fornix is that portion of this eral nucleus receives input from the anterolateral system and the fiber bundle that arches around the rostromedial end of the thal- medical lemniscus. As it does so, the column joins its counterpart on the op- interpeduncular fossa and medial to the optic tract. The col- umn of the fornix also signifies, in cross section or axial planes, 15. Answer A: The anterior commissure, as it passes laterally from the laterally adjacent interventricular foramen and genu of the the midline, separates the dorsal basal nuclei (putamen and globus internal capsule. The mammillothalamic tract is located caudal pallidus) from the ventral striatum and ventral pallidum. The pos- to the fornix, and the crus of the fornix is found along the mid- terior commissure is located at the caudal aspect of the third ven- line superior to the thalamus. The anterior limb of the internal tricle just above the opening of the cerebral aqueduct, and the capsule is found between the head of the caudate nucleus and the Massa intermedia bridges the third ventricle in about 80% of indi- lenticular nucleus (mainly the putamen). The rostral wall of the third ventricle is formed by the lus contains pallidothalamic fibers and traverses the posterior lamina terminalis and the septum pellucidum forms the medial limb of the internal capsule en route to the dorsal thalamus. Answer A: The amygdaloid complex is located immediately in- ternal to the uncus. Bilateral damage to rostral portions of the temporal lobe may include the amygdala and result in a constella- Review and Study Questions for tion of deficits known as the Klüver-Bucy syndrome. The hip- Chapter 5 pocampal formation is internal to the cortex of the parahip- pocampal gyrus, and the anterior thalamic nucleus is internal to the anterior thalamic tubercle. A 16-year-old boy is brought to the emergency department fol- longitudinally oriented fibers of the cingulum and the gracile tu- lowing a diving accident at a local quarry. The examination reveals bercle is the external elevation formed by the gracile nucleus. At 36 hours after the accident the boy is able to dorsiflex his toes, barely move his right lower extremity at the knee, and is able to perceive pinprick stimulation of the perianal 17. Answer D: The optic radiations are located in the lateral wall of skin (sacral sparing). Which of the following most specifically de- the posterior horn of the lateral ventricle as they pass through the scribes the spinal cord lesion in this patient? A thin layer of white (A) Central cord matter, the tapetum, separates the optic radiations from the wall (B) Complete of the ventricle. The cisterns at the midbrain on the basal aspect of (C) Hemisection the hemisphere contain the optic tract. The other ventricular (D) Incomplete spaces listed have no direct relationship to the optic radiations. Which of the following represents the most likely level of damage the emergency department after experiencing sudden onset of to the spinal cord resulting from the fracture to the vertebral col- weakness of his left upper and lower extremities. Damage to which of the following (A) T6 on the left tracts or fiber bundles of the medulla would most likely explain (B) T8 on the left this deficit? The artery of Adamkiewicz is an especially large spinal medullary (E) Vestibulospinal fibers artery supplementing the arterial blood supply to the spinal cord. Which of the following represents the most consistent location of this vessel? A 78-year-old healthy, active woman experiences a sudden weak- ness of her right upper extremity during an angiogram to deter- (A) At C7–C8 on the left mine the patency of her carotid bifurcation.