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Psychodynamic theories of personality: Psychoanalytic theories of personality are referred to as psychodynamic theory generic viagra sublingual 100mg on-line. This theory at­ tempts to understand personality in terms of mental functions may be rational discount 100mg viagra sublingual amex, irrational order viagra sublingual 100mg mastercard, conscious or unconscious discount 100mg viagra sublingual with mastercard. Freud’s theory of psychoanalysis emphasizes man as dynamic system of energies and main store­ house of such energies in unconscious. From anxiety, defense mechanism or unconscious attempts to reduce anxiety by denying or destroying realty,. The technique of Eric Berne’s transactional refers to wholesome transaction from childhood to adulthood. Then from 5 up to early adolescence sexual force is subordinated which marks the latency, period and finally the genital stage of heterosexuality. Carl Jung differs from Freud in taking a more positive and optimistic attitude towards human nature believing that people not only try to gratify their instincts but also try to develop their potential. Jung agreeing with Freudian view of unconsciousness, which represents the accumulated experi­ ences, and culture of the human species throughout its evolutionary development from primitive times. To Erickson, personality is the resultant from interaction between the needs of a person and the demands of a society at a particular stage of development. Ego identify crisis during adolescence and now an individual resolves such crisis determines personality characteristics. Svilan has stressed the interpersonal nature of personality and has laid on the acquisition of language as a means of normal personality development. Social learning theories of personality: These theories say that consistency of behavior, results not only from rigid personality traits but also from other factors like environmental stability. Dollard and Miller pointed fear, as an important factor in personality development as it acts as a powerful motive or drive in the promotion of learning. A person’s behavior depends upon the specific nature of the situation, how the situation is appraised by him as well as past reinforcement of behaviour in similar situations. Behaviorists theories of personality: Behavourists is such a skinner emphasize that conditioning alone is not adequate to explain human character and personality. These theories emphasize the existence of positive growth promoting forces in personality beyond more conflict resolution or tension reduction and also stresses present rather than past experiences. Maslow and Carl Roger both dealt on humanistic and psychoanalytic theories on growth and self actualization. An individual with a strong positive self – concept seek growth and have pleasant productive relation with others. Kelly’s cognitive theory of personality consists of personal constructs that is the ways a person has of evaluating himself and his circumstances. Defense mechanism: Another mode of reacting to difficulties is that of mental mechanism or defense oriented reactions to stress aims chiefly at protecting the self from hurt and disorganization. No Expression Mode of reactions 1 Withdrawal Protecting self from unpleasant, reality by refusal to perceive or face it. Nursing services are necessary for every patient seeking care of various types including primary, secondary, tertiary and restorative. As nursing is an important part of health care delivery system, the nurses need to understand the system to effectively deliver quality care within it. Nursing : Nursing is the process of recognizing, understanding and meeting the health needs of any person or society and is based on a constantly changing body of scientific knowledge. The nursing process is an orderly systematic manner of determining the patient’s problems, mak­ ing plans to solve them, initiating the plan or assigning others to implement it and evaluating the extent to which the plan was effective in resolving the problems identified. The nursing process is a systematic method for assessing health status, diagnosing health care needs, formulating a plan of care, initiating plan and evaluating the effectiveness of plan. Data are collected in a systematic fashion, utilizing the interview or nursing history, physical examina­ tions, laboratory results and other resources. Diagnosis: Nursing diagnosis is a clinical judgment about individual family or community responses to actual and potential health problems and life processes. Planning: Planning is a systematic approach in developing a plan of action based on a careful assess­ ment. Strategies are developed to prevent, minimize or connect the problems identified in the nursing diagnosis. It consists of several steps including establishing priorities, setting objectives, writing interven­ tions, recording outcomes of nursing interventions in an organized fashion to complete the nursing care plan.

Associated rib fractures were found in 30 of 34 was called “extrapleural fluid” by Smedal and Lippincott in (88 purchase 100mg viagra sublingual with mastercard. More than half of the patients had an associated 2 3 1950 and “retropleural hematoma” by Scheff et al generic 100mg viagra sublingual overnight delivery. These to 48 hours after admission in 30 patients purchase 100 mg viagra sublingual overnight delivery, but delayed 5 days terms are almost unknown in our practice of cardiothoracic in 1 patient and 10 days in 3 patients order 100mg viagra sublingual otc. Of these four patients, and trauma surgery, probably because of the unrecognized there were only two patients with associated hemothorax: this significance of epipleural or subpleural bleeding. Retropleural is not informative enough ment was given), and we found that no patient developed a because the pleura turns itself, and what is called retropleural delayed hemothorax. Conservative treatment with observation and chest radio- graph control was provided in 33 patients, and 1 patient Classification needed a thoracotomy to evacuate the hematoma after unsuc- We suggest the following simple etiologic classification cessful needle aspiration. Blunt thoracic injury begins with fractures of the ster- the aortic wall, including the pleural spaces and mediastinum. We completed an angiogram of the aortic arch in origin of blood is usually intercostal or internal mammary three cases with suspected widened mediastinum, but this vessels. A history of surgery, thickening of the overlying pleura that persists for 2 years or particularly that of open sympathectomy1–3 and lung more. Extrapleural tumor risk factors such as old age with tortuous vessels, skeletal could be even more confusing to diagnose if it is discovered deformity such as scoliosis, other comorbidity such as neu- after trauma. A pleural thoracostomy drainage might prove unsatisfactory when the thickening that does not shift with gravity could be a clotted hematoma is clotted. Therefore, the recognition mended, and one may observe the recently described “dis- and the proper treatment of such a rare entity is important. Such a bleeder, 288 August 2000 Traumatic Extrapleural Hematoma however, could be identified using thoracic artery angiogram retropleural hematomas following sypathectomy. Life-threatening hemorrhage from ered the preferred approach for the management of pleural inadvertent cervical arteriotomy. An unusual complication of fractures, hemothorax, lung contusions, pneumothorax, and percutaneous catheterization of the internal jugular vein. Epipleural hematoma: etiology, extrathoracic injuries were cerebral concussion and clavicular morphology and clinical course [in German]. Although huge extrapleural hematoma might cause ven- complication after blunt thoracic trauma [in German]. Unusual clinical forms mothorax, lung contusion, and pneumothorax might provide of extrapleural (epipleural) hematoma on the chest x-ray [in the surgeon with a reliable clinical clue that the patient is at German]. Extrapleural hematoma: a discomfort and a transient rise in temperature but has less recognizable complication of central venous pressure monitoring. Extrapleural hematoma following implying greater blood loss, can produce dyspnea or become 13 infraclavicular subclavian vein catheterization [letter]. Left extrapleural of intrathoracic lesions such as neurofibroma if it is found in hemothorax from rupture of the subclavian artery. Pleural complications Primary hemangiopericytoma of the chest wall: a case report [in in lung transplant recipients. Subjects: 418 patients with blunt chest trauma of whom 29 had a fractured sternum (11 with retrosternal haematoma and 18 without) and 389 did not (7 with widened mediastinum and 382 without). Results: Retrosternal haematomas were found adjacent to many fractures and ranged in size from a few mm to 2 cm. There was no signiŽ cant difference in the number of associated lesions between patients with sternal fractures with or without a retrosternal haematoma. Conversely, patients with a widened mediastinum had a higher injury severity score, longer hospital stay (p < 0. Six patients still had pain 1 month after injury of whom two had injury-related long-term disability because of pain. The early mortality in our study was 2/29 in patients with sternal fractures and 1/7 in patients with widened mediastinum.

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Fracture neck femur whether intra-capsular or extra-capsular can be diagnosed and differentiated by clinical examination and confirmed by the roentgenograms 100mg viagra sublingual. Any underlying pathologic condition like metastasis or osteoporosis if present can also be identified on roentgenograms cheap viagra sublingual 100 mg on-line. Fracture neck femur intra-capsular can be divided as per the following classifications: (A) Garden Classification  Type 1 is a stable fracture with impaction in valgus order viagra sublingual 100mg with amex. The aim of treatment is to achieve union of the fracture and a durable hip joint afterwards viagra sublingual 100 mg low price. More than 21 days – Neglected fracure Management: Primary health centre level: The doctor on duty should recognise the features of fracture and disloction. The injured should be referred to the higher centre earliest feasible causing no further harm. Investigations: X-rays of the pelvis including both hip and knee joint and of other areas if required, General Investigations and specific if required according to the status of the health of the patient. Sub-capital and transcervical fractures should be fixed with multiple Kirschner (K) wires or Moore’s pins after closed reduction in valgus. Basicervical fractures can be fixed either by K wires, Moore’s pins or cancellous/cannulated lag screws. Age 16-50 years Sub-capital fractures: Undisplaced: Internal fixation with 2-3 cancellous/cannulated lag screws Displaced: Closed reduction and fixation with Lag screws. Valgus osteotomy and fixation with double angled blade plate can also be done to convert shearing forces into compression forces. Transcervical fractures: Undisplaced: Internal fixation with 2-3 cancellous/cannulated lag screws Displaced: Closed reduction and fixation with Lag screws. Valgus osteotomy and fixation with double angled blade plate can also be done to convert shearing forces into compression forces. If closed reduction fails open reduction is done followed by any of the above procedures. Age 50-60 years: Sub-capital fractures: Undisplaced: Internal fixation with 2-3 cancellous/cannulated lag screws Displaced: Closed reduction and fixation with Lag screws. Valgus osteotomy and fixation with double angled blade plate can also be done to convert shearing forces into compression forces. Arthroplasty including hemi or excision may be done according to the need and requirement of the patient. If closed reduction fails open reduction and fixation with any of the methods described above may be done or hemi/excision arthroplasty may be offered according to the need and requirement of the patient. Transcervical fractures: Undisplaced: Internal fixation with 2-3 cancellous/cannulated lag screws Displaced: Closed reduction and fixation with Lag screws. Valgus osteotomy and fixation with double angled blade plate can also be done to convert shearing forces into compression forces. Arthroplasty including hemi or excision may be done according to the need and requirement of the patient. If closed reduction fails open reduction and fixation with any of the methods described above may be done or hemi/excision arthroplasty may be offered. Physiologic Age above 60 years: Sub-capital fractures: Undisplaced: Internal fixation with 2-3 cancellous/cannulated lag screws. Arthroplasty including hemi or excision may be done according to the need and requirement of the patient. Displaced: Arthroplasty including hemi or excision may be done according to the need and requirement of the patient. Transcervical fractures: Undisplaced: Internal fixation with 2-3 cancellous/cannulated lag screws. Arthroplasty including hemi or excision may be done according to the need and requirement of the patient. Displaced: Arthroplasty including hemi or excision may be done according to the need and requirement of the patient. Investigations: X-rays of the pelvis including both hips and knee and of other areas if required, General Investigations and specific if required according to the presence of any co-morbidity. Treatment: All the treatment as in situation 1 Treatment for the referred patients in the form of multispecialty approach.

The Asian H2N2 influenza virus was charac- terised by early summer buy discount viagra sublingual 100 mg, 1957 generic viagra sublingual 100 mg free shipping, but significant mortality in the United States did not occur until October – and in 1968 buy 100mg viagra sublingual with visa, the pandemic wave of mortality in Europe peaked a full year after the pandemic strain first arrived (Simonson 2004) viagra sublingual 100mg with visa. Instead, mortality rates can remain elevated for several years – during which time an effective vaccine would be in high demand. Will it be mild like the last two pandemics of 1968 and 1957, when the new pandemic strain resulted from the reassortment of the pre-existing human strains and an avian influenza strain? Incidence of adamantane resistance among influenza A (H3N2) viruses isolated worldwide from 1994 to 2005: a cause for concern. Adamantane resistance among influ- enza A viruses isolated early during the 2005-2006 influenza season in the United States. Risk of influenza A (H5N1) infection among health care workers exposed to patients with influenza A (H5N1), Hong Kong. High levels of adamantane resistance among influenza A (H3N2) viruses and interim guidelines for use of antiviral agents--United States, 2005-06 influenza sea- son. Induction of proinflammatory cytokines in human macrophages by influenza A (H5N1) viruses: a mechanism for the unusual severity of human disease? Comparison of elderly peo- ple´s technique in using two dry powder inhalers to deliver zanamivir: randomised con- trolled trial. Characterization of a novel influenza A virus hemagglutinin subtype (H16) obtained from black-headed gulls. Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syn- drome. Protection of mice and poultry from lethal H5N1 avian influenza virus through adenovirus-based immunization. Neuraminidase inhibitor susceptibility network position statement: antiviral resistance in influenza A/H5N1 viruses. Management of influenza in households: a prospective, randomized comparison of oseltamivir treatment with or without postexpo- sure prophylaxis. Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenzavirus infections. Zanamivir for treatment of symptomatic influenza A and B infection in children five to twelve years of age: a randomized controlled trial. Development of adenoviral-vector-based pan- demic influenza vaccine against antigenically distinct human H5N1 strains in mice. Whole-genome analysis of human influenza A virus reveals multiple persistent lineages and reassortment among recent H3N2 viruses. Role of domestic ducks in the propagation and biological evolution of highly pathogenic H5N1 influenza viruses in Asia. Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Antibody response in individuals infected with avian influenza A (H5N1) viruses and detection of anti-H5 antibody among household and so- cial contacts. Transmission of H7N7 avian influenza A virus to human beings during a large outbreak in commercial poultry farms in the Netherlands. Avian influenza (H5N1) viruses isolated from humans in Asia in 2004 exhibit increased virulence in mammals. Early alterations of the receptor-binding prop- erties of H1, H2, and H3 avian influenza virus hemagglutinins after their introduction into mammals. Efficacy and safety of the neuraminidase inhibi- tor zanamivir in the treatment of influenza A and B virus infections. Pathogenicity of a Hong Kong-origin H5N1 highly pathogenic avian influenza virus for emus, geese, ducks, and pigeons. Long-term use of oseltamivir for the pro- phylaxis of influenza in a vaccinated frail older population.

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