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Relaxing to reduce anxiety Children benefit from learning to relax generic cialis soft 20mg without a prescription erectile dysfunction medication uk, much in the same way that adults do purchase cialis soft us impotence vacuum treatment. We discussed relaxation methods for adults in Chapters 12 and 13, but kids need some slightly different strategies. Chapter 20: Helping Kids Conquer Anxiety 297 Usually, we suggest teaching kids relaxation on an individual basis rather than in groups. They deal with their embarrassment by acting silly and then fail to derive much benefit from the exercise. Individual training doesn’t usually create as much embarrassment, and keeping kids’ attention is easier. Breathing relaxation The following directives are intended to teach kids abdominal breathing that has been shown to effectively reduce anxiety. Pretend that your stomach is a big balloon and that you want to fill it as full as you can. Now make a whooshing sound, like a balloon losing air, as you slowly let the air out. Hold it for a moment and then let the air out of your balloon ever so slowly as you make whooshing sounds. Relaxing muscles An especially effective way of achieving relaxation is through muscle relax- ation. Pretend the floor is trying to rise up and that you have to push it back down with your legs and feet. Pretend you’re squeezing Play-Doh between your hands and make it as squished as you can. To do that, bring your shoulders way up high and try to touch your ears with your shoulders. Finally, squish your face up like it does when you eat something that tastes really, really bad. Chapter 20: Helping Kids Conquer Anxiety 299 Imagining your way to relaxation One way to help your child relax is through reading books. You can also find various books and tapes specifically designed for helping kids relax. Unfortunately, some of the tapes use imagery of beauti- ful, relaxing scenes that kids may find rather boring. Rather than beautiful scenes of beaches and lakes, kids can relax quite nicely to more fanciful scenes that appeal to their sense of fun and joy. The scenes don’t need to be about relaxation per se; they just need to be entertaining and pleasant. This child, with a little help from her mom, wrote and illustrated each page of her own relaxation book as in the following excerpt, titled “Imagine Unicorns and Smiling Stars”: Close your eyes and relax. Imagine unicorns dancing in outer space with smiling stars, blue moons, and friendly aliens in their spaceship soaring. Exorcizing anxiety through exercise Exercise burns off excess adrenaline, which fuels anxiety. All kids obviously need regular exercise, and studies show that most don’t exercise enough. Yet it may be more important for anxious kids to participate in sports for two reasons. Although they may feel frustrated and upset at first, they usually experience considerable pride and a sense of accomplishment as their skills improve. Consider the following activities: ✓ Swimming: An individual sport that doesn’t involve balls thrown at your head or collisions with other players. Swimmers compete against them- selves, and many swim teams reward most participants with ribbons, whether they come in first or sixth. Many martial arts instructors have great skill for working with uncoor- dinated, fearful kids. In other words, find something for your kids to do that involves physical activity. They can benefit in terms of decreased anxiety, increased confi- dence, and greater connections with others. Getting Help from Others The goals of childhood include learning how to get along with others, learn- ing self-control, and preparing for adult responsibilities. Children make prog- ress toward these goals by interacting with friends and family as well as by attending school. If anxiety interferes with these activities, then consultation and professional treatment may be needed. In other words, if a child can’t play, learn, or participate in activities because of worries, it’s time to get help. Who to get help from We recommend that parents first turn to their child’s medical doctor to make sure there are no physical reasons for a child’s anxiety. Certain medications prescribed for other conditions can cause a child to feel anxious. If the culprit is anxiety, rather Chapter 20: Helping Kids Conquer Anxiety 301 than a drug or physical problem, the medical provider may have recommen- dations for mental-health providers. The therapy can seem like play to your child, but therapy should be based on an approach that has been shown to help children overcome anxiety. We generally recommend practitioners trained in cognitive or behavioral strategies because their effectiveness has been supported most consistently by research. Although the treatment may be relatively brief, don’t expect it to happen in one or two sessions. Don’t seek help from some- one without a license to practice mental-health counseling. Professionals who usually treat children may be clinical psychologists, social workers, counselors, or school psychologists. Psychiatrists can also be involved in treating childhood anxiety disorders; however, they usually prescribe medication. We recommend that treatment for anxiety, especially for children, begin with psychotherapy rather than medication. We take this approach because of unknown side effects of long- term use of medication and the great potential of relapse when medication is stopped. In contrast, the new ways of thinking or behaving learned through psychotherapy can last a lifetime. If your insurance doesn’t pay for psychotherapy, consider this: A study reported in the Journal of Abnormal Psychology (2008) found that the medi- cal costs of anxious children were almost 21 times higher than those without anxiety. Covering effective treatment for anxious children is cost-effective for health insurance companies.

Your mind is unconsciously asking order cialis soft no prescription erectile dysfunction 5x5, “Is that person acting in a way that fits with my internal belief system? Of course you are the center of your own world order cialis soft without prescription laptop causes erectile dysfunction, but a lot of your stress comes from this tendency to judge. If you can consciously perceive life through a perspective that is not quite so self-referential, you can get around your own habitual patterns of judgment. You are then present to what you are experiencing without “sticking” to it by getting caught up in all the judgments and comparisons. The idea is to create interest in whatever you perceive, in other words, to be actively external or other directed. Whatever or whomever you encounter, make a conscious and deliberate attempt to bring to the experience an attitude of interest and curiosity. Bring mindfulness to the moment by being present to what is, rather than telling stories about it. This is because your inner child does not normally view nature and buildings and so forth as a significant threat. It’s important to recognize that everyone shares the same human condition as you do, with all its hopes and fears. We all have an inner child, with its core-wounding, or emotionally damaging, childhood experiences, as well as our fair share of ongoing adult stressors that directly influence our behaviours. It can be helpful to remember that, although someone’s actions may not seem appropriate, that person is driven by his or her own unmet needs and fears, just like you. If you knew a person’s history, you’d likely have more sympathy for that individual’s behaviour. You might even realize that you would probably be doing exactly what that person is doing, if given the same circumstances. They may present initially in a way that seems angry or distant, but once I learn their stories, I can understand why they are the way they are. Mika first came to my office complaining of a long-standing history of abdominal pain, nausea, headaches, sleep disorders and fatigue. As we explored her history, she revealed that she had suffered physical and sexual abuse as a five-year-old child back in Thailand. Her medical symptoms were a physical expression of her childhood traumas, as well as the ongoing stress of living and working in a new country. When my patient Larry first came to my office, he was initially very uptight and angry. My initial reaction to his angry demeanor was to be defensive, but The Mindful Mind • 137 slowly as the conversation unfolded and I explored what was going on in his life, he shared that he had been looking after his father for many years. What became apparent was that Larry was scared of suffering the same fate as his father and was worried that his symptoms could reflect an underlying serious medical problem. When I could explain the nature of his symptoms to him and reassure him, his spirits lifted and he became very pleasant and grateful. You don’t know the stories of the people you meet, but what’s for sure is that everyone has a story. If you knew that person’s story you would probably feel a stronger sense of compassion for him or her. It will help you to be more open and accepting of them until you really do get to know them. When you look at someone else, remember your own picture and let it be a reminder that the other person too has an inner child who’s looking for love, acceptance, and safety. Naturally, in order to be treated well by other people, you need to treat other people the same way. The idea here is to try to get out of your own inner personal perspective and connect with people from a place of shared humanity. If you begin to focus more on similarities rather than differences, you will be able to be more understanding and compassionate. When you can start to treat other people more compassionately, you may also start to treat yourself 138 • Mindfulness Medication with more compassion as well. Summary • If you can view life through an external rather than an internal self-referencing perspective, there will be less of a tendency for your mind to judge. Try to bring your attention to one of your favourite holiday places, write a shopping list, or recite a prayer or poem. Even try solving a crossword puzzle to remove yourself from the clutches of your own story. A bit of distraction can sometimes give you that little morsel of distance that you need in order to come to your thoughts or problems more mindfully. Focus on the Dominant Word in the Thought Another interesting technique that you can use when stressed, is to continue to repeat the dominant word in the story that your mind is telling you in response to stress-filled thoughts. You may have done something and, as a result, your mind is telling you that you’re stupid, terrible, or foolish. You would then continue to repeat one of these words, for example, “terrible,” over and over again, until all that you’re left with is the act of repeating the word, without any of the feelings that originally went along with the story. The word “terrible” becomes just an empty sound without the associated energy of the rest of your inner commentary. By using this technique, you’re short-circuiting the story and your mind will move on to 139 140 • Mindfulness Medication something else. It really becomes evident, with this technique, how temporary your thoughts actually are. Interestingly, when you bring your attention specifically to the act of looking for what your next thought will be, your mind stops or slows down its chatter. As you bring your focus to your own thought process, your mind tends to settle down. You can use this technique whenever you encounter a sensation such as seeing a new person. If you see a stranger walking toward you, before your mind criticizes, compares and judges, ask yourself, “What’s next? This will allow you to experience what is, as it is, rather than through the filter of your mind’s stories. Feed the Fire Feeding the Fire is another technique that you can use when your mind is being self-critical, blaming and angry. Poor Mika had forgotten her friend’s birthday and her mind was saying, “You’re so thoughtless, stupid and horrible. She could intentionally worsen the content of her inner-commentary to make it more and more outlandish and ridiculous under the circumstances. There is a part inside of Mika that knows that these increasingly ridiculous thoughts are untrue.

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Te specific laboratory procedures are procedures order cialis soft mastercard erectile dysfunction in females, which are grouped according to billed according to which system of coding? A hospital has a contract with a major medical (known) revenue based upon a negotiated per-capita insurer that reimburses the laboratory at a rate fee for the members of the group discount 20mg cialis soft otc erectile dysfunction vitamin shoppe. Tis type of the laboratory must manage its resources to provide reimbursement is called: covered laboratory tests to the group at a cost that A. A preferred provider discount prospective payment system is used by Medicare and C. Diagnosis-related group and is based upon projecting the cost of a Education and management/Laboratory economics/2 laboratory test in a specific region. According to federal and state regulations, a the fees for laboratory tests are incorporated hospital’s capital budget should include which into the reimbursement covering the specific of the following before projects that cost $150,000 diagnosis-related group rather than the type can be submitted for approval? Salaries and wages for new employees obstetrics department or new wing to the laboratory. A certificate of need There are specific federal guidelines (most states Education and management/Laboratory economics/1 also require them) to follow and the limit is set at $150,000. This is done to control duplication of services as well as oversupply of hospital beds. In order to budget for next year’s salaries for these employees, the laboratory 25. A The total (paid) hours are the total number of hours manager needs to submit which figures for the for which employees are paid. Total hours of part-time employees the total (paid) hours in order to give a clear picture of what is needed for the next year of wages and Education and management/Laboratory economics/1 salaries. Submit as four individual tests Education and management/Laboratory regulation 27. Professional certification of all testing personnel analyte and at least three testing events per year are D. The testing events are evenly spaced manufacturer’s performance specifications throughout the year. Unsatisfactory performance for the same analyte for two out of two events or Education and management/Laboratory regulation two out of the three most recent events constitutes and law/2 unsuccessful participation and may result in punitive 28. Twelve challenges per analyte and one testing event per month Education and management/Laboratory regulation and law/1 Chapter 9 | Education and Management 529 29. Be purchased by an authorized agency such as standard precautions/2 the College of Pathology B. Have concentration values that cover the Answers to Questions 29–34 laboratory’s reportable range C. For all other tests, a score below 80% Education and management/Laboratory regulation is defined as unsatisfactory performance. Tree times the normal range for the specific for calibration is every 6 months or more frequently analyte if specified by the manufacturer. Traceable to a reference method and reference must cover the reportable range of the method. Twice the laboratory’s reference range for the (more if specified by the manufacturer). C Calibrators must have an assigned concentration Education and management/Laboratory regulation determined by assay using a reference method. Tests that are qualitative or waived and some high-complexity tests as well as waived and moderate-complexity tests moderate-complexity tests. Waived and moderate-complexity tests laboratory must be certified at all three levels. B The Civil Rights Act of 1964 prohibits by federal law discrimination in employment because of race, color, Education and management/Laboratory regulation religion, or gender. Sexual harassment is a form of discrimination hear complaints of discrimination by employees and and therefore is prohibited by the: initiate legal action as appropriate. Department of Health and Human Services Education and management/Labor law/1 530 Chapter 9 | Education and Management 35. A new employee’s performance is to be evaluated not be released without his or her consent to at the end of his or her probationary period, and anyone outside the clinical laboratory except to the: must relate to: A. Recruitment practices Education and management/Laboratory regulation Education and management/Apply principles of and law/2 laboratory management/Personnel/1 36. Unethical behavior by a laboratory supervisor Answers to Questions 35–40 that results in a compromise of employee safety should be: 35. D Direct confrontation is in order, followed by laboratory management/Personnel/2 reporting the behavior to a higher authority at 37. Insufficient work space area laboratory deficiencies, while outdated or inadequate C. D Sexual harassment is a form of discrimination and it is prohibited by the Civil Rights Act of 1964 38. Unwelcome sexual advances by a supervisor a favorable performance evaluation constitutes B. Additionally, offensive language fellow laboratory employee and behavior with sexual connotations are forms of C. These documents must be located in an hazardous chemicals address which of the easily accessible place so that all employees have following conditions? Physical characteristics of the chemical once per year during safety inservice training. Specific health hazards associated with the review should reflect the job description used at the chemical time of hire. All of these options job description that states the responsibilities and Education and management/Laboratory regulation activities of the position. Job performance criteria and safety/1 and the rating system used should be clearly stated and available to the employee. Which regulatory agency mandates the following Answers to Questions 41–45 requirements for protection of employees of clinical laboratories? All clinical laboratories in the United States The law requires health care providers to safeguard B. Environmental Protection Agency laboratories and to provide patients with a compliance statement D. Industrial laboratories that defines who is entitled to receive their health Education and management/Apply knowledge of lab information. The physician ordering the tests as regulations/1 well as health care workers directly involved with the patient are allowed to see laboratory results. Records of a patient’s laboratory test results may Laboratory results may also be released to the be released without the prior consent of the patient patient’s insurance provider, and to medical review to all of the following except: officers, and public health officials. All of these options Education and management/Apply knowledge of quality performance/2 45. Improve overall wages for lab employees Education and management/Quality improvement/2 532 Chapter 9 | Education and Management 46. Which of the following is not an appropriate Answers to Questions 46–51 guideline for phlebotomists to follow in order to prevent a malpractice lawsuit?

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It contains numerous blood vessels and lymphatics that nourish the Spinal cord underlying tissues order genuine cialis soft online chewing tobacco causes erectile dysfunction. Because of the thinness and The spinal cord transmits sensory impulses from delicacy of the arachnoid and pia mater cheap 20mg cialis soft erectile dysfunction zinc, these two the body to the brain and motor impulses from the meninges are collectively called the leptomeninges. The sen- Peripheral Nervous System sory nerve tracts are called ascending tracts because the direction of the impulse is upward. A cross-section of the consists of 12 pairs of cranial nerves and 31 pairs spinal cord reveals an inner gray matter composed of spinal nerves. The somatic nervous system consists of nerve The entire spinal cord is located within the fibers that transmit sensory information to the spinal cavity of the vertebral column, with spinal brain and spinal cord, and nerve fibers that trans- nerves exiting between the intervertebral spaces mit impulses from the brain and spinal cord to throughout almost the entire length of the spinal muscles under conscious or voluntary control, such column. The specific names, the spinal nerves are identified by autonomic nervous system consists of nerves that the region of the vertebral column from which control involuntary movement, such as digestion, they exit. To a large extent, tion from three coverings called meninges (singu- these subdivisions oppose the action of the other, lar, meninx). These coverings include the dura although in certain instances, they may exhibit mater, arachnoid, and pia mater. In general, The dura mater is the outermost covering of the sympathetic subdivision produces responses the brain and spinal cord. An increases in skeletal muscles to prepare an individ- example of a mixed nerve is the facial nerve. It acts ual to either fight or retreat from a threatening in a motor capacity by transmitting impulses for situation. However, it also acts in a sen- generally responds when immediate action is sory capacity by transmitting taste impulses from not required or a threatening situation subsides. This subdivision is sometimes called the “rest and relax” or “rest and digest” condition. Sensory nerves are attachment to the spinal cord: an anterior (ven- afferent, and receive impulses from the sense tral) root and a posterior (dorsal) root. Some to form the spinal nerve that has both afferent and cranial nerves are composed of both sensory and efferent qualities. Table 14-2 Actions Regulated by Sympathetic and Parasympathetic Systems This table summarizes some of the responses regulated by the sympathetic and parasympathetic divi- sions of the peripheral nervous system. Sympathetic Division Parasympathetic Division Dilates pupils Constricts pupils Inhibits the flow of saliva Increases the flow of saliva Relaxes bronchi Constricts bronchi Accelerates heart rate Slows heart rate Slows digestive activities Accelerates digestive activities Constricts visceral blood vessels Dilates visceral blood vessels Anatomy and Physiology 433 Connecting Body Systems–Nervous System The main function of the nervous system is to identify and respond to internal and external changes in the environment to maintain homeostasis. Specific functional relationships between the nervous system and other body systems are discussed below. Blood, Lymph, and Immune Genitourinary • Nervous system identifies changes in • Nervous tissue in reproductive organs blood and lymph composition and pro- receives pleasure responses. Cardiovascular Integumentary • Nervous tissue, especially the conduction • Sensory nervous system supplies recep- system of the heart, transmits a contrac- tors in the skin that respond to environ- tion impulse. Digestive Musculoskeletal • Nervous stimuli of digestive organs propel • Nervous system provides impulses for food by peristalsis. It is time to review nervous system structures by completing Learning Activity 14–1. Anatomy and Physiology 435 C1 C2 C3 C4 Cervical nerves C5 C6 C7 C8 T1 T2 T3 T4 T5 T6 Thoracic nerves T7 T8 T9 T10 T11 T12 A. L1 Central L2 White canal matter Gray Lumbar nerves matter L3 Posterior L4 root L5 S1 Posterior root S2 ganglion S3 Sacral nerves S4 S5 Pia mater Co Coccygeal nerve Arachnoid Spinal membrane nerve Dura mater Anterior roots Subarachnoid space Cauda equina Figure 14-5. The most common type, which accounts for about 80% of all strokes, is Damage to the brain and spinal cord invariably ischemic stroke. Ischemic stroke is caused by a causes signs and symptoms in other parts of the narrowing of the arteries of the brain or the arter- body. Common signs and symptoms for many neu- ies of the neck (carotid), generally due to athero- rological disorders include headache, insomnia, back sclerosis. Careful observation of the patient brain tissue and, within a few minutes, the tissue during the history and physical examination may begins to die. Occasionally, pieces of plaque break provide valuable clues about mental status and cog- loose and travel to the narrower vessels of the brain, nitive and motor ability. An tion, gait, balance, and reflexes provide additional intracerebral hemorrhage is caused by the sudden diagnostic clues. This condition is commonly caused by a rup- detailed images that can locate cerebrovascular tured aneurysm and is usually fatal. Spinal nerves exit the spinal experience a brief “blackout,” blurred vision, or column at each level along the length of the dizziness and may be unaware of the “minor spine. A family history of cerebrovascular dis- the result of a herniated disc, degenerative ease and high blood pressure appears to be a con- changes, arthritis, fractures, bone spurs, or tributing factor to stroke. The usually administered within 3 hours of symptom offending nerve root is commonly identified dur- onset when ischemic stroke is diagnosed. Anti- ing the history and physical examination by eval- hypertensives may also be administered to control uating the area of the skin known to be served by blood pressure. Rest tions, depending on the type of stroke and anti-inflammatory medications are usually recommended. However, for disabling pain that Seizure Disorders lasts for several months or is accompanied by loss of bowel or bladder control, surgery to remove the Seizure disorders include any medical condition cause of the pressure (decompression surgery) characterized by sudden changes in behavior or may be the only option. Causes of Cerebrovascular Disease epilepsy include brain injury, congenital anomalies, Cerebrovascular disease refers to any functional metabolic disorders, brain tumors, vascular distur- abnormality of the cerebrum caused by disorders of bances, and genetic disorders. Two ischemic stroke, intracerebral hemorrhage, and major types of seizures are partial and generalized. Occasionally, ness of about 10 to 30 seconds with repetitive, visual disturbances exist. In a general- symptoms temporarily disappear, but progressive ized seizure, the entire brain is involved. In the tonic phase of a tonic-clonic anywhere from 7 to 30 years after the onset of the seizure, the entire body becomes rigid; in the disease. In status epilepticus, autoimmune disease or a slow viral infection is tonic-clonic seizures follow one after another believed to be the most probable cause. It is a life-threatening emergency that involves the Alzheimer Disease whole cortex and emergency medical attention is essential. Epilepsy can usually be controlled by plaques develop in the cerebral cortex and disrupt antiepileptic medications. The clinical manifestations of Alzheimer dis- ease include memory loss and cognitive decline. Parkinson Disease There is also a decline in social skills and ability to Parkinson disease, also called shaking palsy, is a carry out activities of daily living. Most patients progressive neurological disorder affecting the undergo personality, emotional, and behavioral portion of the brain responsible for controlling changes. As neurons degenerate, the patient tration and increased fatigue, restlessness, and anx- develops uncontrollable nodding of the head, iety are common. Alzheimer disease was once con- decreased speed of movement (bradykinesia, sidered rare but is now identified as a leading cause hypokinesia), tremors, large joint stiffness, and a of senile dementia.

E. Ismael. Pine Manor College. 2019.

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