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She remarked upon the spiritual compo- or her retention of “vital powers” by meet- nent of disease and illness cheap 10mg toradol with amex pain treatment doctors, and she felt they could ing his or her needs buy 10mg toradol otc allied pain treatment center oh, and thus, putting the present an opportunity for spiritual growth. In this, patient in the best condition for nature to all persons were viewed as equal. A nurse was defined as any woman who had “charge of the personal health of somebody,” thus, putting the patient in the best condition for whether well, as in caring for babies and children, nature to act upon (Nightingale, 1860/1969). Nursing proper, or “sick” nursing, was both an art and a sci- ence and required organized, formal education to care for those suffering from disease. Above all, nursing was “service to God in relief of man”; it was a “calling” and “God’s work” (Barritt, 1973). Nursing activities served as an “art form” through which spiritual development might occur (Reed & Zurakowski, 1983/1989). All nursing actions were guided by the nurses’ caring, which was guided by Image rights unavailable. Consistent with this caring base is Nightingale’s views on nursing as an art and a science. Again, this was a reflection of the marriage, essential to Nightingale’s underlying worldview, of science and spirituality. On the surface, these might appear to be odd bedfellows; however, this marriage flows di- rectly from Nightingale’s underlying religious and philosophic views, which were operationalized in her nursing practice. Theory must be reformulated if incon- quires as exclusive a devotion, as hard a preparation, sistent with empirical evidence. This experiential as any painter’s or sculptor’s work; for what is the hav- knowledge was then to be transformed into empir- ing to do with dead canvas or cold marble, compared ically based generalizations, an inductive process, to with having to do with the living body—the Temple of God’s spirit? It is one of the Fine Arts; I had almost arrive at, for example, the laws of health. Nursing is an art; and if it is to be made According to Nightingale’s model, nursing con- an art, it requires as exclusive a devotion, tributes to the ability of persons to maintain and as hard a preparation, as any painter’s or restore health directly or indirectly through manag- sculptor’s work; for what is the having to ing the environment. The person has a key role in do with dead canvas or cold marble, com- his or her own health, and this health is a function pared with having to do with the living of the interaction between person, nurse, and envi- body—the Temple of God’s spirit? However, neither the person nor the en- of the Fine Arts; I had almost said, the vironment is discussed as influencing the nurse finest of the Fine Arts.

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Sodium Sodium is the major cation in extracellular fluid found in tissue spaces and ves- sels proven toradol 10 mg pain treatment toothache. Sodium plays an important role in the regeneration and transmission of nerve impulses and affects water distribution inside and outside cells 10mg toradol overnight delivery back pain treatment natural. When it shifts into the cell, depolarization (contraction) occurs; when it shifts out of the cell, potas- sium goes back into the cell and repolarization (relaxation) occurs. The kidneys regulate the sodium balance by retaining urine when the sodium concentration is low and excreting urine when the sodium concentration is high. Most excess sodium is excreted in urine although sodium also leaves the patient as perspira- tion and in feces. The serum sodium level, which is the ratio of sodium to water, is the indicator of the sodium level in a patient’s body. A patient’s serum sodium level moves out of the normal range when the patient is retaining too much or too little water, has a high or low concentrations of sodium, or a combination of both. A patient is hypernatremic when there is a high concen- tration of sodium and hyponatremic when there is a low concentration of sodium. Hypernatremia Hypernatremia occurs when the patient’s serum sodium is greater than 145 mEq/L. This happens for one of two reasons: The patient’s sodium concentration has increased while the volume of water remains unchanged or the patient’s water volume has decreased while the sodium concentration remains unchanged. Regardless of what happened, the patient experiences hyperosmolality, which is a higher-than-normal concentration of sodium. This causes water to shift out of cells and into extracellular space resulting in cellular dehydration. However, a patient whose consciousness is impaired or who cannot swallow, such as a frail elderly patient, is at risk for hypernatremia. These are: • Agitation • Restlessness • Weakness • Seizures • Twitching • Coma • Intense thirst • Dry swollen tongue • Edematous (swollen) extremities The nurse should educate the patient to: • Avoid foods rich in sodium such as canned foods, lunch meats, ham, pork, pickles, potato chips, and pretzels. Hyponatremia Hyponatremia occurs when the patient’s serum sodium is less than 135 mEq/L. There are two reasons why this happens: the patient has increased the volume of water while the sodium concentration remains normal or the patient losses sodium while the water volume remains normal.

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Alternatively buy 10mg toradol with amex pain medication for pancreatitis in dogs, if the activity of the analogue is less than that of the original lead the next step is to produce the analogue indicated by the L route on the tree toradol 10mg amex pain clinic treatment options. Utilisation of Operational Schemes for Analog Synthesis in Drug Design by J G Topliss is followed and the appropriate analogue synthesized. This procedure is repeated, the activity of each new analogue being compared with that of its precursor in order to determine which branch of the tree gives the next ana- logue. It should be realized that only some of the compounds synthesized will be more potent than the original lead A S. The first step in the Topliss approach is to synthesize the 4-chloro derivative (B) of A. Suppose the activity of B is greater than that of A, then following the M branch the Topliss tree (Figure 4. In this case, the Topliss tree shows that the next most promising analogue is the 4-trifluromethyl derivative of (D) of A. At this point one would also synthesize and biologically test the 2,4-dichloro (E) and the 4-nitro analogues (F) of A. It is emphasized that the decision tree is not a synthetic pathway for the production of each of the analogues. It simply suggests which of the substituents would be likely to yield a more potent analogue. The synthetic route for producing each of the suggested analogues would vary for each analogue and would use the most appropriate starting materials. The Topliss decision tree does not give all the possible analogues but it is likely that a number of the most active analogues will be found by this method. Illustrate the answer by reference to the changes in the activities of 4-alkylresorcinols caused by changes in the chain length of the 4-alkyl group.

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