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Currently quit smoking 26 months ago order nicotinell 17.5 mg, most of the local governments are making efforts to quit smoking sign purchase 35 mg nicotinell with mastercard be selected in the many projects designated and supported by central government quit smoking brochures cheap nicotinell 52.5mg online. However quit smoking new mexico discount nicotinell 35 mg with visa, most of local governments are focusing on the proclamatory designation rather than on the improvement of regional characteristics and the cognition of local residents. It would be observed through the case of Dangjin City that the unilateral promotion by public sector is hard to achieve the policy promotion effect for the local resident Therefore, for the women-friendly city in Korea, it requires the policy direction to establish the policy reflected with regional characteristics and step-by-step and feasible policy sharing with the local resident. Ethical Clearance: Not required Source of Funding: this paper was completed by revised report of the mid- to long-term development plan for women-friendly cities in Dangjin City, Korea. In 2011, research and consulting on implementation of women-friendly designated cities. Analysis of Women-Friendly Designated City Implementation Status in 2013 and the Mid- to Long-term Development Plan. Method/Statistical Analysis: this study evaluated the effectiveness of a skill-training program using video recording and self-evaluation. A quasi-experimental design was used such that 43 students were allocated into experimental (n = 22) and control groups (n = 21). Prior to the intervention, confidence to practice and problem-solving ability were assessed and actual performance of each core nursing skill added to the post experimental evaluation. Findings: Comparing posttest scores, study results showed statistically significantly better performance in nursing skills (p<. The change of scores in the experimental group on confidence to practice statistically significantly improved in the experimental group compared to changed scores in the control group. Improvements/Applications: Based on the study findings, video recording and self-evaluation provided effective training on core nursing skills. However, caution is needed as no clear evidence emerged for problem solving, which is a critical element in nursing education. Thus, we recommend the use of these strategies as a supplement to clinical placement. Future interventions need to provide additional strategies with robust study designs using randomized controlled trials. Keywords: Nursing students, Core nursing skills, Performance, Self-confidence, Problem-solving. Introduction In undergraduate nursing education, researchers have identified limitations in the clinical practice of nursing students, due to safety issues for students and patients[1]. At present, clinical practice largely depends on the observation that students lack direct practice of nursing skills. Nevertheless, a growing need exists for verification of practical capability in nursing students before graduation[2]. Nursing is a discipline based on practice and the integration of theory and practice in buoying nursing skill is a crucial part of the nursing curriculum[1]. Nursing students desires more opportunities for real-world training rather than classroom-based Corresponding Author: Sun Kyung Kim Assistant Professor, Department of Nursing, Mokpo National University, Korea e-mail: skkim@mokpo. For the performance evaluation of nursing students, the Korean Accreditation Board of Nursing Evaluation[4] has developed 20 core nursing skills that are essential for students to achieve to the standard. Traditionally, education to attain these nursing skills involves theoretical lecture and demonstration. Additionally, given the importance of repetitive practice, educators developed strategies for effective training. To encourage practice of nursing skills, most schools offer students chances to self-practice what they have learned and incorporated active learning as a requirement educators expect from individual students[5]. Previous studies identified that technologies could ease the burden of educators[6]. Rapid changes in science and technology enable educators to revise the curriculum by adapting technology development[6]. Previous reviews revealed the effectiveness of skill-training education using video recording[7-8].

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On examination quit smoking 2 years ago still anxiety order nicotinell 35mg line, she is afebrile quit smoking jitters generic nicotinell 35 mg, tachycardic with a heart rate of 104 bpm quit smoking with acupuncture discount 52.5mg nicotinell otc, blood pressure 115/74 mm Hg quit smoking inspirational quotes buy generic nicotinell 52.5mg online, and shallow respirations of 22 breaths per minute. She is moving uncomfortably on the stretcher, her skin is warm and diaphoretic, and she has scleral icterus. Her abdomen is soft, mildly distended with marked rightupper quadrant and epigastric tenderness to palpation, hypoactive bowel sounds, and no masses or organomegaly appreciated. Her leukocyte count is 16,500/mm3 with 82% polymorphonuclear cells and 16% lymphocytes. A plain film of the abdomen shows a nonspecific gas pattern and no pneumoperitoneum. She also has hyperbilirubinemia and an elevated alkaline phosphatase level, suggesting obstruction of the common bile duct caused by a gallstone, which is the likely cause of her pancreatitis. Considerations this 42-year-old woman complained of episodes of mild right-upper quadrant abdominal pain with heavy meals in the past. However, this episode is different in severity and location of pain (now radiating straight to her back and accompanied by nausea and vomiting). The elevated amylase level confirms the clinical impression of acute pancreatitis. Hypertriglyceridemia is another common cause (1%-4% of cases) and occurs when serum triglyceride levels are more than 1000 mg/dL, as is seen in patients with familial dyslipidemias or diabetes (etiologies are given in Table 14­2). When patients appear to have "idiopathic" pancreatitis, that is, no gallstones are seen on ultrasonography and no other pre-disposing factor can be found, biliary tract disease is still the most likely cause-either biliary sludge (microlithiasis) or sphincter of Oddi dysfunction. Abdominal pain is the cardinal symptom of pancreatitis and often is severe, typically in the upper abdomen with radiation to the back. The pain often is relieved by sitting up and bending forward, and is exacerbated by food. Patients commonly experience nausea and vomiting that is precipitated by oral intake. The most common test used to diagnose pancreatitis is an elevated serum amylase level. It is released from the inflamed pancreas within hours of the attack and remains elevated for 3 to 4 days. Amylase undergoes renal clearance, and after serum levels decline, its level remains elevated in the urine. Amylase is not specific to the pancreas, however, and can be elevated as a consequence of many other abdominal processes, such as gastrointestinal ischemia with infarction or perforation; even just the vomiting associated with pancreatitis can cause elevated amylase of salivary origin. Elevated serum lipase level, also seen in acute pancreatitis, is more specific than is amylase to pancreatic origin and remains elevated longer than does amylase. Treatment of pancreatitis is mainly supportive and includes "pancreatic rest," that is, withholding food or liquids by mouth until symptoms subside, and adequate narcotic analgesia, usually with meperidine. In patients with severe pancreatitis who sequester large volumes of fluid in their abdomen as pancreatic ascites, sometimes prodigious amounts of parenteral fluid replacement are necessary to maintain intravascular volume. When pain has largely subsided and the patient has bowel sounds, oral clear liquids can be started and the diet advanced as tolerated. The large majority of patients with acute pancreatitis will recover spontaneously and have a relatively uncomplicated course. Several scoring systems have been developed in an attempt to identify the 15% to 25% of patients who will have a more complicated course. When three or more of the Ranson criteria are present (Table 14­1), a severe course complicated by pancreatic necrosis can be predicted. Pancreatic complications include a phlegmon, which is a solid mass of inflamed pancreas, often with patchy areas of necrosis. Either necrosis or a phlegmon can become secondarily infected, resulting in pancreatic abscess. Abscesses typically develop 2 to 3 weeks after the onset of illness and should be suspected if there is fever or leukocytosis. Pancreatic necrosis and abscess are the leading causes of death in patients after the first week of illness. A pancreatic pseudocyst is a cystic collection of inflammatory fluid and pancreatic secretions, which unlike true cysts do not have an epithelial lining.

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Treatment the avoidance of exposure to quit smoking florida free patches buy 35mg nicotinell overnight delivery irritants and allergens and high-dose topical glucocorticoids are the mainstays of therapy quit smoking jail nicotinell 35 mg cheap. Pathogenesis Freezing temperatures lead to quit smoking games cheap nicotinell 52.5 mg both direct cellular injury as well as vascular compromise quit smoking symptoms order nicotinell 52.5mg fast delivery. Prolonged exposure to cold temperatures can lead to vasoconstriction, cold-mediated dehydration, endothelial injury, thrombosis, and ischemia of auricular tissue. In the early stage, this process may be reversible, but over time, it leads to tissue necrosis. Ultimately, as the ear thaws, pain, erythema, and subcutaneous bullae secondary to extravasated extracellular fluid or blood may develop. The blisters of partial-thickness burns should be dйbrided, and bacitracin ointment applied. Full-thickness, subdermal, and deep partial-thickness burns of the auricle heal with scarring and contracture and may be complicated by suppurative chondritis. These burns should be treated with both topical (usually silver based) and systemic cartilage penetrating antibiotics. Secondary reconstruction is usually performed at approximately 1 year after injury. Nonhemorrhagic blisters may be dйbrided, and patients should be given pain medicine and antibiotics. Aloe vera has antithromboxane properties and, together with ibuprofen, may aid in reestablishing circulation. More aggressive dйbridement should be delayed for several weeks until demarcation is complete. Surgical management and strategies in the treatment of hypothermia and cold injury. Clinical Findings Patients may present with pain, pruritus, conductive hearing loss, and bleeding. A persistent foreign body may lead to infection and the formation of granulation tissue. General Considerations Thermal injury can be classified by the degree of the burn. Subdermal burns extend into the subcutaneous tissue, including fat, muscle, tendon, cartilage, and bone. Two percent lidocaine may be used for the removal of insects both to achieve topical anesthesia and also to kill the insect. Clinical Findings Superficial auricular burns present with erythema secondary to dermal capillary dilation and vessel congestion. Patients with partial-thickness burns usually present with blisters that blanch on direct pressure and are very painful. Deep partial-thickness burns are associated with less pain, and there may be an eschar. Full-thickness and subdermal burns are painless because dermal nerve endings have been destroyed. This subtype occurs predominantly on the trunk, appearing as indurated, erythematous scaly patches. These lesions may be mistaken for other dermatologic conditions, including eczema and psoriasis. Clinical Findings Patients may initially present with a skin lesion that is nodular, ulcerated, and/or bleeding. Basal cell carcinomas of the auricle typically occur on the posterior surface of the pinna and in the preauricular area. Pathogenesis Chronic long-term sun exposure is the predominant cause of basal cell carcinoma. Other risk factors include fair skin, outdoor occupations, and a history of skin carcinoma. This staging system is limited by the fact that it does not account for histologic subtypes or the anatomic variability of the skin of the external ear compared with other skin sites. Differential Diagnosis Given the variability of subtypes, the differential diagnosis includes benign nevi, amelanotic melanomas, cutaneous squamous cell carcinomas, eczema, and scleroderma. Radiation therapy-Indicated for poor surgical candidates or unresectable lesions. Curettage with electrodissection-Operator dependent and typically used to excise nodular lesions and desiccate the base.

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Surgical oesophageal transection or transjugular portosystemic shunting can be considered in patients with recurrent or intractable variceal bleeding quit smoking 5 as generic nicotinell 17.5mg with visa. Administration of N-acetylcysteine may be of benefit in acute liver failure caused by paracetamol overdose (p quit smoking pill order 17.5mg nicotinell with visa. Management of ascites Ascites can be due to quit smoking 6 month benefits safe nicotinell 52.5 mg a combination of factors quit smoking idaho discount nicotinell 35mg without a prescription, including portal hypertension, hypoalbuminaemia and secondary hyperaldosteronism. First-degree relatives should be screened with serum iron and transferrin saturation. Females may present post-menopausally because continuous menstruation until then reduces the iron load. Clinical presentation It usually occurs in men over the age of 30 years who present with. Diagnosis the serum iron is raised so that the serum iron-binding capacity is nearly saturated. Biopsy of most tissues (skin, marrow, testes) shows excess iron deposits, but diagnosis is often made on liver biopsy, which shows iron staining of the liver with perilobular fibrosis. Patients present acutely with tender hepatomegaly (without hepatojugular reflux), resistant ascites and hepatic failure. Chronic onset is associated with weight loss, upper gut bleeding and spider naevi. All patients have abnormal liver function tests, but the pattern is variable and similar to other chronic liver diseases. Treatment is surgical by side-to-side portocaval shunting or orthotopic liver transplantation. If there is a web, surgical correction may be attempted by transatrial membranectomy. Treatment Deplete the body of the excess iron (up to 50 g) by weekly venesection of 500 ml (which contains 250 mg of iron). This is continued until a normal serum iron is established and/or the patient becomes anaemic (in about 2 years). Maintenance venesection will be required (about 500 ml every 3 months, depending on the serum iron). Treat appropriately the diabetes, hypogonadism, heart failure and arrhythmias, hepatic cell failure and portal hypertension. Rare cirrhoses Idiopathic haemochromatosis (bronzed diabetes) Idiopathic haemochromatosis is an autosomal recessive disorder of iron metabolism characterised 152 Liver disease Overload of the tissues with iron can follow either repeated blood transfusions (about 100 units), as for instance in thalassaemia, or, rarely, after excessive iron ingestion. If the iron is in the reticuloendothelial cells only, the patients tend not to develop serious sequelae and the condition is called haemosiderosis. The Kayser­ Fleischer ring is a deep copper-coloured ring at the periphery of the cornea, which is thought to represent copper deposits. Other drugs producing cholestasis are other phenothiazines, carbimazole, erythromycin estolate (but not the stearate), sulphonylureas, sulphonamides, rifampicin and nitrofurantoin. Occasionally there may be a more generalised reaction with fever, rash, lymphadenopathy and eosinophilia. It occurs 2­3 weeks after starting the drug and can be caused by halothane (after multiple exposure), monoamine oxidase inhibitors, methyldopa (which more commonly gives haemolytic jaundice) and the antituberculous drugs ethionamide and pyrazinamide (p. Direct hepatotoxicity In some cases hepatotoxicity is dose-dependent, although individual susceptibility is extremely variable. The mechanisms are: Drug jaundice Drugs are responsible for up to 10% of all patients admitted with jaundice. Histologically, there are bile plugs in the canaliculi and there may be an inflammatory infiltrate of eosinophils in the portal tracts. The classical example is chlorpromazine jaundice, which occurs 3­6 weeks after starting the drug. Proteinuria, haematuria and disorders of excretory function often cause no symptoms if mild, being picked up during routine screening.

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