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Client must want to be- come a productive member of society before he or she can be helped best albuterol 100 mcg. Encourage client to explore how he or she would feel if the circumstances were reversed discount albuterol 100 mcg without prescription. An attempt may be made to enlighten the client to the sensitivity of others by promoting self-awareness in an effort to help the client gain insight into his or her own behavior generic albuterol 100 mcg without a prescription. Throughout relationship with client buy generic albuterol 100 mcg on line, maintain attitude of “It is not you albuterol 100 mcg with visa, but your behavior, that is unacceptable. Client shows regard for the rights of others by delaying grati- fication of own desires when appropriate. Long-term Goal Client will demonstrate ability to interact with others with- out becoming defensive, rationalizing behaviors, or expressing grandiose ideas. Focusing on positive aspects of the personality may help to improve self- concept. Encourage client to recognize and verbalize feelings of inad- equacy and need for acceptance from others, and how these feelings provoke defensive behaviors, such as blaming others for own behaviors. Recognition of the problem is the first step in the change process toward resolution. Provide immediate, matter-of-fact, nonthreatening feed- back for unacceptable behaviors. Providing this information in a nonthreatening manner may help to eliminate these undesirable behaviors. Help client identify situations that provoke defensiveness and practice through role-playing more appropriate responses. Role-playing provides confidence to deal with difficult situ- ations when they actually occur. Positive feedback enhances self-esteem and encourages repetition of desirable behaviors. Help client set realistic, concrete goals and determine appropriate actions to meet those goals. Evaluate with client the effectiveness of the new behaviors and discuss any modifications for improvement. Because of Personality Disorders ● 303 limited problem-solving ability, assistance may be required to reassess and develop new strategies in the event that certain of the new coping methods prove ineffective. Client verbalizes correlation between feelings of inadequacy and the need to defend the ego through rationalization and grandiosity. Client interacts with others in group situations without tak- ing a defensive stance. Possible Etiologies (“related to”) [Lack of positive feedback] [Unmet dependency needs] [Retarded ego development] [Repeated negative feedback, resulting in diminished self- worth] [Dysfunctional family system] [Absent, erratic, or inconsistent parental discipline] [Extreme poverty] [History of childhood abuse] Defining Characteristics (“evidenced by”) [Denial of problems obvious to others] [Projection of blame or responsibility for problems] [Grandiosity] [Aggressive behavior] [Frequent use of derogatory and critical remarks against others] [Manipulation of one staff member against another in an at- tempt to gain special privileges] [Inability to form close, personal relationships] Goals/Objectives Short-term Goal Client will verbalize an understanding that derogatory and criti- cal remarks against others reflects feelings of self-contempt. It is important for client to achieve something, so plan for activities in which success is likely. Because client is unable (or unwilling) to limit own maladaptive behaviors, assistance is required from staff. All staff must be consistent and follow through with consequences in a matter-of-fact manner. From the onset, client must be aware of the outcomes his or her maladaptive behaviors will effect. Without consistency of follow-through from all staff, a positive outcome cannot be achieved. Encourage client to talk about his or her behavior, the limits, and consequences for violation of those limits. Discussion of feelings regarding these circumstances may help the client achieve some insight into his or her situation. Discuss how manipulative behavior interferes with forma- tion of close, personal relationships. Client may be unaware of others’ perception of him or her and of why these behav- iors are not acceptable to others. Posi- tive reinforcement enhances self-esteem and encourages repetition of desirable behaviors. Encourage client to confront the fear of failure by attending therapy activities and undertaking new tasks. Help client identify positive aspects of the self and develop ways to change the characteristics that are socially unaccept- able. Individuals with low self-esteem often have difficulty recognizing their positive attributes. They may also lack problem-solving ability and require assistance to formulate a plan for implementing the desired changes. Enforce limit-setting in a matter-of-fact manner, imposing previously established consequences for violations. Negative feedback can be ex- tremely threatening to a person with low self-esteem, pos- sibly aggravating the problem. Encourage independence in the performance of personal responsibilities and in decision-making related to own self- care.

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Centrally acting mus- cle relaxants depress neuron activity in the spinal cord or in the brain order albuterol 100 mcg with mastercard. They are used to treat acute spasms from muscle trauma albuterol 100mcg lowest price, but are less effective for treating spasms caused by chronic neurological disorders cheap albuterol 100mcg otc. These drugs decrease pain purchase albuterol 100mcg mastercard, increase range of motion and have a sedative effect on the patient discount albuterol 100mcg fast delivery. Centrally acting muscle relaxants should not be taken concurrently with central nervous system depressants such as barbiturates, narcotics, and alcohol. Diazepam (Valium) and Baclofen (Lioresal) These are used to treat acute spasms from muscle trauma and for treating spasms caused by chronic neurologic disorders. Peripherally acting muscle relax- ants depress neuron activity at the skeletal muscles and have a minimal effect on the central nervous system. These are most effective for spasticity or muscle contractions caused by chronic neurologic disorders. This is also used to treat malignant hypertension which is an allergic reaction to anesthesia. Patients experience fatigue and muscle weakness—particularly in respiratory muscles, facial muscles, and muscles in the extremities. They have drooping eye- lids (ptosis) and difficulty in chewing and swallowing and their respiratory mus- cles become paralyzed which leads to respiratory arrest. They include ambenonium (Mytelase), edrophonium Cl (Tensilon), Neostigmine bromide (Prostigmin), and Pyridostigmine bromide (Mestinon). Multiple lesions of the myelin sheath that surround the nerve fibers occur that are called plaque. At times patients don’t experience symptoms and other times symptoms can become severe and debilitating. Interferonß-1B (betaseron) and interferonß-1a (avonex) These are used to reduce the frequency and severity of relapses. Copolymer 1 This drug is in clinical trials and appears to decrease the disease’s activity. Copaxone (glatiramer acetate injection) This drug reduces new brain lesions and the frequency of relapses in people with relapsing-remitting multiple sclerosis. Part of the patient’s brain that controls thought, memory, and language becomes impaired. Alzheimer’s disease affects 5% of people between 65 and 74 years of age and half of those older than 85 years. Although the cause of Alzheimer’s disease remains unknown, investigators have discovered Alzheimer’s patients have abnormal clumps of amyloid plaques and tangled bundles of fibers called neurofibrillary tangles in parts of their brain. Amyloid plaques, neurofibrillary tangles, and decreased chemical levels impair thinking and memory by disrupting these messages and causing nerve cells to die. Eventually, the patient loses mental capacity and the ability to carry out daily activities. Although there isn’t a treatment that stops Alzheimer’s disease, there are medications that provide some relief to patients who are in the early and middle stages of the disease. Tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) These drugs prevent some symptoms from becoming worse for a limited time. Tranquilizers, mood elevators, and sedatives These can help control behavioral symptoms such as sleeplessness, agitation, wandering, anxiety, and depression. Effects of Cholinergic and Anticholinergic Drugs Body Tissue Cholinergic Response Anticholinergic Response Cardiovascular* Decreases heart rate, lowers blood Increases heart rate with pressure due to vasodilation, large doses. Eye+ Increases papillary constriction, Dilates pupils of the eye or miosis (pupil becomes smaller), (mydriasis) and paralyzes and increases accommodation ciliary muscle (cycloplegia), (flattening or thickening of eye causing a decrease in lens for distant or near vision). Glandular* Increases salivation, perspiration, Decreases salivation, and tears sweating, and bronchial secretions. Bronchi (lung)* Stimulates bronchial smooth Dilates the bronchi and muscle contraction and increases decreases bronchial bronchial secretions. Striated muscle+ Increases neuromuscular Decreases tremors and transmission and maintains rigidity of muscles. Central nervous system Drowsiness, disorientation, and hallucination can result from large doses. Seventy-five percent of persons with seizures had their first seizure before 18 years of age. These include grand mal (tonic-clonic), petit mal (absence), and psychomotor seizures. Hydantoins (phenytoin, mephenytoin, ethotoin) These treat grand mal (tonic-clonic) seizures and psychomotor seizures. Barbiturates (Phenobarbital, mephobarbital, primidone) These are used for treating grand mal and acute episodes or status epilepticus; meningitis, toxic reactions, and eclampsia Succinimides (ethosuximide) These are used to treat absence seizures and may be used in combination with other anticonvulsants. Oxazolidones (trimethadione) This is used to treat petit mal seizures and may be used in combination with other drugs or singly for treating refractory petit mal seizures.