By W. Jens. Florida Atlantic University. 2018.

Secobarbital (Seconal) and pentobarbital (Nembutal) are short-acting barbiturates that induce sleep generic 150mg cleocin with mastercard. For longer periods of sleep 150 mg cleocin mastercard, patients are prescribed intermediate acting such as amobarbital (Amytal) buy 150mg cleocin with mastercard, aprobarbital (Alurate) and bubatabarbital (Butisol). Phenobarbital and mephobarbital are long-acting barbiturates used for controlling epileptic seizures. Anesthetic agents were introduced in surgery in the early 1800s in the form of nitrous oxide (laughing gas), which continues to be used today for dental pro- cedures. Ether is a highly flammable liquid with a pun- gent odor that causes nausea and vomiting and is seldom used today. General anesthetics are used for general surgery, cardiac surgery, neuro- surgery, and pediatric surgery. A general anesthetic can consist of one medication or a combination of med- ications—called balanced anesthesia—depending on the patient’s age, weight, medical history, general health, and allergies. The night before the surgery, the patient is given a hypnotic to assist with a good night’s sleep. On the day of the surgery, premedication may be given to the patient about one hour before surgery. A short-acting barbiturate such as thiopental sodium (Pentothal) is then administered in the operating room to induce anes- thesia. Depending on the nature of the operation, the patient may also receive a muscle relaxant. The patient experiences four stages of anesthesia, some of which are not observable because they occur rapidly. These stages are: Stage one: analgesia The patient experiences analgesia (a loss of pain sensation) but remains con- scious and can carry on a conversation. This stage is typically bypassed by administering a barbiturate such as sodium pentothal before the anesthesia. Stage four: medullary paralysis Breathing and other vital functions cease to function because the respiratory cen- ter (medulla oblongata) is paralyzed. These properties make it especially useful in developing countries and during warfare medical treatment. Ketamine is frequently used in pediatric patients because anesthesia and analgesia can be achieved with an intramus- cular injection.

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The child views the self as an extension of the parenting figure cheap cleocin 150 mg line, although there is a developing awareness of external sources of need fulfillment order 150mg cleocin visa. The child is beginning to recognize that there is separ- ateness between the self and the parenting figure cleocin 150mg without prescription. This phase is characterized by increased locomotor function- ing and the ability to explore the environment indepen- dently. This is frightening to the child, who wants to regain some lost closeness but not return to symbiosis. The child wants the mother there as needed for “emotional refueling” and to maintain feelings of security. In this phase, the child completes the individuation process and learns to relate to objects in an effective, constant manner. A sense of separateness is established, and the child is able to internalize a sus- tained image of the loved object or person when out of sight. The theory of object relations suggests that the individual with borderline personality is fixed in the rapprochement phase of development. This fixation occurs when the mother begins to feel threatened by the increasing autonomy of her child and so withdraws her emotional support during those times or she may instead reward clinging, dependent behaviors. In this way, the child comes to believe that “To grow up and be independent = a ‘bad’ child. In addition, because object constancy is never achieved, the child continues to view objects (people) as parts—either good or bad. Symptomatology (Subjective and Objective Data) Individuals with borderline personality always seem to be in a state of crisis. Their affect is one of extreme intensity and their behavior reflects frequent changeability. These changes Personality Disorders ● 281 can occur within days, hours, or even minutes. Often these individuals exhibit a single, dominant affective tone, such as depression, which may give way periodically to anxious agitation or inappropriate outbursts of anger. Depression occurs in response to feelings of abandonment by the mother in early childhood (see “Predisposing Factors”). Underlying the depression is a sense of rage that is sporadically turned inward on the self and externally on the environment. Seldom is the individual aware of the true source of these feelings until well into long- term therapy.

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