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The fundamental responsibility of the nurse is fourfold: to promote health buy 100 mg lasix mastercard prehypertension natural remedies, to prevent illness discount lasix 40mg visa blood pressure kiosk locations, to restore health, and to alleviate suffering. The nurse, when acting in a professional capacity, should at all times maintain standards of personal conduct that reflect credit on the profession. The nurse takes appropriate action to safeguard the individual when his or her care is endangered by a coworker or any other person. Members of the armed forces, prisoners and persons taking no active part in the hostilities a. The following acts are and shall remain prohibited at any time and in any place whatsoever with respect to the above-mentioned persons: a. Everyone is entitled to all the rights and freedoms, set forth in this Declara- tion, without distinction of any kind, such as race, color, sex, language, reli- gion, political or other opinion, national or social origin, property, birth or other status (Article 2), b. No one shall be subjected to torture or to cruel, inhuman, or degrading treat- ment or punishment (Article 5). In relation to detainees and prisoners of conscience, interrogation proce- dures are increasingly being employed resulting in ill effects, often perma- nent, on the person’s mental and physical health. Nurses having knowledge of physical or mental ill-treatment of detain- ees and prisoners must take appropriate action, including reporting the matter to appropriate national and/or international bodies. Nurses participate in clinical research carried out on prisoners only if the freely given consent of the patient has been secured after a complete explana- tion and understanding by the patient of the nature and risk of the research. The nurse’s first responsibility is to the patients, notwithstanding con- siderations of national security and interest. It will come into effect at some future date (unknown at the time of writing), and the Act will give effect to rights and freedoms guaranteed under the European Convention on Human Rights. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which this penalty is provided by law. Deprivation of life shall not be regarded as inflicted in contravention of this article when it results from the use of force that is no more than absolutely necessary: a. Ethical Documents 401 Article 3 No one shall be subjected to torture or to inhuman or degrading treat- ment or punishment. No one shall be deprived of his liberty save in the following cases and in accordance with a procedure prescribed by law: a. Everyone who is arrested shall be informed promptly, in a language that he under- stands, of the reasons for his arrest and of any charge against him. Everyone arrested or detained in accordance with the provisions of paragraph 1(c) of this article shall be brought promptly before a judge or other officer autho- rized by law to exercise judicial power and shall be entitled to trial within a reasonable time or to release pending trial. Everyone who is deprived of his liberty by arrest or detention shall be entitled to take proceedings by which the lawfulness of his detention shall be decided speed- ily by a court and his release ordered if the detention is not lawful. Everyone who has been the victim of arrest or detention in contravention of the provisions of this article shall have an enforceable right to compensation. In the determination of his civil rights and obligations or of any criminal charge against him, everyone is entitled to a fair and public hearing within a reasonable time by an independent and impartial tribunal established by law. Judgment shall 402 Appendix 1 be pronounced publicly but the press and public may be excluded from all or part of the trial in the interests of morals, public order or national security in a demo- cratic society, where the interests of juveniles or the protection of the private life of the parties so require, or to the extent strictly necessary in the opinion of the court in special circumstances where publicity would prejudice the interests of justice. Everyone charged with a criminal offence shall be presumed innocent until proved guilty according to law.

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In short purchase lasix 100 mg with mastercard blood pressure question, true healing is a gift from God who has given the doctor what is required to heal by natural means buy lasix 100 mg on line blood pressure understanding. Mediaeval medicine had inherited from late antiquity the conviction that there was a close correlation between the universe, the macrocosm, and humans, the microcosm. The four humours – blood, yellow and black bile, and phlegm – had to be kept in balance by, for example, bloodletting, and doctors had special zodiacal calen- dars to identify the best times for bleeding. The rabbinic Responsa literature of the Middle Ages, where the mediaeval rabbis respond to questions by their followers, contains much of Traditional Jewish medicine | 301 medical interest. Here, we see the attitudes of people, distressed by illness, to healing practices and what they had recourse to in the hope of returning to full health. There was an association between sanctified wine for the ceremonies of kiddush and havdalah and the strengthening of weak eyes because mediaeval Jews saw the drinking of the wine or merely bathing the eyes with it as a remedy in itself. Patients would ask the rabbi for permission to undergo procedures that might be in conflict with the laws of Shabbat and many of the medications would have required the taking of foodstuffs forbidden by a kosher diet. In general permission seems to have been given for the consumption of the most outlandish products if it would benefit health, although some rabbis indicated that they would withhold consent ‘to all remedies which are biblically forbidden’. One celebrated ingredient was the Egyptian mummy, the embalmed flesh of which was taken internally or more often applied as a plaster. Given the scarcity of mummies from Egypt, eventually the bones and flesh of ordinary corpses were ground up and sold as mummies. Some rabbis had problems about using ‘the flesh of corpses’ which the mummy represented, but usually permitted it considering that the product no longer resembled its original matter. Using the principle of sympathy it was the upper half of the mummy, containing as it does the heart, lungs and stomach, that was considered most likely to be effective. A modest Jewish herbal of the fifteenth century copied and illustrated in Italy preserves a sense of plants and their properties. Here St John’s wort (Hyper- icum perforatum) is considered to be a diuretic and expectorant. People with epilepsy could be given such products as broth from a reptile or a mole whereas people with mental illness could be given the flesh of a fowl that had died a natural death. Topical treatments, including ointments, bathing and the application of plasters and poultices, such as oats or barley, were also used. One plaster that was ‘proved by experience’ had sheep fat, butter, olive oil, wax, egg yolk, almonds, alum and herbs all fried together. Substances of medicinal plants played a 302 | Traditional medicine major part in the lives of mediaeval Jews. They served as foodstuffs, herbs, cosmetics, condiments and incense as well as in home industries such as tanning, dyeing and ink production. Thus, herbs gathered in a cemetery were considered of high medicinal value because of their association with the spirits and their occult potency. In the Arab world many of these practitioners inherited their skills through numerous generations of the same family. Indeed, the efficacy of many plant medicines has long been understood for simple symptom control and some products could be used for more specific conditions. To this day there are many plant-based remedies in official national pharmacopoeias that have stood the test of time and have met the criteria of randomised control trials. The mixture included saltpetre, sage, bay and cinnamon, which was beaten thoroughly with honey. After drinking the decoction the disturbance should leave and the patient is then recommended to drink some wine. In the Materia Medica of Maimonides there are a number of plant medications with an identifiable psychoactive effect and, given his custom of tailoring his prescriptions to individual patients, we have a clear idea of his clinical practice. Maimonides, practising in Cairo and personal physician to the Sultan of Egypt, was well aware of psychosomatic factors in disease, considering that ‘the skilled physician should place nothing ahead of recti- fying the state of the psyche by removing these passions’.

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It is used in shocked patients purchase 100mg lasix overnight delivery heart attack medication, because unlike other intra- venous anaesthetics it raises rather than lowers blood pressure buy 40 mg lasix amex hypertension 2013. An intravenous dose produces anaesthesia within 30–60 seconds, which lasts for 10–15 minutes. There is a high incidence of hallucinations, nightmares and transient psychotic effects. Midazolam is a water-soluble benzodiazepine and useful Adverse effects intravenous sedative. It has a more rapid onset of action than • Psychosis and hallucinations are common. Prior administration of a small dose of midazolam decreases the dose of intravenous anaesthetic required for induction. Repeated doses of midazolam • Intravenous anaesthetics may cause apnoea and accumulate and recovery is prolonged. Diazepam is used for premedication (oral), sedation (by • Adequate resuscitation facilities must be available. A preparation formulated as an emulsion in soya- bean oil has reduced thrombophlebitis from intravenous diazepam. Etomidate High-dose opioids (see Chapter 25) are used to induce and can suppress synthesis of cortisol (see below) and it should maintain anaesthesia in poor-risk patients undergoing major not be used for maintenance of anaesthesia. Addition of a Most sedative and analgesic drugs are given by continuous small dose of volatile anaesthetic, benzodiazepine or propofol intravenous infusion both for convenience of administration is required to avoid awareness during anaesthesia. Opioids are often Fentanyl is a synthetic opioid and is the most commonly combined with benzodiazepines (e. It is very the level of sedation is particularly important in cases where lipid soluble and has an onset time of one to two minutes. It long-acting opioids or benzodiazepines are being used whose has approximately 100 times the analgesic activity of mor- action may be prolonged due to accumulation of drug and phine. Propofol is increasingly used where short- t being two to four hours, the short duration of action (the term sedation or regular assessment is required, because its 1/2 peak effect lasts only 20–30 minutes) being explained by redis- lack of accumulation results in rapid recovery. Etomidate was used for intensive care after multiple injections because of saturation of tissue stores. Inhalational agents, such as isoflurane, Fentanyl and the other potent opioids must not be used in situ- have also been successfully used to provide sedation. Fentanyl has Occasionally, muscle relaxants are indicated in critically ill little cardiovascular effect, but bradycardia may occur. Atracurium is then the drug Neuroleptanalgesia is produced by a combination of a of choice and sedation must be adequate to avoid awareness. It has a short duration Modern induction methods are simple and not unpleasant, of action of five to ten minutes, and is often used as an infusion, and the chief aim of premedication is now to allay anxiety in but causes marked respiratory depression for some minutes. It has an ester linkage, making it susceptible to rapid thereby resulting in fewer side effects and improved recovery. Opioids such as morphine, phenothiazines and late even after a three-hour infusion. It is a useful adjunct to anaesthetics, particularly in Gastric prokinetic agents, anti-emetics and H2-receptor antag- patients with renal or hepatic impairment.

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