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language disorders

TB 2

people with stroke care

language disorders

cause

retro country tables lesions (infarction in the supply area of the temporal artery posterior)

Prärolandische lesions, anterior part of the language area (infarction in the supply area of the precentral artery)

temporo-parietal lesions (abscesses in brain tumors, temporal lobe and cerebral processes degradation)

Large linkshemi-spherical lesions (infarction in the entire supply territory of the middle cerebral artery)

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illness experience






"serious diseases are among the most profound and most dramatic experience of man, with immalle dimensions of human existence are concerned. "

• altered body image and diminished well-being [Foreign bodies in the body]
• changed self-concept [Biography, changing roles]
• disorders of emotional balance by perception of potential threat
• uncertainty related to the observance of social roles and relationships
• need for situational adjustment
• fear of vital threat / death
  

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The self-concept according to Carl Rogers






"Man is a tendency to self- to develop the inherent possibilities, and although this is done under the right circumstances in a constructive, socially unifying Art .. "
-> actualizing tendency

"People know and feel inside of it, what does it well."

"Man can and will solve their problems themselves."

The basic variables of the helper - Role:

• acceptance
• empathy
• congruence

The process of personality development
7 stages: low -> high or
standstill -> motion
first Relationship to feelings and personal opinions
2. Experiential way (restrained; straight on sinking)
third Incongruence
4th The communication of the self (anxiety, resistors)
5th Construction experience
6th Relationship problems (fight or flight)
7th Personal relationships

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Coping






= describes an effective coping strategy in stressful situations.
"This strategy is not the destruction of a protective function, but the reality-based management of a crisis." This would include
...:

• cognitive control
• emotional control [can drain rage] [get her disease under control, even learn to care?; What can I do with my body still]
  
• pragmatic control
• social control [Waiting, family, friends, living will]

Which coping strategies used by the patient, which can strengthen that, I positive?

more to it; Click HERE

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instance model of Freud's model of crisis

superego (Moralitätsprinzip)

Reviewed the wishes of the ES, if they should be allowed or not.

• shaped by society, education
• values, norms and rules are stored

I (reality principle)

reality _ nature and demands of the outside world How do I do in the real world ?

mediated between the superego and ES; verified the reality: realized or wards off claims by the ES.

ES (pleasure principle)

Bring to specific needs and requirements.

• dreams, motivations

The layer model of Sigmund Freud

• any threat, crisis, traumatic situation runs the risk of displaced instead managed to
• from the subconscious out to be messages sent to "knock" and you to; message = mostly

distorted defenses
> Projection [Transfer of desires and disapproval to others]
> Identification [increase self-esteem by identifying with a person or institution of higher "rank"]
> denial [A. strongest, "it never happened", do not have true / can]
'repression' Societal [. & Morally illicit / prohibited is pushed away -> develops may an "internal dynamics"; briefly displacing the viability]
ensures> regression [revert to an earlier stage of development, let go, to retreat inward, is age] irrelevant
> reaction formation [displacement to be secured by the reversal into its opposite (eg unrequited love to hate)]
> shift [outer emotions are transformed into physical symptoms, psychosomatic medicine]
> rationalization [feelings not to be left only arguments offered]
> shift [substitute satisfaction, comfort eating, shopping, addictions;. Etc.]

importance of defense mechanisms

positive (rather short duration)	negative (if over)
protection act remains signaling allows a "relative" comfort	unresolved costs in the long term power, changed the perception can pathological behavior / Experience promote may may not be workable, accessible then only on a psychoanalysis

dealing with defense mechanisms perceive

~ ~ sensitive learn
not name offensive! (Strengthens the defense, destroys the protective function) do not personally take
~! (See separate defenses; perceive their own feelings) give
~ Area (without respect evaluation; name your own feelings)

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processing ...

... as a learning process into eight phases of spiral Erika Schuchardt

The phases are not necessarily run in chronological order. Phases can be skipped and you can fall back.

first Uncertainty

• 
  preoccupation with symptoms, but no assignment
• What's going on ...?

second Certainty

• diagnosis is made
• Yes, but this can not be ...?

3. Aggression

• anger, disappointment, etc.
• why me ...?

4th Negotiating

• in the phase are often chosen strategies
• If ..., but must ...?

5th Depression

• depressed mood -> sadness, withdrawal, hopelessness
• ... Why, everything is meaningless ...?

6th Adoption

• acceptance of change by the disease -> exhaustion
• I realize now .. erst.!

7th Activity

• debate with the disease -> learn
• I am doing this ..!

8th Solidarity

• my experiences I share with others ... We
• act!

What can help in a period of ...
... Uncertainty: reconnaissance / / active listening
... certainty: advice / / active listening
... aggression can live out active listening / / in a given frame / / scream therapy
. .. trial: evaluation of therapy / / self-concept support, make conscious risk assessment / / no false promises / / Nurse must maintain objectivity
... Depression: support group / / coping strategies / / include family & friends -> Living with the disease mourn / / make & promote
... adoption: Motivate / / accompany and support ...
Activity: instruction, advice, training as needed / / Note does not overburden
... Solidarity: imagine support groups

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Active listening






means ... to try

• in the party empathize
• to think about when talking to
• the interviewer attention and interest towards bringing (nonverbal communication)
  

goals:

• my conversation partner feels accepted and understood
• problems
• discuss feelings let out [entlastet_Hilfe to help themselves through new perspectives ]
• provide security

techniques:
paraphrasing (rewriting)
verbalization (feelings of the interlocutor mirror)
demands (what, how ?;... never: Why)
summarize (what arrived for me)
Clarify (comprehension questions Next run for me)
(keep conversation going)
weighing
Error Active listening
come ... most often when the listener the momentary feelings of the other party can not follow or is unable to understand or to keep out his own feelings tries.

• trivializing (play down -> "Wars not so bad")
• diagnose (drawers thinking, generalize)
• conducting (the "only" pretend right solution -> inhibits independent thinking)
• examine ( targeted questions, manipulate determine the direction of conversation /)
• interpret (particular interpretation of the problem)
• moralizing (through moral approach to put pressure, role behavior demand)
• and more ...

more information, click HERE

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The four - ears - model of Schulz von Thun






Guide
factual content:
says what the speaker objectively, as established fact, assertion or expression. (. Does not matter whether he is right Every takes its environmental differently.)
appeal:
would achieve what the speaker to the listener? Why did he invite him?
self-revelation ear
says what the speaker about himself? What we learn about his person, his mood, his worries, his mental state?
relationship:
As the speaker sees his relationship to the listener? As
whom he treated him?

more information, click HERE

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life & Dietetics in ancient






This is my Einsprechthema for the oral exam!

• dietetics, "diaita" = life

• includes the regulation of the order of life, basic human needs

• today's diet, comprising only a small area of dietetics

• following basic conditions:

first Light and air

second Food and drink

third Work and rest

4th Sleep and waking

5th Excretions and secretions

6th Stimulation of the mind, mental balance

• not only to cure diseases, including those for prevention

• was tailored to the patient tailored application

• the concept dietetics also included provisions:

~ about the clothes and the bearing

~ on Diet, Physical Activity & ; baths

~ via body and speech exercises

&

• measures to drain juices adulterated with:

~ emetics and laxatives
~ bloodletting
~ Cupping

• nursing
  was as part of treatment is always in your treatment plan anchored
  - therefore belonged to the then medicine to

• dietetics was the most important part of the general treatment

• only in recent centuries was strictly between Medicine and nursing distinction

• the field of dietetics in the care has remained and was even strengthened (ATL)

dietetics from Hippocrates	ATL's by L. Juchli
light and air, food and drink work and rest sleep and waking excretions / secretions stimulation of the mind	find meaning Eating and Drinking deal be waking and sleeping retirement deal

Humoral and cellular pathology
four humours theory

1. black bile (earth)
2. phlegm (water)
3. blood (air)
4. yellow bile (fire)

All diseases are derived from the incorrect composition of the blood
and body fluids and the accumulation of pollutants; dyscrasia.

• disease course was divided into several stages:

1. disturbance of the juice mixture
2. reaction of the body with fever and / or inflammation
3. leaving the slag

• internal and external influences on recovery course

life in ancient

• Greek philosophers developed the first medical & health science
• disease is no longer supernatural, by gods
• release sent by a natural reaction of the body
• strongest principle: Dietetics and juices teaching
  

Total
health education based on the principle of Dietetics
juices and teaching. The highest bid for it is a life under absolute
discipline. Only then complete health (primary objective) is achieved.
But life unworkable

further information, click HERE

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infection routes






= section between the exit and entrance Forte Forte, on the way of pathogen in the new host organism enters.

infection routes

direct transfer	indirect transfer
airborne (by exhaling, coughing, sneezing)	dirt & lube infection inanimate (on linen, Books, dishes, etc.) alive (about beetles, flies, fleas, lice, etc.)
contact infection	food poisoning
placental infection (over placenta to the newborn)

Cyclic general, infection

• with local infections begin
• pathogens in the tissue
• kill the pathogen into the host lymphatic system
  
• phagocytosis in lymph nodes ( the pathogen)
• breaking the Lymphschranke (pathogen into the blood)

By breaking the Lymphschranke, transition from a local infection to a general infection.
stages
first Incubation

• symptoms
• time of penetration of the pathogen to the outbreak of the disease
  

second Generalization

• hämotogene spread of the pathogen
• head & body aches, mild fever

third Organ manifestation

• localization of excitation in certain organs and tissues
• expression of the clinical Photo
  

symptoms	general symptoms
hepatitis [yellowing, liver swelling] meningitis [neck stiffness, increased muscle tone, vomiting, headaches] vomit bowel disease [diarrhea, nausea] respiratory [cough, labored breathing, sputum]	fever

4.Rekonvaleszenz

• recovery agents will be the body's own defense or therapy or killed

4th

• death due to insufficient body defense, high virulence or lack of therapy

permanent shedders: Risk of infection from others, by the elimination of pathogens due to illness made.

more information, click HERE

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virus - genetics

The viral genetic information is subject to permanent genetic changes. Constant adjustments to the defense reactions of the infected organism are possible.

infection forms

infest a body cell by viruses is from "non-injury" to the "total destruction".

• 
  
  cytolytic infection




• 
  
  Efficient replication of the virus in the host cell


• 
  
  massive changes in cell metabolism -> necrosis!


• 
  
  non-lytic infection




• 
  
  be virus replication without destroying the host cell


• 
  
  host cells are often destroyed by the body's own defense


• 
  
  latent infection




• 
  
  infection of the Will cell


• 
  
  virus enters Latenszustand on


• 
  
  viruses to escape the clutches of the immune system and remain for life in the body


• 
  
  possible activation of the virus by stress, hormonal influences , psychological stress, ...


• 
  
  transforming infection / tumor formation




• 
  
  a deregulation of the generation cycle of the cell


• 
  
  there is an excessive growth and reproduction

virus infections are treated symptomatically in particular. Viruses are ressistent antibiotics. Vaccinations work well. The go through a viral infection has also immunogenic. Special form of immunization: Feiung silent, ie one has the virus without falling ill and is taken become immune.

reproduction cycle of viruses

Einzellschritte	Description	Figure
adsorption	binding of the virus to its host cell by specific interaction between viral proteins on the surface of the virus and host cell receptors
penetration	naked viruses by endocytosis (invagination of the cell membrane and Education a vesicle -> lysis and release of viral nucleic acid enveloped viruses: fusion of the viral envelope with the host cell membrane, release of capsid into the cell
uncoating	release of the nucleic acid of the capsid and penetration of nucleic acid through the pores of the nuclear membrane into the nucleus, empty protein shell disintegrates
replication	synthesis of viral envelope protein, often replicating the virus nucleic acid -> Composition of a new generation of infectious virus particles
composition "self assembly"	spontaneous joint storage matching Parts, composed of protein folding
release "Release"	helpers by lysis of the host cell with programmed cell death by exocytosis budding virus is like a vesicle pinched off

further information; HERE

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edema

= accumulation of extravascular extracellular click and / or liquid in body cavities or tissues. Edema can occur localized and generalized.

nature

doughy, swollen, pale tissue

pathogenesis

intravascular (room in the blood vessels)	interstitium (space between cells)	intracellular (space inside the cells)
infirmity of the capillary membrane result: increased Wasserausstrom into the interstitium protein deficiency in the blood	transfer of lymph vessels

Clinical form of edema

1. inflammatory edema [through increased Kapillarwanddurchlässigkeit _{for H 2 O} and increase the colloid osmotic pressure caused by proteins in the tissue and increase the Capillary pressure caused by histamine]


2. 
   
   toxic edema [Kapillarwandschädigung by toxins, such as end-stage renal failure, etc.]


3. 
   
   mechanical edema [to transfer large lymphatic vessels (hence " lymphedema ) ; occurs locally after surgery with, for example Lymphgefäßentfernung]


4. 
   
   congestive edema [in obstruction of venous outflow, generally in heart failure]


5. 
   
   renal edema [Nierenkapillarschädigung by protein deficiency or increased salt retention]


6. 
   
   hunger edema / cachectic edema [by protein deficiency in the blood due to food shortage]


7. 
   
   edema due to liver damage [reduced albumin production, impaired lymphatic circulation in the liver, ie Lymph passes through the liver surface into the abdominal cavity, it comes to ascites ]


8. 
   
   Schwangerschaftsödem [Altosteron by increased release with a result of the increased salt retention in the kidney, the pressure of the uterus Pelvic & iliac vein, there is a congestive edema in the legs]
   

further information, click HERE

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ischemia (ischemia)

= reduced blood flow through a Organ District, as a result of reduced blood supply.

causes

local causes	General causes
narrowing or complete blockage of an artery	hypovolemia

consequences: depend on:

(a) duration [3 - 5 min. ischemia has no harmful effect min> 5. are to follow recorded according to fabric]

(b) primary sensitivity of the tissue [specialized cells or organ tissues holds 1 - from 1.5 hours ischemia, skin tissue for several hours]

(c) vascular architecture [is possible, a collateral circulation ?; dual blood supply is available;? are functional end arteries exist]

infarction localized necrosis of a body part ...? verurscht ligated by blood flow.

1. 
   
   ischemic infarction




• 
  
  blaser infarction


• 
  
  by arterial occlusion (coagulation necrosis)


2. 
   
   hemorrhagic infarction




• 
  
  red infarct


• 
  
  by venous occlusion (blood pressure into the body)

further information? Click HERE

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inflammation

= sum of all reactions of the connective tissue prior to tissue damage. Inflammation is a vital reaction, ie bound to life.

causes

1. busy organisms [fungi, worms, bacteria, viruses ,...]


2. 
   
   allergens [foreign allergens, Car allergens]


3. 
   
   physical and chemical stimuli [poisons, Radiation ,...]


4. 
   
   foreign bodies [objects tumors ,...]

expiry of an inflammatory response

impairment (Functional laesa)

injurious action of a substance

tissue damage (Alteration)

Local reaction of the organism

Transient vasoconstriction the arterioles ("initial ischemia")

vasodilation of arterioles and formation of an active hyperemia (increased blood circulation by 10-fold)

REDNESS (rubor) / / WARMING (Calor)

enlargement of the lumen of the capillaries and venules

exudation (plasma leakage into the interstitium

)

SWELLING (tumor)

increasing the viscosity of the blood

(irritation of the nerve terminal)

PAIN (Dolor)

emigration of leukocytes from the vessels into the damaged Tissue ("chemotaxis" = attraction of leukocytes

phagocytosis of bacteria (or the like.) And tissue debris

regression with resorption of

exudate without tissue destruction

"restitution ad integrum" =

complete cure

progression in the continuance of

harmful effect / inflammatory response

proliferation

= formation of granulation tissue with capillary buds

scarring

(regression of the capillaries)

Common symptoms

• 
  
  leukocytosis with left shift


• 
  
  increase in immunoglobulins


• 
  
  fever as a sign of metabolic increase


• 
  
  subjective fatigue and malaise

influences on the course of the inflammatory Reaction

• 
  
  type of inflammation caused


• 
  
  duration of the injurious effect


• 
  
  responsiveness and disease resistance of the affected organism

forms of inflammation

first serous inflammation

• 
  
  abundant protein-rich exudate


• 
  
  "serous catarrh "


• 
  
  much mucus

second fibrinous inflammation

• 
  
  accumulation of exudate with Fibrinmaterial


• 
  
  at (mucus) skin


• 
  
  formation of grayish-yellow pseudomembrane on the inflammatory area (eg diphtheria)

third purulent inflammation

• 
  
  little exudate


• 
  
  enriched [thereby placing a proteolytic enzyme which leads to liquefaction of tissue] with leukocytes are going to be essentially fatty


• 
  
  yellowish cream-like texture

further information, click HERE

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hyperemia

= increased blood content of an organ or organ district.

division

active arterial hyperemia	passive / passive congestion
redness warming swelling faster blood flow stream with lower gas exchange	cyanotic redness (a lot of hemoglobin, low oxyhemoglobin) lower heating swelling from edema late effects: hemorrhagic infarction connective tissue Veräderung the tissue with "shrinkage" fatty

attempts at stasis of the body to divert blood to bypass circuits. This depends on existing collaterals . footage click HERE

collateral circulation
Source: Surgical Clinic and University clinic I Department of General, Vascular and Thoracic Surgery, Charité - University Medicine Berlin, Campus Benjamin Franklin Free and Humboldt-Universität zu Berlin

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hemorrhage (bleeding)

= leakage of blood from the vessels into the tissue, body cavities or externally.

blood types & causes

first Zerreißungsblutungen [are localized vascular damage caused by trauma and / or arrodierende (creeping) Processes.]

arrodierende processes can be ...

inflammation

... ... ... ulcers

tuberculosis caverns

tumors

... ... ... pathogens

enzymatic digestion

pathological vascular changes can be ...

... varicose veins ...

atherosclerosis

aneurysms ... ...

medial necrosis of the aorta

Zerreißblutungen be favored by the clinical picture of hypertension.

second Passage bleeding [are local or generalized vascular damage, and no tear of the vessel but lesion of the endothelium . Blood components are passive "pushed out";. Minimal bleeding]

lesions of the endothelium may be caused by ...

... hypoxia (O 2 - deficiency)

... toxic damage (snake venoms, fungi ,...)

... toxic effects of pathogens

... Vitamin C deficiency (scurvy )

designation the hemorrhage according to their location

1. 
   
   hematoma = large localized mass of blood in the tissue, with swelling


2. 
   
   Suggilation = not sharply defined bloody infiltration of the tissue, because where skin bone is


3. 
   
   hemorrhagic infarction = hemorrhage in an internal organ with subsequent necrosis


4. 
   
   apoplexy cerebral hemorrhage or cerebral infarction =


5. 
   
   hemoptysis = cough of blood from pulmonary hemorrhage


6. 
   
   hematemesis = blood vomiting


7. 
   
   melena = blood discharge in stool


8. 
   
   hematuria = blood supply in the urine


9. 
   
   menorrhagia = excessive menstrual bleeding


10. 
    
    metrorrhagia = uterine bleeding (not menstrual)


11. 
    
    hematosalpinx = blood in the fallopian tube


12. 
    
    hemothorax = blood in the pleural space


13. 
    
    hemopericardium = blood in the pericardium (hence compression of the atria)


14. 
    
    Hämatoperitoneum = blood in the peritoneal cavity


15. 
    
    hemarthrosis = blood in the joint capsule

episodes of bleeding

• 
  
  extensive acute blood loss leading cause shock


• 
  
  major chronic blood loss depletion of iron stores and thus to a iron deficiency anemia and a hyperplasia of the bone marrow

more information about bleeding, click HERE

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antibiotics






means "acting against something alive."

• are of course originally formed metabolites of fungi and bacteria
• today are predominantly synthetic or semi-synthetic antibiotics used

effect

• bacteriostatic = inhibit growth and / or multiplication of bacteria
• bactericidal (bacteriolytic) = bacteria are killed

Antibiotics - Therapy
Indications:

• bacterial infections
• prophylactic antibiotics - treatment for ...
• contamination-risk surgery
• diagnostic / therapeutic interventions for heart valve insufficiency (& artificial heart valves)

distinction:

broad-spectrum-A.	narrow band-A.
cover a broad excitation field high hit probability for unknown pathogens corresponds to the clinical reality	cover a narrow excitation field very effective action avoid disturbance of the physiological microflora possible after the detection of pathogens ( antibiogram) and resistance testing

forms of antibiotics - treatment

monotherapy	combination therapy
low Therapy risk	broad antibiotic coverage, for unknown pathogens or mixed infections to prevent development of resistance

side effects

most common side effects	patient observation
allergies	lesions, redness, pustules, itching
gastrointestinal intolerance	excretion, nausea, vomiting, diarrhea
damage to the physiological resident flora in the intestine, skin, mucous membranes, female genital	itching, vaginal discharge
resistance	stop the symptoms of the underlying disease
vein irritation from iv administration	puncture of the venous access; Scmerzen

nursing principles

• keeping accurate dosing / dosing intervals
  
• when taken orally, gastrointestinal complaints, the absorption decrease of the antibiotic -> the therapy is ineffective
• close attention to the preparation requirements (with iv administration)
• Consistent intake to the end
  

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necrosis






necrosis = cell death
causes:

• lack of blood supply
• heat / cold
• traumatic effects
• bacterial toxins
• endogenous enzymes
• autoimmune reaction

Nekroseformen:
first Coagulation necrosis
strong protein coagulation, the cytoplasm becomes solid, opaque, compact and white. Architecture of the tissue remains shadowy. The sites look conical. occurrence mainly heart, liver, kidney and spleen.

inflammation of the pancreas with cell death, necrotizing pancreatitis

second caseous necrosis
Struckturlose necrosis with complete loss of the original tissue architecture, dull white appearance. consistency: white dry, brittle and greasy. occurrence mainly from pulmonary tuberculosis, syphilis, and fungal infections.

lung (tuberculosis)

third Colliquation
Gewebsverflüssigungen This leads to the central nervous system.

4th moist gangrene
Occurs on extremities and internal organs as a result of arterial occlusion with subsequent colonization by rotting bacteria. It comes to smelly urine degeneration of the tissue. (Such as smoker's leg)

Smoking leg

5th dry gangrene
case of significant water loss occurs blackish discoloration, shrinkage, and mummy-like appearance in extremities.

6th Calcification
Is necrotic tissue which has not been absorbed. -> Kalkkörnchen in the tissue.

consequences:

• leukocyte infiltration
• Demakation (differentiation between health and sickness)
• rejection of necrotic tissue
• leaving an ulcer
• scarring
  
• formation of cavities (caverns)