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The stranger to trusted friend enabler is ex- Enablers tremely helpful when a researcher enters and re- In order to discover the peoples’ or insiders’ (in- mains in a strange and unfamiliar environment buy generic zestril 2.5mg line heart attack questionnaire. Being a trusted friend leads to inform- out ideas from informants in meaningful and nat- ants sharing their cultural secrets and their insights ural ways order zestril master card pulse pressure normal rate. For instance buy cheap zestril arrhythmia nursing diagnosis, the author used the point that enablers are different from tools, scales, stranger friend enabler to assess her relationship or measurement instruments used in quantita- with elderly residents and the staff in a study of cul- tive studies, which tend to cut off natural flow ture care in a retirement home. Some of the enablers that abler to enter the informant’s world and get close to serve as important guides to obtain data naturalis- the people who were being studied (McFarland, tically and holistically are: Leininger’s observation 1997). Initially the researcher worked with a staff participation reflection enabler (Table 20–1); the nurse while observing and interviewing the in- stranger to trusted friend enabler (Table 20–2); formants for the first few weeks she was at the in- Leininger’s acculturation enabler (Leininger, stitution. The staff nurse was friendly and acted as 1991b); and specific enablers developed by the re- a guide but also watched the researcher and searcher to tap into ideas of informants related to planned her day in a general way. Overview and reflection of the Theory of Culture Care and the Ethnonursing Research Method. Examples of special enablers can be found to a trusted friend; the informant revealed mean- in the studies previously mentioned and in other ingful and sensitive information to her, and the in- ethnonursing research studies listed in the refer- formant felt safe and trusted the researcher. This ences at the end of this chapter and in the Journal of enabler is invaluable to gauge one’s relationship Transcultural Nursing (1989 to 1999). This enabler is useful with all informants, but espe- Qualitative Criteria to cially with immigrant groups undergoing rapid Evaluate Ethnonursing Studies cultural changes. The Sunrise Enabler was also de- veloped to help researchers discover multiple and Leininger (1991b, 1995) has developed specific cri- diverse holistic lifeways related to culture care ex- teria to evaluate qualitative research, including periences and practices. Because qualitative studies holistic yet specific factors influencing care in cul- have very different meanings and purposes, goals, tures under study within ethnohistorical, language, and outcomes from quantitative studies, the nurse social structure, and environmental contexts researcher is required to use qualitative criteria to (Leininger, 1991b, 1995, 1997). Credibility: Refers to direct evidence from the must be clearly stated to provide guidance to assist people and the environmental context as truths nurses in providing culturally congruent and rele- to the people. Themes are the dominant finding from evidence from the people who can firmly and the analysis, and thematic statements require much knowingly confirm the data or findings. Meaning-in-context: Refers to meaningful or un- the emic and etic raw data and holistic findings. Recurrent patterning: Refers to documented evi- The general research process of conducting an dence of repeated patterns, themes, and acts ethnonursing study is presented as a guide. The over time, reflecting consistency in lifeways or process may be modified to fit with the research patterned behaviors. Saturation: Refers to in-depth evidence of taking flexible so the researcher can move with the people in all that can be known or understood about and be open to make allowances or change plans in phenomena or a domain of inquiry under study accord with naturalistic developments. Transferability: Refers to whether the findings and processing research data, modifications in the from the study will have similar (not identical) research plan often become necessary.


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H H H H H H Cyclopropane 3 In cyclopropane buy zestril 2.5 mg heart attack jim jones, each C atom is still sp -hybridized buy zestril 5mg on line adderall xr hypertension, so we should have a bond angle of 109 cheap zestril 5 mg line hypertension medicines. The angle strain can be defined as the strain induced in a molecule when bond angle deviates from the ideal tetrahedral value. Conformational isomerism in cyclobutane Cyclobutane comprises four carbons and eight hydrogen atoms (C4H8). However, cyclobutane in its planar form will give rise to torsional strain, since all H atoms are eclipsed. H H H H H H H H H H H H H H H Cyclobutane as a planar molecule H All H atoms are eclipsed Most stable folded conformation of cyclobutane Bond angle = 90o H atoms are not eclipsed Cyclobutane, in fact, is not a planar molecule. To reduce torsional strain, this compound attains the above nonplanar folded conformation. Hydrogen atoms are not eclipsed in this conformation and torsional strain is much less than in the planar structure. However, in this form angles are less than 90 , which means a slight increase in angle strain. Conformational isomerism in cyclopentane Cyclopentane is a five- carbon cyclic alkane. However, in this form the torsional strain is very large, because most of its hydrogen atoms are eclipsed. Thus, to reduce torsional strain, cyclopentane twists to adopt a puckered or envelope shaped, nonplanar conformation that strikes a balance between increased angle strain and decreased torsional strain. H H H H H H H H H H H H H H H H H H H H Cyclopentane as a planar molecule Most stable puckered conformation of cyclopentane Bond angle = 108o Most H atoms are nearly staggered Conformational isomerism in cyclohexane Cyclohexane (C6H12)isa six-carbon cyclic alkane that occurs extensively in nature. If we consider cyclohexane as a planar and regular hexagon, the 3 angles are 120 (cf. H H H H H H H H H H H H 4 H H 1 H H H 5 6 H H H H H H H H H H H 3 H H H H 2 H H H H Cyclohexane as a planar molecule Most stable chair conformation Boat conformation of cyclohexane Bond angle 120o of cyclohexane All neighbouring C-H bonds are staggered 3. To strike a balance between torsional strain and angle strain, and to achieve more stability, cyclohexane attains various conformations, among which the chair and boat conformations are most significant. In the chair conformation, the C–C–C angles can reach the strain free tetrahedral value (109. Here the H atoms on C2–C3 and C5–C6 are eclipsed, which results in an increased torsional strain. In the chair conformation of cyclohexane, there are two types of position for the substituents on the ring, axial (perpendicular to the ring, i. Six hydrogen atoms are in the axial positions and six others in the equatorial positions. Each carbon atom in the cyclohexane chair conformation has an axial hydrogen and an equatorial hydrogen atom, and each side of the ring has three axial and three equatorial hydrogen atoms.

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Drugs that block the effect of acetylcholine are called anticholinergic discount zestril 2.5mg online blood pressure 8060, or parasympatholytics purchase zestril 2.5mg without a prescription blood pressure nausea. They are also known as cholinergic antagonists because they inhibit the effect of acetylcholine on the organ 2.5 mg zestril mastercard arteria bologna 8 marzo 2014. In a fight response, eyes dilate so you can see better and lungs inspire more oxygen while increasing your heart rate. Salivary glands reduce the secretion of saliva giving the person the dry mouth feeling in an emergency. Instead, the flight response is really the opposite of fight and allows the individual to relax and function normally. Beta2-adrenergic receptors are in the smooth muscle of the lungs, arterioles of skeletal muscles, and the uterine muscles. Adrenergics also stimulate the dopaminergic receptor located in the renal, mesenteric, coronary, and cerebral arteries to dilate and increase blood flow. They promote reuptake of the transmitter back into the neuron (nerve cell terminal). Transmitters are transformed or degraded by enzymes making them unable to attach to a receptor. Sympathomimetic drugs stimulate andrenergic receptors and are classified into three categories according to its effect on organ cells. Indirect-acting sympathomimetics—stimulate the release of norepineph- rine from terminal nerve endings. Mixed-acting sympathomimetics—have the effect of both direct-acting sympathomimetics and indirect-acting sympathomimetics. They simulate the adrenergic receptor sites and stimulate the release of norepinephrine from terminal nerve endings. Ephedrine is an example of a mixed-acting sympathomimetic and is used to treat idiopathic orthostatic hypotension and hypotension resulting from spinal anesthesia. Ephedrine also stimu- lates beta2-receptors to dilate bronchial tubes and is used treat mild forms of bronchial asthma. For example, epinephrine (Adrenalin) acts on alpha1-, beta1-, beta2-receptor sites. These receptor sites include an increase in blood pressure, pupil dilation, increase in heart rate (tachycardia), and bronchodilation. Alpha-adrenergic blockers inhibit the response at the alpha-adrenergic recep- tor sites.


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