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The sound of a typical conversation (about 60 decibels) is 1 buy extra super cialis 100mg visa,000 times louder than the sound of a faint whisper (30 decibels) extra super cialis 100mg with mastercard, whereas the sound of a jackhammer (130 decibels) is 10 billion times louder than the whisper 100 mg extra super cialis for sale. Audition begins in the pinna discount extra super cialis 100 mg line, the external and visible part of the ear order 100 mg extra super cialis mastercard, which is shaped like a funnel to draw in sound waves and guide them into the auditory canal. At the end of the canal, the sound waves strike the tightly stretched, highly sensitive membrane known as thetympanic membrane (or eardrum), which vibrates with the waves. The resulting vibrations are relayed into the middle ear through three tiny bones, known as the ossicles—the hammer (or Attributed to Charles Stangor Saylor. The vibrations cause the oval window, the membrane covering the opening of the cochlea, to vibrate, disturbing the fluid inside the cochlea. The movements of the fluid in the cochlea bend the hair cells of the inner ear, much in the same way that a gust of wind bends over wheat stalks in a field. The movements of the hair cells trigger nerve impulses in the attached neurons, which are sent to the auditory nerve and then to the auditory cortex in the brain. The cochlea contains about 16,000 hair cells, each of which holds a bundle of fibers known as cilia on its tip. The cilia are so sensitive that they can detect a movement that pushes them the width of a single atom. To put things in perspective, cilia swaying at the width of an atom is equivalent to the tip of the Eiffel Tower swaying by half an [1] inch (Corey et al. The resulting vibrations are moved by the three small ossicles into the cochlea, where they are detected by hair cells and sent to the auditory nerve. Although loudness is directly determined by the number of hair cells that are vibrating, two different mechanisms are used to detect pitch. The frequency theory of hearing proposes that whatever the pitch of a sound wave, nerve impulses of a corresponding frequency will be sent to the auditory nerve. For example, a tone measuring 600 hertz will be transduced into 600 nerve impulses a second. This theory has a problem with high-pitched sounds, however, because the neurons cannot fire fast enough. To reach the necessary speed, the neurons work together in a sort of volley system in which different neurons fire in sequence, allowing us to detect sounds up to about 4,000 hertz. The cochlea relays information about the specific area, or place, in the cochlea that is most activated by the incoming sound. The place theory of hearing proposes that different areas of the cochlea respond to different frequencies. Higher tones excite areas closest to the opening of the cochlea (near the oval window). Pitch is therefore determined in part by the area of the cochlea firing the most frequently. Just as having two eyes in slightly different positions allows us to perceive depth, so the fact that the ears are placed on either side of the head enables us to benefit from stereophonic, or three- dimensional, hearing. If a sound occurs on your left side, the left ear will receive the sound slightly sooner than the right ear, and the sound it receives will be more intense, allowing you to quickly determine the location of the sound. Although the distance between our two ears is only about 6 inches, and sound waves travel at 750 miles an hour, the time and intensity differences [2] are easily detected (Middlebrooks & Green, 1991). When a sound is equidistant from both ears, such as when it is directly in front, behind, beneath or overhead, we have more difficulty pinpointing its location. It is for this reason that dogs (and people, too) tend to cock their heads when trying to pinpoint a sound, so that the ears receive slightly different signals. Hearing Loss More than 31 million Americans suffer from some kind of hearing impairment (Kochkin, [3] 2005). Conductive hearing loss is caused by physical damage to the ear (such as to the eardrums or ossicles) that reduce the ability of the ear to transfer vibrations from the outer ear to the inner ear. Sensorineural hearing loss, which is caused by damage to the cilia or to the [4] auditory nerve, is less common overall but frequently occurs with age (Tennesen, 2007). The cilia are extremely fragile, and by the time we are 65 years old, we will have lost 40% of them, [5] particularly those that respond to high-pitched sounds (Chisolm, Willott, & Lister, 2003). Prolonged exposure to loud sounds will eventually create sensorineural hearing loss as the cilia are damaged by the noise. People who constantly operate noisy machinery without using Attributed to Charles Stangor Saylor. Sounds that are 85 decibels or more can cause damage to your hearing, particularly if you are exposed to them repeatedly. Sounds of more than 130 decibels are dangerous even if you are exposed to them infrequently.

Once the action potential occurs order 100mg extra super cialis amex, the number of positive ions exceeds the number of negative ions in this segment trusted 100 mg extra super cialis, and the segment temporarily becomes positively charged purchase extra super cialis 100mg otc. The electrical charge moves down the axon from segment to segment extra super cialis 100 mg discount, in a set of small jumps generic extra super cialis 100mg otc, moving from node to node. When the action potential occurs in the first segment of the axon, it quickly creates a similar change in the next segment, which then stimulates the next segment, and so forth as the positive electrical impulse continues all the way down to the end of the axon. As each new segment becomes positive, the membrane in the prior segment closes up again, and the segment returns to its negative resting potential. In this way the action potential is transmitted along the axon, toward the terminal buttons. The entire response along the length of the axon is very fast—it can happen up to 1,000 times each second. An important aspect of the action potential is that it operates in an all or nothing manner. What this means is that the neuron either fires completely, such that the action potential moves all the way down the axon, or it does not fire at all. Thus neurons can provide more energy to the neurons down the line by firing faster but not by firing more strongly. Furthermore, the neuron is prevented from repeated firing by the presence of a refractory period—a brief time after the Attributed to Charles Stangor Saylor. Neurotransmitters: The Body’s Chemical Messengers Not only do the neural signals travel via electrical charges within the neuron, but they also travel via chemical transmission between the neurons. Neurons are separated by junction areas known as synapses, areas where the terminal buttons at the end of the axon of one neuron nearly, but don’t quite, touch the dendrites of another. The synapses provide a remarkable function because they allow each axon to communicate with many dendrites in neighboring cells. Because a neuron may have synaptic connections with thousands of other neurons, the communication links among the neurons in the nervous system allow for a highly sophisticated communication system. When the electrical impulse from the action potential reaches the end of the axon, it signals the terminal buttons to release neurotransmitters into the synapse. A neurotransmitter is a chemical that relays signals across the synapses between neurons. Neurotransmitters travel across the synaptic space between the terminal button of one neuron and the dendrites of other neurons, where they bind to the dendrites in the neighboring neurons. Furthermore, different terminal buttons release different neurotransmitters, and different dendrites are particularly sensitive to different neurotransmitters. The dendrites will admit the neurotransmitters only if they are the right shape to fit in the receptor sites on the receiving neuron. For this reason, the receptor sites and neurotransmitters are often compared to a lock and key (Figure 3. The neurotransmitters fit into receptors on the receiving dendrites in the manner of a lock and key. When neurotransmitters are accepted by the receptors on the receiving neurons their effect may be either excitatory (i. Furthermore, if the receiving neuron is able to accept more than one neurotransmitter, then it will be influenced by the excitatory and inhibitory processes of each. If the excitatory effects of the neurotransmitters are greater than the inhibitory influences of the neurotransmitters, the neuron moves closer to its firing threshold, and if it reaches the threshold, the action potential and the process of transferring information through the neuron begins. Neurotransmitters that are not accepted by the receptor sites must be removed from the synapse in order for the next potential stimulation of the neuron to happen. This process occurs in part through the breaking down of the neurotransmitters by enzymes, and in part through reuptake, a process in which neurotransmitters that are in the synapse are reabsorbed into the transmitting terminal buttons, ready to again be released after the neuron fires. More than 100 chemical substances produced in the body have been identified as neurotransmitters, and these substances have a wide and profound effect on emotion, cognition, and behavior. Neurotransmitters regulate our appetite, our memory, our emotions, as well as our muscle action and movement. Drugs that we might ingest—either for medical reasons or recreationally—can act like neurotransmitters to influence our thoughts, feelings, and behavior. Anagonist is a drug that has chemical properties similar to a particular neurotransmitter and thus mimics the effects of the neurotransmitter. When an agonist is ingested, it binds to the receptor sites in the dendrites to excite the neuron, acting as if more of the neurotransmitter had been present.

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Are there fees or membership required to access the infor- Yes/No mation you need? This nursing theory resource will ground my inquiry as a credible, authoritative, and accurate source of information. Yes/No Reservations: ____________________________________________________________________________________ questions may not apply to all Web sites and may be • How comprehensive do you intend your analy- modified by the purpose of the Web site. Following are key reflective preparations that will When you have answered as many questions as help focus your activities: you are able to, synthesize your findings. White paper: Criteria for assessing the accuracy, credibility, currency, and trust- quality of health information on the Internet (working draft). Nursing decision making and the science of the Bartlett Publishers and National League for Nursing. The Nightingales Florence Nightingale transformed a “calling from were on an extended European tour, begun in 1818 God” and an intense spirituality into a new social shortly after their marriage. A reflection on this statement A legacy of humanism, liberal thinking, and love appears in a well-known quote from Notes on of speculative thought was bequeathed to Nursing (1859/1992): “Nature [i. His views on the educa- tion of God] alone cures … what nursing has to tion of women were far ahead of his time. Florence and her sis- Although Nightingale never defined human care or ter studied music; grammar; composition; modern caring in Notes on Nursing, there is no doubt that languages; Ancient Greek and Latin; constitutional her life in nursing exemplified and personified an history and Roman, Italian, German, and Turkish ethos of caring. It is model is yet to truly come of age in nursing or the Parthenope, the older sister, who clutches her fa- health care system. Justice- making is understood as a manifestation of com- passion and caring,“for it is our actions that brings about justice” (p. This chapter reiterates Nightingale’s life from the years 1820 to 1860, delineating the formative influences on her thinking and providing historical context for her ideas about nursing as we recall them today. Part of what follows is a well-known tale; yet it remains a tale that is irresistible, casting an age-old spell on the reader, like the flickering shadow of Nightingale and her famous lamp in the dark and dreary halls of the Barrack Hospital, Scutari, on the outskirts of Constantinople, circa 1854 to 1856. Early Life and Education A profession, a trade, a necessary occupation, some- thing to fill and employ all my faculties, I have always felt essential to me, I have always longed for, con- sciouslyornot.... Nightingales and both daughters made an extended —Florence Nightingale, private note, 1850, cited tour of France, Italy, and Switzerland between the in Woodham-Smith (1983, p. From there, Nightingale vis- By all accounts, Nightingale was an intense and ited Germany, making her first acquaintance with serious child, always concerned with the poor and Kaiserswerth, a Protestant religious community the ill, mature far beyond her years. A few months that contained the Institution for the Training of before her seventeenth birthday, Nightingale Deaconesses, with a hospital school, penitentiary, recorded in a personal note dated February 7, 1837, and orphanage. What that Fleidner, and his young wife had established this service was to be was unknown at that point in community in 1836, in part to provide training for time. This was to be the first of four such experi- women deaconesses (Protestant “nuns”) who ences that Nightingale documented. Nightingale was to return there in The fundamental nature of her religious convic- 1851 against much family opposition to stay from tions made her service to God, through service to July through October, participating in a period of “nurses training” (Cook, Vol. What the make it without”(Nightingale, private note, cited in Kaiserswerth training lacked in expertise it made Woodham-Smith, 1983). It would take 16 long and torturous years, from Florence wrote, “The world here fills my life with 1837 to 1853, for Nightingale to actualize her call- interest and strengthens me in body and mind” ing to the role of nurse. Nightingale took two trips to Paris she turned down proposals of marriage, potentially, in 1853, hospital training again was the goal, this in her mother’s view, “brilliant matches,” such as time with the sisters of St. In August 1853, she accepted her need to serve God and to demonstrate her caring first “official” nursing post as superintendent of an through meaningful activity proved stronger.

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