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Possible Etiologies (“related to”) Self-concept disturbance [Unmet dependency needs] [Retarded ego development] [Retarded superego development] [Negative role-modeling] Knowledge deficit about ways to enhance mutuality Defining Characteristics (“evidenced by”) Discomfort in social situations Inability to receive or communicate a satisfying sense of social engagement (e proven 1mg prazosin. Long-term Goal Client will interact appropriately with others purchase prazosin 1 mg with amex, demonstrating concern for the needs of others as well as for his or her own needs, by time of discharge from treatment. Establish trust by always being honest; keep all promises; convey acceptance of person, separate from unacceptable behaviors (“It is not you, but your behavior, that is unacceptable. Presence of a trusted individual increases feelings of security during uncomfortable situations. Positive feedback enhances self-esteem and encour- ages repetition of desirable behaviors. Confront client as soon as possible when interactions with others are manipulative or exploitative. Because of the strong id influence on client’s be- havior, he or she should receive immediate feedback when behavior is unacceptable. Consistency in enforcing the con- sequences is essential if positive outcomes are to be achieved. Act as a role model for client through appropriate interac- tions with him or her and with others. It is through these group interactions with positive and negative feedback from his or her peers that client will learn socially accept- able behavior. Client has satisfactorily established and maintained one interpersonal relationship with nurse or therapist, without evidence of manipulation or exploitation. Client demonstrates ability to interact appropriately with others, showing respect for self and others. Client is able to verbalize reasons for inability to form close interpersonal relationships with others in the past. Possible Etiologies (“related to”) Lack of interest in learning [Low self-esteem] [Denial of need for information] [Denial of risks involved with maladaptive lifestyle] Unfamiliarity with information sources Defining Characteristics (“evidenced by”) [History of substance abuse] [Statement of lack of knowledge] [Statement of misconception] [Request for information] [Demonstrated lack of knowledge regarding basic health practices] [Reported or observed inability to take the responsibility for meeting basic health practices in any or all functional pat- tern areas] [History of lack of health-seeking behavior] Inappropriate or exaggerated behaviors (e. An adequate database is necessary for the development of an effective teaching plan. Teaching will be ineffective if presented at a level or by a method inappropriate to the client’s ability to learn. Provide information regarding healthful strate- gies for activities of daily living as well as about harmful effects of substance abuse on the body. Include suggestions for community resources to assist client when adaptability is impaired. Input from individuals who are directly involved in the potential change increases the likelihood of a positive outcome. Implement teaching plan at a time that facilitates, and in a place that is conducive to, optimal learning (e. Provide activities for client and significant others in which to actively participate during the learning exercise. Ask client and significant others to demonstrate knowledge gained by verbalizing information regarding positive self- care practices. Verbalization of knowledge gained is a mea- surable method of evaluating the teaching experience. Provide positive feedback for participation, as well as for accurate demonstration of knowledge gained. Positive feed- back enhances self-esteem and encourages repetition of desirable behaviors. Client is able to verbalize available community resources for obtaining knowledge about and help with deficits related to health care. Incest is the occurrence of sexual contacts or interaction between, or sexual exploitation of, close relatives, or between participants who are related to each other by a kinship bond that is regarded as a pro- hibition to sexual relations (e. Neglect of a Child Physical neglect of a child includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision. Emotional neglect refers to a chronic failure by the parent or care- taker to provide the child with the hope, love, and support nec- essary for the development of a sound, healthy personality. Physical Abuse of an Adult Physical abuse of an adult may be defined as behavior used with the intent to cause harm and to establish power and con- trol over another person. It may include slaps, punches, biting, hair-pulling, choking, kicking, stabbing or shooting, or forcible restraint. Sexual Abuse of an Adult Sexual abuse of an adult may be defined as the expression of power and dominance by means of sexual violence, most com- monly by men over women, although men may also be victims of sexual assault. Sexual assault is identified by the use of force and executed against the person’s will. Various components of the neurological system in both humans and animals have been implicated in both the facilitation and inhibition of aggressive impulses. Areas of the brain that may be in- volved include the temporal lobe, the limbic system, and the amygdaloid nucleus (Tardiff, 2003). Studies show that various neurotransmitters—in particular norepinephrine, dopa- mine, and serotonin—may play a role in the facilitation and inhibition of aggressive impulses (Hollander, Berlin, & Stein, 2008).

Anus The anus refers not to an actual anatomical structure but to the external opening of the anal canal buy generic prazosin 2mg online. The skin that immediately surrounds the anus is variously referred to as the anal verge or anal margin (173) purchase prazosin 1mg online. Because the anal canal can evert and invert as the anal sphincters and pelvic floor muscles relax and contract, the anal verge/margin is not a fixed, identifiable landmark. Perianal Area The perianal area is a poorly defined, approximately circular area that includes the folds of skin encircling the anus. It is covered by skin that is often Sexual Assualt Examination 103 hyperpigmented when compared with the skin on the buttocks, although this varies with age and ethnicity (174). Anal Canal Although the anal canal has been variously defined, the definition that has practical clinical forensic value is that of the anatomical anal canal, which extends from the anus to the dentate line. The dentate line refers to the line formed either by the bases of the anal columns (most distinct in children) or, when these are not apparent, by the lowest visible anal sinuses (175). The average length of the anatomical anal canal in adults (age range 18–90 years) is only 2. Between the epithelial zones of the anal canal and the rectum is the anal transitional zone, which is usually located in the region of the anal columns and is purple (177). The anal canal, as previously defined, is lined by nonkeratinized squa- mous epithelium and is salmon pink in the living (174). It is sensitive to touch, pain, heat, and cold to just above the dentate line (175). The anus and lumen of the anal canal usually appear as an asymmetric Y-shaped slit when viewed via a proctoscope (anoscope). The folds of mucosa and subcutane- ous tissue (containing small convulated blood vessels surrounded by con- nective tissue) between the indentations of the Y are referred to as the anal cushions. Although this appearance is usually obscured externally by the folds of skin on the perianal area, it may become apparent if the patient is anesthetized or as the anus dilates. Rectum The rectum extends from the anal transitionary zone to the sigmoid colon and is 8–15 cm long. Anal Sphincters and Fecal Incontinence Although numerous muscles encircle the anal canal, the two that are forensically significant are the internal and the external anal sphincters. Internal Anal Sphincter This sphincter is a continuation of the circular muscle coat of the rectum and extends 8–12 mm below the dentate line. In the normal living subject, the internal anal sphincter is tonically contracted so that the anal canal is closed. The internal sphincter is supplied by autonomic nerve fibers and is not consid- ered to be under voluntary control (3). Thus, although it appears to contract 104 Rogers and Newton during a digital assessment of voluntary anal contraction, it is presumed to result from its compression by the surrounding external sphincter fibers (177). External Anal Sphincter This sphincter encircles the internal sphincter but extends below it, end- ing subcutaneously. The lower edges of the external and internal sphincters can be distinguished on digital palpation. Although this sphincter is tonically contracted in the resting state, this contraction can be overcome with firm pressure (177). If the patient is asked to contract the anus during a digital assessment, the external sphincter can be felt to ensure contraction and clos- ing of the anus tightly. However, because the muscle fibers are predominantly the slow-twitch type, a maximum contraction of the external sphincter can only be maintained for approx 1 minute(178). Fecal continence is maintained by several factors, the relative impor- tance of which has not been fully elucidated. Currently, the most important factor is the angulation between the rectum and the anal canal, which is main- tained at a mean of 92° by continuous contraction of the puborectalis muscles, located above the external sphincter. Both sphincters have supportive roles in maintaining fecal continence (175), and their disruption can result in inconti- nence (see Subheading 10. Forensic Evidence The presence of semen in the anus or rectum of a male complainant can be corroborative evidence of alleged anal intercourse in conjunction with the presented history and possible physical findings. The same is only true for a female complainant if no semen is detected in the vagina, because semen has been found on rectal and anal swabs taken from women who described vaginal intercourse only. It is postulated that the presence of semen in these cases results from vaginal drainage (49,179). Swabs should also be taken if a condom or lubricant was used during the sexual assault and if anilingus is alleged (see Subheading 7. Just as when sampling the skin elsewhere, if the perianal skin is moist, the stain should be retrieved on dry swabs. If there is no visible staining or the stain is dry, the double-swab technique should be used (28).

Stangor is chair of the undergraduate committee in the psychology department and has won the distinguished teaching award from the University of Maryland cheap prazosin 2 mg mastercard. One important resource was an advisory board of instructors from across the country 1mg prazosin for sale. Their thoughtful and insightful feedback throughout development was invaluable in creating this first edition. Isaak, University of Louisiana at Lafayette  Kerry Jordan, Utah State University  Jerwen Jou, University of Texas–Pan American  Peggy Norwood, Community College of Aurora  Karen Rhines, Northampton Community College  Eva Szeli, Arizona State University  Anton Villado, Rice University Introduction to Psychology also benefited from reviews at various stages of the book‘s development. Achorn, The University of Texas at San Antonio  Mara Aruguete, Lincoln University  David Carlston, Midwestern State University  Jenel T. Fernando, California State University, Los Angeles  William Goggin, University of Southern Mississippi  Karla A. Lassonde, Minnesota State University, Mankato  Greg Loviscky, Pennsylvania State University  Michael A. Peteet, University of Cincinnati  Brad Pinter, Pennsylvania State University, Altoona  Steven V. Isaak, University of Louisiana at Lafayette, for his work on the accompanying Test Item File and PowerPoint slides; and to Chrissy Chimi and Stacy Claxton of Scribe, Inc. Completion of the book and supplements required the attention of many people, including Michael Boezi, who signed the book and supported my efforts from beginning to end; Pam Hersperger, who managed the book through development; and Gina Huck Siegert, who worked closely with me on all aspects of the project. I was able to give a lecture on the sympathetic nervous system, a lecture on Piaget, and a lecture on social cognition, but how could I link these topics together for the student? I felt a bit like I was presenting a laundry list of research findings rather than an integrated set of principles and knowledge. How could they be expected to remember and understand all the many phenomena of psychology? And why, given the abundance of information that was freely available to them on the web, should they care about my approach? My pedagogy needed something to structure, integrate, and motivate their learning. Eventually, I found some techniques to help my students understand and appreciate what I found to be important. First, I realized that psychology actually did matter to my students, but that I needed to make it clear to them why it did. One of the most fundamental integrating principles of the discipline of psychology is its focus on behavior, and yet that is often not made clear to students. Affect, cognition, and motivation are critical and essential, and yet are frequently best understood and made relevant through their links with behavior. Once I figured this out, I began tying all the material to this concept: The sympathetic nervous system matters because it has specific and predictable influences on our behavior. Piaget‘s findings matter because they help us understand the child’s behavior (not just his or her thinking). And social cognition matters because our social thinking helps us better relate to the other people in our everyday social lives. This integrating theme allows me to organize my lectures, my writing assignments, and my testing. Second was the issue of empiricism: I emphasized that what seems true might not be true, and we need to try to determine whether it is. The idea of empirical research testing falsifiable hypotheses and explaining much (but never all) behavior—the idea of psychology as a science— was critical, and it helped me differentiate psychology from other disciplines. The length of existing textbooks was creating a real and unnecessary impediment to student learning. I was condensing and abridging my coverage, but often without a clear rationale for choosing to cover one topic and omit another. My focus on behavior, coupled with a consistent focus on empiricism, helped in this regard—focusing on these themes helped me identify the underlying principles of psychology and separate more essential topics from less essential ones. Five or ten years from now, I do not expect my students to remember the details of most of what I teach them. However, I do hope that they will remember that psychology matters because it helps us understand behavior and that our knowledge of psychology is based on empirical study. I begin my focus on behavior by opening each chapter with a chapter opener showcasing an interesting real-world example of people who are dealing with behavioral questions and who can use psychology to help them answer those questions. The opener is designed to draw the student into the chapter and create an interest in learning about the topic. Each chapter contains one or two features designed to link the principles from the chapter to real-world applications in business, environment, health, law, learning, and other relevant domains. For instance, the application in Chapter 6 "Growing and Developing"—“What Makes a Good Parent? I have also emphasized empiricism throughout, but without making it a distraction from the main story line.