This chapter reviews prevention, including genetic counseling. It discusses genetic testing for diagnosis as opposed to screening and the treatment for genetic disease. Methods of prevention begin with education of the public and health care professionals and identification of those at risk. Genetic counseling is the process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease. The malignant cells often exhibit aneuploidy as well as translocations that are found only within the tumor cells. Genetic errors that arise from specific cell lines are somatic mutations. It is suggested that there is a thorough collection of family, genetic, and medical history for children entering the adoption process. Nurses may play a variety of roles in genetic counseling that reflect their preparation, area of practice, primary functions, and setting. The chapter explains the incidence of chromosome abnormalities.

The initial recognition of the need for a genetics referral may arise when a nurse suspects a genetic contribution to disease because of personal or family medical history and/or findings from a physical assessment. Family history is a valuable and cost-effective tool that is often underutilized in clinical practice. Many common genetic conditions result from complex interactions between genetic and environmental factors. It is critical to collect information about potential environmental exposures to help inform a patient’s risk assessment. Health care professionals should become familiar about toxic environmental agents that are common in their specific geographic location. A growing number of Food and Drug Administration (FDA) approved drugs have labeling that includes pharmacogenomic information, which can be used to optimize drug dosage and prevent adverse and life-threatening drug reactions in a patient or family member.

Nurses working in the field of obstetrics must have a greater depth and breadth of genetic knowledge over any other subspecialty. In gestation, nurses should include education on the effects of teratogens, prenatal screening options, and prenatal diagnoses. After delivery, early recognition of genetic disorders is important for immediate initiation of potentially life-saving therapies. Preconception education is a critical component of health care for women of reproductive age. The Centers for Disease Control and Prevention (CDC) recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent neural tube defects (NTDs). Counseling can still be useful in terms of optimum pregnancy management in a setting best able to cope with any anticipated problems. Complex and multifaceted maternal and fetal factors influence the consequences of drugs, radiation, and chemical and infectious agents to the developing fetus.

This chapter examines pre- and postconference expectations and activities, explores forms to be used by the professor and the students, suggests care plans and patient assignments, and describes sample concept maps and a math skills assessment. A student with no experience in health care may be shy or sheepish when it comes to hands-on care. It may be of benefit for the students to be paired in the first few weeks of clinical classes. The care plan forms can help guide the student through the nursing process. Medication forms will help the student learn about various medications. Nursing education has adopted the use of concepts maps to assist students in gathering patient information. Patient safety is the number one priority for all health care professionals. Dose calculations are a daily activity for nurses.

This chapter discusses basic review of the admission process, and describes an admission assessment exercise that allows students to assume the roles of both patient and nurse. It also describes the role of nurse in which the student learns to collect patient data and record data appropriately, and also explains the role of the electronic medication administration record (eMAR). Preconference begins with a review of the skills previously mastered: hand washing, obtaining vital signs, and performing those daily nursing activities such as taking assessments and collecting data on patients. The student is responsible for making copies of the nursing notes for the required clinical assignments. With the admission assessment exercise, the clinical instructor can discuss the correlation of the vital signs, medications, past medical history, and familial history. New designs in technology have facilitated new medication administration practices that will reduce the number of medication errors in health care facilities.

As everyone knows, true creativity comes from simple formulas and the memorization of data. This chapter focuses on divergent thinking tests, which are still the most common way that creativity is measured. Guilford derived the core ideas behind divergent thinking as well as many popular measures. The people who score the Torrance Tests are specifically trained to distinguish responses that are truly original from those that are just bizarre. There are other tests that measure creativity, but most are either a variation on divergent thinking or use some type of raters. For example, the Evaluation of Potential Creativity (EPOC) has begun to be used in some studies and may be promising, but is still largely rooted in a mix of divergent thinking scoring and raters. Another test is the Finke Creative Invention Task, which is clever but also requires raters for scoring.

The Big Five, which this chapter discusses in more detail, are extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience. Each of these five factors represents a continuum of behavior, traits, and inclinations. There are some popular personality measures that use different theories, such as Eysenck’s Personality Questionnaire, which looks at extraversion and neuroticism as well as psychoticism. The personality factor most associated with creativity is openness to experience. Indeed, one way that researchers study creativity is by giving creative personality tests. Being open to new experiences may also help creative people be more productive. King found that people who were creative and high on openness to experience were more likely to report creative accomplishments. DeYoung and S. B. Kaufman, of course, are not the only people to blend or split different factors of personality to present new models. Fürst, Ghisletta, and Lubart suggest three factors: plasticity, divergence, and convergence.

This chapter explores three ’classic’ studies of creativity and mental illness. The first is Jamison whose focus is on the connection between bipolar disorder and creativity. The second is Andreasen, who used structured interviews to analyze 30 creative writers, 30 matched controls, and first-degree relatives of each group. The writers had a higher rate of mental illness, with a particular tendency toward bipolar and other affective disorders. The third major work is Ludwig, who utilized the historiometric technique. All three studies have come under serious criticism. Many of the studies of Big-C creators are historiometric, akin to Ludwig’s work. Some such studies claim that eminent creators show higher rates of mental illness. A much more common approach is to look at everyday people and give them measures of creativity and mental health. Typically, researchers look at what are called subclinical disorders—in other words, they’re not clinically significant.

One school admissions area that already uses creativity is gifted admissions—which students are chosen to enter gifted classes, programs, or after-school activities. Both education and business play great lip service to creativity. Puccio and Cabra review the literature on creativity and organizations and do a nice job of highlighting how every couple of years, a new report from industry emphasizes the importance of creativity. It is important to note that there is a large inconsistency between gender differences on creativity tests and actual creative accomplishment. Although gender differences on creativity tests are minor or nonexistent, differences in real-world creative accomplishment are large and significant. This chapter shows how creativity can play a role in admissions and hiring. Hiring measures tend to have better validity, even the general mental ability (GMA) measures; even if minorities score lower, the accuracy of prediction is consistent by ethnicity.

Creative people are also often seen as being outsiders and eccentric. Sen and Sharma’s examination of creativity beliefs in India tested beliefs about the Four P’s and found that creativity was more likely to be described as a holistic essence of an individual, and less likely to be focused on the product or process. Romo and Alfonso studied Spanish painters and found that one of the implicit theories that the painters held about creativity involved the role of psychological disorders. Plucker and Dana found that past histories of alcohol, marijuana, and tobacco usage were not correlated with creative achievements; familial drug and alcohol use also was not significantly associated with creative accomplishments or creative personality attributes. Humphrey, McKay, Primi, and Kaufman did find that illegal drug use predicted self-reported creative behaviors even when openness to experience was controlled.

Multiple physical changes can impair the mental health of the aging individual. These changes include: acid-based imbalances, dehydration, electrolyte changes, hypothermia or hyperthermia, and hypothyroidism. This chapter reviews the most common mental health disorders affecting the elderly population and trends affecting care delivery. Moreover, chronic, unresolved pain has been associated with an increased risk of a mental health disorder such as depression, suicide, or anxiety. The aging individual may exhibit signs and symptoms of insomnia such as sleeping for short periods during the night, sleeping during times of normal social activities, arising early in the morning while others sleep, and experiencing daytime sleepiness. The chapter concludes by applying the nursing process from an interpersonal perspective to the care of an elderly patient with a mental health disorder.

The learning landscape continues to evolve as new technological tools enable teachers to deliver robust learning experiences. It is important to help teachers, administrators, and students know where to begin so that the transition to virtual learning is smooth, without educational loss. This chapter consists of two sections: current trends and issues in technology integration and technological pedagogical content knowledge. The first section briefly reviews the trends in instructional or educational technologies that are causing administrators, teachers, and students to reflect on and modify their thinking about learning and educational content delivery. The second section explores constructivism, the scientific underpinnings of nursing informatics, and ethics. Nurse educators must also address the ethical challenges brought about by this evolving learning landscape. After reading this chapter, one can understand current trends and issues, as well as the influence of nursing informatics and ways to approach new ethical dilemmas.

Healthcare is in a state of rapid change. Although practice environments have become more complex, educational delivery methods have remained stagnant. Innovative technologies provide opportunities to enhance nursing student learning and help nursing programs become more responsive to changes in the practice environment; however, obstacles may hinder successful implementation. With the increasing complexity of today’s health care environment, innovations in nursing curricula are necessary. This chapter explores some of the general challenges associated with the integration of innovative educational technologies, as well as some challenges unique to virtual simulation. It helps the reader to analyze the challenges of integrating educational technologies into nursing education associated with faculty, administrators, and students. It also helps the reader to examine practical and philosophical barriers related to technology integration and explores challenges unique to the adoption of virtual simulation.

Simulation has many advantages for nursing education, some of which include creating safe learning environments for students and reinforcing information learned in the classroom; it also has the advantage of being available in inclement weather as well as 24 hours a day for student access. Simulation in nursing is one of many methods used for teaching students. Teaching and learning in a virtual learning environment has many advantages for administrators, faculty, and students. One of the advantages includes the use of other disciplines to help create or participate in a virtual world learning experience. The virtual learning environment can be created to look similar to real communities, disaster areas, or homes, with avatars populating that environment. The advantage to using virtual reality, rather than a real-life experience, is that in real life, students could be immersed in an environment that could cause them harm.

One of the best known psychologists of the 20th century was Jean Piaget. The memory he described was from when he was about 2 years old, a kidnapping attempt in which his nurse tried to protect him. According to the storehouse metaphor, memory is kind of a warehouse. When one remembers an event from one’s life, one looks through this warehouse. Remembering a past event is also a kind of simulation, a simulation of what happened in the past, rather than a veridical reproduction of the past. In fact, our best understanding is that brains are massively parallel simulation devices. Constructive theories deal with filling in gaps at encoding as the event transpires, whereas reconstructive theories deal with filling in gaps at retrieval as one tries to remember the event. When thinking about memory illusions it is important to make a similar distinction.

This chapter discusses the assessment and laboratory findings, imaging, diagnosis and management of ascites. A common complication of cirrhosis is ascites, or the accumulation of fluid in the abdominal cavity. Ascites that develops from cirrhosis is associated with portal hypertension. The patient with cirrhosis and ascites may complain of increased weight gain, lower extremity edema, and abdominal bloating or distension. Physical examination findings may reveal a distended or even tense abdomen, positive fluid wave, dullness to abdominal percussion, and peripheral edema. Routine laboratory testing, such as complete blood count, complete metabolic panel, and liver function testing, should be performed with new-onset ascites and at routine return visits. Patients with cirrhosis and ascites can develop electrolyte imbalances and renal failure. Ultrasound is helpful to determine whether ascites is present if there is any uncertainty upon physical examination. Patients should abstain from alcohol consumption and avoid using nonsteroidal anti-inflammatory drugs.

This chapter focuses on an area that has been at the center of the debate between the approaches: processing ambiguous words and sentences. Interestingly, an important factor for ambiguity resolution appears to be the frequency of the different meanings of the ambiguous words. Subordinate- bias effect is as follows: in a neutral, nonbiasing context, words that are balanced cause longer reading times than words that are either unbalanced or unambiguous. Different languages impose different rules about how grammatical categories may be combined. In the garden path model, sentence processing happens in two stages: an initial structure building stage in which the only information that is used is syntactic, and then a second stage in which the structure is checked against semantic and pragmatic information. Constraint-based models take a very different approach to how sentences are initially parsed and how mistakes are sometimes made.

This chapter shows the importance, for older persons, of support groups. In spite of the changes that have occurred in the American family, and all the negative things that fill the popular press concerning family relationships, the family is still the backbone of support for most older people. To some extent, the type of family support older people obtain depends on whether they are living in the community or in an institutional setting such as a group home, retirement village, or nursing facility. Whether a person is married, has great impact on that person’s support within a family setting including emotional, financial, and physical support, particularly in times of illness or infirmity. The success of a second marriage depends to a considerable extent on the reaction of the adult children of the elderly couple. Older grandparents, no matter how motivated, can find caring for grandchildren to be very tiring.

This chapter shows how the United States and the world are experiencing an aging evolution we are growing older. America is going through a revolution. As a whole, Americans are becoming older, and there are many more older people among people than ever before in our history. Obviously all cohorts of the population youth, young adults, middle-aged, young-old, oldest-old are heterogeneous. When some people think about the elderly as a whole, they picture frail, weak, dependent persons, some in nursing homes and many confined to their homes. The chapter demonstrates the differences the various age categories have in relation to selected chronic health conditions that cause limitations of activity. Widowhood is much more common for elderly American women than for older men. The aging of Baby Boomers will solidify the shift America is experiencing with the aging of its population. Centenarians make up a small percentage of the total U.S. population.

The researchers were specifically interested in whether they would get more incorrect responses depending on the type of sentence. From a certain perspective, passive sentences are more complicated than active sentences and so perhaps it is the case that passives are more difficult simply because they are more complicated. It appears that the important difference between subject cleft and actives on one hand, and passives on the other, is that the order of the roles is reversed between them: in active sentences, the agent comes first. Indeed, there is a growing body of evidence that languages allow English speakers to structure their utterances in a way that can flag certain parts of the sentence as particularly important or worthy of special attention. Recently, psycholinguists have been interested, too, in how information structure influences language processing.

Inflammatory bowel disease (IBD) is a broad diagnosis that includes two major chronic diseases: ulcerative colitis (UC) and Crohn’s disease (CD). IBD is typically diagnosed in young adulthood. Smoking has been associated with a higher risk of developing CD. UC is an inflammatory disease of the mucosa of the colon and rectum. Typical symptoms include bowel movement urgency, tenesmus and bloody diarrhea. CD is a chronic inflammatory disorder of the alimentary tract. It is associated with high levels of proinflammatory cytokines. Referral to a gastroenterologist specializing in IBD may be needed. To confirm diagnosis, a flexible sigmoidoscopy is necessary in cases of UC and a colonoscopy is necessary in cases of CD. The goal for treatment of IBD is to suppress the immune system and help heal the bowel. Initial treatment for patients with mild to moderate UC includes 5-aminosalicyclic acid compounds.

The study of the properties of language can be divided up into roughly five, somewhat overlapping categories: sound system, word structure, sentence structure, meaning, and real-world use. In spoken languages, segments are sounds—each language has a set of sounds that are produced by changing the positions of various parts of the vocal tract. The sound system of language is actually studied in two main parts: phonetics, phonology. Phonemes can be combined to make words, and words themselves have an internal structure and can even be ambiguous based on this structure. Syntax is the study of how sentences are formed. There are two noun phrases (NPs) in the sentence—the artist and a paintbrush. The field of semantics is concerned with meaning in language and can be divided into two major parts: lexical and propositional.

Some drugs, like aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), have been blamed for peptic ulcer formation. The most common peptic ulcers are duodenal ulcers. Risk factors for the development of peptic ulcer disease are chronic NSAID use, older age, Helicobacter pylori infection, use of anticoagulant or anti-platelet medications, history of prior ulcers, use of corticosteroids, alcohol use, and smoking. One of the goals of treatment for the patient with peptic ulcer disease is eradication of H. pylori infection. Complications that develop if peptic ulcer is untreated include gastrointestinal bleeding, gastric cancer and gastric outlet obstruction, with bleeding the most common. Most patients with peptic ulcer disease are asymptomatic. When symptoms do arise, dyspepsia is a common complaint. Sucralfate, a formula of aluminum hydroxide and sulfated sucrose, is given to patients with peptic ulcer disease to protect the gastric and duodenal mucosa.

The idea of the mad genius persisted all the way to modern times and was even promulgated in scientific circles. Not only was genius mad, but it was associated with criminality and genetic degeneration. The empirical research relevant to the mad-genius issue uses three major methods: the historiometric, the psychometric and the psychiatric. The historical record is replete with putative exemplars of mad genius. The mental illness adopts a more subtle but still pernicious guise-alcoholism. In fact, it sometimes appears that alcoholism is one of the necessities of literary genius. Psychopathology can be found in other forms of genius besides creative genius. Of the available pathologies, depression seems to be the most frequent, along with its correlates of suicide and alcoholism or drug abuse. Family lineages that have higher than average rates of psychopathology will also feature higher than average rates of genius.

This chapter talks about questions related to how speakers and hearers influence each other. It looks at research on dialogue, and especially how a dialogue context influences speakers. Speakers have an impact on their listeners. The goal of a dialogue is successful communication and so it would make sense that a speaker would pay careful attention to the needs of a listener and do things like avoid ambiguity and package information in a way that flags particular information as important or new to the listener. Ambiguity may be avoided depending on the speaker’s choice of words and so a natural question is whether, and when, speakers appear to avoid ambiguous language. In terms of pronunciation, speakers reduce articulation and intelligibility over the course of a dialogue. There are some constraints and preferences on how to interpret pronouns and other coreferring expressions that appear to be structural or syntactic in nature.

This chapter discusses the incidence and risk factors, assessment, laboratory and image testing, diagnosis and treatment of constipation. Constipation affects 15" of adults in Western countries and 33" of patients older than 60. History is important when trying to determine the cause of constipation. The patient should be asked for a detailed description of bowel movements, including how many per day or week, how often, and how long has constipation been a problem. A complete blood count and complete metabolic panel should be obtained. Several electrolyte imbalances can cause constipation. Constipation is often caused by inadequate fiber intake or hydration, inactivity, or can be medication-related. Providers should encourage patients with acute constipation to increase hydration and fiber intake to 20 to 35 grams per day. Nutritional modification may be enough to resolve constipation and can likely prevent further episodes. In some cases of chronic constipation, nonpharmacologic treatments are helpful.

This chapter discusses the incidence and risk factors, assessment and laboratory findings, diagnosis and management of celiac disease. Celiac disease is considered an autoimmune disorder with a genetic component. If left untreated, patients with celiac disease have an increased risk of developing gastrointestinal cancers and enteropathy-associated T-cell lymphoma. Some of the disease’s symptoms are asymptomatic, whereas some have severe malabsorption issues with skin manifestations. Celiac disease is frequently found in patients who have other autoimmune disorders. A serologic test called immunoglobulin A (IgA) anti-tissue transglutaminase (tTGA) is performed to detect possible celiac disease in patients over two years old. Characteristic histological changes of celiac disease are villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis, and mucosal inflammation. The only curative treatment for celiac disease is strict adherence to a gluten-free diet (GFD). It is important to recognize other vitamin deficiencies in patients with celiac disease, including B 12, D, iron, and folate.

This chapter differentiates intelligence and related constructs such as creativity and intellectual giftedness, which helps people to better understand each construct. Sternberg proposed a way to classify the various approaches to studying the intelligence-creativity relationship. Guilford’s Structure of the Intellect (SOI) model is probably the most explicit, with divergent thinking specifically identified as one of his five cognitive operations. The relationship between intelligence and giftedness has also received substantial attention. Every gifted education program has a formal assessment procedure to identify potential participants, and creativity assessments are often included in the battery of measures in these identification systems. The Marland Definition suggests that giftedness and talent are manifest in six areas: general intellectual ability, specific academic aptitude, creative or productive thinking, leadership ability, visual and performing arts, and psychomotor ability. It has been extremely influential and is still used by many school districts in their identification of talented students.

Diarrheal diseases are one of the top leading causes of death worldwide. Although in normal healthy people diarrhea is considered a self-limiting illness, certain individuals can be susceptible to severe dehydration that can cause serious complications. Providers should ask about the patient’s definition of diarrhea, as individuals may differ on its meaning. Correcting dehydration and preventing worsened hydration status is the top priority when treating the patient with diarrhea. Patients must be educated to eat high-carbohydrate foods like bananas, rice, baked potatoes, applesauce, and saltine crackers for a day or two prior to resuming a normal diet. Probiotics have been shown to recolonize the intestine with healthy bacterial flora, which may have been lost from episodes of diarrhea. Multiple episodes of diarrhea cause perineal irritation and tenderness, even pain. To slow down or reduce the frequency of diarrhea, loperamidine or atropine can be used.

This chapter shows an overview of the techniques that are used to measure language processing. It shows at the things psycholinguists do when designing experiments in order to ensure that their results are valid. Online measures include any measure considered to give information about language processing as it happens. The prototypical off-line measure is the questionnaire—literally asking people for their judgments about what they’ve just encountered. In fact, all kinds of data can be collected from questionnaire studies. The button press task is perhaps the most versatile of all the things that people can do to collect data involving response times. The conscious responses discussed about here are vocal response. Like eye-tracking, event-related brain potentials (ERPs) help to understand the technique if people know a bit about the response measured—in this case, the brain. In many ways, functional magnetic resonance imaging (FMRI) can be considered the complement to ERPs.

So here the authors are, caught between two worldviews. In one camp, they have educators and academics, attempting to overthrow the “old guard”—those of them who define giftedness through the narrow lens of IQ tests. They are hoping to establish a raison d’etre for gifted education—a field with a wobbly foundation. In the other camp, the authors have parents and the psychologists who specialize in working with the gifted, railing against the externalizing of giftedness. They want the inner world of the gifted to be recognized and appreciated. Controversy has dogged the study of giftedness since its inception, and is likely to continue into the foreseeable future. Multiple views will somehow have to learn to coexist. The psychology of giftedness is a fledgling. An impressive number of people think they know more about the gifted than one does and they are delighted to share their opinions.

Irritable bowel syndrome (IBS) is a common disorder. It is characterized as a functional disturbance of bowel motility with symptoms of lower abdominal pain and alternating episodes of diarrhea and constipation. Risk factors for the development of IBS include alcohol consumption and high levels of psychological stress. Diagnosis is made by history and physical examination. If bloody stools are reported, then a complete blood count is necessary to rule out anemia. Patients report mucus-like stools with IBS. The management of IBS depends mostly on symptom control, especially stress management. Dietary changes are necessary and include no alcohol or caffeine, avoidance of substances to which one is allergic, and an increase in dietary fiber intake. Adequate hydration is important. Some patients report relief from pain and abdominal distension with the use of probiotics. For any patient suffering from IBS, tricyclic antidepressants and antispasmodics can be tried to improve symptoms.

This chapter reviews liver testing and some reasons for the liver abnormalities. The liver function test (LFT) is a combination of serum testing, including alkaline phosphate, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin levels. Alkaline phosphatase is a serum level that is derived from bone and liver cells. Albumin is a protein that is produced by the liver. Low levels are seen in patients who have chronic liver disease, malnutrition, or cancer. Imaging studies that are frequently ordered for the patient with abnormal LFT results are an initial abdominal ultrasound and/or CT scan if further imaging is required. Mild elevations are seen in patients with chronic hepatitis B or C, fatty liver disease, or alcoholic cirrhosis. There are certain medications that can cause acute elevations in LFT readings. Some of those include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, antiseizure medications, antituberculosis medications, antilipid agents, sulfonylureas, herbal medications, and illicit drugs.

Psycholinguist is someone who studies phenomena in the intersection of linguistics and psychology. The whole endeavor of psycholinguistics often finds a home in the broader research field of cognitive science—an interdisciplinary field that addresses the difficult question of how animals, people, and even computers think. The centrality of language in the daily lives means that any disruption to the ability to use it may be keenly felt—the worse the disruption, the more devastating the impact. From the beginning of psychology, there has been an interest in language. In psychology, behaviorism was a movement in which the study of mental states was more or less rejected, and the idea that one could account for human behavior in terms of mental states or representation was discounted. This book covers a number of topics that are very much relevant in current psycholinguistics, including child language acquisition, sign language, language perception, and grammatical structure.

To truly understand how important and central memory is to us, it is important to understand what life is like for people who experience memory loss, or amnesia. This chapter examines the amnestic syndrome, which has been widely studied and the knowledge of which has significantly influenced theories of memory. The abilities and nonabilities of those with amnestic syndrome demonstrate that there are multiple independent systems of memory. The chapter also examines two controversial diagnoses, the main feature of which is memory loss dissociative identity disorder (DID) and psychogenic or dissociative amnesia. It discusses a form of memory loss that does not fit the technical definition of amnesia because it eventually affects not just memory but all cognition: Alzheimer’s disease (AD). AD is common among older adults and demonstrates how a worsening loss of memory and cognition can lead to a complete disruption of everyday life.

In our success-oriented culture, optimal development of giftedness often is construed as fulfilling one’s potential for greatness. In humanistic psychology, optimal development has been conceptualized differently. Self-realization can be understood in terms of Maslow’s self-actualization, Dabrowski’s secondary integration, Jung’s individuation, or other theoretical perspectives of human development. The goals of inner development involve deepening the personality, overcoming conflicts, and actualizing one’s potential for becoming one’s best self. Many parents of the gifted complain that their children are the ones exerting the pressure. Their speed of learning and quest for knowledge often exceed their parents’ comfort level. The purpose of parent guidance is to foster “optimal development” through early intervention and prevention of social and emotional problems. Assessment can act as a prelude to family therapy. Family therapy usually involves a commitment to several successive sessions to deal with family interactions.

This chapter discusses the incidence, assessment, laboratory findings, additional studies, diagnosis and treatment options of nausea and vomiting (N/V). N/V are common complaints in primary care offices. Initial evaluation of the patient with N/V includes determining how long the patient has had symptoms. The most common complications of N/V are dehydration and conditions caused by electrolyte imbalances, mainly hypokalemia and metabolic alkalosis. Depending on the degree of dehydration, basic laboratory evaluation may be needed to evaluate specifically for anemia, infection, and electrolyte imbalances. Esophagogastroduodenoscopy (EGD) can be performed for patients with unexplained N/V. Abdominal X-rays can be performed if there is concern about a bowel obstruction. For patients who are dehydrated, intravenous fluids (IVFs) are usually needed to assist with hydration until oral intake is possible. Antiemetics are medications that works by controlling response from the central nervous system.

This chapter discusses the incidence and risk factors, assessment and laboratory findings, diagnosis, and management of food intolerances or allergies. Food allergies are common and recognized more frequently as a cause of gastrointestinal distress. Most common reactions occur from peanuts and tree nuts, followed by fish and shellfish allergies. Patients at risk are those who have asthma and/or a history of allergic reactions to food. Symptoms can range from mild to severe anaphylactic-type reactions. Patients should be questioned regarding skin lesions, rash, difficulty breathing, palpitations, chest pain, nausea and diarrhea. Patients with an immunological reaction to food develop symptoms acutely, usually within minutes to two hours after consumption of the offending food. Antigen leukocyte cellular antibody test (ALCAT) measures body’s response to food antigens. The key to managing the patient with a food allergy is to identify the trigger. An accurate dietary history is important in identifying the possible allergen.

Abdominal pain can occur in a patient for any number of reasons. When evaluating the patient with abdominal pain, obtaining a detailed history is important in determining the proper diagnosis. Vital signs should be obtained and a detailed abdominal examination including a rectal examination, and pelvic examination, should be performed. In the patient with acute abdominal pain, laboratory testing should include complete blood count with differential, complete metabolic panel, lipase and amylase tests, liver function tests, urinalysis, and pregnancy test. Abdominal flat and upright films are useful in the patient presenting with abdominal pain. Bowel obstruction or intestinal perforation can be seen on these films. Abdominal ultrasound imaging is preferred in cases in which peritonitis is a concern and/or if the patient is pregnant or possibly pregnant. Surgical and acute abdomen are terms used to describe abdominal pain that quickly worsens and will likely continue to do so without surgery.

The abdominal assessment is an essential tool for providers to diagnose and treat gastrointestinal (GI) illnesses appropriately. Good assessment skills begin with taking a thorough patient history. A thorough history must include a diet history, presence of abdominal distension or bloating, nausea, vomiting, diarrhea, constipation and so on. The provider should auscultate the abdomen using a systematic approach, moving through all abdominal quadrants. Percussion, followed by palpation, is next in the abdominal examination. A stool test for occult blood is recommended if there is concern about GI bleeding or if the patient has anemia. CT scan is a useful and frequently ordered test when trying to determine cause of acute abdominal pain. Esophagogastroduodenoscopy (EGD) is a procedure performed by a gastroenterologist to evaluate the upper structures of the GI tract. Colonoscopy is a procedure performed by a gastroenterologist to evaluate the large intestine and rectum.

Hepatorenal syndrome (HRS) is a condition seen in patients with cirrhosis and ascites in which there is deterioration of the kidneys. Patients with HRS may present without symptoms. Others may have acute worsening of liver function such as worsening jaundice and hepatic encephalopathy, fever, chills, hypotension, tachycardia, dry skin and mucous membranes, dizziness, cold intolerance, or other signs of anemia. Blood and urine cultures may be required to evaluate for sepsis. Careful monitoring of renal function to re-evaluate for improvement or deterioration is essential. A renal ultrasound is usually obtained when there is an acute rise in creatinine to ensure no other etiologies are contributing to the rise in creatinine level, such as kidney stone, chronic renal damage, or other issues. All possible precipitants for development of HRS should be investigated, including evaluating for sepsis, gastrointestinal bleeding, malnutrition issues, electrolyte imbalances, and acute hepatitis.

Cirrhosis, also known as end-stage liver disease, is the final stage of liver fibrosis progression. Cirrhosis can develop for a variety of reasons with the most common causes being alcohol consumption, viral hepatitis, and nonalcoholic steatohepatitis. Management goals are to prevent complications and to preserve quality of life. Cirrhosis is divided into two subsets: compensated and decompensated. There are many nonspecific symptoms that can be associated with cirrhosis, including fatigue, weakness, loss of appetite, and weight loss. Patients with cirrhosis may have abnormal liver function test (LFT) readings, hyperbilirubinemia, elevated international normalized ratio (INR), thrombocytopenia, anemia, leukopenia, hyponatremia, hypoalbuminemia, renal insufficiency, and glucose intolerance. The gold standard for determining the presence and staging of cirrhosis is a liver biopsy. Patients with cirrhosis should undergo screening measures to avoid complications, including regular esophagogastroduodenoscopy (EGD) to appropriately manage varices and prevent bleeding episodes, and imaging studies to rule out hepatocellular carcinoma.

Gastroesophageal reflux disease (GERD) is a common condition in which stomach contents flow upward causing bothersome symptoms, including a burning sensation in the esophagus and throat, and other complications. Normally, the lower esophageal sphincter (LES) maintains a pressure barrier between the stomach and the esophagus. Complications of GERD include Barrett’s esophagus, peptic stricture, asthma, chronic cough, and esophageal adenocarcinoma. Patients with GERD often complain of heartburn, dysphagia, and regurgitation. Diagnosis of GERD is made by clinical symptoms. The differential diagnosis of the patient with GERD may include infectious or eosinophilic esophagitis, cancer, peptic ulcer disease, coronary artery disease, or stricture motor impairment of the esophagus. For medication management, most providers recommend prescribing a proton pump inhibitor (PPI) twice a day for symptom control. Antireflux surgery is an option for patients with GERD who are unable to take medications to treat the symptoms.

Intelligence is a hypothesized quality whose ontology, etiology, and scale must be inferred through indirect means. Personal definitions of intelligence are not the same as constructs of intelligence. Psychological constructs are highly technical, painstakingly crafted, and subjected to rigorous theoretical examination and empirical testing. Intellectual abilities are organized at a general level into two general intelligences, viz., fluid intelligence and crystallized intelligence. Intelligence is the sum total of all cognitive processes. It entails planning, coding of information and attention, as well as arousal. Given his personal history and society’s attitudes toward heredity, that Galton concluded that the development of genius, must be understood in terms of hereditary processes. The chapter concludes with two tables presenting definitions of intelligence provided by several prominent historical and living intelligence theorists. They convince readers that human intelligence is a fascinating and complex subject, and to provide a foreshadowing of many of the essential issues.

This chapter discusses the assessment and laboratory findings, diagnostic studies imaging studies and management of gastrointestinal bleeding. It also discusses the signs and symptoms of esophageal varices and variceal hemorrhage. Risk factors for variceal hemorrhage or bleeding include advanced cirrhosis, increased size of varices, and presence of red wale signs seen on esophagogastroduodenoscopy (EGD). Complications of variceal hemorrhage can include infection, severe anemia, and death. Providers should note patient history of melena, hematemesis, hematochezia, syncope, dizziness, palpitations, or prior history of gastrointestinal (GI) bleeding. Routine laboratory testing, such as complete blood count, complete metabolic panel, prothrombin/international normalized ratio (PT/INR), and liver function testing, should be performed on all patients suspected of having variceal hemorrhage. Patients may require serial hemoglobin and hematocrit to check for worsening anemia. Prevention of variceal hemorrhage is key for variceal management. Patients with variceal hemorrhage require urgent hospital admission to the intensive care unit (ICU).

This chapter focuses on the causes of liver disease, including alpha-1 antitrypsin deficiency, Budd-Chiari syndrome (BCS), hereditary hemochromatosis (HH), primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC), polycystic liver disease, and Wilson’s disease. Vascular disorders of the liver include congenital vascular malformations, portal vein thrombosis, sinusoidal obstruction syndrome, and BCS. PBC is an autoimmune disorder that affects the bile ducts. A serologic marker that is highly suggestive of PBC is antimitochondrial antibody (AMA). BCS should be considered in patients with abdominal pain, hepatomegaly, ascites, or with known risk factors of thrombosis. Ultrasonography is performed to evaluate the hepatic vasculature for thrombosis or blood-flow issues. There can be some laboratory abnormalities in patients with PSC and PBC. These include mild alkaline phosphatase, alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Treatment for the patient with hemochromatosis includes phlebotomy weekly or twice a week, removing one unit of whole blood.