O. Gunnar. University of the Pacific.
The secre- tions from these glands form a protective layer that warms sporanox 100mg, moistens trusted 100mg sporanox, and helps Chapter 8: Oxygenating the Machine: The Respiratory System 133 to filter air as it’s inhaled buy generic sporanox 100 mg line. Beneath the protective layer generic 100 mg sporanox with visa, areolar connective tissue containing lymphocytes (which form a thin lymphoid tissue) removes foreign materials. A layer of blood vessels next to the periosteum (the membrane cover- ing the surface of bones) forms a rich plexus (network) that tends to swell when irritated or inflamed, closing the ostia (openings) of the nasal sinuses. Lined with a ciliated columnar epithe- lium (refer to Chapter 4’s tissue discussion), sinuses are cavities in the bone that reduce the skull’s weight and act as resonators for the voice. Each of the sinuses is named for the bone containing it, as follows: Frontal sinuses are located in the front bone behind the eyebrows. Ethmoid and sphenoid sinuses are located in the ethmoid and sphenoid bones in the cranial cavity’s floor. Beyond the sinuses and connected to them are nasal ducts that extend from the medial angle of the eyes to the nasal cavity. These ducts let serous fluid — a biology term referring to any fluid resembling serum — from the eyes’ lacrimal glands (tear ducts) flow into the nasal cavity. The nasal cavity performs several important functions: It drains mucous secretions from the sinuses. Dust and bacteria are caught in the mucous and passed outward from the nasal cavity by the motion of the cilia. Some of that gunk is taken up by lymphatic tissue in the nasal cavity and respiratory tubes for delivery to the lymph nodes, which destroy invading germs. Beyond the nasal cavity is the nasopharynx, which connects — you guessed it — the nasal cavity to the pharynx. With a bit of a refresher on the nasal and sinus passages, do you think you can hit the following practice questions on the nose? Which of the following statements about the mucous membranes of the nasal cavity is not true? Use the terms that follow to identify the structures of the respiratory tract shown in Figure 8-2. The top of the throat con- sists of these key parts: Chapter 8: Oxygenating the Machine: The Respiratory System 135 Pharynx: The pharynx is an oval, fibromuscular sac about 5 inches long and tapering to 1⁄2 inch in diameter at its anteroposterior end, which is a fancy biology term meaning “front to back. On the back wall of the pharynx is a mass of lymphoid tissue called the pharyngeal tonsil, or adenoids. Larynx: Connecting the pharynx with the trachea, this collection of nine carti- lages is what makes a man’s prominent Adam’s apple. Also called the voice box, the larynx looks like a triangular box flattened dorsally and at the sides that becomes narrow and cylindrical toward the base (see Figure 8-3). Ligaments con- nect the cartilages controlled by several muscles; the inside of the larynx is lined with a mucous membrane that continues into the trachea. Three of the larynx’s nine cartilages go solo — the thyroid, the cricoid, and the epiglottis — while three more come in pairs — the arytenoids, the corniculates, and the cuneiforms. The thyroid cartilage (thyroid in Greek means “shield-shaped) is largest and consists of two plates called laminae that are fused just beneath the skin to form a shield-shaped process, the Adam’s apple. Immediately above the Adam’s apple, the laminae are separated by a V-shaped notch called the superior thyroid notch. The ring- shaped cricoid cartilage is smaller but thicker and stronger, with shallow notches at the top of its broad back that connect, or articulate, with the base of the arytenoid car- tilages. The arytenoid cartilages both are shaped like pyramids, with the vocal folds attached at the back and the controlling muscles that move the arytenoids attached at the sides, moving the vocal cords. On top of the arytenoids are the corniculate carti- lages, small conical structures for attachment of muscles regulating tension on the vocal cords. Nestled in front of these and inside the aryepiglottic fold, the cuneiform cartilages stiffen the soft tissues in the vicinity. The epiglottis, sometimes called the lid on the voice box, is a leaf-shaped cartilage that projects upward behind the root of the tongue. Attached at its stem end, the epiglottis opens during respiration and reflex- ively closes during swallowing to keep food and liquids from getting into the respira- tory tract. When talking, the folds stretch for high sounds or slacken for low sounds, causing the opening into the glottis — the opening in the larynx — to form an oval. Just above these folds are the ventricular vocal folds, also known as vestibular or false folds, that don’t produce sounds. Use the terms that follow to identify the structures of the larynx shown in Figure 8-3. Corniculate cartilage Going deep inside the lungs After the pharynx and larynx comes the trachea, more popularly known as the wind- pipe. Roughly 6 inches long in adults, it’s a tube connected to the larynx in front of the esophagus that’s made up of C-shaped rings of hyaline cartilage and fibrous connec- tive tissue that strengthen it and keep it open. Just above the heart, the trachea splits into two bronchi divided by a sharp ridge called the carina, with each leading to a lung. But they’re not identical: The right primary bronchus is shorter and wider than the left pri- mary bronchus. Each primary bronchus divides into secondary bronchi with a branch going to each lobe of the lung; the right side gets three secondary bronchi while the left gets only two. Once inside a designated lobe, the bronchus divides again into terti- ary bronchi. The right lung has ten such branches: three in the superior (or upper) lobe, two in the middle lobe, and five in the inferior (or lower) lobe. The left lung has only four tertiary bronchi: two in the upper lobe and two in the lower lobe. Each tertiary bronchi subdivides one more time into smaller tubes called bronchioles (see Figure 8-4), which lack the supporting cartilage of the larger structures. Each bronchiole ends in an elongated sac called the atrium (also known as an alveolar duct or alveolar sac). Alveoli (or air cells) surround the atria, as do small capillaries that pick up oxygen for delivery elsewhere in the body and dump off carbon dioxide fetched from elsewhere. Overall, there are 23 branches in the respiratory system, with a combined surface area (counting the alveoli) the size of a tennis court! Knowing that the bronchi aren’t evenly distributed, you may have guessed that the lungs aren’t identical either. They’re both spongy and porous because of the air in the sacs, but the right lung is larger, wider, and shorter than the left lung and has three lobes. The left lung divides into only two lobes and is both narrower and longer to make room for the heart because two-thirds of that organ lies to the left of the body’s midline. Each lobe is made up of many lobules, each with a bronchiole ending in an atrium inside. Covering each lung is a thin serous membrane called the visceral pleura that folds back on itself to form a second outer layer, the parietal pleura, with a pleural cavity between the two layers. These two layers secrete a watery fluid into the cavity to lubricate the surfaces that rub against each other as you breathe. When the pleural membrane becomes inflamed in a condition called pleurisy, a sticky discharge roughens the pleura, causing painful irritation. An accompanying bacterial infection means that pus accumulates in the pleural cavity in a condition known as empyema. The pulmonary trunk comes from the right ventricle of the heart and then branches into the two pulmonary arteries carrying venous blood (the only arteries that contain blood loaded with carbon dioxide from various parts of the body) to the lungs. That blood goes through capillaries in the lungs where the carbon dioxide leaves the blood and enters the alveoli to be expelled during exhalation; oxygen leaves the alveoli through the capillaries to enter the bloodstream. After that, oxygenated arterial blood returns to the left atrium through the pulmonary veins (the only veins that contain oxygenated blood), completing the cycle. Bronchial arteries branch off the thoracic aorta of the heart, supplying the lung tissue with nutrients and oxygen. Fill in the blanks to complete the following sentences: The trachea divides into two 55. If a pin were to pierce the body from the outside in the thoracic region, the third structure it would reach would be the a. Use the terms that follow to identify the structures of the bronchiole shown in Figure 8-4.
They may also lack problem-solving skills and require assistance to formulate a plan for implementing the desired changes trusted sporanox 100mg. Positive feedback enhances self-esteem and encourages repetition of desired behaviors proven 100mg sporanox. The ability to perform self-care activities independently provides a feeling of self-control and enhances self-esteem order sporanox 100 mg. Promote feelings of control or power by encouraging input into the decision-making regarding treatment and for plan- ning discharge from treatment buy sporanox 100mg with amex. Client demonstrates ability to manage own self-care, make independent decisions, and use problem-solving skills. Client sets goals that are realistic and works to achieve those goals without evidence of fear of failure. Possible Etiologies (“related to”) [Physical illness accompanied by real or perceived disabling symptoms] [Unmet dependency needs] [Dysfunctional family system] Deﬁning Characteristics (“evidenced by”) Change in self-perception of role Change in [physical] capacity to resume role [Assumption of dependent role] Change in usual patterns of responsibility [because of conﬂict within dysfunctional family system] Goals/Objectives Short-term Goal Client will verbalize understanding that physical symptoms in- terfere with role performance in order to ﬁll an unmet need. Long-term Goal Client will be able to assume role-related responsibilities by time of discharge from treatment. An accurate database is required in order to formulate appropriate plan of care for the client. Identify ways in which client and other family members have responded to these conﬂicts. It is necessary to identify speciﬁc stressors, as well as adaptive and maladap- tive responses within the system, before assistance can be provided in an effort to create change. Help client identify feelings associated with family conﬂict, the subsequent exacerbation of physical symptoms, and the accompanying disabilities. Help client identify changes he or she would like to occur within the family system. Encourage family participation in the development of plans to effect positive change, and work to resolve the conﬂict for which the client’s sick role provides relief. Input from the individuals who will be directly in- volved in the change will increase the likelihood of a positive outcome. Allow all family members input into the plan for change: knowledge of beneﬁts and consequences for each alternative, selection of appropriate alternatives, methods for implemen- tation of alternatives, and an alternate plan in the event ini- tial change is unsuccessful. Ensure that client has accurate perception of role expecta- tions within the family system. Use role-playing to practice areas associated with his or her role that client perceives as painful. Repetition through practice may help to desensitize client to the anticipated distress. As client is able to see the relationship between exacerba- tion of physical symptoms and existing conﬂict, discuss more adaptive coping strategies that may be used to prevent inter- ference with role performance during times of stress. The nurse may make suggestions and help the client practice through role-play, but the client alone must decide what will be adaptive in his or her personal situation. The nurse must be careful not to impose on the client ideas that the nurse thinks are more appropriate but which may not be adaptive for the client. Psychological Factors Affecting Medical Condition ● 273 Possible Etiologies (“related to”) Lack of interest in learning [Severe level of anxiety] [Low self-esteem] [Regression to earlier level of development] Deﬁning Characteristics (“evidenced by”) [Denial of emotional problems] [Statements such as, “I don’t know why the doctor put me on the psychiatric unit. Long-term Goal By time of discharge from treatment, client will be able to verbal- ize psychological factors affecting his or her medical condition. Assess client’s level of knowledge regarding effects of psy- chological problems on the body. An adequate database is necessary for the development of an effective teaching plan. The client has the right to know about and accept or refuse any medical treatment. These feelings may have been suppressed or repressed for so long that their disclosure may be very painful. Verbalization of feelings in a nonthreatening environment and with a trusting individual may help the client come to terms with unresolved issues. Have client keep a diary of appearance, duration, and intensi- ty of physical symptoms. A separate record of situations that the client ﬁnds especially stressful should also be kept. Com- parison of these records may provide objective data from which to observe the relationship between physical symptoms and stress. Provide instruction in assertiveness techniques, especial- ly the ability to recognize the differences among passive, assertive, and aggressive behaviors and the importance of respecting the human rights of others while protecting one’s own basic human rights. These skills will preserve client’s self-esteem while also improving his or her ability to form satisfactory interpersonal relationships. Discuss adaptive methods of stress management such as relaxation techniques, physical exercise, meditation, breath- ing exercises, and autogenics. Use of these adaptive tech- niques may decrease appearance of physical symptoms in response to stress. Client verbalizes an understanding of the relationship between psychological stress and exacerbation of physical illness. Client demonstrates the ability to use adaptive coping strate- gies in the management of stress. These clusters, and the disorders classiﬁed under each, are described as follows: 1. For purposes of this text, passive-aggressive personality disorder is described with the cluster C disorders. The essential feature is a pervasive and unwarranted suspiciousness and mistrust of people. There is a general expectation of being exploit- ed or harmed by others in some way. Symptoms include guardedness in relationships with others, pathological jealousy, hypersensitivity, inability to relax, unemotional- ity, and lack of a sense of humor. These individuals are very critical of others but have much difﬁculty accepting criticism themselves. This disorder is character- ized by an inability to form close, personal relationships. Symptoms include social isolation; absence of warm, ten- der feelings for others; indifference to praise, criticism, or the feelings of others; and ﬂat, dull affect (appears cold and aloof). This disorder is char- acterized by peculiarities of ideation, appearance, and be- havior, and deﬁcits in interpersonal relatedness that are not severe enough to meet the criteria for schizophrenia. Symptoms include magical thinking; ideas of reference; social isolation; illusions; odd speech patterns; aloof, cold, suspicious behavior; and undue social anxiety. This disorder is charac- terized by a pattern of socially irresponsible, exploitative, and guiltless behavior, as evidenced by the tendency to fail to conform to the law, to sustain consistent employ- ment, to exploit and manipulate others for personal gain, to deceive, and to fail to develop stable relationships. The individual must be at least 18 years of age and have a his- tory of conduct disorder before the age of 15. The features of this dis- order are described as marked instability in interpersonal relationships, mood, and self-image. The instability is sig- niﬁcant to the extent that the individual seems to hover on the border between neurosis and psychosis. Symptoms include exagger- ated expression of emotions, incessant drawing of atten- tion to oneself, overreaction to minor events, constantly seeking approval from others, egocentricity, vain and de- manding behavior, extreme concern with physical appear- ance, and inappropriately sexually seductive appearance or behavior. This disorder is char- acterized by a grandiose sense of self-importance; pre- occupation with fantasies of success, power, brilliance, beauty, or ideal love; a constant need for admiration and attention; exploitation of others for fulﬁllment of own desires; lack of empathy; response to criticism or failure with indifference or humiliation and rage; and preoccupa- tion with feelings of envy. This disorder is charac- terized by social withdrawal brought about by extreme sensitivity to rejection. Symptoms include unwillingness to enter into relationships unless given unusually strong guarantees of uncritical acceptance; low self-esteem; and social withdrawal despite a desire for affection and accep- tance. Individuals with this disorder passively allow others to assume responsibility for major areas of life because of their inability to func- tion independently. They lack self-conﬁdence, are unable to make decisions, perceive themselves as helpless and stu- pid, possess fear of being alone or abandoned, and seek constant reassurance and approval from others. This dis- order is characterized by a pervasive pattern of perfec- tionism and inﬂexibility. Interpersonal relationships have a formal and serious quality, and others often perceive these individuals as stilted or “stiff. Oppositional deﬁant disorder in childhood or adolescence is a predisposing factor.
A nutritional therapy for patients who have which of the following nutrients due to their nonfunctional gastrointestinal tracts or larger muscle mass? Place the patient in the Trendelenburg posi- tion to facilitate the ﬂuid aspiration process buy sporanox 100mg low price. Checking the placement of a gastrostomy or Circle the letters that correspond to the best jejunostomy tube requires regular comparisons answers for each question purchase sporanox 100mg free shipping. Prolonged fasting Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins discount sporanox 100mg visa. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care sporanox 100mg generic, 7th Edition. The percentage of carbohydrates decreases nutrients because they are needed by the as ﬁber intake increases. Vitamins are inorganic compounds needed for transport through the blood or for use by the body in moderate amounts. The period between when carbohydrates most are either not synthesized in the body are consumed and when they are used for or not made in sufﬁcient quantities. All carbohydrates, except for indigestible all body ﬂuids and tissues in the form of ﬁber, provide 12 cal/g regardless of the salts or combined with organic compounds. Which of the following statements regarding are microminerals because they are needed the function of protein in the body are by the body in amounts of less than accurate? Water accounts for 35% to 50% of the different proteins are made by combining adult’s total weight. Which of the following are daily recommended food servings for speciﬁc food groups according b. Dietary protein is broken down into amino acid particles by pancreatic enzymes in the c. The body’s protein tissues are in a constant describe factors that inﬂuence nutrient state of ﬂux. Fats in the diet are soluble in water and, caloric needs of the older adult increase. Food fats contain mixtures of saturated and are greater in infancy than at any other unsaturated fatty aids depending on the time in life. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Elevate the head of the bed at least 30 functions degrees during the feeding and for at least 2. Change the delivery set every other day oncotic pressure according to agency policy. Check the residual before intermittent feed- ings and every 8 hours during continuous 7. Is necessary for absorption of fat-soluble vitamins Fill-in-the-Blank Questions 9. Scurvy, hemorrhage, delayed wound healing Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Hypokalemia, muscle cramps and weak- detoxiﬁcation reactions ness, irregular heartbeat 26. Microcytic anemia, pallor, decreased clotting, nerve transmission, muscle work capacity, fatigue, weakness contraction 16. Oxidizes sulfur and products of sulfur inﬂammation and poor wound healing metabolism Match the function in Part B with the mineral 34. List one food source for each balance; energy metabolism mineral on the line provided at the end of the sentence. Micronutrients Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. The study of nutrients and how they are person to mild or subclinical deﬁciencies of handled by the body vitamin A, vitamin C, folate, and vitamin B6. Vitamins and minerals that are required in much smaller amounts to regulate and control body processes e. Explain the difference between the following the function and recommended percentage fatty acids, and give an example of each. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Brieﬂy describe the following eating disorders and the typical characteristics of individuals c. Megadoses of nutrient supplements: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. What developmental you are caring for at home for adequate factors inﬂuence their nutritional needs? Describe the following types of diets, noting include the recommended number of servings their nutritional value, and give an example of foods from the food pyramid? Brieﬂy describe the following types of enteral Use the following expanded scenario from feedings, noting their advantages and disad- Chapter 36 in your textbook to answer the vantages. Nasogastric feeding tube: Scenario: William Johnston, a 42-year-old executive, is newly diagnosed with high blood pressure and high cholesterol. Nasointestinal feeding tube: that his health has been the last thing on his mind and that his health habits are less than admirable. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. I guess it’s no wonder I’ve gained his admission to the hospital because she was a few pounds over the years! What patient teaching might the nurse provide emaciated man who weighs 149 pounds. Johnston meet his nutritional and wife reports that he has lost 20 pounds in the exercise needs? The staff at the long-term care facility report that he was eating his meals and his wife validated that this was the case. What would be a successful outcome for this had seemed more agitated and hyperactive patient? Identify pertinent patient data by placing a single underline beneath the objective data in the case study and a double underline beneath 3. Complete the Nursing Process Worksheet on likely to bring about the desired outcome? Write down the patient and personal nursing strengths you hope to draw on as you assist 4. He was diagnosed with Alzheimer’s disease 4 years ago, and 1 year ago, he was admitted to a long-term care facility. His wife of 49 years is Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. For the purposes of this exercise, develop the one patient goal that demonstrates a direct resolution of the patient problem identified in the nursing diagnosis. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Measurement of residual urine by catheteriza- tion after voiding veriﬁes which of the 6. Which of the following catheters should be used to drain a patient’s bladder for short 7. Impaired Skin Integrity related to urinary tract system should be kept in mind functional incontinence when considering catheterization? Risk for Urinary Tract Infection related to dehydration Circle the letters that correspond to the best answers for each question. Which of the following nursing interventions would be least effective when trying to main- 1.
For extensive burns generic sporanox 100mg overnight delivery, extensive treatment is needed generic 100mg sporanox visa, which may include lengthy hospital stays to ensure that infection does not occur sporanox 100mg for sale, and outpatient appointments for therapy sporanox 100mg fast delivery. Dietary Recommendations A healthy diet is critical for effective burn treatment to replace vital nutrients, promote wound healing, and reduce the risk of infection and scars. Also, for more serious burns, the healing process consumes many calories and a healthy diet can help keep your body strong during this process. Foods to include: • Drink plenty of water and electrolyte drinks to replace lost ﬂuids. Note: Those with severe burns need to increase total caloric intake because as the body tries to repair, it burns calories at a faster rate. To manage a minor burn: • Gently cool and clean the area with cold water or cold wet compresses for at least 15 minutes. Do not cover with any type of petroleum-based cream or butter, as they retain heat, slow healing, and in- crease risk of infection. Honey products are also available in a spray, salve, or tincture (The British Journal of Surgery, 1991: 78; 497–498). Top Recommended Treatments Aloe vera gel: Cooling, helps relieve pain and inﬂammation, and also has anti-inﬂammatory properties. It is commonly used to manage burns and has a long history of use to promote wound healing, although the scientiﬁc research is lacking. Use aloe vera from a plant (split open a leaf) or get pure aloe gel at a health food store or pharmacy. Antioxidants: Studies have shown that oral supplements of vitamins A, C, E, zinc, and selenium can help to protect the skin from sunburn due to free radical-producing ultravio- let rays. Topical vitamin E cream or oil is commonly used to promote skin healing and may reduce scarring. Complementary Treatments Calendula cream: Soothing, has anti-inﬂammatory properties, and may help promote tissue repair. After a burn has cooled, cleanse with chamomile B tea and apply fresh aloe vera gel. Eat a healthy diet packed with lots of fresh fruits and vegetables, whole grains, and ﬁsh. Increase total calorie intake during the healing process and drink lots of liquids. It is the leading cause of premature death in Canada—about 1,006,000 potential years were lost in 2003 as a result of cancer. Cancer has become an age-related phenomenon: 44 percent of new cancer cases and 60 percent of cancer deaths will occur among those who are at least 70 years old. Rather, in many cases it is generally thought that our lifetime exposure to factors that increase our risk, such as smoking or eating a poor diet, leads to the development of cancer. Our bodies are made up of millions of cells grouped together to form tissues or organs, such as muscles, skin, bones, and organs. Cancer occurs when there is an abnormal growth of cells, which can form lumps or tumours, or can spread through the bloodstream and lymphatic system to other parts of the body. Benign tumour cells stay in one place in the body and are not usually life-threatening. Malignant tumour cells are able to spread to invade nearby tissues and other parts of the body, which is a process called metastasis. Finding cancer early and getting treat- ment before it spreads can greatly help improve your chances of survival. While we think of cancer as one disease, it is actually a group of more than 100 different diseases. It can involve any tissue of the body and have many different forms in each body area. The four most common types of cancer in Canada are breast, prostate, lung, and colon. A great deal of research has focused on the underlying causes of abnormal cell growth. We do know that certain factors, such as free radical damage, genetics, diet, and lifestyle, are involved. While many of us may blame our family history, only about 5–10 percent of cancers are attributed to faulty genes. Having a family history may increase your risk of certain cancers, but researchers feel that whether or not those genes are “switched on” may depend largely on lifestyle and environment. These critical yet often overlooked factors play a role not only in prevention but also in the treatment and recovery from cancer. Based on current incidence rates, 39 percent of Canadian women will develop cancer during their lifetimes. Cancer is a very broad subject and it is beyond the scope of this chapter to discuss each type and make individualized recommendations. The goal here is to provide you with information on known risk factors for the most common forms of cancer, how to reduce your risk of getting cancer, and how to improve your chances of survival if 152 you have cancer. If you have been diagnosed with cancer, it is critical that you consult with your health care provider to create an individualized program. In many cases, dietary and lifestyle strategies and supplements can be taken along with your other treatments. Certain supplements, however, could interact with chemotherapy or other medical treatments, so it is important to work with your health care provider. Research shows that overall 30–35 percent of all cancers can be prevented by be- ing active, eating well, and maintaining a healthy body weight. It may take months or years before there are any signs or symptoms, and these symptoms can vary greatly depending on the location of the cancer. Some substances used in pesticides are classiﬁed as known, probable, or possible carcinogens. Exposure to many different risk factors may increase a person’s risk more than the risk associated with each individual toxin or chemical, so it is important to avoid as many known risk factors as possible. Researchers looked at a group of 44,778 pairs of twins from Finland, Sweden, and Denmark, in order to assess the risks of cancer for the twins of people with cancer. The researchers concluded that inherited genetic factors make only a minor contribution to the susceptibility of breast, prostate, and colorectal cancer. More importantly, they con- cluded that environmental factors make a major contribution to all of the 28 anatomi- cal sites of cancer studied (New England Journal of Medicine, 2000: 343; 78–85). Today there are numerous options for medical treat- ment including chemotherapy, radiation, surgery, and hormone therapy. For those who have cancer, a good nutritional program can help prevent weight loss, aid digestion, support immune function, and boost energy levels. Dietary Recommendations Foods to include: C • Boost ﬁbre intake: aim for 25–30 g daily of soluble and insoluble ﬁbre. Eat 2 tbsps of milled ﬂaxseed every day: it provides ﬁbre and contains compounds that help in the prevention of cancer. Foods that contain the highest amounts of pesticide residue include peaches, strawberries, apples, spinach, nectarines, celery, pears, cherries, potatoes, peppers, and raspberries. If organics are not available or cost-prohibi- tive, wash your produce with lots of water and scrub the skins. In 1992, a review of 200 studies showed that cancer risk in people consuming diets high in fruits and vegetables was only one-half that in those consuming few of these foods. It is clear that there are components in a plant-based diet that can reduce cancer risk, but few Canadians get the recommended intake of these foods (Nutrition and Cancer, 1992; 18 (1): 1–29). Avoid trans fats (found in many processed/snack foods and fried foods) completely. Heavy drinking increases the risk of cancers of the mouth, esophagus, breast, colorectal, and stomach. If you drink, limit yourself to one or two drinks daily and choose red wine as it contains antioxidants that may offer cancer-protecting properties. This conclusion was drawn from 41,836 women who took part in the Iowa Women’s Health Study (Journal of the National Cancer Insti- tute, 1998; 90 (22): 1724–1729). Marinades that contain olive oil, vinegar, garlic, mustard, lemon juice, rosemary, oregano, and curcumin have been to shown to be ideal. Aim for one hour of moderate-intensity activity each day, such as walking, cycling, or swimming. Several long-term studies have found that drinking chlorinated tap water increases the risk of cancer, particularly bladder cancer. Ask manufacturers about non-vinyl hard ﬂooring alternatives, and consider other types of materials such as natural ﬂooring and fabric shower curtains.