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Download Pharmacology for Nurses A Pathophysiologic Approach 4th Edition Adams Solutions Manual all chapters
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CHAPTER 9
PSYCHOSOCIAL, GENDER, AND CULTURAL
INFLUENCES ON PHARMACOTHERAPY
LEARNING OUTCOME 1
Describe fundamental concepts underlying a holistic approach to patient care and their
importance to pharmacotherapy.
POWERPOINT SLIDES
SLIDES 2–3
LEARNING OUTCOME 2
Identify psychosocial and spiritual factors that can affect pharmacotherapeutics.
POWERPOINT SLIDES
SLIDES 4–7
LEARNING OUTCOME 3
Explain how ethnicity can affect pharmacotherapeutic outcomes.
POWERPOINT SLIDES
SLIDE 8
LEARNING OUTCOME 4
Identify examples of how cultural values and beliefs can influence pharmacotherapeutic
outcomes.
POWERPOINT SLIDES
SLIDES 9–11
LEARNING OUTCOME 5
Explain how community and environmental factors can affect health care outcomes.
POWERPOINT SLIDES
SLIDES 12–16
LEARNING OUTCOME 6
Convey how genetic polymorphisms can influence pharmacotherapy.
POWERPOINT SLIDES
SLIDES 17–21
LEARNING OUTCOME 7
Relate the implications of gender to the actions of certain drugs.
POWERPOINT SLIDES
SLIDES 22–25
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in front of the city. The arrival of the squadron was the signal for
energetic operations. The army, which had heretofore confined its
efforts to the persecution of a defenceless peasantry, was brought
within the restraints of discipline. The established policy of the
Christian sovereigns, who, in the conduct of important enterprises,
endeavored to impress upon the besieged the hopelessness of
protracted resistance, was again observed. Substantial buildings
were erected for the shelter of the soldiery. The avenues were lined
with shops which, divided according to the various trades, suggested
the occupations and the traffic of a considerable city. The families of
the troops took up their residence within the intrenchments. Severe
police regulations were established. Fortifications, whose materials
and general plan were sufficiently solid and durable for the protection
of a populous town rather than for the defence of a temporary
encampment, rose before the eyes of the disheartened Moslems. A.
strict blockade was maintained; the predatory excursions of the
Christians were extended beyond the limits of the already ravaged
territory, and the surviving provincials forced to take advantage of the
impregnable security of mountain strongholds. The difficulties
attending the prosecution of the enterprise in which he had
embarked soon impressed themselves upon the Castilian King.
Seville at that time was one of the best fortified cities in Europe. It
was also one of the most populous, as it contained eighty thousand
families, divided into twenty-four tribes according to the ancient
Arabic system; and, as those families were polygamous, the number
of its inhabitants could hardly have been less than five hundred
thousand. Long exposed to the hazards of revolution and conquest,
it had been strengthened by every dynasty by which it had been
governed. A double line of walls, protected by a moat, encircled it. Its
outworks were of unusual solidity, among these the Tower of Gold,
which still exists in excellent preservation and indicates the massive
construction of these defences, guarded the approach from the river.
The present condition of the fortifications, some of which were
contemporaneous with the Cæsars, suggests the ease with which an
enemy provided only with the comparatively imperfect appliances of
mediæval engineering could have been repelled. Its greatest
weakness was to be found in the multitude of refugees who, driven
from the open country, thronged its habitations, inviting, by the
reckless disregard of sanitary precautions and by an increased
consumption of provisions, the insidious approaches of disease and
famine.
The employment of the influence of the Holy See in the wars of
Valencia offered a precedent too valuable to be neglected in the
present emergency. The tremendously effective intervention of the
Papacy was again solicited to arouse the latent enthusiasm of
Europe. From every corner of Spain, from every land subject to the
spiritual jurisdiction of Rome, volunteers marched to join the legions
of Christendom before the gates of Seville. Unlike former crusades,
which had assumed a more or less partisan character and whose
summons had been generally unheeded save by those directly
interested in the result, representatives of all the states enclosed by
the Pyrenees, the Mediterranean, and the ocean hastened to
participate in the perils and to share the glory of a campaign
destined to remove from Southern Andalusia the most serious
impediment to Christian supremacy and the most formidable
adversary of Spanish power. The princes of Castile, Aragon,
Portugal, appeared escorted by the chivalry of their several
kingdoms. From the pulpits of a thousand cathedrals and churches
resounded the stirring call to arms. Frantic appeals to the fanaticism
of the masses were made alike by famous prelates in great
ecclesiastical assemblies and by itinerant friars at the wayside cross.
Bishops cast aside the habiliments of the altar for the panoply of war.
The metropolitan of Santiago, followed by a body of Galician
peasantry, came to contribute, by his ghostly counsels and the
inspiration of the patron saint of Spain, to the final overthrow of the
accursed infidel. A motley assemblage of foreigners, of unsavory
antecedents and mercenary character, added to the numbers, if not
the efficiency, of the Christian host.
The siege of Seville, which lasted for seventeen months, proved
to be the most arduous and obstinately contested struggle in the
history of the Reconquest. The city, with a river easily accessible to
an enemy on one side and the others surrounded by a vast and level
plain, was necessarily compelled to rely for its defensive capacity
and advantages mainly upon the art and ingenuity of man. Across
the Guadalquivir was the suburb now known as Triana, whose
fortifications, not inferior in strength to those of the capital itself, were
manned by a brave and determined garrison. A bridge of boats
moored with heavy chains connected the city and the suburb. The
communication of these two points was a source of constant
annoyance to the Castilians, and the investment had hardly been
completed when the King of Granada volunteered to undertake the
destruction of the bridge. A fleet of fire-rafts was prepared, but it
drifted ashore before reaching its destination. The purpose of the
besiegers was subsequently accomplished by means of boats laden
with stone, whose weight, aided by the force of the current, shattered
the bridge and drove its swinging fragments upon opposite banks of
the river. The isolation of Triana failed to compel its surrender, which
was one of the principal objects of the attack. Upon the broken
bridge the frequent sallies of the garrison still carried death and
terror into the Christian ranks. No nation of that period had a more
thorough acquaintance with the art of defensive warfare than the
Spanish Moslems. The sudden sally, the skirmish, the night attack
were not more congenial to their nature than was their ability to
detect, and their skill to foil, the well-matured designs of an enemy.
The ramparts of Seville and Triana were equipped with the most
formidable engines known to the military science of the age. The
Saracen catapults projected for immense distances and with
crushing power masses of stone and iron weighing more than a
thousand pounds. Their balistas cast a hundred arrows at once, and
the force of these missiles was so tremendous that they transfixed
with ease a horse completely sheathed in steel. The secret of the
composition of Greek fire the Moors had long before learned from
the soldiers of Constantinople, and this dangerous agent of
destruction had in their hands reached an even higher degree of
efficiency than it had elsewhere attained. Numbers of movable
towers, together with their unfortunate occupants, were consumed
by its unquenchable flames before they had time to approach the
walls. Considering the long duration of the siege, but little damage
was inflicted upon the fortifications of the city. The ordinary
resources of engineering skill became useless in the face of the
vigilance and determination of the garrison. Repeated attempts to
carry the place by escalade were repulsed. It was found
impracticable to mine the walls. Owing to the accuracy and
penetration of the projectiles discharged by the enemy, the machines
of the Christians could not be worked within a range that would
prove effective. The usual means at the disposal of an attacking
force having failed, it became necessary to resort to a blockade,
which the great numbers of the besieged must in the end render
successful. Hunger and despair were thus eventually found to be
more powerful weapons than all the military appliances at the
command of an extensive monarchy, than the enthusiastic energy of
a great nation, than the combined efforts of a thoroughly organized
hierarchy, than even the benedictions and indulgences of the Papal
throne. All of these influences had been exerted to effect the
subjection of the Moorish capital, and all had hitherto proved
unavailing. The Moslems, inclined to come to terms before their
provisions were entirely consumed and the patience of their enemies
exhausted, attempted to treat upon a basis of ordinary tribute and
vassalage,—a proposition which the King of Castile peremptorily
declined to consider. They then continued to offer concessions more
and more favorable to the dignity of the Christian monarchy, until a
treaty was finally agreed upon. It was with the greatest reluctance
that the piety of the Moslems consented to the surrender of their
great mosque, which, with its minaret, was the most sacred as well
as the most conspicuous monument of the city. They proposed its
demolition as one of the conditions of surrender. To this Ferdinand
replied that if a single brick of the edifice was disturbed he would not
leave a Moor alive in Seville. The title to the capital and its
dependencies was transferred to the Castilian crown. The
inhabitants who preferred to remain the subjects of the conqueror
were assured the enjoyment of their laws and their religion, and were
to be liable only to the imposition of taxes legalized by Moslem
usage; those to whom such propositions were repugnant were
permitted to retain their personal effects, and were promised
transportation to any land possessed by their co-religionists which
they might, without restriction, select. The policy of a court which
habitually encouraged the infraction of treaties was not favorable to
the retention of a population whose skill and industry were the true
sources of the wealth of Andalusia. The surviving members of the
Almohade dynasty passed over to Africa. A large majority of the
Moors emigrated to Granada, where the liberality of their new
sovereign and their own energy and perseverance soon raised them
to a higher condition of prosperity than ever. The conduct of
Mohammed I., who was placed in an anomalous and painful
situation by an inexorable decree of destiny, elicited the unstinted
praise of both friend and foe. His efforts contributed largely to the
success of the Christians. His military accomplishments and
personal courage were the admiration of cavaliers versed in every
martial exercise and in every stratagem of war. He enjoyed the
esteem and confidence of his royal suzerain. Yet, while participating
in the triumphs of his new allies, he never renounced the ties of
blood and faith which still bound him to his countrymen. His
intercession procured for them advantageous terms in the day of
disaster and humiliation. His sympathy alleviated the bitterness of
defeat. And when no other alternative was left to the vanquished
excepting the capricious indulgence of a perfidious enemy or
voluntary exile, they found under his sceptre a secure and happy
refuge from insult and oppression. More than a hundred thousand of
the most industrious peasantry in the world were thus added to the
population of his dominions by the politic and generous behavior of
the King of Granada. These colonists received ample grants of
lands. Seeds and implements of husbandry were furnished them by
the government, and they were exempted from all taxation for a term
of years. By this great immigration, which impoverished the territory
conquered by the Christians, the states of Granada received a
proportionate increase of profit and affluence.
The occupation of Seville by the Castilians was characterized by
the usual ceremonies incident to the capture of a Mussulman city.
The mosques were purified and consecrated to the Christian
worship. In the division of the spoil and the distribution of the rich
states of the Moslem, the Church exercised without remonstrance
the privileges of priority of selection and exorbitant estimate of
service. In the partition of infidel possessions the pretensions of the
altar were fast becoming paramount to the rights of the crown. The
ecclesiastical jurisdiction, suspended since the era of Visigothic
supremacy, was restored. A metropolitan diocese was established. A
multitude of religious houses were founded by the piety of the King
and the zeal or repentance of his followers; thousands of colonists
supplied the vacancies caused by emigration, and Seville within a
few months assumed the dull and cheerless appearance of a
Spanish city. The maritime district of Andalusia, to the westward, as
well as the towns situated between the capital and the coast,
successively acknowledged the claims of Spanish sovereignty, and
the undisputed authority of Castile and Leon soon prevailed from the
mountains of Biscay to the Mediterranean Sea.
While these events were transpiring, the Kings of Aragon and
Portugal had wrested from the grasp of the Moslems, enfeebled by
internal dissensions and constant defeat, the last fragments of the
empire of the khalifs; and there remained of the extensive territory
once ruled by the mighty potentates of Cordova but a single district,
designated in the enumeration of their states as a province, but now
daily increasing in renown as the tributary but powerful kingdom of
Granada.
The character of Ferdinand III., like that of so many of his
successors, was largely formed by the monitions of ecclesiastical
counsellors. He was most emphatically the creature of his age,—an
age of romantic undertakings, of mistaken piety, of religious
intolerance. Like the King of Aragon, his contemporary, the early
years of his reign were disturbed by domestic discord. Like him, also,
he triumphed by the aid of the clergy. Profoundly sagacious, he was
ever ready to profit by the factional quarrels of his infidel enemies.
He made large additions to his power by furnishing Castilian troops
to aid the ambition or the enmity of Saracen partisans in return for
the cession of important castles and fertile territory. As a pretended
neutral, alternately supporting the pretensions and promoting the
feuds of rival Moslem princes, the Crown of Castile was always the
gainer. King Ferdinand was a worthy representative of the
proselyting spirit which characterized his royal line from the very
institution of the monarchy. Popular with the masses, his subjects
had declared him worthy of canonization even in his lifetime. To the
ecclesiastical order he was an ideal sovereign. His donations to the
Church were frequent and prodigal. In the occupation of conquered
cities he always permitted the crucifix to take precedence of the
sceptre. When the wretched Albigenses, fleeing from the tortures of
Montfort and the swords of his bravos, attempted to find an asylum
beyond the Pyrenees, the pious King of Castile burned all who fell
into his hands, and even performed the highly meritorious duty of
personally assisting at the sacrifice and of heaping fagots upon the
funeral pyres which consumed those obstinate and abominable
heretics.
The conqueror of Andalusia fixed his final residence in the largest
of the provincial capitals which had bowed before the invincible
efforts of his arms. A few hours before his death, on the thirtieth of
May, 1252, in abasing humility he received the last sacrament,
kneeling upon the bare earth, with a rope about his neck, in the
guise and the attitude of a convicted malefactor.
In the great cathedral of Seville, the most incomparable
monument of ecclesiastical architecture in Europe, a magnificent
chapel has been raised to his memory. Before the high altar the
venerated monarch lies enshrined in a casket of massy silver.
Mounted effigies, encased in the armor of the thirteenth century,
tower above the kneeling worshippers. On the walls, carved in stone,
are the historic escutcheons of Castile and Leon. The royal
sepulchre bears an inscription in four languages—Latin, Spanish,
Hebrew, and Arabic—the respective idioms of the clergy, the people,
the tributary, and the conquered race. Around it, on each anniversary
of his death, a detachment of Granadan Moors, with lighted tapers in
their hands, once stood motionless and in silence. To-day, three
times in every year, the body of Castile’s most famous sovereign is
exposed to public view adorned with all the pomp of royalty,—with
the crown, the sceptre, the robes; mass is said, and a regiment of
soldiers salute the mouldering remains of one of the most eminent
and successful commanders of his time.
CHAPTER XX
PROSECUTION OF THE RECONQUEST
1252–1475