By V. Silvio. Winona State University.
Monitoring The general condition and the vital signs of the patient should be followed discount 75 mg triamterene overnight delivery blood pressure chart when pregnancy. Volume Excess Extra cellular fluid volume excess is generally iatrogenic or secondary to renal insufficiency generic 75mg triamterene amex blood pressure chart bpm, cirrhosis, or congestive heart failure. Clinical feature Subcutaneous edema, basilar rales on chest auscultation, distention of peripheral veins, and functional murmurs may be detected. Children, the elderly, patients with cardiac or renal problems are at increased risk of dangers of fluid replacement. During this period, it may not be advisable to administer large quantities of isotonic saline. Sodium depletion (Hyponatremia): Na+ less than 130 milliequivalent/liter Hyponatremia can be associated with 1. Most frequent cause of sodium and water depletion in surgery is small intestinal obstruction. Duodenal, Biliary, pancreatic and high intestinal fistula are also causes of hyponatremia. Water intoxication with excess volume and edema, over-prescribing of intravenous 5% D/W and colorectal washouts with plain water Clinical feature It can present with signs and symptoms of either fluid excess or fluid overload depending on the primary cause. Laboratory: Serum sodium and other electrolytes, hematocrit drops Treatment Ringer’s Lactate or Normal Saline In cases of volume depletion. Sodium Excess (Hypernatremia): Na+ more than 145 mmol Causes Excessive water loss in burns or sweating, insensible losses through the lungs. Clinical feature Depending on the cause it can be of fluid excess or fluid deficit. Treatment 5% D/W can be infused slowly 9 + Potassium (K ) Potassium is the most abundant intracellular cation. Prolonged administration of potassium free parenteral fluids with continued obligatory renal loss of potassium 4. Clinical symptoms and signs such as listlessness, slurred speech, muscular hypotonia, and depressed reflexes are presenting features. Potassium Excess (Hyperkalemia): K + more than 5 mmol Significant quantity of intracellular potassium is released into the extra cellular space in response to severe injury, surgery, acidosis and a catabolic state. A significant rise in serum potassium concentration may occur in these states in the presence of oliguric or anuric renal failure. Clinical features Nausea, vomiting, intermittent intestinal colic and diarrhea are the presenting pictures. Disappearance of T waves, heart block and cardiac arrest may develop with increasing levels of potassium. Hypocalcaemia (serum level below 8mg/dl) Common causes include: Hypoparathyroidism after thyroid surgery Acute pancreatitis Massive soft tissue infection (necrotizing fascitis) and Pancreatic and small bowel fistulas Clinical feature Latent hypocalcemia: Positive Chovestek’s and Trousseu’s sign. Symptomatic: Numbness and tingling, hyperactive tendon reflexes, muscle and abdominal cramp, tetany with carpopedal spasm and convulsions. Symptoms can include fatigue, lassitude, weakness of varying degree, anorexia, nausea and vomiting. Other symptoms include severe headaches, pain in the back and extremities, thirst, polydypsia and polyuria. Alkalosis (accumulation of Base or loss of acid) Metabolic Alkalosis Causes • Loss of acid from the stomach by repeated vomiting or aspiration • Excessive ingestion of absorbable alkali • Hypokalemic alkalosis in patients with pyloric stenosis: potassium loss due to repeated vomiting. Clinical Features • Cheyne-stokes respiration with periods of apnea • Tetany sometime occurs. It can also be caused by hyperventilation due to severe pain, hyper pyrexia and high altitude. Treatment Can be corrected by breathing into a plastic bag, or insufflation of carbon dioxide. Acidosis (accumulation of acid or loss of base) Metabolic Acidosis Causes Increase in fixed acids due to: • Anaerobic tissue metabolism (shock, infection, tissue injury) • Retention of metabolites in renal insufficiency • Formation of ketone bodies in diabetes or starvation Loss of bases in: Chronic diarrhea, gastro colic or high intestinal fistula, excess intestinal aspiration Clinical Features Besides signs and symptoms of the primary etiology like shock and infection, rapid, deep, noisy breathing is found. Treatment Tissue hypoxia should be treated by reperfusion Sodium bicarbonate can be given where bases have been lost or where the degree of acidosis is so severe that myocardial function is compromised. Respiratory Acidosis Causes Impaired alveolar ventilation due to: - Airway obstruction - Thoracic and upper abdominal incisions, abdominal distention in ileus - Pulmonary diseases (pneumonia, atelectasis especially post operative - Inadequate ventilation of the anesthetized patient Clinical Features Restlessness, hypertension and tachycardia may indicate inadequate ventilation with hypercapnia. Renal (slow) Diarrhea, As in respiratory acidosis Small-bowel fistula Metabolic Loss of fixed Vomiting Pulmonary (rapid) alkalosis acids Gastric suction Decrease rate and depth of Gain of base (pyloric obstruction) breathing bicarbonate Excessive bicarbonate Renal (slow) Potassium intake As in respiratory alkalosis depletion Diuretics 14 Review Questions 1. Know blood transfusion reactions and their preventions Definition Blood transfusion is the procedure of introducing the blood of a donor, or pre-donated blood by a recipient into the recipient’s bloodstream.
In response to this pressure change triamterene 75 mg visa blood pressure numbers for seniors, the flow of blood temporarily reverses direction through the foramen ovale purchase triamterene 75mg mastercard blood pressure zoloft, moving from the left to the right atrium, and blocking the shunt with two flaps of tissue. The increased oxygen concentration also constricts the ductus arteriosus, ensuring that these shunts no longer prevent blood from reaching the lungs to be oxygenated. Getting blood pressure under control: high blood pressure is out of control for too many Americans [Internet]. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source. P6 Section 3: Patient management The curriculum is underpinned by the principles P8 Section 4: Common problems and of adult learning. It is outcomes based, providing conditions a strong foundation for workplace learning and P11 Section 5: Safe patient care assessment, and facilitating doctors to refect on their current practice and take responsibility P12 Section 6: Communication for their own learning. A holistic approach is P12 Section 7: Professionalism adopted, focusing on integrated learning and P15 References assessment, identifying commonalities between different activities and delineating meaningful P16 Appendix 1: Patient Safety Framework key clinical and professional activities. Introduction to the Addiction Medicine module The Hospital Skills Program Addiction Medicine Doctors working within designated alcohol module identifes capabilities required to provide and other drug services have an extended role safe care to patients with alcohol and other drug requiring additional capabilities that are shaded problems. Central to the module is the professional development and training (see need for doctors to educate colleagues in order References). There is a large degree of does not extend beyond substance abuse to overlap between the two groups with a common other addictions such as gambling and eating base of knowledge, skills and attitudes. Has a good case-specific nuances and linking understanding of working knowledge their relational significance, a situation to appropriate of the management of thus reliably identifying key action. Fluent in most Has a comprehensive clinical decision making procedures and clinical understanding of the rural and clinical proficiency in management tasks. Responsibility (R) Uses and applies Autonomously able to Works autonomously, integrated management manage simple and consults as required for approach for all cases; common presentations and expert advice and refers consults prior to disposition consults prior to disposition to relevant teams about or definitive management or definitive management for patients who require and arranges senior review more complex cases. Confederation of Postgraduate Medical Education Councils (2009), Australian Curriculum Framework for Junior Doctors, Version 2. Mental Health and Drug and Alcohol Offce 2009, Mental Health for Emergency Departments – A Reference Guide. Ten Cate O and Scheele F (2007), “Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Van der Vleuten C and Schuwirth L (2005), “Assessing professional competence: from methods to programs” Medical Education 39: 309-317. The level of knowledge and performance required by an individual Category 1 Health care workers who provide is determined by their level of patient safety support services (eg, personal responsibility: care workers, volunteers, transport, catering, cleaning and reception Level 1 Foundation knowledge and staff). Level 4 Organisational knowledge and performance elements are Category 4 Clinical and administrative leaders required by health care workers with organisational responsibilities in category 4. Health care workers can move through the Patient Safety Framework as they develop personally and professionally. May not be used or reproduced without the express written permission of The National Center on Addiction and Substance Abuse at Columbia University. Pacheco, PhD President President Emeritus, University of Arizona Institute of Medicine and University of Missouri System Mark S. Rodriguez University of Florida College of Medicine Circuit Judge and McKnight Brain Institute Ninth Judicial Circuit of Florida Departments of Psychiatry, Neuroscience, Anesthesiology, Community Health & Family Reverend Msgr. Schaeffer Division on Alcohol and Drug Abuse, Judge Robert Maclay Widney McLean Hospital Chair & Professor University of Southern California Elizabeth R. Although advances in neuroscience, brain imaging and behavioral research clearly show that addiction is a complex brain disease, today the disease of addiction is still often misunderstood as a moral failing, a lack of willpower, a subject of shame and disgust. That is more than the number of people with heart disease (27 million), diabetes (26 million) or cancer (19 million). Another 32 percent of the population (80 million) uses tobacco, alcohol and other drugs in risky ways that threaten health and safety. While as of now there is no cure for addiction, there are effective psychosocial and pharmaceutical treatments and methods of managing the disease.
Please note that this set of guidelines is limited to small cell cheap triamterene 75mg visa pulse pressure stroke volume, non-small cell lung cancer discount 75mg triamterene visa blood pressure keeps spiking, and carcinoid. Patients from the age of 16 to the end of their 18th year should be treated in a principal treatment centre (see Appendix 10 for contact details of principal treatment centres). Teenagers and young adults in this age group should be treated either in the principal treatment centre or a designated hospital. All members of the stakeholder group have had the opportunity to review the guidelines, and their comments have been taken into consideration. Chapter 2, on early diagnosis, sets challenging improvements in availability of reports by radiologists of all chest X-rays of patients attending emergency departments. This is not current practice in all district general hospitals at the present time. The role of endo-bronchial ultrasound and biopsy of mediastinal nodes for staging of the disease is discussed in Chapter 3 on referral and diagnosis, and choice of radiological test and biopsy technique are covered in Chapter 4. It is essential to have a fully represented team participating in decision making to ensure that state-of-the-art treatment is offered to patients with the best chance of an improved outcome. The need for data collection to measure outcomes is stressed in Chapter 7, and the collection thereof, in particular the clinical data, remains the responsibility of the members of the multidisciplinary team, with support from a data manager. A summary of key information and guidance for staff dealing with patients and giving diagnoses of cancer is provided in Chapter 8. In Chapter 9, guidance is given for ways of achieving good communication with patients and professionals in primary care and the community. In Chapter 10, recommendations are made regarding requirements of a high-quality surgical service and how these standards can be measured. For more advanced, but potentially curable disease other radical treatments are described in Chapter 12 using concomitant or sequential chemo-radiotherapy or radiotherapy alone, and recommendations are made for follow-up of this group. The management of small cell lung cancer, Chapter 14, is largely unchanged, though there are recommendations for oral topotecan second line. The role of the nurse in providing information for patients and carers so that they can cope with the illness, and then deal with the consequences and long term side effects of the treatment as survivors is also discussed. As the majority of patients with lung cancer present with their disease in an advanced stage, palliative treatment of these patients is important to improve their quality of life, and in Chapter 17 this is considered in some detail, particularly in relation to some advances in specific therapies. During the coming months the clinicians will develop standards and measures against which organisations can be assessed. Measures to prevent people from taking up smoking, or helping them to quit, will reduce the number of deaths from lung cancer. In addition, patients with lung cancer undergoing curative treatment who stop smoking pre-treatment reduce the risk of complications from surgery. Rates are higher in males than females and in more socio-economic deprived groups. Incidence rates of lung cancer closely reflect past smoking prevalence with a time lag of approximately 20 to 30 years. Smoking prevalence has decreased over the past 50 years and this accounts for the decrease in the rates of lung cancer. The provision of effective smoking cessation services in an acute Trust setting remains highly variable despite evidence that delivering smoking cessation interventions to inpatients in hospital is effective (Rigotti et al. This is clearly a missed opportunity to deliver stop smoking interventions at a point at which an individual may be more susceptible to health advice and hence more motivated to quit. The key document for acute Trusts is Stop Smoking Interventions in Secondary Care. The main barriers to successful implementation tend to be administrative elements such as data collection. Lack of support from the Trust was also commonly cited as a barrier to implementing interventions. Smoking cessation interventions must be targeted to reach different population groups and provided across a range of settings. In particular, there has been an increased focus on the need to establish effective smoking cessation services in secondary care (Fiore et al.
Fibre makes food bulky or bigger — thiscanhelpapersonwhois overweight to eat less food discount 75 mg triamterene visa blood pressure medication that doesn't cause cough. Fibre slows the absorption of nutrients cheap triamterene 75 mg fast delivery blood pressure medication that doesn't cause dizziness, so it helps nutrients to enter the blood stream slowly. In this section you have learned about the macronutrients: carbohydrates, fats, proteins, water and ﬁbre, and how they nourish the body. You are now going to learn more about vitamins and minerals, the important micronutrients. They are grouped together because, as their name implies, they are a vital factor in the diet. Classiﬁcations of vitamins Vitamins are classiﬁed into two groups: Fat soluble vitamins (vitamins A, D, E and K) are soluble in fats and fat solvents. Water soluble vitamins (vitamins B and C, and folic acid) are soluble in water and so they cannot be stored in the body. However, an adequate micronutrient intake can only be achieved through sufﬁcient intake of a balanced diet that includes plenty of fruits and vegetables. Vitamins Function Food sources Vitamin A Night vision Breastmilk, tomatoes, cabbage, Epithelial cells form the thin layer Healing epithelial cells lettuce, pumpkins of tissue lining the gut, Normal development of teeth Mangoes, papaya, carrots respiratory and genitourinary and bones Liver, kidney, egg yolk, milk, systems. Vitamin K For blood clotting Green leafy vegetables Fruits, cereals, meat, dairy products B complex Metabolism of carbohydrates, Milk, egg yolk, liver, kidney proteins and fats and heart Whole grain cereals, meat, whole bread, ﬁsh, bananas Scurvy is a disease caused by Vitamin C Prevention of scurvy Fresh fruits (oranges, banana, vitamin C deﬁciency which leads mango, grapefruits, lemons, Aiding wound healing to sore skin, bleeding gums and potatoes) and vegetables internal bleeding. Examples of minerals include calcium, iron, iodine, ﬂuorine, phosphorus, potassium, zinc, selenium, and sodium. Minerals Function Food sources Calcium Gives bones and teeth rigidity and Milk, cheese and dairy products strength Foods fortiﬁed with calcium, e. The vitamins and minerals that make up micronutrients have a crucial role in enabling the body to function properly. Your role as a Health Extension Practitioner is to advise people in your community to have a balanced diet that includes micronutrients. You will learn more about micronutrients in Study Session 7, in particular the impact of deﬁciencies in vitamin A, iron and iodine on individuals and communities. In this section we’ll discuss what a balanced diet is and the beneﬁts of a balanced diet. It is important that you know enough to be able to recommend a balanced diet for the people in your community. Eating a balanced diet means choosing a wide variety of foods and drinks from all the food groups. It also means eating certain things in small amounts, namely saturated fat, cholesterol, simple sugar, salt and alcohol. The goal is to take in all of the nutrients you need for health at the recommended levels and perhaps restrict those things that are not good for the body. Then you can decide if people need help or food from the other food groups further support or information to improve the balance of things they eat. It helps us identify the food groups people should combine in order to make a balanced diet. The food groups at the top of the pyramid should be eaten in moderation (small amount) but food groups at the bottom of the pyramid should be eaten in larger amounts. For example, ‘injera’ is the staple diet in many sites, maize in other areas, and ‘kocho’ in the southern part of the country. These foods are usually cheap, and provide most of the energy, protein and ﬁbre in a meal, as well as some vitamins. For example, legumes such as peas, beans and lentils add protein, iron and other minerals and fat; green and yellow vegetables and fruits add vitamins A and C, folate, and ﬁbre. A diet which is composed of staples, legumes and vegetables or fruits is a good, balanced diet because this combination of foods will provide most of the nutrients that the people in your community need. Animal sources are good because they contain plenty of protein, have high energy (due to the fats), and the iron is easily absorbed compared with the iron sourced from plants. Therefore adding small amounts of animal products like meat, milk and eggs to staples, legumes and vegetables will improve the balanced diet.
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