By W. Angir. Lenox Institute of Water Technology.
Consists of a hospital bed generic 75 mg lyrica with mastercard, bed side stand order 150mg lyrica otc, over bed table lyrica 75 mg lowest price, chair, overhead light, suction and oxygen, electrical outlets, sphygmomanometer, a nurse’s call light, waste container and bed side table and others as needed and available. Hospital Bed • Gatch bed: a manual bed which requires the use of hand racks or foot pedals to manipulate the bed into 50 Basic Clinical Nursing Skills desired positions i. Side rails • It should be attached to both sides of the bed _ Full rails – run the length of the bed – Half rails _ run only half the length of the bed and commonly attached to the pediatrics bed. Bed Side Table/Cabinet • Is a small cabinet that generally consists of a drawer and a cupboard area with shelves • Used to store the utensils needed for clients care. Includes the washbasin (bath basin, emesis (kidney) basin, bed pan and urinal • Has a towel rack on either sides or along the back • Is best for storing personal items that are desired near by or that will be used frequently E. Over Bed Table • The height is adjustable 51 Basic Clinical Nursing Skills • Can be positioned and consists of a rectangular, flat surface supported by a side bar attached to a wide base on wheels • Along side or over the bed or over a chair • Used for holding the tray during meals, or care items when completing personal hygiene F. The Chair • Most basic care units have at least one chair located near the bedside • For the use of the client, a visitor, or a care provider G. Overhead Light (examination light) • Is usually placed at the head of the bed, attached to either the wall or the ceiling • A movable lamp may also be used • Useful for the client for reading or doing close work • Important for the nurse during assessment H. Suction and Oxygen Outlets • Suction is a vacuum created in a tube that is used to pull (evacuate) fluids from the body E. Care of Patient Unit • Nursing staffs are not responsible for actual cleaning of dust and other dirty materials from hospital. General Instructions for Care of Hospital Equipment • Use articles only for the purpose for which they are intended. Care of Linen and Removal of Stains • Clean linen should be folded properly and be kept neatly in the linen cupboard. Care of Pick Up Forceps and Jars Pickup forceps: is an instrument that allows one to pick up sterile equipment. Pick up forceps should be kept inside the jar in which 2/3 of the jar should be filled with antiseptic solution • Wash pick up forceps and jars and sterilize daily • Fill jar with disinfectant solution daily such as detol or preferably carbolic solution 56 Basic Clinical Nursing Skills • Care should be taken not to contaminate tip of the forceps • Always hold tip downward • If tip of forceps is contaminated accidentally, it should be sterilized before placing it back in the jar to avoid contamination. Rubber Bags Example: hot water bottles, ice bags should be drained and dried They should be inflated with air and closed to prevent the sides from sticking together 6. Rubber Tubing • Should be washed with warm, soapy water • The inside should be flushed and rinsed well Study questions: 1. Admission Admission is a process of receiving a new patient to an individual unit (ward) of the hospital. Make introduction and orient the patient • Greet the patient • Introduce self to the patient and the family • Explain what will occur during the admission process (admission routines) such as admission bath, put on hospital gowns etc. Observation and physical examination such as: • Vital signs; temperature pulse, respiration and blood pressure. Documentation • Record all parts of the admission process • Other recording include ⇐ Notification to dietary departments ⇐ Starting kardex card and medication records ⇐ If there is specific form to the facility, complete it. Transfer of the patient to another unit Transfer of the patient to another unit is done for several reasons. Procedure Explain the transfer to the client and the family Assemble all the client’s personal belongings, charts, x-films and lab reports. Give the time, the unit to which the transfer occurs, types of transportation (wheelchair, stretcher), and the cleint’s physical and psychological condition Make sure that the receiving unit is ready. Plan for continuing care of the patient • Referral as necessary • Give information for a person involved in the patient care. Teaching the patient about • What to expect about disease outcome • Medications (Treatments) • Activity • Diet 62 Basic Clinical Nursing Skills • Need for continued health supervision, and others as needed 4. Do final assessment of physical and emotional status of the patient and the ability to continue own care. Check and return all patients’ personal property (bath items in patient unit and those kept in safe area). Help the patient or family to deal with business office for customary financial matters and in obtaining supplies. Keep records o Write discharge note o Keep special forms for facility Discharge summaries usually include: • Description of client’s condition at discharge • Treatment (e. Wound care, Current medication) • Diet • Activity level • Restrictions Referral is a condition in which a client/patient is sent to a higher health care system for better diagnostic and therapeutic actions. When the patient wants to leave an agency without the permission of the physician/nurse in charge – an authorized. If the client refuses to sign the form, document the fact on the form and have another health professional witness this 6. When the patient leaves the agency, notify the physician, nurse in charge, and agency administration as appropriate 8. Assist the patient to leave as if this were a usual discharge from the agency (the agency is still responsible while the patient is on premises) 64 Basic Clinical Nursing Skills Study Questions: 1. Vital Signs (Cardinal Signs) Vital signs reflect the body’s physiologic status and provide information critical to evaluating homeostatic balance. The term “vital” is used because the information gathered is the clearest indicator of overall health status. I Temperature –Body temperature is the measurement of heat inside a person’s body (core temperature); it is the balance between heat produced and heat lost. Core Temperature • Is the Temperature of the deep tissues of the body, such as the cranium, thorax, abdominal cavity, and pelvic cavity • Remains relatively constant • Is the Temperature that we measure with thermometer 2. Surface Temperature: • The temperature of the skin, the subcutaneous tissue and fat Alterations in Body Temperature 0 0 Normal body temperature is 37 C or 98. Intermittent fever: the body temperature alternates at regular intervals between periods of fever and periods of normal or subnormal temperature. Remittent fever: a wide range of temperature fluctuation (more 0 than 2 c) occurs over the 24 hr period, all of which are above normal 3. Relapsing fever: short febrile periods of a few days are interspersed with periods of 1 or 2 days of normal temperature. Constant fever: the body temperature fluctuates minimally but always remains above normal Factors Affecting Body Temperature 1. Age 70 Basic Clinical Nursing Skills • Children’s temperature continue to be more labile than those of adults until puberty • Elderly people, particularly those > 75 are at risk of hypothermia • Normal body temperature of the newborn if taken orally 0 is 37 C. Diurnal variations (circadian rhythms) • Body temperature varies through out the day • The point of highest body temperature is usually reached between 8:00 p. Hormones • In women progesterone secretion at the time of o ovulation raises body temperature by about 0. Stress 71 Basic Clinical Nursing Skills • Stimulation of skin can increases the production of epinephrine and nor epinephrine – which increases metabolic activity and heat production. Measuring Body Temperature Sites to Measure Temperature Most common are: • Oral • Rectal • Axillary • Tympanic Thermometer: is an instrument used to measure body temperature Types 1. Tympanic 72 Basic Clinical Nursing Skills In other way it is also divided as mercury, digital and electronic types. In developed countries, mercury type thermometers are no more use in hospital setup but in our context still very important.
Prophylactic dosing should be started in anticipation of an influenza A outbreak and before or after contact with individuals with influenza A virus respiratory tract illness buy lyrica 75mg. When prophylaxis is started with inactivated influenza A virus vaccine buy generic lyrica 75 mg on line, it should be administered for 2 to 4 weeks after the vaccine has been given (i purchase 75 mg lyrica free shipping. When inactivated influenza A virus vaccine is un- available or contraindicated, amantadine should be administered for the duration of known influenza A infection in the community because of repeated and unknown exposure. The daily dosage of amantadine for adults is 200 mg; two 100 mg tablets (or four teaspoonfuls of syrup) as a once daily dose. If central nervous system effects develop on a once daily dosage, a split dosage schedule may reduce such complaints. Low-dose amantadine (100 mg/day) can reduce toxicity and may maintain the prophylactic efficacy seen with 200 mg/day (Sears 1987). In an experimental challenge study on 78 subjects, using doses of 50 mg, 100 mg or 200 mg/day, there was no significant difference between the groups in influenza illness or viral shedding (Reuman 1989). In elderly institutionalised patients, individualised dosing of amantadine, based upon a patient’s creatinine clearance, seems to be effective while reducing adverse reactions (Kolbe 2003). Amantadine may cause mydriasis and should therefore not be given to patients with untreated closed-angle glaucoma. Care should be exer- cised when administering amantadine to patients with a history of recurrent ec- zematoid rash, or to patients with psychosis or severe psychoneurosis not controlled by chemotherapeutic agents (Symmetrel 2003). For prophylaxis, amanta- dine should be started as soon as possible after exposure and continued for at least 10 days. Special Dosage: persons with reduced kidney function and elderly persons may need lower doses (or less frequent doses). Reduced clearance in individuals > 60 years and in patients with renal insufficiency: half-life is increased when creatinine clearance is less than 40 ml/min. Comments/Warnings: no well-controlled studies have been done in pregnant women to evaluate the safety of amantadine. Although no informa- tion is available on the effects in infants, the manufacturer recommends that aman- tadine be used cautiously in nursing mothers. Patients receiving amantadine who note central nervous system effects or blurring of vision should be cautioned against driving or working in situations where alert- ness and adequate motor co-ordination are important. Prolonged excretion of amantadine-resistant influ- enza a virus quasi species after cessation of antiviral therapy in an immunocompromised patient. Incidence of adamantane resistance among influenza A (H3N2) viruses isolated worldwide from 1994 to 2005: a cause for concern. A prospective double-blind study of side effects associated with the administration of amantadine for influenza A virus prophy- laxis. Gender and age as factors in the inhibition of renal clearance of amantadine by quinine and quinidine. An amantadine hydrochloride dosing program adjusted for renal function during an influenza outbreak in elderly institutional- ized patients. Structural characteristics of the M2 protein of influenza A viruses: evidence that it forms a tetrameric channel. The neuraminidase enzyme is responsible for cleaving sialic acid residues on newly formed virions and plays an essential role in the re- lease and spread of progeny virions. When exposed to oseltamivir, the influenza virions aggregate on the surface of the host cell, thereby limiting the extent of in- fection within the mucosal secretions (McNicholl 2001) and reducing viral infec- tivity. Oseltamivir is indicated in the prophylaxis of influenza and for the treatment of uncomplicated acute illness due to influenza in patients 1 year and older who have been symptomatic for no more than 2 days. H5N1 strains are generally sensitive against oseltamivir, but there are no data on its clinical efficacy. Clinical studies have shown that neuraminidase inhibitors can decrease the duration of influenza-related symptoms if initiated within 48 hours of onset. Clinical efficacy is about 60-70 % and, for treatment started within 48 hours, symptoms such as my- algias, fever, and headache were reduced by approximately 0. Treatment with oseltamivir does not seem to adversely affect the primary in vivo cellular immune responses to influenza virus infection (Burger 2000). Oseltamivir is generally well-tolerated with the only clinically important side effect being mild gastrointestinal upset (Doucette 2001). Recently, the drug has been linked to a number of cases of psychological disorders and two teenage suicides in Japan. However, there is currently no evidence of a causal relationship between oseltamivir intake and suicide. Oseltamivir 195 Structure Oseltamivir is an ethyl ester prodrug which requires ester hydrolysis to be con- verted to the active form, oseltamivir carboxylate [3R,4R,5S]-4-acetamido-5- amino-3-(1-ethylpropoxy)-1-cyclohexene-1-carboxylate phosphate. The discovery of oseltamivir was possible through rational drug design utilising available x-ray crystal structures of sialic acid analogues bound to the active site of the influenza virus neuraminidase (Lew 2000). Oseltamivir was developed through modifications to the sialic acid analogue framework (including the addition of a lipophilic side chain) that allow the drug to be used orally (Kim 1998). Pharmacokinetics Following oral administration, oseltamivir is readily absorbed from the gastrointes- tinal tract. After conversion to the active metabolite oseltamivir carboxylate in the liver, it distributes throughout the body, including the upper and lower respiratory tract (Doucette 2001). The active metabolite is detectable in plasma within 30 minutes and reaches maximum concentrations after 3 to 4 hours. Once peak plasma concentrations have been attained, the concentration of the active metabolite declines with an apparent half-life of 6 to 10 hours (He 1999). In patients with renal impairment, metabolite clearance decreases linearly with creatinine clearance, and averages 23 h after oral administration in individuals with a creatinine clear- ance < 30 ml/min (Doucette 2001). A dosage reduction to 75 mg once daily is rec- ommended for patients with a creatinine clearance < 30 ml/min (1. The drug and the active metabolite are excreted by glomerular filtration and active tubular secretion without further metabolism (Hill 2001). Neither compound interacts with cytochrome P450 mixed-function oxidases or glucuronosyltransferases (He 1999). Thus, the potential is low for drug-drug in- teractions, which appear to be limited to those arising from competitive inhibition of excretion by the renal tubular epithelial cell anionic transporter. Probenecid blocks the renal secretion of oseltamivir, more than doubling systemic exposure oseltamivir carboxylate (Hill 2002). This competition is unlikely to be clinically 196 Drug Profiles relevant, but there has been speculation about using probenecid to “stretch” osel- tamivir stocks in situations of pandemic shortage (Butler 2005). The metabolism of oseltamivir is not compromised in hepatically impaired patients and no dose adjustment is required (Snell 2005). In elderly individuals, exposure to the active metabolite at steady state is approxi- mately 25 % higher compared with young individuals; however, no dosage adjust- ment is necessary (He 1999). Young children 1 to 12 years of age clear the active metabolite oseltamivir car- boxylate at a faster rate than older children and adults, resulting in lower exposure. Increasing the dose to 2 mg/kg twice daily resulted in drug exposures comparable to the standard 1 mg/kg twice daily dose used in adults (Oo 2001). Toxicity The most frequent side effects are nausea and vomiting which are generally of a mild to moderate degree and usually occur within the first 2 days of treatment.
Cells cheap 150mg lyrica mastercard, for example purchase 75 mg lyrica overnight delivery, have a cell membrane (also referred to as the plasma membrane) that keeps the intracellular environment—the fluids and organelles—separate from the extracellular environment order 150 mg lyrica fast delivery. Blood vessels keep blood inside a closed circulatory system, and nerves and muscles are wrapped in connective tissue sheaths that separate them from surrounding structures. In the chest and abdomen, a variety of internal membranes keep major organs such as the lungs, heart, and kidneys separate from others. The body’s largest organ system is the integumentary system, which includes the skin and its associated structures, such as hair and nails. The surface tissue of skin is a barrier that protects internal structures and fluids from potentially harmful microorganisms and other toxins. Metabolism The first law of thermodynamics holds that energy can neither be created nor destroyed—it can only change form. Your basic function as an organism is to consume (ingest) energy and molecules in the foods you eat, convert some of it into fuel for movement, sustain your body functions, and build and maintain your body structures. Your body can assemble, by utilizing energy, the complex chemicals it needs by combining small molecules derived from the foods you eat • Catabolism is the process by which larger more complex substances are broken down into smaller simpler molecules. The complex molecules found in foods are broken down so the body can use their parts to assemble the structures and substances needed for life. Responsiveness Responsiveness is the ability of an organism to adjust to changes in its internal and external environments. An example of responsiveness to external stimuli could include moving toward sources of food and water and away from perceived dangers. Changes in an organism’s internal environment, such as increased body temperature, can cause the responses of sweating and the dilation of blood vessels in the skin in order to decrease body temperature, as shown by the runners in Figure 1. Movement Human movement includes not only actions at the joints of the body, but also the motion of individual organs and even individual cells. As you read these words, red and white blood cells are moving throughout your body, muscle cells are contracting and relaxing to maintain your posture and to focus your vision, and glands are secreting chemicals to regulate body functions. Your body is coordinating the action of entire muscle groups to enable you to move air into and out of your lungs, to push blood throughout your body, and to propel the food you have eaten through your digestive tract. Consciously, 16 Chapter 1 | An Introduction to the Human Body of course, you contract your skeletal muscles to move the bones of your skeleton to get from one place to another (as the runners are doing in Figure 1. Anatomic structures and physiological processes allow runners to coordinate the action of muscle groups and sweat in response to rising internal body temperature. Development includes the process of differentiation, in which unspecialized cells become specialized in structure and function to perform certain tasks in the body. Development also includes the processes of growth and repair, both of which involve cell differentiation. Humans, like all multicellular organisms, grow by increasing the number of existing cells, increasing the amount of non-cellular material around cells (such as mineral deposits in bone), and, within very narrow limits, increasing the size of existing cells. Because death will come to all complex organisms, without reproduction, the line of organisms would end. Earth and its atmosphere have provided us with air to breathe, water to drink, and food to eat, but these are not the only requirements for survival. Although you may rarely think about it, you also cannot live outside of a certain range of temperature and pressure that the surface of our planet and its atmosphere provides. The three basic classes of nutrients are water, the energy-yielding and body-building nutrients, and the micronutrients (vitamins and minerals). Depending on the environmental temperature and our state of health, we may be able to survive for only a few days without water. The body’s functional chemicals are dissolved and transported in water, and the chemical reactions of life take place in water. Moreover, water is the largest component of cells, blood, and the fluid between cells, and water makes up about 70 percent of an adult’s body mass. Water also helps regulate our internal temperature and cushions, protects, and lubricates joints and many other body structures. The energy-yielding nutrients are primarily carbohydrates and lipids, while proteins mainly supply the amino acids that are the building blocks of the body itself. You ingest these in plant and animal foods and beverages, and the digestive system breaks them down into molecules small enough to be absorbed. Although you might feel as if you are starving after missing a single meal, you can survive without consuming the energy-yielding nutrients for at least several weeks. Water and the energy-yielding nutrients are also referred to as macronutrients because the body needs them in large amounts. These elements and compounds participate in many essential chemical reactions and processes, such as nerve impulses, and some, such as calcium, also contribute to the body’s structure. Your body can store some of the micronutrients in its tissues, and draw on those reserves if you fail to consume them in your diet for a few days or weeks. Some others micronutrients, such as vitamin C and most of the B vitamins, are water-soluble and cannot be stored, so you need to consume them every day or two. Narrow Range of Temperature You have probably seen news stories about athletes who died of heat stroke, or hikers who died of exposure to cold. Such deaths occur because the chemical reactions upon which the body depends can only take place within a narrow range of body temperature, from just below to just above 37°C (98. When body temperature rises well above or drops well below normal, certain proteins (enzymes) that facilitate chemical reactions lose their normal structure and their ability to function and the chemical reactions of metabolism cannot proceed. Adequate water (from the extracellular fluid in the body) is necessary to produce sweat, so adequate fluid intake is essential to balance that loss during the sweat response. Not surprisingly, the sweat response is much less effective in a humid environment because the air is already saturated with water. Thus, the sweat on the skin’s surface is not able to evaporate, and internal body temperature can get dangerously high. The body responds to cold by reducing blood circulation to the extremities, the hands and feet, in order to prevent blood from cooling there and so that the body’s core can stay warm. Even when core body temperature remains stable, however, tissues exposed to severe cold, especially the fingers and toes, can develop frostbite when blood flow to the extremities has been much reduced. This form of tissue damage can be permanent and lead to gangrene, requiring amputation of the affected region. Controlled Hypothermia As you have learned, the body continuously engages in coordinated physiological processes to maintain a stable temperature. Controlled hypothermia is clinically induced hypothermia performed in order to reduce the metabolic rate of an organ or of a person’s entire body. Controlled hypothermia often is used, for example, during open-heart surgery because it decreases the metabolic needs of the brain, heart, and other organs, reducing the risk of damage to them. The heart is cooled further and is maintained at a temperature below 15°C (60°F) for the duration of the surgery.