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It should be used only if the intestines do not work adequately purchase 10 mg rosuvastatin with visa, if the client has an obstruction or has fistula buy rosuvastatin 5mg on-line, if the bowel rest is required order rosuvastatin 10mg without a prescription. Implantable vascular access devices are placed under the skin in a subcutaneous pocket and a surgically tunneled silicone catheter is place in the cephalic or external jugular vein and threaded to the superior vana cava. Planning/Objective Setting - To provide a nitrogen source for clients unable to ingest protein normally. Teach Valsalva’s Maneuver for use during catheter insertion procedure if client does not have a cardiac disorder. Position client in head-down position with head turned to opposite direction of catheter insertion size. Cleanse insertion area with Betadine solution (if allergic to Betadine solution, use 70% isopropyl alcohol). But if unconscious, place in prone position with head over the edge of the bed or head lower than the body. Measure the tube from the tip of the nose up to the ear lobe and from the bridge of the nose to the end of the sternum. If required, and continue the process until the returned fluid becomes clear and the prescribed solution has been used. An electric suction machine The continues method is indicated when it is absolutely necessary and desirable to keep the stomach and duodenum empty and at rest. Draw plunger back to with draw the fluid collect specimen, If needed 236 Basic Clinical Nursing Skills 9. Enema Enema: is the introduction of fluid into rectum and sigmoid colon for cleansing, therapeutic or diagnostic purposes. Purpose: • For emptying – soap solution enema • For diagnostic purpose (Barium enema) • For introducing drug/substance (retention enema) Solution used: 1. Epsum salt 15 gm – 120 gm in 1,000 ml of H2O 237 Basic Clinical Nursing Skills Mechanisms of some solutions used in enema 1. Soap solution: increases peristalsis due to irritating effect of soap to the lumenal mucosa of the colon. Classified into: • Cleansing (evacuation) • Retention • Carminative • Return flow enema Cleansing enema Kinds: 1. High enema ƒ Is given to clean as much of the colon as possible ƒ The solution container should be 30-45 cm about the rectum 2. Low enema ƒ Is administered to clean the rectum and sigmoid colon only 238 Basic Clinical Nursing Skills Guidelines o Enema for adults are usually given at 40-43 c and for children at o 37. Colonoscopy ƒ To remove feces prior to a surgical procedure or a delivery ƒ For incontinent patients to keep the colon empty ƒ For diagnostic test E. Principles: ƒ Is given slowly by means of a rectal tube ƒ The amount of fluid is usually 150-200 cc ƒ Cleansing enema is given after the retention time is over ƒ Temperature of enema fluid is 37. Procedure Similar with the cleansing enema but the enema should be administered very slowly and always be preceded by passing a flatus tube 242 Basic Clinical Nursing Skills Note 1. Kinds of solution used to supply body with fluid are plain H2O, normal saline, glucose 5% sodabicarbonate 2-5% 6. Asafetida in 1:1000 to relieve distention Procedure • Insert the tube like the cleansing enema • The client lies on the bed with hips close to the side of the bed (client assumes a right side lying position for siphoning) • Open the clamp and allow to run about 1,000 cc of fluid in the bowel, then siphon back into the bucket • Carry on the procedure until the fluid return is clear Note: • The procedure should not take > 2 hrs • Should be finished 1 hr before exam or x-ray – to give time for the large intestine to absorb the rest of the fluid • Give cleansing enema ½ hr before the rectal wash out • Allow the fluid to pass slowly Amount of solution • 5-6 liters or until the wash out rectum fluid becomes clear Passing a Flatus Tube Purpose • To decrease flatulence (sever abdominal distention) • Before giving a retention enema 244 Basic Clinical Nursing Skills Procedure • Place the patient in left. Lateral position • Lubricate the tube about 15 cm • Separate the rectum and insert 12-15 cm in to the rectum and tape it • Connect the free end to extra tubing by the glass connector • The end of the tube should reach the (tape H2O) solution in the bowel • The amount of air passed can be seen bubbling through the solution (a funnel may be connected to free end of tube and placed in an antiseptic solution in bowel) • Teach client to avoid substances that cause flatulent • Leave the rectal tube in place for a period or no longer than 20 minute – can affect the ability to voluntarily control the sphincter if placement is prolonged • Reinsert the rectal tube every 2-3 hrs if the distention has been unrelieved or reaccumulates – allows gas to move in the direction of the rectum. Urinary Catheterization Definition of catheterization: Is the introduction of a tube (catheter) through the urethra into the urinary bladder • Is performed only when absolutely necessary for fear of infection and trauma 245 Basic Clinical Nursing Skills Note. Determine appropriate catheter size - are determined by diameter of lumen - graded on French scale or number. Determine appropriate catheter length by the clients gender • For adult male – 40 cm catheter • For adult females – 22 cm catheter 4. Select appropriate balloon size • 5 ml – for adults • 3 ml – for children Catheterization Using a straight catheter Purpose • To relieve discomfort due to bladder distention • To assess the residual urine • To obtain a urine specimen • To empty the bladder prior to surgery Equipment I.

Regulation of Hormone Secretion To prevent abnormal hormone levels and a potential disease state order rosuvastatin 5mg without a prescription, hormone levels must be tightly controlled rosuvastatin 10 mg amex. Feedback loops govern the initiation and maintenance of most hormone secretion in response to various stimuli buy rosuvastatin 5 mg cheap. Role of Feedback Loops The contribution of feedback loops to homeostasis will only be briefly reviewed here. Positive feedback loops are characterized by the release of additional hormone in response to an original hormone release. The initial release of oxytocin begins to signal the uterine muscles to contract, which pushes the fetus toward the cervix, causing it to stretch. This, in turn, signals the pituitary gland to release more oxytocin, causing labor contractions to intensify. Negative feedback is characterized by the inhibition of further secretion of a hormone in response to adequate levels of that hormone. An example of a negative feedback loop is the release of glucocorticoid hormones from the adrenal glands, as directed by the hypothalamus and pituitary gland. As glucocorticoid concentrations in the blood rise, the hypothalamus and pituitary gland reduce their signaling to the adrenal glands to prevent additional glucocorticoid secretion (Figure 17. This signaling is inhibited when glucocorticoid levels become elevated by causing negative signals to the pituitary gland and hypothalamus. Role of Endocrine Gland Stimuli Reflexes triggered by both chemical and neural stimuli control endocrine activity. These reflexes may be simple, involving only one hormone response, or they may be more complex and involve many hormones, as is the case with the hypothalamic control of various anterior pituitary–controlled hormones. Humoral stimuli are changes in blood levels of non-hormone chemicals, such as nutrients or ions, which cause the release or inhibition of a hormone to, in turn, maintain homeostasis. For example, osmoreceptors in the hypothalamus detect changes in blood osmolarity (the concentration of solutes in the blood plasma). This reabsorption causes a reduction of the osmolarity of the blood, diluting the blood to the appropriate level. High blood glucose levels cause the release of insulin from the pancreas, which increases glucose uptake by cells and liver storage of glucose as glycogen. An endocrine gland may also secrete a hormone in response to the presence of another hormone produced by a different endocrine gland. Such hormonal stimuli often involve the hypothalamus, which produces releasing and inhibiting hormones that control the secretion of a variety of pituitary hormones. A common example of neural stimuli is the activation of the fight-or-flight response by the sympathetic nervous system. When an individual perceives danger, sympathetic neurons signal the adrenal glands to secrete norepinephrine and epinephrine. These responses boost the body’s transport of oxygen to the brain and muscles, thereby improving the body’s ability to fight or flee. Foods and liquids should not be microwave-heated in any form of plastic: use paper, glass, or ceramics instead. This complex secretes several hormones that directly produce responses in target tissues, as well as hormones that regulate the synthesis and secretion of hormones of other glands. In addition, the hypothalamus–pituitary complex coordinates the messages of the endocrine and nervous systems. In many cases, a stimulus received by the nervous system must pass through the hypothalamus–pituitary complex to be translated into hormones that can initiate a response. The hypothalamus is a structure of the diencephalon of the brain located anterior and inferior to the thalamus (Figure 17. In addition, the hypothalamus 744 Chapter 17 | The Endocrine System is anatomically and functionally related to the pituitary gland (or hypophysis), a bean-sized organ suspended from it by a stem called the infundibulum (or pituitary stalk). It consists of two lobes that arise from distinct parts of embryonic tissue: the posterior pituitary (neurohypophysis) is neural tissue, whereas the anterior pituitary (also known as the adenohypophysis) is glandular tissue that develops from the primitive digestive tract. The hormones secreted by the posterior and anterior pituitary, and the intermediate zone between the lobes are summarized in Table 17. The pituitary gland consists of an anterior and posterior lobe, with each lobe secreting different hormones in response to signals from the hypothalamus. The cell bodies of these regions rest in the hypothalamus, but their axons descend as the hypothalamic–hypophyseal tract within the infundibulum, and end in axon terminals that comprise the posterior pituitary (Figure 17.

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Further discount rosuvastatin 5mg otc, the walls of the larger vessels are too thick for nutrients to diffuse through to all of the cells purchase rosuvastatin 20mg fast delivery. Larger arteries and veins contain small blood vessels within their walls known as the vasa vasorum—literally “vessels of the vessel”—to provide them with this critical exchange discount rosuvastatin 5mg on-line. Since the pressure within arteries is relatively high, the vasa vasorum must function in the outer layers of the vessel (see Figure 20. The lower pressure within veins allows the vasa vasorum This OpenStax book is available for free at http://cnx. The restriction of the vasa vasorum to the outer layers of arteries is thought to be one reason that arterial diseases are more common than venous diseases, since its location makes it more difficult to nourish the cells of the arteries and remove waste products. There are also minute nerves within the walls of both types of vessels that control the contraction and dilation of smooth muscle. Both arteries and veins have the same three distinct tissue layers, called tunics (from the Latin term tunica), for the garments first worn by ancient Romans; the term tunic is also used for some modern garments. From the most interior layer to the outer, these tunics are the tunica intima, the tunica media, and the tunica externa (see Figure 20. Comparison of Tunics in Arteries and Veins Arteries Veins General Thick walls with small lumens Thin walls with large lumens appearance Generally appear rounded Generally appear flattened Endothelium usually appears wavy due to constriction of Endothelium appears smooth Tunica intima smooth muscle Internal elastic membrane Internal elastic membrane present in larger vessels absent Normally thinner than the tunica externa Smooth muscle cells and Normally the thickest layer in arteries collagenous fibers Smooth muscle cells and elastic fibers predominate (the Tunica media predominate proportions of these vary with distance from the heart) Nervi vasorum and vasa External elastic membrane present in larger vessels vasorum present External elastic membrane absent Normally the thickest layer in veins Normally thinner than the tunica media in all but the largest Collagenous and smooth arteries Tunica externa fibers predominate Collagenous and elastic fibers Some smooth muscle fibers Nervi vasorum and vasa vasorum present Nervi vasorum and vasa vasorum present Table 20. Lining the tunica intima is the specialized simple squamous epithelium called the endothelium, which is continuous throughout the entire vascular system, including the lining of the chambers of the heart. Damage to this endothelial lining and exposure of blood to the collagenous fibers beneath is one of the primary causes of clot formation. Until recently, the endothelium was viewed simply as the boundary between the blood in the lumen and the walls of the vessels. Recent studies, however, have shown that it is physiologically critical to such activities as helping to regulate capillary exchange and altering blood flow. The endothelium releases local chemicals called endothelins that can constrict the smooth muscle within the walls of the vessel to increase blood pressure. Uncompensated overproduction of endothelins may contribute to hypertension (high blood pressure) and cardiovascular disease. Next to the endothelium is the basement membrane, or basal lamina, that effectively binds the endothelium to the connective tissue. The basement membrane provides strength while maintaining flexibility, and it is permeable, allowing materials to pass through it. The thin outer layer of the tunica intima contains a small amount of areolar connective tissue that consists primarily of elastic fibers to provide the vessel with additional flexibility; it also contains some collagenous fibers to provide additional strength. In larger arteries, there is also a thick, distinct layer of elastic fibers known as the internal elastic membrane (also called the internal elastic lamina) at the boundary with the tunica media. Like the other components of the tunica intima, the internal elastic membrane provides structure while allowing the vessel to stretch. It is permeated with small openings that 892 Chapter 20 | The Cardiovascular System: Blood Vessels and Circulation allow exchange of materials between the tunics. In addition, many veins, particularly in the lower limbs, contain valves formed by sections of thickened endothelium that are reinforced with connective tissue, extending into the lumen. Under the microscope, the lumen and the entire tunica intima of a vein will appear smooth, whereas those of an artery will normally appear wavy because of the partial constriction of the smooth muscle in the tunica media, the next layer of blood vessel walls. It is generally the thickest layer in arteries, and it is much thicker in arteries than it is in veins. The tunica media consists of layers of smooth muscle supported by connective tissue that is primarily made up of elastic fibers, most of which are arranged in circular sheets. Contraction and relaxation of the circular muscles decrease and increase the diameter of the vessel lumen, respectively. Specifically in arteries, vasoconstriction decreases blood flow as the smooth muscle in the walls of the tunica media contracts, making the lumen narrower and increasing blood pressure. Similarly, vasodilation increases blood flow as the smooth muscle relaxes, allowing the lumen to widen and blood pressure to drop. Both vasoconstriction and vasodilation are regulated in part by small vascular nerves, known as nervi vasorum, or “nerves of the vessel,” that run within the walls of blood vessels. These are generally all sympathetic fibers, although some trigger vasodilation and others induce vasoconstriction, depending upon the nature of the neurotransmitter and receptors located on the target cell.

Radioactive iodine ( I) Thiourea Compounds Inhibit the formation of throid hormone through inhibiting the oxidation of iodide to iodine by peroxidase enzyme and blocking the coupling of iodothryosines to form iodothyronines buy rosuvastatin 10mg lowest price. Toxicities include drug fever purchase rosuvastatin 20mg with amex, skin rashes discount rosuvastatin 20mg visa, increased size and vascularity of the thyroid gland, and agranulocytosis. Ionic Inhibitors Potassium percholate prevents the synthesis of thyroid hormones through inhibition of uptake and concentration of iodide by the gland. It has the risk of aplastic anemia, therefore no longer used in the treatment of hyperthyroidism. Iodides: Improve manifestations of hyperthyroidism by decreasing the size and vascularity of the gland so they are required for preoperative preparation of the patient for partial thyroidectomy. Iodides act through inhibition of the “protease” enzyme which releases T3 and T4 from thyroglobulin, and organification. It is trapped and concentrated as ordinary iodine, which emits beta rays that act on parenchymal cells of the gland. It is contraindicated in pregnancy and lactation as it affects thyroid gland in the fetus and the infant. Propranolol This is an important drug which controls the peripheral manifestations of hyperthyroidism (tachycardia, tremor). Manifestations include hyperpyrexia, gastrointestinal symptoms, dehydration, tachycardia, arrhythmia, restlessness, etc. Management: It consists of infusion of intravenous fluids, supportive management, and also administration of propylthiouracil, sodium iodide, hydrocortisone, and propranolol. Discuss the mechanism and beneficial effects of combined oral contraceptive pills. Describe the mechanims of action and the adverse effects of antituberculois drugs. Discuss the use, mechanism of action and problems associated with anthelminthic drugs. Antimicrrobials: are chemical agents (synthetic/natural) used to treat bacterial, fungal and viral infections. Antibiotics: are substances produced by various species of microorganisms (bacteria, fungi, actinomycetes) that suppress the growth of other microorganisms. Bactericidal versus bacteriostatic action: When antimicrobial agents lead to the death of the susceptible microbe (e. Antiprotozoals: are drugs used to treat malaria, amoebiasis, gardiasis, trichomoniasis, toxoplasmosis, pneumocystis carinii pneumonia, trypanosomiasis and leshmaniasis. The classificastion, pharmacokinetics, pharmacodynamics, clinical uses, adverse effects of commonly used antimicrobias, antiprotozoals, antihelimenthics are disscused. Alteration of the drug-binding site: this occurs with penicillins, aminoglycosides and erythromycin. Anibacterial agents Cell wall synthesis inhibitors Members the group: Beta-lactam antibiotics, vancomycin, bacitracine, and cycloserine Beta-lactam antibiotics: Penicillins, cephalosporins, carbapenems, and monobactams are members of the family. All members of the family have a beta-lactam ring and a carboxyl group resulting in similarities in the pharmacokinetics and mechanism of action of the group members. They are water-soluble, elimination is primary renal and organic anion transport system is used. Penicillins Penicillins have similar structure, pharmacological and toxicological properties. The prototype of penicillins is penicillin G and is naturally derived from a genus of moulds called penicillium. Classification: Penicillins can be classified into three groups: Natural Penicillins, Antistaphylococcal penicillins, and Extended-spectrum penicillins. Mechanism of Action: Penicillins inhibit bacterial growth by interfering with a specific step in bacterial cell wall synthesis (block the transpeptidation reaction).

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