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Clinical features-history of exposure should be sought order generic clomid pills women's health zymbiotix; exclude drugs and alcohol as possible causes 2 buy generic clomid menstrual 2 days late. Amebic Liver Abscess: The liver is the most common site of extra-intestinal Amebiasis Most patients have fever order 50 mg clomid visa women's health clinic lloydminster, right-upper quadrant pain (dull or pleuritic), point tenderness over the liver and right-sided pleural effusion (common), jaundice (rare) (9) Fewer than 30 % of patients have active diarrhea (9) Patients from endemic areas may present with prolonged fever, weight loss and hepatomegaly 10-15 % of patients present only with fever. Laboratory diagnosis: Depends on the identification of cysts in the feces or of trophozoites in the feces. Repeated examination of the stool may be necessary since cyst excretion is variable and may be undetectable at times. Laboratory diagnosis- Identification of eggs or proglottids in the stool; use of scotch-tape may be helpful as in pinworm infection as the eggs are sometimes present in the perianal area. All patients suspected of having cysticercosis should be referred to higher centers for better diagnosis and management. The spores are able to survive cooking, and if the cooked food (meat and poultry) is not cooled enough, they will germinate. General After completing this module the learner will be able to assess and manage cases of food borne disease. Specific After reading this module you will be able to: ¾ Assess the patient with food borne disease ¾ Make the Nursing diagnosis ¾ Plan the Nursing intervention ¾ Implement the planned intervention ¾ Evaluate the outcomes of the intervention 3. Subjective Data • Onset and duration of the disease (14) • History of ingestion of contaminated food (food with unusual odor or taste, uncooked vegetables, raw meat etc. Nursing Diagnosis Based on the classification of the food borne diseases and findings of the nursing assessment the following actual and potential nursing diagnosis can be made: i. Poisoning related to the ingestion of contaminated food with chemical poisons, poisonous plants and toxins. Knowledge deficit about possible causes of the disease and preventive measures related to lack of information. Risk for fluid volume deficit related to vomiting and increased loss of fluids and electrolytes from gastro-intestinal tract. Establish goals for the nursing intervention • To remove or inactivate the poison before it is absorbed. Establish expected outcomes The patient: • Reveals reduced/ no effects of the poisoning chemical, poisonous plant or toxins • Reports less pain • Reports a decrease in the frequency of diarrheal stools • Tolerates small frequent feeding • Verbalizes concerns and fears • Reports the different causes and preventive measures of food borne disease 78 • Has no observable signs and symptoms of fluid balance • Prevents spread of the infection to others D. Reducing / eliminating the effects of the poisonous chemical, poisonous plant or toxins ¾ Attain control of the air way, ventilation, and oxygenation • Prepare for mechanical ventilation if respirations are depressed. Use gastric emptying procedures as; the following may be used: • Syrup of ipecac to induce vomiting in the alert patient. Administer the specific chemical antagonist or physiologic antagonist as early as possible to reverse or diminish effects of the toxin. Poisons may excite the central nervous system or the patient may have seizures from oxygen deprivation. Measures to Relief Pain To ease anal irritation (pains) caused by diarrhea, clean the area carefully and apply a repellent cream, such as petroleum jelly, warm sitz baths and application of witch hazel compresses can also soothe irritation. Establishing a Regular Pattern of Bowel Elimination and Maintaining Nutritional Balance ¾ Administer medications, as ordered, correlate dosages and routes with the patient’s meals and activities. If the patient is receiving a potassium supplement, be especially alert for the development of hyperkalemia (14,28,29). Reducing Anxiety ¾ An opportunity is provided for the patient to express fears and worry about being embarrassed by lack of control over bowel elimination. The patient is encouraged to be sensitive to body clues that warn of impending urgency (abdominal cramping, hyperactive bowel sounds). Special absorbent underwear, which will protect clothes if there is accidental fecal discharge, may be helpful. Teaching about Possible Causes of the Disease and Preventive Measures ¾ Teach the patient about his or her specific disease and therapeutic regimens. She or he is instructed about personal hygiene and the maintenance of the home environment to prevent the disease. Teach also about proper storage of the food items, chemicals, insecticides/ pesticides, detergents and petroleum products brought to home for household purposes. Instruct the patient to thoroughly cook foods, to properly preserve perishable foods, to always wash his hands with water and soap before handling food, especially after using the bath room toilet, to clean utensils thoroughly, and to eliminate flies and roaches in the home. But fluid balance is difficult to maintain during an acute episode of the disease because the feces are propelled through the intestines too quickly to allow for water absorption; and vomiting that leads to water loss; output exceeds intake. When a patient experiences such a condition the nurse assesses for dehydration (decreased skin turgor, achycardia, weak pulse, decreased serum sodium, thirst) and keeps an accurate record of intake and output. Preventing the Spread of the Disease to Others ¾ To prevent the spread of the infection wash your hands thoroughly after giving care (see figure 3. In general all patients with such disease should be treated as potentially infectious until they are proven to be otherwise. Gloves must be changed between patient care activities and hands must be washed after gloves are removed. Ensure that patients with highly transmissible organisms are physically separated from other patients if hygiene or institutional policy dictates. Potential Complications Based on the assessment data, a potential complication is cardiac dysrhythmia related to electrolyte depletion. Vitals signs, including apical pulse and changes in tendon reflexes and muscle strength, are monitored frequently. Treatment of Specific Food-Borne Diseases Food-borne diseases for which their specific chemotherapy is not indicated in this section please refer annex-v i. Food-borne infections Apart from the chemotherapy management of food-borne infections include fluid and electrolyte replacement. Staphylococcal food poisoning • Fluid replacement and close observation • Antibiotics are rarely used b. Botulism • Penicillin should be given to eradicate Clostridium botulinum from the site, even though the benefit of this therapy is unproven ¾ Chemical poisoning: a. Insecticide poisoning (organophosphates and carbamate ingestion) • Use activated charcoal • Supportive measures: - Oxygenation 84 - Ventilatory assistance - Treat seizure • Atropinization: 0. Mushroom poisoning: - Gastric emesis with ipecac - Decontamination with activated charcoal with sorbitol for catharsis - Atropine - Withdraw ingestion of poisonous plants - Supportive therapy 2. Fungal toxins Aflatoxins: -Treament in Hepatocellullar carcinoma includes drugs 5- flouroucil and mitomycin, and surgery. The dormitories harbor toilets with a water flush design but as water is scarce it is common to observe piles of human excreta with a buzzing population of flies feeding on the excreta. The water then is filled, for storage, to open barrels or narrow mouthed jerrycans with plastic hoses pulled over the floors in the kitchen of the cafeteria. The cafeteria lacks adequate dishes but this is compromised by rotating the utensils to serve more students. During this rotation the dishes are simply rinsed in a bowel of water before they are given to the next user in the queue. However, after a session of service the utensils are finally washed for the next session in a three-compartment manual dish washing system filled with cold water and at the first compartment having detergents. Despite this fact the management of the boarding school is not prepared to train them on proper food handling assuming that they have the experience and the training requires additional cost.

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In developed countries buy generic clomid 50 mg online pregnancy zantac, mercury type thermometers are no more use in hospital setup but in our context still very important generic 25 mg clomid fast delivery women's health center tucson az. Procedure • Explain the procedure to the patient • Wash hands and assemble necessary equipment and bring to the patient bedside purchase clomid 100 mg otc menstrual extraction procedure. Oral Procedure • Explain the procedure to the patient • Wash hands and assemble necessary equipment and bring to the patient bedside. Ensure that the bulb rests well under the tongue, where it will be in contact with blood vessels close to the surface. Contraindication • Child below 7 yrs • If the patient is delirious, mentally ill • Unconscious • Uncooperative or in severe pain • Surgery of the mouth • Nasal obstruction • If patient has nasal or gastric tubs in place 4. Axillary Procedure • Wash hands • Make sure that the client’s axilla is dry, If it is moist, pat it dry gently before inserting the thermometer. Hold the electronic thermometer in place until the reading registers directly • Remove and read the thermometer. Many pediatric and intensive care units use this type of thermometer because it records a temperature so rapidly. Procedure • Wash the hands • Explain the procedure to the client to ensure cooperation and understanding • Hold the probe in the dominant hand. For a 76 Basic Clinical Nursing Skills child of 6 years or younger, use your nondominant hand to pull the ear down and back. Position changes: when a patient assumes a sitting or standing position blood usually pools in dependent vessels of the venous system. Carotid: at the side of the neck below tube of the ear (where the carotid artery runs between the trachea and the sternoclidiomastoid muscle) 2. Apical: at the apex of the heart: routinely used for infant and children < 3 yrs th th th In adults – Left midclavicular line under the 4 , 5 , 6 intercostals space Children < 4 yrs of the Lt. Brachial: at the inner aspect of the biceps muscle of the arm or medially in the antecubital space (elbow crease) 5. Pedal (Dorslais Pedis): palpated by feeling the dorsum (upper surface) of the foot on an imaginary line drawn from nd the middle of the ankle to the surface between the big and 2 toes 79 Basic Clinical Nursing Skills Method Pulse: is commonly assessed by palpation (feeling) or auscultation (hearing) The middle 3 fingertips are used with moderate pressure for palpation of all pulses except apical; the most distal parts are more sensitive, Assess the pulse for • Rate • Rhythm • Volume • Elasticity of the arterial wall Assess the Pulse for Fig. Hyperventilation: very deep, rapid respiration Hypoventilation: very shallow respiration Two Types of Breathing 1. Costal (thoracic) • Involves the external muscles and other accessory muscles (sternoclodio mastoid) • Observed by the movement of the chest up ward and down ward. Diaphragmatic (abdominal) • Involves the contraction and relaxation of the diaphragm, observed by the movement of abdomen. Assessment • The client should be at rest • Assessed by watching the movement of the chest or abdomen. Systolic pressure: is the pressure of the blood as a result of contraction of the ventricle (is the pressure of the blood at the height of the blood wave); 2. Pulse pressure: is the difference between the systolic and diastolic pressure Blood pressure is measured in mm Hg and recorded as fraction. Conditions Affecting Blood Pressure Fever Increase 84 Basic Clinical Nursing Skills Stress " Arteriosclerosis " Obesity " Hemorrhage Decrease Low hematocrit " External heat " Exposure to cold Increase Sites for Measuring Blood Pressure 1. Leg using posterior tibial or dorsal pedis Methods of Measuring Blood Pressure Blood pressure can be assessed directly or indirectly 1. Direct (invasive monitoring) measurement involves the insertion of catheter in to the brachial, radial, or femoral artery. Phase 1: The pressure level at which the 1st joint clear tapping sound is heard, these sounds gradually become more intense. To ensure that they are not extraneous sounds, the nurse should identify at least two consecutive tapping sounds. Phase 2: The period during deflation when the sound has a swishing quality Phase 3: The period during which the sounds are crisper and more intense Phase 4: The time when the sounds become muffled and have a soft blowing quality Phase 5: The pressure level when the sounds disappear Procedure Assessing Blood pressure Purpose o To obtain base line measure of arterial blood pressure for subsequent evaluation o To determine the clients homodynamic status o To identify and monitor changes in blood pressure resulting from a disease process and medical therapy. Prepare and position the patient appropriately • Make sure that the client has not smoked or ingested caffeine, with in 30 minutes prior to measurement. The arm should be slightly flexed with the palm of the hand facing up and the fore arm supported at heart level • Expose the upper arm 2. The bladder inside the cuff must be directly over the artery to be compressed if the reading to be accurate. For initial examination, perform preliminary palipatory determination of systolic pressure 87 Basic Clinical Nursing Skills • Palpate the brachial artery with the finger tips • Close the valve on the pump by turning the knob clockwise. Position the stethoscope appropriately • Insert the ear attachments of the stethoscope in your ears so that they tilt slightly fore ward. Key Terminology: 90 Basic Clinical Nursing Skills Hemoglobine Hematocrite Leukocyte Occult Stroke Urinalysis Specimen Collection Specimen collection refers to collecting various specimens (samples), such as, stool, urine, blood and other body fluids or tissues, from the patient for diagnostic or therapeutic purposes. General Considerations for Specimen Collection When collecting specimen, wear gloves to protect self from contact with body fluids. Get request for specimen collection and identify the types of specimen being collected and the patient from which the specimen collected. Give adequate explanation to the patient about the purpose, type of specimen being collected and the method used. Get the appropriate specimen container and it should be clearly labeled have tight cover to seal the content and placed in the plastic bag or racks, so that it protects the laboratory technician from contamination while handling it. Put the collected specimen into its container without contaminating outer parts of the container and its cover. All the specimens should be sent promptly to the laboratory, so that the temperature and time changes do not alter the content. Collecting Stool Specimen Purpose • For laboratory diagnosis, such as microscopic examination, culture and sensitivity tests. Equipments required o Clean bedpan or commode o Wooden spatula or applicator o Specimen container o Tissue paper 92 Basic Clinical Nursing Skills o Laboratory requests o Disposable glove, for patients confined in bed o Bed protecting materials o Screen Procedure i) For ambulatory patient Give adequate instruction to the patient to • Defecate in clean bedpan or commode (toilet) • Avoid contaminating the specimen by urine, menstrual period or used tissue papers, because these may affect the laboratory analysis. Obtain stool sample • Take the used bedpan to utility room/toilet container using spatula or applicator without contaminating the outside of the container. Timed urine specimen • It is two types Short period → 1-2 hours Long period → 24 hours Purpose • For diagnostic purposes - Routine laboratory analysis and culture and sensitivity tests Equipments Required • Disposable gloves • Specimen container • Laboratory requisition form (Completely filled) 95 Basic Clinical Nursing Skills • Water and soap or cotton balls and antiseptic solutions (swabs). Obtain urine specimen • Ask patient to void • Let the initial part of the voiding passed into the receptacle (bed pan or urinal) then pass the next part (the midstream) into the specimen container. Care of the specimen and the equipment • Handle and label the container correctly • Send the urine specimen to the laboratory immediately together with the completed laboratory requested forms • Empty the receptacles content properly • Give appropriate care for the used equipments 6. Collecting the urine • Usually it begin in the morning • Before you begin the timing, the patient should void and do not use this urine (It is the urine that has been in the bladder some time) • Then all urine voided during the specified time (e. Collecting sputum specimen Sputum is the mucus secretion from the lungs, bronchi and trachea, but it is different from saliva. The best time for sputum specimen collection is in the mornings up on the patient’s awaking (that have been accumulated during the night).

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Incidence of adamantane resistance among influenza A (H3N2) viruses isolated worldwide from 1994 to 2005: a cause for concern cheap clomid generic breast cancer jerseys. A prospective double-blind study of side effects associated with the administration of amantadine for influenza A virus prophy- laxis buy clomid in united states online women's health clinic denton tx. Gender and age as factors in the inhibition of renal clearance of amantadine by quinine and quinidine discount 100 mg clomid mastercard pregnancy implantation calculator. 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. In many cases, it is not possible to reliably estimate their frequency or establish a cause relationship to oseltamivir exposure:! Aggravation of diabetes Oseltamivir use does not appear to be associated with an increased risk of skin re- actions (Nordstrom 2004); however, anecdotal reports describe isolated skin reac- tions, i. The use of oseltamivir in infants younger than 1 year is not recommended as studies on juvenile rats revealed potential toxicity of oseltamivir for this age group. Moreo- ver, high drug levels were found in the brains of 7-day-old rats which were exposed to a single dose of 1,000 mg/kg oseltamivir phosphate (about 250 times the recom- mended dose in children). Further studies showed the levels of oseltamivir phos- phate in the brain to be approximately 1,500 times those seen in adult animals. How- ever, given the uncertainty in predicting the exposure in infants with immature blood-brain barriers, it is recommended that oseltamivir not be administered to children younger than 1 year, the age at which the human blood-brain barrier is generally recognised to be fully developed (Dear Doctor-Letter, http://InfluenzaReport. Oseltamivir 197 Oseltamivir is a pregnancy category C drug, as there are insufficient human data upon which to base a risk evaluation of oseltamivir to the pregnant woman or de- veloping foetus. In lactating rats, oseltamivir is excreted in the milk, but oseltamivir has not been studied in nursing mothers and it is not known, if oseltamivir is excreted in human milk. After reports of psychological disorders in patients treated with oseltamivir, Japa- nese authorities have amended the patient information to list psychiatric effects, such as delusions, in the list of side effects. Efficacy Treatment Oseltamivir, 75 mg bid for 5 days, administered to otherwise healthy adults with naturally acquired febrile influenza when started within 36 hours of the onset of symptoms, reduced the duration of the disease by up to 1. Earlier initiation of therapy was associated with a faster resolution: initiation of therapy within the first 12 h after fever onset reduced the total median illness duration 3 days more than intervention at 48 h. In addition, the earlier administration of oseltamivir reduced the duration of fever, severity of symptoms and the times to return to baseline activity (Aoki 2003). A meta-analysis of 10 placebo-controlled, double-blind trials suggests that oseltamivir treatment of influenza illness reduces lower respira- tory tract complications, use of antibacterials, and hospitalisation in both healthy and “at-risk” adults (Kaiser 2003). The efficacy and safety of oseltamivir in patients with chronic respiratory diseases (chronic bronchitis, obstructive emphysema, bronchial asthma or bronchiectasis) or chronic cardiac disease has not been well defined. In one small randomised trial oseltamivir significantly reduced the incidence of complications (11 % vs.

By B. Chenor. Marquette University.