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Associate Professor, California Northstate University College of Medicine
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The incidence of rheumatic 286 Endometriosis fever in the United States and other developed countries has generally decreased, but the exact incidence is difficult to deter mine because the infection may go unrecognized, and people may not seek treatment. Clinical diagnostic criteria are not standardized, and autopsies are not routinely performed. Further information about rheumatic fever and rheumatic endocarditis E can be found in pediatric nursing books. Endometriosis Endometriosis is a benign lesion with cells similar to those lin ing the uterus, growing aberrantly in the pelvic cavity outside the uterus. During menstruation, this ectopic tissue bleeds, mostly into areas having no outlet, which causes pain and adhesions. There is a high incidence among patients who bear children later and have fewer children. Clinical Manifestations • Symptoms vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain (some patients have no pain. Assessment and Diagnostic Methods A health history, including an account of the menstrual pat tern, is necessary to elicit specific symptoms. On bimanual Endometriosis 287 pelvic examination, fixed tender nodules are sometimes pal pated, and uterine mobility may be limited, indicating adhe sions. Laparoscopic examination confirms the diagnosis and enables clinicians to determine the diseases stage. Medical Management Treatment depends on symptoms, desire for pregnancy, and E extent of the disease. Pregnancy often alleviates symptoms because neither ovula tion nor menstruation occurs. Pharmacologic Therapy • Palliative measures (eg, use of medications, such as analgesic agents and prostaglandin inhibitors) for pain. Side effects are related to low estrogen levels (eg, hot flashes and vaginal dryness. Surgical Management • Laparoscopy to fulgurate endometrial implants and to release adhesions. Nursing Management •Obtain health history and physical examination report, concentrating on identifying when and how long specific 288 Epididymitis symptoms have been bothersome, the effect of prescribed medications, and the womans reproductive plans. Epididymitis Epididymitis is an infection of the epididymis, which usually spreads from an infected urethra, bladder, or prostate. In pre pubertal males, older men, and homosexual men, the pre dominant causal organism is Escherichia coli, although in older men, the condition may also be a result of urinary obstruc tion. Clinical Manifestations • Often slowly develops over 1 to 2 days, beginning with a low-grade fever, chills, and heaviness in the affected testi cle. Epididymitis 289 • Urinary frequency, urgency, or dysuria, and testicular pain aggravated by bowel movement. Nursing Management •Place patient on bed rest with scrotum elevated with a scrotal bridge or folded towel to prevent traction on sper matic cord, to improve venous drainage, and to relieve pain.
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Responsibility for the use of a medicine ?off-label? lies solely with the prescribing veterinary surgeon. He or she should inform the owner of the reason why a medicine is to be used ?off-label? and record this reason in the patient?s clinical notes. Obtain signed informed consent if an unauthorized product is to be used, ensuring that all potential problems are explained to the client. An ?off-label? medicine must show a comparative clinical advantage to the authorized product in the specifc circumstances presented (where applicable. Medicines may be used ?off-label? in the following ways (this is not an exhaustive list):. Authorized product used to treat an animal in an unauthorized physiological state. Adverse effects may or may not be specifc for a species, and idiosyncratic reactions are always a possibility. When using novel or unfamiliar drugs, consider pharmaceutical and pharmacological interactions. In some species, and with some diseases, the ability to metabolize/excrete a drug may be impaired/enhanced. Use the lowest dose that might be effective and the safest route of administration. Information on ?off-label? use may be available from a wide variety of sources (see Appendix. It is recommended that, in general, medications are kept in and dispensed in the manufacturer?s original packaging. Medicines can be adversely affected by adverse temperatures, excessive light, humidity and rough handling. Loose tablets or capsules that are repackaged from bulk containers should be dispensed in child-resistant containers and supplied with a package insert (if one exists. Tablets and capsules in foil strips should be sold in their original packaging or in a similar cardboard box for smaller quantities. Preparations for external application should be dispensed in coloured futed bottles. Oral liquids should be dispensed in plain glass bottles with child-resistant closures. The name of the veterinary surgeon who prescribed the medication (if not an authorized use. The words ?For external use only? should be included on labels for products for topical use. In order to comply with the new Veterinary Medicines Regulations (2005), records of all products supplied on prescription must be kept for 5 years. When a batch is brought into use in a practice, the batch number and date should be recorded. It is not necessary to record the batch number of each medication used for a given animal.
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Contraindications: Do not use in animals with hypoadrenocorticism, E hyperkalaemia or hyponatraemia. S Action: Bulk-forming agent that increases faecal mass and stimulates T peristalsis. Use: Management of impacted anal sacs, diarrhoea and constipation, U and the control of stool consistency after surgery. As the preparations swell in contact with water, they should be administered with plenty of water available. X Contraindications: Do not use in cases of intestinal obstruction or where enterotomy or enterectomy is to be performed. F Action: Inhibits bacterial protein synthesis, resulting in a bactericidal effect that is concentration-dependent. G Use: Active against a range of Gram-negative and some H Gram-positive pathogens although resistance is quite widespread and it is less active than other aminoglycosides. It is specifcally I indicated in the treatment of infections caused by Leptospira and Mycobacterium tuberculosis (in combination with other drugs. J Aminoglycosides require an oxygen-rich environment to be effective, thus they are ineffective in sites of low oxygen tension (abscesses, K exudates) and all obligate anaerobes are resistant. Use of streptomycin is L limited and if an aminoglycoside is indicated other members of the family are more commonly employed. There is a M marked post-antibiotic effect, allowing the use of pulse-dosing regimens which may limit toxicity. P Adverse reactions: Streptomycin is ototoxic, interfering with balance Q and hearing, which can be permanent. Nephrotoxicosis may be a problem but is less likely than with other aminoglycosides. Drug interactions: Increased risk of nephrotoxicity when used with S cephalosporins (notably cefalotin) and cytotoxic drugs. The effects of T neostigmine and pyridostigmine may be antagonized by aminoglycosides. Action: In an acidic medium an aluminium ion detaches from the D compound, leaving a very polar, relatively non-absorbable ion. H Use: Treatment of oesophageal, gastric and duodenal ulceration, used with an H2 receptor antagonist or proton pump inhibitor but I given separately. M Drug interactions: Sucralfate may decrease the bioavailability of H2 antagonists, phenytoin and tetracycline.
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Heres everything you need to select the appropriate diagnoses for your patients and develop safe and efective care plans. It should be compiled by the indexer and only needs to contain the disorder/disease and the page number in which the care plan for that disorder/disease begins. Nursing Priorities Establishes a general ranking of needs and concerns on which the Nursing Diagnoses are ordered in constructing the plan of care. Discharge Goals Identifies generalized statements that could be developed into short-term and intermediate goals to be achieved by the client before being discharged from nursing care. They may also provide guidance for creating long-term goals for the client to work on after discharge. Nursing Diagnosis the general need or problem (diagnosis) is stated without the distinct cause and signs and symptoms, which would be added to create a client diagnostic statement when specific client information is available. For example, when a client displays increased tension, apprehension, quivering voice, and focus on self, the nursing diagnosis of Anxiety might be stated: severe Anxiety related to unconscious conflict, threat to self-concept as evidenced by statements of increased tension, apprehension; observations of quivering voice, focus on self. In addition, diagnoses identified within these guides for planning care as actual, risk, or health-promotion can be changed or deleted and new diagnoses added, depending entirely on the specific client situation or available information. May Be Related to/Possibly Evidenced by these lists provide the usual or common reasons (etiology) why a particular need or problem may occur with probable signs and symptoms, which would be used to create the related to and evidenced by portions of the client diagnostic statement when the specific situation is known. When a risk diagnosis has been identified, signs and symptoms have not yet developed and therefore are not included in the nursing diagnosis statement. Furthermore, health-promotion diag noses (readiness for enhanced) do not contain related factors, but do have defining characteristics for the evidenced by segment of the client diagnostic statement. Desired Outcomes/Evaluation Criteria—Client Will these give direction to client care as they identify what the client or nurse hopes to achieve. They are stated in general terms to permit the practitioner to modify or individualize them by adding time lines and specific client criteria so they become measurable. The outcome label is selected from a standardized nursing language and serves as a general header for the outcome indicators that follow. Nursing actions are divided into independent—those actions that the nurse performs autonomously—and collaborative—those actions that the nurse performs in conjunction with others, such as implementing physician orders. When creating the individual plan of care, interventions would normally be ranked to reflect the clients specific needs and situation. In addition, the division of independent and collaborative is arbitrary and is actually dependent on the individual nurses capabilities, agency protocols, and professional standards. Rationale Although not commonly appearing in client plans of care, rationale has been included here to provide a pathophysiological basis to assist the nurse in deciding about the relevance of a specific intervention for an individual client situation. Clinical Pathway this abbreviated plan of care or care map is event or task-oriented and provides outcome-based guidelines for goal achievement within a designated length of stay. Davis Company Copyright © 1984, 1989, 1993, 1997, 2000, 2002, 2006, and 2010 by F. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
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