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Patients with hypothyroidism are very susceptible to respiratory depression with use of hypnotics and sedatives erectile dysfunction statistics race buy cheap silagra on line. Use of an artificial airway and ventilatory support may be necessary with respiratory depression do herbal erectile dysfunction pills work generic 50mg silagra. Explain to patient and family that change in cognitive and mental functioning is a result of disease process. Monitor cognitive and mental processes and response of these to medication and other therapy. Reassures patient and family about the cause of the cognitive changes and that a positive outcome is possible with appropriate treatment 4. Permits evaluation of the effectiveness of treatment Shows improved cognitive functioning Identifies time, place, date, and events correctly Responds when stimulated Responds spontaneously as treatment becomes effective environment Interacts spontaneously with family and Explains that change in mental and cogni tive processes is a result of disease processes Takes medications as prescribed to prevent decrease in cognitive processes Collaborative Problem: Myxedema and myxedema coma Goal: Absence of complications 1. Monitor patient for increasing severity of signs and symptoms of hypothyroidism: a. Decreased vital signs (blood pressure, respiratory rate, temperature, pulse rate) c. Ventilatory support is necessary to maintain adequate oxygenation and maintenance of an airway 3. The slow metabolism and atherosclerosis of myxedema may result in angina with administration of thyroxine 4. The nurse instructs the patient about the desired actions and side effects of medications and about how and when to take prescribed medications. The importance of continuing to take medications as prescribed even after symptoms improve is stressed to the patient. Because of the slowed mental processes that occur with hypothyroidism, it is important that a family member also be informed and instructed about treatment goals, medication schedules, and side effects to be reported to the physician. The nurse provides written instructions and guidelines for the patient and family. Dietary instruction is provided to promote weight loss once medication has been initiated and to promote return of normal bowel patterns. The patient and family are often very concerned about the changes they have observed as a result of the hypothyroid state. It is often reassuring to the patient and family to be informed that many of the symptoms will disappear with effective treatment (Chart 42-3). The patient with hypothyroidism and myxedema coma needs considerable follow-up and health care. Before hospital discharge, arrangements are made to ensure that the patient returns to an environment that will promote adherence to the prescribed treatment plan. Assistance in devising a schedule or record ensures accurate and complete administration of medications. The nurse reinforces the importance of continued thyroid hormone replacement and periodic follow-up testing and instructs the patient and family members about the signs of overmedication and undermedication. Extra clothing and blankets are provided, and the patient is protected from drafts. Use of heating pads and electric blankets is avoided because of the risk of peripheral vasodilation, further loss of body heat, and vascular collapse. Additionally, the patient could be burned by these items without being aware of it because of delayed responses and decreased mental status. The nonspecific, early symptoms may produce negative reactions by family members and friends, and the family and friends may have labeled the patient mentally unstable, uncooperative, or unwilling to participate in self-care activities. As hypothyroidism is treated successfully and symptoms subside, the patient may experience depression and guilt as a result of the progression and severity of symptoms that occurred. The nurse informs the patient and family that the symptoms and inability to recognize them are common and part of the disorder itself. The patient and family may require assistance and counseling to deal with the emotional concerns and reactions that result. A careful history may identify the need for further teaching about the importance of the medication. In addition, the patient is reminded of the importance of participating in general health promotion activities and recommended health screening.
Isolation barrier preContagious cautions with full Bubonic plague: transface respirators erectile dysfunction pump ratings order silagra 100 mg on-line. Pneumonic plague: transmitted through Clothing and linens with body fluids on respiratory droplet them should be contact cleaned with the usual disinfectant impotence zantac purchase silagra 50mg with visa. Initial: Abrupt onset of fever, fatigue, chills, headache, lower backache, malaise, rigor, coryza, dry cough, and sore throat without adenopathy. As disease progresses: Sweating, fever, progressive weakness, anorexia, and weight loss demonstrate continued illness. Mortality secondary to: pneumonitis (if inhalation is the source) with copious watery or purulent sputum, hemoptysis, respiratory insufficiency, sepsis, and shock. Inhalation botulism: fever; symmetric descending flaccid paralysis with multiple cranial nerve palsies. Classic signs and symptoms include diplopia, dysphagia, dry mouth, lack of fever, and alert mental status. Other possible symptoms include ptosis of the eyelids, blurred vision, enlarged sluggish pupils, dysarthria, and dysphonia. Bubonic plague: Sudden fever and chills, weakness, a swollen and tender lymph node (bubo) in the groin, axilla, or cervical area. The resultant bacteremia progresses to septicemia from the endotoxin and, finally, shock and death. Pneumonic plague: Severe bronchospasm, chest pain, dyspnea, cough, and hemoptysis. There is a 100% mortality associated with pneumonic plague if not treated within the first 24 hours. For persons exposed to tularemia, tetracycline or doxycycline is recommended for 14 days. Aminoglycosides and clindamycin are contraindicated because they exacerbate neuromuscular blockage. There is a 2% rate of anaphylaxis to the antitoxin; therefore, diphenhydramine (Benadryl) and epinephrine must be immediately available for use. Supportive care-mechanical ventilation, nutrition, fluids, prevention of complications (Mortality rate = 5%) Streptomycin or gentamicin for 1014 days. Tetracycline or doxycycline is an acceptable alternative if an aminoglycoside cannot be given. People with close contact exposure (<2 meters) require prophylaxis with doxycycline for 7 days. Laundry and biological wastes should be autoclaved before being washed with hot water and bleach. All persons who have household or face-to-face contact with the patient after the fever begins should be vaccinated within 4 days to prevent infection and death (Franz & Zajtchuk, 2000; Inglesby et al. A patient with a temperature of 38°C (101°F) or higher within 17 days after exposure requires isolation. Postvaccination encephalitis occurs in approximately 1 of every 300,000 patients and has a 25% fatality rate. Cremation is preferred for all deaths, because the virus can survive in scabs for up to 13 years. There are many agents, including those that affect nerves (sarin, soman), those that affect blood (cyanide), those that are vesicants (lewisite, nitrogen and sulfur mustard, phosgene), heavy metals (arsenic, lead), volatile toxins (benzene, chloroform), pulmonary agents (chlorine), and corrosive acids (nitric acid, sulfuric acid) (Table 72-3). Chlorine, phosgene, and cyanide are widely used in industry and therefore are readily available. Therefore, in the presence of most chemicals, the victim should stand up to avoid heavy exposure (because the chemical will sink toward the floor or ground). Chemical Weapons Agents that may potentially be used in chemical warfare are overt agents in that the effects are more apparent and occur more quickly than those caused by biological weapons. Superficial to partial-thickness burn with vesicles that coalesce Vesicant Agents Lewisite Sulfur mustard Nitrogen mustard Phosgene Pulmonary Agents Phosgene Chlorine Blistering agents Separation of alveoli from capillary bed Pulmonary edema, bronchospasm Airway management Ventilatory support Bronchoscopy Chapter 72 Weaponized agents (chemicals developed as weapons by the military) are more likely than industrial chemicals to penetrate and cause secondary exposure as well. For example, if 1000 mg of a chemical were released and the time of exposure to this amount of chemical was 10 minutes, then the concentration time would be 10,000 mg/min. Sulfur mustards and pulmonary agents have the longest latency, whereas vesicants, nerve agents, and cyanide produce symptoms within seconds. Examples of vesicants include lewisite, phosgene, nitrogen mustard, and sulfur mustard.
Abdominal dressings are monitored for drainage if an abdominal surgical approach was used impotence vs infertile purchase silagra in india. In preparation for hospital discharge erectile dysfunction treatment medscape order discount silagra on line, the nurse gives prescribed guidelines for activity restrictions to promote healing and to prevent postoperative bleeding. Deep Vein Thrombosis Because of positioning during surgery, postoperative edema, and immobility, the patient is at risk for deep vein thrombosis and pulmonary embolus. In such cases, the nurse needs to determine what the experience means to the patient and how to assist her in expressing her feelings. Throughout the pre- and postoperative and recovery periods, explanations are given about physical preparations and procedures that are performed. Patient education addresses the outcomes of surgery, possible feelings of loss, and options for management of symptoms of menopause. Women vary in their preferences; many want a choice of treatment options, a part in decision making, accurate and useful information at the appropriate time, support from their health care providers, and access to professional and lay support systems. Chapter 47 Management of Patients With Female Reproductive Disorders 1439 the knees is avoided. The nurse assists the patient to ambulate early in the postoperative period, and the patient is encouraged to exercise her legs and feet while in bed. Because the patient may be discharged within 1 or 2 days of surgery, she is instructed to avoid prolonged sitting in a chair with pressure at the knees, sitting with crossed legs, and inactivity. Bladder Dysfunction Because of possible difficulty in voiding postoperatively, an indwelling catheter may be inserted before or during surgery and is left in place in the immediate postoperative period. If a catheter is in place, it is usually removed shortly after the patient begins to ambulate. After the catheter is removed, urinary output is monitored; additionally, the abdomen is assessed for distention. If the patient does not void within a prescribed time, measures are initiated to encourage voiding (eg, assisting the patient up to the bathroom, pouring warm water over the perineum). She is instructed to check the surgical incision daily and to contact her primary health care provider if redness or purulent drainage or discharge appears. She is informed that her periods are now over but that she may have a slightly bloody discharge for a few days; if bleeding recurs after this time, it should be reported immediately. The patient is instructed about the importance of an adequate oral intake and of maintaining bowel and urinary tract function. The patient is informed that postoperative fatigue may occur but that it should gradually decrease. This does not mean sitting for long periods, because doing so may cause blood to pool in the pelvis, increasing the risk for thromboembolism. The nurse explains that showers are preferable to tub baths to reduce the possibility of infection and to avoid the dangers of injury that may occur when getting in and out of the bathtub. The patient is instructed to avoid straining, lifting, having sexual intercourse, or driving until her surgeon permits her to resume these activities. Vaginal discharge, foul odor, excessive bleeding, any leg redness or pain, or an elevated temperature should be reported to her primary health care provider promptly. The nurse should be familiar with information given to the patient by the surgeon regarding all activities and restrictions to reinforce them and prevent confusion. Continuing Care Follow-up telephone contact provides the nurse with the opportunity to determine whether the patient is recovering without problems and to answer any questions that may have arisen. Notes no chest or calf pain and no redness, tenderness, or swelling in the extremities d. Reports no urinary problems or abdominal distention Radiation Therapy Radiation is usually the treatment of choice for squamous cell carcinoma of the cervix, depending on the stage of the cancer. In uterine and ovarian cancers, however, radiation is usually an adjunct to surgery. When radiation is the definitive treatment of cervical cancer, a combination of external pelvic irradiation and internal (intracavitary) irradiation may be used. Only in the earliest microinvasive carcinomas of the cervix is intracavitary irradiation used alone. Once the disease extends to the pelvic side walls, however, perhaps only one third of patients are cured, although many more benefit from the palliative effects of radiation (ie, reduction in tumor bulk and control of infection, pain, and bleeding). Radiation enteritis, resulting in diarrhea and abdominal cramping, and radiation cystitis, manifested by urinary frequency, urgency, and dysuria, may occur. Occasionally, severe reactions require interrupting treatment until normal tissue repair occurs.
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