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Here’s why this book is so terrific: It will teach you all the important things you need to buy atarax 25 mg overnight delivery anxiety symptoms treatment know about pathophysiology buy atarax 25 mg without prescription anxiety 4th. Memory joggers offer mnemonics and other aids to purchase atarax 10mg online anxiety 13 help you understand and remember difficult concepts buy generic atarax 25 mg online anxiety pregnancy. We’ll be there to explain key concepts, provide important care reminders, and offer reassurance. Oh, and if you don’t mind, we’ll be spicing up the pages with a bit of humor along the way, to teach and entertain in a way that no other resource can. Joy 1 Pathophysiology basics Just the facts In this chapter, you’ll learn: the structure of cells and how cells reproduce, age, and die the concept of homeostasis and how it affects the body the causes of disease the process of disease development. Other organisms, such as humans, consist of millions of cells grouped into highly specialized units that function together throughout the organism’s life. Cell components Cells are composed of various structures, or organelles, each with specific functions. Just your average cell the illustration below shows cell components and structures. More components the typical animal cell is characterized by several additional elements: • Adenosine triphosphate, the energy that fuels cellular activity, is made by the mitochondria. Cell division and reproduction Individual cells don’t live as long as the organism they’re a part of. In the second stage, called cytokinesis, the cytoplasm divides, beginning during late anaphase or telophase. Chromatin, the small, slender rods of the nucleus that give it its granular appearance, begins to form. Replicate and divide these illustrations show the different phases of cell reproduction, or mitosis. Prophase During prophase, the chromosomes coil and shorten, and the nuclear membrane dissolves. Each chromosome is made up of a pair of strands called chromatids, which are connected by a spindle of fibers called a centromere. Metaphase During metaphase, the centromeres divide, pulling the chromosomes apart. Anaphase At the onset of anaphase, the centromeres begin to separate and pull the newly replicated chromosomes toward opposite sides of the cell. Telophase In the final phase of mitosis—telophase—a new membrane forms around each set of 46 chromosomes. The spindle fibers disappear, cytokinesis occurs, and the cytoplasm divides, producing two identical new daughter cells. Stressors, changes in the body’s health, disease, and other extrinsic and intrinsic factors can alter the cells’ normal functioning. Adaptation Cells generally continue functioning despite challenging conditions or stressors. When cell integrity is threatened, the cell reacts by drawing in its reserves to keep functioning, by adaptive changes or by cellular dysfunction. If enough reserve is available and the body doesn’t detect abnormalities, the cell adapts by atrophy, hypertrophy, hyperplasia, metaplasia, or dysplasia. It results from disuse, insufficient blood flow, malnutrition, denervation, or reduced endocrine stimulation. Hypertrophy Hypertrophy is an increase in the size of a cell due to an increased workload. It can result from normal physiologic conditions or abnormal pathologic conditions. Hyperplasia Hyperplasia, an increase in the number of cells, is caused by increased workload, hormonal stimulation, or decreased tissue. Metaplasia Metaplasia is the replacement of one adult cell with another adult cell that can better endure the change or stress. Dysplasia In dysplasia, deranged cell growth of specific tissue results in abnormal size, shape, and appearance. Although dysplastic cell changes are adaptive and potentially reversible, they can precede cancerous changes. One of the first indications of cell injury is a biochemical lesion that forms on the cell at the point of injury. The cells of the immune system may be altered, making the patient susceptible to infection. Draw on your reserves, adapt, or die When cell integrity is threatened—for example, by toxins, infection, physical injury, or deficit injury—the cell reacts in one of two ways: • by drawing on its reserves to keep functioning • by adapting through changes or cellular dysfunction. If enough cellular reserve is available and the body doesn’t detect abnormalities, the cell adapts. Toxic injury Toxic injuries may be caused by factors inside the body (called endogenous factors) or outside the body (called exogenous factors). Common endogenous factors include genetically determined metabolic errors, gross malformations, and hypersensitivity reactions. Exogenous factors include alcohol, lead, carbon monoxide, and drugs that alter cellular function. Examples of such drugs are chemotherapeutic agents used for cancer treatment and immunosuppressive drugs that prevent rejection in organ transplant recipients. Infectious injury Viral, fungal, protozoan, and bacterial agents can cause cell injury or death. These organisms affect cell integrity, usually by interfering with cell synthesis, producing mutant cells.

A nursing action important to purchase atarax 25mg with amex anxiety blood pressure this patient’s care is (1) obtaining a stool specimen generic atarax 25 mg free shipping anxiety symptoms high blood pressure. Removing excess fluid and undigested food particles gives the digestive system time to buy atarax 10mg visa anxiety wrap for dogs heal discount 10 mg atarax mastercard anxiety symptoms on one side of body. The bowel is manipulated during abdominal surgery, which can disturb elimination, and anesthesia decreases bowel mobility. You know that her problem is a result of immobility, decrease in fluid intake, and a lack of interest in her food. Although protein is an important nutrient, protein intake will not help relieve constipation. An astute nurse would include which of the following in her plan of care for this patient Since pancreatitis is often related to excessive alcohol intake, and his wife mentions that he likes to drink beer, this patient may have an alcohol addiction and be at risk for neurological changes or seizures. Which foods listed below should be excluded from the diet of a patient with ulcerative colitis High fiber foods and dairy products are likely to exacerbate the symptoms of ulcerative colitis. The nurse was instructing the woman who suffered from Crohn’s disease in a high-calorie, high-protein, low-residue diet. Sponge cake is a low-residue food, while raw vegetables, whole grain breads and cereals are all high in fiber and residue. A patient with acute pancreatitis is admitted to the med surg unit where the nurse is working. When caring for him, the nurse is aware that an important goal of nursing care for this patient is (1) monitoring respiratory function and providing supplemental O2 if needed. Nausea and vomiting as well as pain are characteristic of pancreatitis, which is frequently associated with excessive alcohol intake. Altered respiratory function, changes in fluid status, or urinary excretion of protein or ketones are not associated with pancreatitis. Melena is dark feces caused by blood; hematemesis is emesis of coffee ground looking appearance, which indicates digested blood; and tachycardia is a compensation for decreased blood volume. In caring for this patient, she must never (1) give the patient something to eat or drink. In case the patient has an emergent condition requiring immediate surgery, they should be kept npo. The nurse is treating a patient with a nasogastric tube due to a bowel obstruction. In the case of a bowel obstruction, a nasogastric tube is used to decrease gastric distention. The airway cannot be suctioned with this tube in place, feeding would not be appropriate with gastric distention, and since the diagnosis has been made, it is unlikely that aspiration of fluid would be used for any diagnostic purposes. The nurse works with elderly long-term care patients who are at risk for constipation. Which of the following interventions would be least effective in the prevention and treatment of this problem The use of stimulant laxatives tends to make the person unable to have normal bowel function without them. When caring for the patient, which assessment should receive priority in his care An elderly patient with diarrhea is at risk for dehydration, and urinary output is a sensitive indicator of hydration status. The nurse is examining a school-aged child who has presented to the emergency room with acute abdominal pain. The boy has a rigid abdomen, lower right quadrant pain, rebound tenderness, a fever, and nausea and vomiting. The symptoms of pain, a rigid abdomen, fever, nausea, and vomiting are indicative of an inflammatory process in the abdomen. The localization of the pain to the right lower quadrant and the presence of rebound tenderness suggest appendicitis. The nurse is teaching a patient with a duodenal ulcer self-help measures to relieve the pain. Aspirin and ibuprofen are irritating to the stomach, and would be contraindicated for a person with a duodenal ulcer. In caring for a patient with peptic ulcer who is at risk for hemorrhage, the nurse must be alert for early signs of hypovolemic shock, which include (1) pale, clammy skin and decreased blood pressure. The early signs of hypovolemic shock are tachycardia, which is an attempt by the body to compensate for lowered blood volume, and decreased urine output, because there is less fluid available and the kidney is compensating by decreasing the amount of urine. Kidneys—two bean-shaped organs that are on each side of the posterior part of the diaphragm, just below the twelfth rib. The fibrous capsule is the outer layer, and the hilus is the entry site for the renal artery and. Regulates fluid volume, excreting approximately 60 cc per hour of urine (filters 125cc of body fluid per minute, the glomerular filtration rate) c. Glomerulus—the branches of the renal artery form capillary networks, called glomeruli, which are enclosed in Bowman’s capsule, a thin-walled sac. Renal tubules—the proximal convoluted tubules are responsible for starting the reabsorption of the fluid from Bowman’s capsule.

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Controlling Anxiety • Decrease anxiety so that patient’s cardiac work is also decreased discount atarax 10mg online anxiety 54321. Restraints are likely to effective 10mg atarax anxiety research be resisted buy generic atarax 25mg online anxiety symptoms all day, and resistance inevitably increases the cardiac workload buy atarax 10 mg on-line social anxiety symptoms quiz. H Minimizing Powerlessness • Assess for factors contributing to a sense of powerlessness, and intervene accordingly. Signs are ventricular dysrhythmias, hypotension, muscle weakness, and generalized weakness. The home care nurse assesses the physical environment of the home and the patient’s support system and suggests adaptations in the home to meet patient’s activity limitations. Evaluation Expected Patient Outcomes • Demonstrates tolerance for increased activity • Maintains fluid balance • Experiences less anxiety • Makes sound decisions regarding care and treatment • Adheres to self-care regimen 354 Hemophilia For more information, see Chapter 30 in Smeltzer, S. There are two hereditary bleeding disorders that are clinically indistinguishable but can H be separated by laboratory tests: hemophilia A and hemophilia B. Both types are inherited as X-linked traits, so almost all affected people are males; females can be carriers but are almost always asymptomatic. Clinical Manifestations the frequency and severity of bleeding depend on the degree of factor deflciency and the intensity of trauma. Hematomas within the muscle can cause peripheral nerve compression with decreased sensation, weakness, and atrophy of the area. Hemophilia 355 • Surgical procedures typically result in excessive bleeding at the surgical site; bleeding is most commonly associated with dental extraction. Nursing Management • Assist family and patient in coping with the condition because it is chronic, places restrictions on their lives, and is an inherited disorder that can be passed to future generations. Ammonia is considered the Hepatic Encephalopathy and Hepatic Coma 357 major etiologic factor in the development of encephalopathy. Patients have no overt signs but do have abnormalities on neuropsychologic testing. Hepatic encephalopathy is the neuropsychiatric manifestation of hepatic failure associated with portal hypertension and the shunting of blood from the portal venous system into the systemic circulation. Circumstances that increase serum ammonia levels precipitate or aggravate hepatic encephalopathy, such as digestion of dietary and blood proteins and ingestion of ammonium salts. Other factors that may cause hepatic encephalopathy include excessive diuresis, dehydration, infections, fever, surgery, some medications, and, H additionally, elevated levels of serum manganese and changes in the types of circulating amino acids, mercaptans, and levels of dopamine and other neurotransmitters in the central nervous system. Clinical Manifestations • Earliest symptoms of hepatic encephalopathy include minor mental changes and motor disturbances. Slight confusion and alterations in mood occur; the patient becomes unkempt, experiences disturbed sleep patterns, and tends to sleep during the day and to experience restlessness and insomnia at night. Medical Management • Administer lactulose (Cephulac) to reduce serum ammonia level. Observe for watery diarrheal stools, which indicate lactulose overdose; monitor for hypokalemia and dehydration. Nursing Management • Maintain a safe environment to prevent bleeding, injury, and infection. Hepatic Failure, Fulminant Fulminant hepatic failure is the clinical syndrome of sudden and severely impaired liver function in a previously healthy person. It is characterized by the development of flrst symptoms or jaundice within 8 weeks of the onset of disease. The hepatic lesion is potentially reversible, and survival rates are approximately 20% to 50%, depending greatly on the cause of liver failure. Viral hepatitis a common cause; other causes include toxic drugs and chemicals, metabolic disturbances, and structural changes. Clinical Manifestations • Jaundice and profound anorexia • Often accompanied by coagulation defects, renal failure and electrolyte disturbances, cardiovascular abnormalities, infection, hypoglycemia, encephalopathy, and cerebral edema 360 Hepatitis, Viral: Types A, B, C, D, E, and G Management • Liver transplantation (treatment of choice) • Blood or plasma exchanges • Liver support systems, such as hepatocytes within synthetic flber columns, extracorporeal liver assist devices, and bioartiflcial liver, until transplantation is possible For more information, see Chapter 39 in Smeltzer, S. This form of hepatitis is transmitted primarily through the fecal–oral route, by the ingestion of food or liquids infected by the virus. The virus is found in the stool of infected patients before the onset of symptoms and during the flrst few days of illness. The incubation period is estimated to be 2 to 6 weeks, with a mean of approximately 4 weeks. The virus is present only briefly in the serum; by the time jaundice appears, the patient is likely to be noninfectious. Recovery from hepatitis A is usual; it rarely progresses to acute liver necrosis and fulminant hepatitis. No carrier state exists, and no chronic hepatithis is associated with hepatitis A. Clinical Manifestations • Many patients are anicteric (without jaundice) and symptomless. Hepatitis, Viral: Types A, B, C, D, E, and G 361 • Liver and spleen are often moderately enlarged for a few days after onset. Assessment and Diagnostic Methods • Stool analysis for hepatitis A antigen • Serum hepatitis A virus antibodies; immunoglobulin Prevention H • Scrupulous hand washing, safe water supply, proper control of sewage disposal. The virus has been found in saliva, semen, and vaginal secretions and can be transmitted through mucous membranes and breaks in the skin. It replicates in the liver H and remains in the serum for long periods, allowing transmission of the virus. Hepatitis B remains a major worldwide cause of cirrhosis and hepatocellular carcinoma. Clinical Manifestations • Symptoms may be insidious and variable; subclinical episodes frequently occur, fever and respiratory symptoms are rare; some patients have arthralgias and rashes. Assessment and Diagnostic Findings Hepatitis B surface antigen appears in blood of up to 90% of patients.

It usually follows wounding with trauma or surgery and requires factors contributing to buy atarax 25mg with visa anxiety symptoms 4dp3dt tissue hypoxia like foreign bodies atarax 10 mg amex anxiety symptoms dogs, vascular insufficiency or occurs as a complication of amputation cheap 10mg atarax anxiety symptoms light sensitivity. More than one species can be isolated or polymicrobial infection with other microorganisms can occur discount atarax 10 mg without prescription anxiety guided meditation. A) Urinary tract infection after catheterization for Prostatectomy B) Abscess formation following injection on the thigh C) Wound abscess following excision of big lipoma on the back D) Lung atelectasis following intubation for laparotomy E) None of the above 2. A) Virulent microorganism B) A tissue of decreased or no blood supply C) A decrease in the immune response of a patient D) All of the above E) None of the above 3. A) Fever B) Loss of function of body part C) Local hyperemia D) Tachycardia E) All of the above 5. The correct way of managing a patient with an abscess is A) Start with effective antibiotics and send home B) Drainage and no antibiotics if no systemic signs C) Apply local ointments for aiding the abscess to burst D) Give effective antibiotics and analgesics E) All except B 7. In a patient with gas gangrene A) Little circulatory support is needed B) Surgical removal of gangrenous tissue is the primary management C) Penicillin is the preferred antibiotic D) B and C are correct E) Systemic signs are not commonly seen 74 Key to the Review Questions 1. Introduction Trauma is one of the leading causes of mortality, morbidity and disability worldwide. In developing countries, the magnitude of the problem has been increasing consuming more and more of the meager health resources of these nations. Moreover, trauma mostly affects people in their productive years of life, hence the high economic and social burden to society. The causes of trauma are various and their relative incidence varies in different populations. Immediate death (50%) • Occur in the first few minutes after the accident • Are due to extensive and lethal injuries to the brain, heart & major blood vessels 2. Early deaths (30%) • Occur in the first few hours • Are due to the collections and bleedings in the chest and abdomen, extensive fractures and increased intracranial pressure • Early resuscitation, diagnosis and appropriate management can prevent these deaths. Types of Trauma: Trauma can be classified according to the: ICause: Homicidal injuries Road traffic accident and falls Industrial accidents, burn, etc. Ithe primary survey and resuscitation this part of management comprises a quick evaluation of the patient to detect immediately life threatening situations and institution of measures to correct them. In a trauma victim, it may be compromised by the back fallen tongue, broken tooth, vomitus, blood etc. If the air way is compromised, use suctioning, jaw trust, positioning, oropharyngeal tube or endotracheal tube to open it, taking care of the cervical spine. It may be compromised by pneumothorax, hemothorax or multiple rib fractures causing flail chest. Look for external hemorrhage and arrest it by pressure, bandaging or tourniquet if the other methods fail. Tachycardia, hypotension, pallor may mean bleeding into the body cavities or from an obvious external wound. EExpose (undress) the patient fully for examination not to miss serious injuries. It includes the following aspects: ATake History: the informant may be the injured patient, relatives, police or ambulance personnel. The history should include: • Time of injury, • Mechanism of injury, • Amount of bleeding, • Loss of consciousness, • Any intervention performed or drugs given should be asked for. CMake necessary investigations such as hematocrite, cross-match, urinalysis, X-ray, ultrasound, etc. However, never send a patient with unstable vital signs for investigation or referral before resuscitation. These include poor condition and design of roads, traffic mix (sharing of road by vehicles of different speeds and pedestrians), poor condition of the vehicles and poor traffic rule enforcement. The incidence of this serious problem can be reduced by improving the public awareness and the quality of training given to the drivers and strict enforcement of traffic rules. Moreover, improving the design and quality of the roads and regular checkup of vehicle fitness would help alleviate the problem. In many developing countries like Ethiopia, the magnitude of the problem is big due to high distribution of firearms among civilians who have little or no knowledge on safe handling and usage. It is made worse by the presence of large number of land mines, which are remnants of repeated wars and conflicts in these poor nations. Generally, missile injuries may be caused by bullets from pistols, rifles, machine guns or fragments from exploded grenades and mines. The degree of injury sustained depends on the amount of energy transferred from the missile to the patient as formulated below. The extensive tissue injury with the high degree of contamination creates a perfect medium for life threatening infection to occur. Missile injuries are classified into: ILowvelocity missile injuries • Comprise missiles fired from hand guns (<400m/s) • Injury is limited to the path of the bullet. All patients with missile injuries should receive broad spectrum antibiotics and tetanus prophylaxis. It is mostly seen in developing countries where there is overcrowding, poor housing designs and wide spread usage of open fire for cooking. Types of burns, according to the mechanism, include: • Flame burn • Scalding • Chemical burn • Electrical burn, etc. The severity of a burn injury is a function of the burn depth (degree) and the extent or percentage of the body surface that is burned. Determining the percentage of burn surface is important to calculate the amount of fluid requirement while determination of burn depth is important for burn wound management. Classification of Burn according to depth (degree) 1First degree burn: It involves the epidermis only and manifests with erythema. The extent or percentage of burn is determined by the “rule of nine” in which the body surface is divided into eleven parts each constituting 9% of the total (fig.