Arthritis Australia

D. Farmon. International Reform University.

The antibiotic pattern of Urease = Neg Lysine decarboxylase = + resistance to carbenicillin and ampicillin is Phenylalanine deaminase = Neg characteristic for Klebsiella prometrium 100 mg on-line. A stool culture from a 30-year-old man suffering from bloody mucoid diarrhea gave the following 43 purchase 200 mg prometrium otc. The biochemical tests Hektoen agar = green colonies; listed are necessary to differentiate Shigella from E. Tree blood cultures taken from a 30-year-old Answers to Questions 45–47 cancer patient receiving chemotherapy and admitted with a urinary tract infection grew 45. Given the following is commonly recovered from immunosuppressed biochemical reactions, which is the most likely patients. Yersinia enterocolita produces Ornithine decarboxylase = Neg non–lactose-fermenting colonies on MacConkey agar, salmon-colored colonies on Hektoen agar, and A. Klebsiella pneumoniae with a translucent border, can be confused with Microbiology/Evaluate laboratory data to make Aeromonas spp. To identifications/Gram-negative bacilli/3 differentiate, an oxidase test must be performed, 46. What is the most likely undercooked ground beef contaminated with fecal identification of this gram-negative rod? Klebsiella pneumoniae Microbiology/Evaluate laboratory data to make identifications/Gram-negative bacilli/3 47. A 6-year-old female patient was admitted to the hospital following 2 days of severe diarrhea. Patient history revealed a hamburger lunch at a fast-food restaurant 3 days earlier. Yersinia enterocolitica Microbiology/Evaluate laboratory data to make identifications/Gram-negative bacilli/3 7. A Yersinia pestis is the cause of bubonic and pneumonic the axilla and groin lymph nodes. Bubonic plague causes swelling of the groin cultures were obtained, resulting in growth of lymph nodes (bubos), whereas pneumonic plague gram-negative rods resembling “closed safety involves the lungs. The transmission is from rodents (rats, Testing demonstrated a nonmotile rod that was ground squirrels, or prairie dogs) to humans by the biochemically inert. What is the most likely bite of fleas (vectors) or by ingestion of contaminated identification? Te majority of clinical laboratories with a available antisera for somatic “O” antigen 157 and microbiology department should have the flagellar “H” antigen 7. However, Yersinia pestis isolates capability of serotyping which pathogenic should be sent to a public health laboratory for Enterobacteriaceae? Ingestion of contaminated tissue of a β-lactamase that hydrolyzes broad-spectrum D. Inhalation of contaminated airborne droplets antibiotics such as the cephalosporins as well as penicillin and monobactam antibiotics. Which isolates of the Enterobacteriaceae family strains are detected by demonstrating their resistance most commonly produce extended-spectrum to β-lactam antibiotics. Salmonella typhi and Shigella sonnei Microbiology/Apply knowledge of fundamental biological characteristics/Antibiotic susceptibility/2 7. Presumptive tests used for identification of the Acinetobacter baumannii Pseudomonas spp. D Both organisms are oxidase positive, motile, and between Pseudomonas aeruginosa and produce pyoverdin. In addition to motility, which test best differentiates Answers to Questions 5–9 Acinetobacter spp. Alcaligenes is motile by peritrichous Identification/2 flagella and oxidase positive. C The two genera, Pseudomonas and Stenotrophomonas, and Stenotrophomonas maltophilia are: are motile and grow well on MacConkey agar. Which Pseudomonas is usually associated with a chronically infected with the mucoid strain of lung infection related to cystic fibrosis? A nonfermenter recovered from an eye wound is types but is distinguished by biochemical tests and oxidase positive, motile with polar monotrichous susceptibility to the polymyxins. Pseudomonas diminuta personnel were infected with these bacteria during Microbiology/Apply knowledge of fundamental the 1960s and 1970s. Which biochemical tests are needed to differentiate Answers to Questions 10–13 Burkholderia cepacia from S. D The oxidase test and red pigment (pyorubin), as well Which is the most likely organism?

However purchase prometrium 200mg otc, many antiseizure medications impair cognitive performance and can prolong the duration of rehabilitation buy prometrium 200mg on line. Therefore, it is important to weigh the overall benefit of these medications against their side effects. Research evidence supports the use of prophylactic antiseizure agents to prevent immediate and early seizures after head injury, but not for prevention of late seizures (Somjen, 2004). The nurse must assess the patient carefully for the development of post-traumatic seizures. Risk factors that increase the likelihood of seizures are brain contusion with subdural hematoma, skull fracture, loss of consciousness or amnesia of 1 day or more, and age older than 65 years (Somjen, 2004). The nurse explains to the patient and family, verbally and in writing, how to monitor for complications that merit contacting the neurosurgeon. If the patient is at risk for late posttraumatic seizures, antiseizure medications may be prescribed at discharge. The patient and family require instruction about the side effects of these medications and the importance of continuing to take them as prescribed. Continuing Care Rehabilitation of the patient with a head injury begins at the time of injury and continues into the home and community. Depending on the degree of brain damage, the patient may be referred to a rehabilitation setting that specializes in cognitive restructuring after brain injury (Ashley, 2004). The patient is encouraged to continue the rehabilitation program after discharge, because improvement in status may continue 3 or more years after injury. Changes in the patient with a head injury and the effects of long-term rehabilitation on the family and their coping abilities need frequent assessment. Teaching points to address with the family of the patient who is about to return home are described in Chart 63-6. Depending on his or her status, the patient is encouraged to return to normal activities gradually. During the acute and rehabilitation phases of care, the focus of teaching is on obvious needs, issues, and deficits. The nurse needs to remind the patient and family of the need for continuing health promotion and screening practices after these initial phases. Patients who have not been involved in these practices in the past are educated about their importance and are referred to appropriate health care providers. The patient is monitored closely for any changes in motor or sensory function and for symptoms of progressive neurologic damage. Edema of the spinal cord may occur with any severe cord injury and may further compromise spinal cord function. These findings usually are recorded on a flow sheet so that changes in the baseline neurologic status can be monitored closely and accurately. The patient should have both eyes closed so that the examination reveals true findings, not what the patient hopes to feel. The patient is also assessed for spinal shock, a complete loss of all reflex, motor, sensory, and autonomic activity below the level of the lesion that causes bladder paralysis and distention. The lower abdomen is palpated for signs of urinary retention and overdistention of the bladder. Further assessment is made for gastric dilation and ileus caused by an atonic bowel, a result of autonomic disruption. Temperature is monitored, because the patient may have periods of hyperthermia as a result of alteration in temperature control due to autonomic disruption. Nursing Interventions Promoting Adequate Breathing and Airway Clearance Possible impending respiratory failure is detected by observing the patient, measuring vital capacity, monitoring oxygen saturation through pulse oximetry, and monitoring 418 arterial blood gas values. Early and vigorous attention to clearing bronchial and pharyngeal secretions can prevent retention of secretions and atelectasis. Suctioning may be indicated, but caution must be used, because this procedure can stimulate the vagus nerve, producing bradycardia, which can result in cardiac arrest. If the patient cannot cough effectively because of decreased inspiratory volume and inability to generate sufficient expiratory pressure, chest physical therapy and assisted coughing may be indicated. Specific breathing exercises are supervised by the nurse to increase the strength and endurance of the inspiratory muscles, particularly the diaphragm. Assisted coughing promotes clearing of secretions from the upper respiratory tract and is similar to the use of abdominal thrusts to clear an airway (see Chapter 25). Ensuring proper humidification and hydration is important to prevent secretions from becoming thick and difficult to remove even with coughing. The patient is assessed for signs of respiratory infection (cough, fever, dyspnea). Smoking is discouraged, because it increases bronchial and pulmonary secretions and impairs ciliary action. Ascending edema of the spinal cord in the acute phase may cause respiratory difficulty that requires immediate intervention. The patient is repositioned frequently and is assisted out of bed as soon as the spinal column is stabilized.

Impact of a computerized physician order entry driven algorithm on the prescribing and utilization of psychiatric drugs order 100mg prometrium overnight delivery. Guidelines for the use of ondansetron in the prevention and treatment of post-operative nausea and vomiting order prometrium 200mg without prescription. Development and implementation of guidelines for the monitoring of serum vancomycin concentrations. A new method for active surveillance of adverse events from diphtheria/tetanus/pertussis and measles/mumps/rubella vaccines. Mail-order prescriptions requiring clarification contact with the prescriber: prevalence, reasons, and implications. Just-in-time evidence-based e-mail “reminders” in home health care: impact on patient outcomes. Prescribing safety features of general practice computer systems: Evaluation using simulated test cases. Evaluation of a pharmacy bar-code controlled drug management system in a community hospital. Strategies for detecting adverse drug events among older persons in the ambulatory setting. Intravenous medication safety system averts high-risk medication errors and provides actionable data. Narrowing the gap in hypertension: effectiveness of a complex antihypertensive program in the elderly. A computerized intervention to improve timing of outpatient follow-up: a multicenter randomized trial in patients treated with warfarin. Pharmacokinetics of computer-controlled alfentanil administration in children undergoing cardiac surgery. Evaluation of computerized decision support for oral anticoagulation management based in primary care. Review of computerized decision support systems for oral anticoagulation management. Oral anticoagulation management in primary care with the use of computerized decision support and near-patient testing: a randomized, controlled trial. Glycemic control and insulin safety: the impact of computerized intravenous insulin dosing. Process evaluation of a cluster randomized trial of tailored interventions to implement guidelines in primary care--why is it so hard to change practice? Pharmacy informatics task force update: Advancing medication- related clinical decision support. Smart infusion systems - How the addition of wireless capability improves smart pump management and utilization. Asthma patients are willing to use mobile and web technologies to support self-management. Pharmacy management based on standardization of processes and their decentralized implementation by clinical area pharmacists. Quality of drug treatment process through medication errors in a tertiary hospital. Current requirements and emerging trends for labelling as a tool for communicating pharmacovigilance findings. Quality insurance of prescribing, dispensing and managing drugs in hospital pharmacy. Medical devices; general hospital and personal use devices; classification of remote medication management system. Smart mote-based medical system for monitoring and handling medication among persons with dementia. Medication administration: the implementation process of bar-coding for medication administration to enhance medication safety. Medication administration: The implementation process of bar-coding for medication administration to enhance medication safety. Unit-of-use bar coding: Balancing the challenge of technological change with improved patient safety. The use of electronic prescribing as part of a system to provide medicines management in secondary care. Evaluating the safety and efficacy of Glucommander, a computer-based insulin infusion method, in management of diabetic ketoacidosis in children, and comparing its clinical performance with manually titrated insulin infusion. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Clinician attitudes towards prescribing and implications for interventions in a multi-specialty group practice. Economic effectiveness of two different automated anesthesia medication dispensing devices at two different facilities.

It is a frequent finding in many disease processes such as asthma generic prometrium 200mg on-line, metabolic acidosis buy prometrium 100mg otc, pulmonary embolism, and pulmonary 415 edema, and also in anxiety-induced states. One way to do this is to have the patient breathe through only one nostril, with the mouth closed. Having the patient breathe in and out of a paper bag is discouraged, as it leads to hypoxemia. After the acute phase of the hyperventilation has been managed, the underlying cause of the problem must be determined. Hypnotic – pertaining to sleep or hypnosis, an agent which induces sleep or which dulls the senses, drugs which cause insensibility to pain by inhibiting afferent impulses or the central centers of the brain receiving sensory impressions, and thus causing partial or complete unconsciousness Hypochondriac – affected with a morbid interest in health and disease Hypoglycemia – deficiency of sugar in the blood, a condition in which there is a level less than 80, hyper function of the pancreas may cause it or injection of an excessive amount of insulin Hypokalemia – an abnormally low concentration of potassium in the blood Hypokinesia – decreased motor reactions to stimulus Hypomania – hypomania and excitement, with a moderate change in behavior Hyponatremia – a decreased concentration of sodium (salt) in the blood Hypophysis – the pituitary body or gland Hypotension – decrease of systolic and diastolic blood pressure below normal, deficiency in tone or tension, below a blood pressure of 90/50 is pathologic, if increased pressure is followed by decreased pressure can be a serious condition, if the systolic and the diastolic drops proportionately – the patient will respond to the administration of stimulants, hypotension causes an accumulation of blood in the veins and slows down the arterial current Hypothalamic – a portion of the diencephalons compromising the ventral wall of the third ventricle below the hypothalamic sulcus, source of the hormones vasopressin and oxytocin stored and released by the neural lobe of the hypophysis Hypothermia – having a body temperature below normal, an art of lowered body temperature, usually between 78 - 90 degrees, to reduce oxygen need during surgery (especially cardiovascular and neurological procedures) and in hypoxia, to reduce blood pressure and to remedy Hypothyroid – marked by insufficient thyroid secretions in the body resulting in diminished basal metabolism, intolerance of cold temperatures, fatigue, mental apathy, physical sluggishness, constipation, muscle aches, dry skin and hair, and coarsening of features. These symptoms are called myxedema 416 Hypotonia – reduced tension, relaxation of arteries, loss of tone of the muscles or intra-ocular pressure Hypoventilation – reduced rate and depth of breathing Hypovolemia– diminished blood supply Hypoxemia – decreased oxygen tension (concentration) in arterial blood, measured by arterial oxygen partial pressure (PaO2) values. Symptoms may include memory issues, balance, ambulation, depending which area of the brain is affected Infiltrates – to pass into or through a substance or a space. A shadow seen on a chest xray, and assumed to represent blood, pus, or other body fluids in the lung Influenza – an acute contagious respiratory infection marked by fevers, muscle aches, headaches, prostration, cough, and sore throat. The disease usually strikes during the winter Influx – a flowing in 417 Insomnia – chronic inability to sleep or sleep prematurely ended or interrupted by periods of wakefulness, may be caused by a heavy late meal, with some coffee or other stimulants, including sugar in any form, overtiredness, mental fatigue, worry, excitement, and principally the fear of being unable to sleep Interstitial – placed or lying between; pertaining to interstices or spaces within an organ or tissue Intestinal atony – lack of muscle tone in the intestine and failure to contract normally, causing a delay in movement of fecal debris to exit the intestine Intracellular – within the cell Intracerebral – within the cerebellum of the brain. It consists of two lateral hemispheres and a narrow middle portion called the vermis. The cerebellum is involved in synergic control of skeletal muscles and plays an important role in the coordination of voluntary movements. It receives afferent impulses but is not a reflex center in the usual sense; however, it may reinforce some reflexes and inhibit others. Although the cerebellum does not initiate movements, it interrelates with many brainstem structures in executing various movements, including maintaining proper posture and balance; walking and running; fine involuntary movements as required in writing, dressing, eating, and playing musical instruments; and smooth tracking movements of the eyes. The cerebellum controls the property of movement such as speed, acceleration, and trajectory Intra ocular pressure – pressure with in the eyeball Intrathecal – within the spinal canal; within a sheath Involutional - a rolling or turning inward – associated with senile, pre-senile types, and manic-depressive groups Iritis – inflammation of the iris of the eye associated with pain, lacrimation, photophobia, diminution of vision, the iris appears swollen, dull and muddy, and pupil is contracted, irregular and sluggish in reaction Irritable bowel – the way the bowel responds excessively to a stimulus – diarrhea may be increased Ischemia – a temporary deficiency of blood flow to any organ or tissue. The deficiency may be caused by diminished blood flow either through a regional artery or throughout the circulation 418 J Jaundice – a condition characterized by yellowness of the skin, white of eyes, mucous membranes and body fluids, due to deposition of bile pigments resulting from excess bilirubin in the blood, it may result from obstruction of bile passageways, excessive destruction of red blood cells, or disturbances in functioning of the liver cells K Keratitis – inflammation and ulceration of the cornea, which is usually associated with decreased visual acuity, Eye pain, tearing, and light sensitivity are the most common symptoms Ketogenic diet – diet is high in fat, adequate in protein, and has negligible amounts of carbohydrate. It was created to stimulate some of the metabolic effects of fasting, a state known to decrease seizures in some individuals. They seem to do well for 2 or 3 months, then the seizures begin to start in again. Ketones – normal metabolic products, B-hydroxylbutyric acid and aminoacetic acid, from which acetone may arise spontaneously. The two acids are products of lipid pyruvate metabolism, and are oxidized by the muscles. It is metabolized by bacteria in the colon with the production of organic acids and is used to treat constipation and the encephalopathy that develops in patients with advanced cirrhosis of the liver. The unabsorbed sugar produces diarrhea and the acid pH helps to contain ammonia in the feces Laryngeal edema – swelling of the larynx in the throat Laryngospasm - spasm of the larynx in the throat Lavage – washing out of a cavity, example the eye or the abdomen abdomen Lecithin – any of a group of phospholipids common in plants and animals. They are found in the liver, nerve tissue, semen, and in smaller amounts in bile and blood. They are essential in the metabolism of fats and are used in the processing of foods, pharmaceuticals products, cosmetics, and inks. Deficiency leads to hepatic and renal disorders, high serum cholesterol levels, atherosclerosis, and arteriosclerosis Lennox-Gestaut - blanket term covering a variety of seizures (atonic drop attacks, complex partial, absence, and occasional tonic clonic) associated with significant delay in motor and intellectual development and does not respond well to drugs Lens – a transparent refractory as in the lens of the eye Lethargy – a condition of functional sluggishness, stupor, a state similar to hypnosis, or the first stage of hypnotism Leukocytosis – an increase in the number of leukocytes in the blood. It occurs most commonly in disease processes involving infection, inflammation, trauma, or stress, but it also can result occasionally from the use of some medications Leukopenia – abnormal decrease of white blood cells usually below 5000. A great number of drugs may cause leucopenia, as can failure of the bone marrow Leukorrhea – a white estrogen related scant/moderate odorless physiological vaginal discharge, normally preceding menarche and occurring during ovulation, during pregnancy, and in response to sexual excitement. Some women note an increased discharge related to oral contraceptive or hormone replacement therapy. Chronic cervicitis and vaginal infections are the most common causes of abnormal genital discharge. Signs of infection include increased discharge, change in color and consistency, odor, vulvar irritation, dysuria, and itching Limbic – the edge or border of a part, the margin Lipase – a fat splitting enzyme found in the blood, pancreatic secretion and tissues 420 Liposome – the recycling center of the cell where large molecules are broken down into small molecules to be reused kidney shaped organs of lymphoid tissues that lie at intervals along the lymphatic vessels Lupus Erythematous - tubercular skin disease, acute or subacute circulatory disorders and trauma predispose, reddish brown soft patches, circumscribed with raised edges and depressed centers which are white and scar like when scales drop off, disease spreads slowly, middle life females are predisposing factors. A chronic autoimmune inflammatory disease involving multiple organ systems and marked by periodic acute episodes. The disease is more prevalent is women of childbearing ages Lymphadenopathy – disease of the lymph nodes Lymphocyte – a white blood cell responsible for much of the body’s immune protection. Fewer than 1% are present in the circulating blood; the rest lie in the lymph nodes, spleen, and other lymphoid organs, where they can maximize contact with foreign antigens Lymph nodes – one of thousands of small kidneyed shaped organs of lymphoid tissue that lie at intervals along the lymphatic vessels Lysis – the gradual decline of a fever or disease; the opposite of crisis. The death of cells or microorganisms, caused by antibodies, complement, enzymes, or other substances M Macrocythemia – condition in which erythrocytes are larger than larger, example in folate or vitamin B12 deficiencies Malaise – discomfort, uneasiness, indisposition, often indicative of infection Malassezia – a genus of fungi that infects animals and humans. In hospitals, the infection tends to occur in patients receiving lipid (fat) infusions. Infections of the bloodstream result in sepsis Mania – madness, characterized by excessive excitement, a form of psychosis characterized by exalted feelings, delusions of grandeur, elevation of mood, psychomotor, over activity and overproduction of ideas Meckel’s diverticulum – a congenital sac or blind pouch sometimes found in the lower portion of the ileum. Sometimes it is continued to the umbilicus as a cord or as a tube forming a fistulous opening at the umbilicus.