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What nursing interventions and patient and family teaching are warranted when caring for this patient Your 24-year-old patient has been receiving corticosteroids for treatment of ulcerative colitis asthma treatment long term buy singulair in india. She is distraught about the changes in her appearance related to corticosteroids and is talking about stopping the corticosteroids because of the weight gain and other symptoms she has experienced asthmatic bronchitis or pneumonia buy singulair without prescription. What teaching should be provided to the patient and her family about the use of corticosteroids Identify the rationale for each area of assessment and how it relates to thyroid function asthma mask quality 5 mg singulair. Your patient asthma vs bronchitis discount generic singulair canada, a 30-year-old woman with two small children, lives within 2 miles of a nuclear power plant. She expresses anxiety and concern about the risks to herself and her children if there is a terrorist attack on the plant. What assessment parameters are important during the pre- and postoperative periods Chapter 42 Assessment and Management of Patients With Endocrine Disorders 1247 fracture before and after surgery for primary hyperparathyroidism. Disclosing subclinical thyroid disease: An approach to mild laboratory abnormalities and vague or absent symptoms. Identify the assessment parameters used for determining the status of upper and lower urinary tract function. Describe the diagnostic studies used to determine upper and lower urinary tract function. Initiate education and preparation for patients undergoing assessment of the urinary system. Dysfunction of the kidneys and lower urinary tract is common and may occur at any age and with varying levels of severity. Assessment of upper and lower urinary tract function is part of every health examination and necessitates an understanding of the anatomy and physiology of the urinary system as well as of the effect of changes in the system on other physiologic functions. Anatomic and Physiologic Overview the urinary system comprises the kidneys, ureters, bladder, and urethra. A thorough understanding of the urinary system is necessary for assessing individuals with acute or chronic urinary dysfunction and implementing appropriate nursing care. Kidneys the kidneys are a pair of brownish-red structures located retroperitoneally (behind and outside the peritoneal cavity) on the posterior wall of the abdomen from the 12th thoracic vertebra to the 3rd lumbar vertebra in the adult. The kidney consists of two distinct regions, the renal parenchyma and the renal pelvis. The cortex contains the glomeruli, proximal and distal tubules, and cortical collecting ducts and their adjacent peritubular capillaries. The pyramids are situated with the base facing the concave surface of the kidney and the apex facing the hilum, or pelvis. The pyramids drain into 4 to 13 minor calices that, in turn, drain into 2 to 3 major calices that open directly into the renal pelvis. The hilum, or pelvis, is the concave portion of the kidney through which the renal artery enters and the renal vein exits. The renal artery (arising from the abdominal aorta) divides into smaller and smaller vessels, eventually forming the afferent arteriole. The afferent arteriole branches to form the glomerulus, which is the capillary bed responsible for glomerular filtration. Blood leaves the glomerulus through the efferent arteriole and flows back to the inferior vena cava through a network of capillaries and veins. Each kidney contains about 1 million nephrons, the functional units of the kidney. Each kidney is capable of providing adequate renal function if the opposite kidney is damaged or becomes nonfunctional.

Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (Position Statement) asthmatic bronchitis smoking singulair 10 mg free shipping. Immunization and the prevention of influenza and pneumococcal disease in people with diabetes asthma 13 month old order singulair 10mg with visa. Third-party reimbursement for diabetes care asthma symptoms after exercise purchase singulair 5 mg amex, selfmanagement education and supplies asthma symptoms 3 months purchase singulair online now. The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes. Participation in a diabetes education and care program: Experience from the Diabetes Care for Older Adults project. National diabetes fact sheet: National estimates and general information and national estimates on diabetes in the United States, 2000. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Translation of the diabetes nutrition recommendations for health care institutions. Position of the American Dietetic Association: Medical nutrition therapy and pharmacotherapy. Pharmacological management of diabetes: Recent progress and future perspective in daily drug treatment. Cardiovascular dysautonomia of patients with end-stage renal disease and type 1 or type 2 diabetes. Sildenafil for treatment of erectile dysfunction in men with diabetes: A randomized controlled trial. Sildenafil (Viagra) for the treatment of erectile dysfunction in men with diabetes. Chapter 41 Assessment and Management of Patients With Diabetes Mellitus 1203 Schlater, A. Lispro insulin for improved glucose control in obese patients with Type 2 diabetes. Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications with type 2 diabetes. Journals for Patients Diabetes Forecast, American Diabetes Association, Membership Center, P. Identify the diagnostic tests used to determine alterations in function of each of the endocrine glands. Compare hypothyroidism and hyperthyroidism: their causes, clinical manifestations, management, and nursing interventions. Compare hyperparathyroidism and hypoparathyroidism: their causes, clinical manifestations, management, and nursing interventions. Use the nursing process as a framework for care of patients with adrenal insufficiency. Disorders of the endocrine system are common and have the potential to affect the function of every organ system in the body. Understanding the function of each of the endocrine glands, and the consequences of hypofunction and hyperfunction of each gland, enables the nurse to anticipate physiologic changes and to plan interventions to address them. Nursing interventions that are essential in managing endocrine disorders are carried out in every setting from the intensive care unit to the outpatient setting and the home. T Chapter 42 Assessment and Management of Patients With Endocrine Disorders 1205 Anatomic and Physiologic Overview the endocrine system has far-reaching effects in the human body because of its links with the nervous system and the immune system. The hormones secreted by the endocrine system are affected in large part by structures in the central nervous system, such as the hypothalamus. Other structures located in the brain, such as the pituitary gland, are endocrine glands that influence the function of a large number of other endocrine glands. The effects of hormones secreted by the endocrine system affect the nervous system and are, in turn, mediated by the nervous system.

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Other causes include surgical removal of both adrenal glands or infection of the adrenal glands asthma definition 7 elements order singulair 5mg on-line. Tuberculosis and histoplasmosis are the most common infections that destroy adrenal gland tissue asthma 7 year cycle discount 4 mg singulair fast delivery. Therapeutic use of corticosteroids is the most common cause of adrenocortical insufficiency (Coursin & Wood asthma knowledge questionnaire cheap 10 mg singulair mastercard, 2002) is asthmatic bronchitis fatal purchase cheap singulair online. Treatment with daily administration of corticosteroids for 2 to 4 weeks may suppress function of the adrenal cortex; therefore, adrenal insufficiency should be considered in any patient who has been treated with corticosteroids. Nursing Management the patient who has undergone surgery to treat pheochromocytoma has experienced a stressful preoperative and postoperative course and may remain fearful of repeated attacks. Although it is usually expected that all pheochromocytoma tissue has been removed, there is a possibility that other sites were undetected and that attacks may recur. Several intravenous lines are inserted for administration of fluids and medications. During the preoperative and postoperative phases of care, the nurse informs the patient about the importance of follow-up monitoring to ensure that pheochromocytoma does not recur undetected. Therefore, the nurse instructs the patient about their purpose, the medication schedule, and the risks of skipping doses or stopping their administration abruptly. Additionally, the nurse provides verbal and written instructions about the procedure for collecting 24-hour urine specimens to monitor urine catecholamine levels. The home care nurse also obtains blood pressure measurements and assists the patient in preventing or dealing with problems that may result from long-term use of corticosteroids. Because of the risk of recurrence of hypertension, periodic checkups are required, especially in young patients and in patients whose families have a history of pheochromocytoma. The patient is scheduled for periodic follow-up appointments to observe for return of normal blood pressure and plasma and urine levels of catecholamines. Mental status changes such as depression, emotional lability, apathy, and confusion are present in 60% to 80% of patients. In severe cases, the disturbance of sodium and potassium metabolism may be marked by depletion of sodium and water and severe, chronic dehydration. With disease progression and acute hypotension, the patient develops addisonian crisis, which is characterized by cyanosis and the classic signs of circulatory shock: pallor, apprehension, rapid and weak pulse, rapid respirations, and low blood pressure. In addition, the patient may complain of headache, nausea, abdominal pain, and diarrhea and show signs of confusion and restlessness. Even slight overexertion, exposure to cold, acute infections, or a decrease in salt intake may lead to circulatory collapse, shock, and death if untreated. The stress of surgery or dehydration resulting from preparation for diagnostic tests or surgery may precipitate an addisonian or hypotensive crisis. Laboratory findings include decreased blood glucose (hypoglycemia) and sodium (hyponatremia) levels, an increased serum potassium (hyperkalemia) level, and an increased white blood cell count (leukocytosis). To reduce the risk of future episodes of addisonian crisis, efforts are made to identify and reduce the factors that may have led to the crisis. Lying, sitting, and standing blood pressures also provide information about fluid status. A decrease in systolic pressure (20 mm Hg or more) may indicate depletion of fluid volume, especially if accompanied by symptoms. The nurse encourages the patient to consume foods and fluids that will assist in restoring and maintaining fluid and electrolyte balance; along with the dietitian, the nurse assists the patient to select foods high in sodium during gastrointestinal disturbances and very hot weather. The nurse instructs the patient and family to administer hormone replacement as prescribed and to modify the dosage during illness and other stressful occasions. Written and verbal instructions are provided about the administration of mineralocorticoid (Florinef) or corticosteroid (prednisone) as prescribed. Even minor events or stressors may be excessive in patients with adrenal insufficiency. During the acute crisis, the nurse maintains a quiet, nonstressful environment and performs all activities (eg, bathing, turning) for the patient. Explaining the rationale for minimizing stress during the acute crisis assists the patient to increase activity gradually. Because of the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises, the patient and family members receive explicit verbal and written instructions about the rationale for replacement therapy and proper dosage. Additionally, they are instructed about how to modify the medication dosage and increase salt intake in times of illness, very hot weather, and other stressful situations.

The glomerular membrane normally allows filtration of fluid and small molecules yet limits passage of larger molecules asthma treatment in jabalpur cheap singulair 5mg without prescription, such as blood cells and albumin asthmatic bronchitis coughing blood discount singulair line. Kidney function begins to decrease at a rate of approximately 1% each year beginning at approximately age 30 asthma breathing treatment discount singulair online american express. Ureters asthma like symptoms after quitting smoking order singulair from india, Bladder, and Urethra Urine, which is formed within the nephrons, flows into the ureter, a long fibromuscular tube that connects each kidney to the bladder. There are three narrowed areas of each ureter: the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovesical junction. The angling of the ureterovesical junction is the primary means of providing antegrade, or downward, movement of urine, also referred to as efflux of urine. Each kidney has about 1 million nephrons, which take two forms: cortical and juxtamedullary. Cortical nephrons are located in the cortex of the kidney; juxtamedullary nephrons are adjacent to the medulla. During voiding (micturition), increased intravesical pressure keeps the ureterovesical junction closed and keeps urine within the ureters. As soon as micturition is completed, intravesical pressure returns to its normal low baseline value, allowing efflux of urine to resume. Therefore, the only time that the bladder is completely empty is in the last seconds of micturition before efflux of urine resumes. The three areas of narrowing within the ureters have a propensity toward obstruction because of renal calculi (kidney stones) or stricture. Obstruction of the ureteropelvic junction is the most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The lining of the ureters is made up of transitional cell epithelium called urothelium. The movement of urine from the renal pelves through the ureters into the bladder is facilitated by peristaltic waves (occurring about one to five times per minute) from contraction of the smooth muscle in the ureter wall (Walsh, Retik, Vaughan & Wein, 1998). In adolescence and through adulthood, the bladder assumes its position in the true pelvis. The bladder is characterized by its central, hollow area called the vesicle, which has two inlets (the ureters) and one outlet (the urethrovesical junction), which is surrounded by the bladder neck. Immediately beneath the adventitia is a smooth muscle layer known as the detrusor. Beneath the detrusor is a smooth muscle tunic known as the lamina propria, which serves as an interface between the detrusor and the innermost layer, the urothelium. The urothelium layer is specialized, transitional cell epithelium, containing a membrane that is impermeable to water. The bladder neck contains bundles of involuntary smooth muscle that form a portion of the urethral sphincter known as the internal sphincter. The portion of the sphincteric mechanism that is under voluntary control is the external urinary sphincter at the anterior urethra, the segment most distal from the bladder (Walsh et al. Chapter 43 the urethra arises from the base of the bladder: In the male, it passes through the penis; in the female, it opens just anterior to the vagina. In the male, the prostate gland, which lies just below the bladder neck, surrounds the urethra posteriorly and laterally. These functions include urine formation; excretion of waste products; regulation of electrolyte, acid, and water excretion; and autoregulation of blood pressure. Figure 43-3 illustrates the three processes of urine formation and typical values of water and electrolytes associated with each process. The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Others are secreted from the blood into the filtrate as it travels down the tubule. Some substances, such as glucose, are completely reabsorbed in the tubule and normally do not appear in the urine. Amino acids and glucose are usually filtered at the level of the glomerulus and reabsorbed so that neither is excreted in the urine. Glucose, however, appears in the urine (glycosuria) if the amount of glucose in the blood and glomerular filtrate exceeds the amount that the tubules are able to reabsorb.