Topamax

By O. Lares. Union Theological Seminary.

The cells of the adrenal cortex order 200mg topamax, which are arranged in continuous cords separated by capillaries order topamax 200 mg otc, are characterized by an abundance of mitochondria, endoplamic reticulum, and accumulation of lipid. Adrenal cortical tissue is structurally arranged into three concentric regions or zones: a thin outer zona glomerulosa, a thick middle zona fasciculate, and an inner zona reticularis bordering on the adrenal medulla. The adrenocorticoid hormones are usually divided into three functional groups: the mineralocorticoids, such as aldosterone, which regulate electrolyte and water balance; the glucocorticoids, such as cortisol, which affect carbohydrate, protein, and fat metabolism; and the adrenogenital steroids or sex hormones. The adrenogenital steroids are of three types: androgens (such as dehydroepiandrosterone), estrogens (such as estradiol), and progestins (such as progesterone). Excessive secretion of adrenal androgens results in precocious pseudopuberty in boys, and causes masculinization of females (adrenogenital syndrome). The plasma 236 Human Anatomy and Physiology concentrations of sodium and potassium are involved in the control of aldosterone secretion. Hyperkalemia (elevated plasma potassium) exerts a direct stimulating effect on the zona glomerulosa, whereas hyponatremia (low plasma sodium) activates the rennin-angiotensin mechanism. Aldosterone plays a major physiologic role in the maintenance of electrolyte and fluid balance by promoting the renal tubular reabsorption of sodium and the secretion of potassium and hydrogen. A similar sodium-retaining, potassium-excreting action is exerted on other target tissues, including salivary glands and sweat glands. A similar sodium-retaining, potassium-excreting action is exerted on other target tissues, including salivary glands and sweat glands. When present in large amounts, these hormones favor redistribution of adipose stores by promoting loss of fat from the extremities, and accumulation of fat depots in central body regions (e. Other permissive effects include support for the metabolic actions (particularly lipolysis) of the catecholamines and glucagons. These hormones also stimulate erythropoiesis and elevate circulating levels of platelets and neutrophils. The Sex Glands The sex glands, the ovaries of the female and the testes of the male, not only produce the sex cells but are also important 239 Human Anatomy and Physiology endocrine organs. The hormones produced by these organs are needed in the development of the sexual characteristics, which usually appear in the early teens and for the maintenance of the reproductive apparatus once full development has been attained. The main androgen produce by the male sex glands, testosterone, is responsible for the growth of and functioning of the male reproductive tract. Testosterone is also responsible for male secondary sex characteristics such as a deep voice and facial hair. In the female, the hormones that most nearly parallel testosterone in their actions are the estrogens. Estrogens contribute to the development of the female secondary sex characteristics and stimulate the development of the mammary glands, the onset of menstruation, and the development and functioning of the reproductive organs. The other hormone produced by the female sex glands, called progesterone, assists in the normal development of pregnancy. Through the production of a hormone called thymosin, it helps in the development of certain white blood cells, called T- lymphocytes that help protect the body against foreign organisms. Because this gland is most active before birth and early in life, it is large during childhood but gradually shrinks in size as one reach adulthood. The Pineal Gland The pineal gland, a small, flattened, cone-shaped structure located between the two parts of the thalamus, produces a hormone called melatonin in a number of animals and also in humans. Melatonin, or some other hormone from the pineal, is thought to regulate the release of certain substances from the hypothalamus, which may in turn regulate the secretion of gonadotropins from the pituitary. There is evidence from animal studies that the production of melatonin is regulated by the amount of light in the environment. Selected Key Terms The following key terms are defined in the Glossary: Anastomosis Diastole Leukaemia Systole Aorta Endocardium Leukocyte Valve Arteriole Endothelium Murmur Vein Artery Epicardium Myocardium Vena cava Atrium Erythrocyte Pericardium Ventricle Capillary Fibrin Plasma Venule Coagulation Haemoglobin Platelet Coronary Hematocrit Pulse Deptum Hemolysis Serum 244 Human Anatomy and Physiology The cardiovascular system is the transport system of the body by which food, oxygen, water and all other essentials are carried to the tissue cells and their waste products are carried away. The blood vessels, the routes by which the blood travels to and through the tissues and back to the heart. However, it differ from other connective tissues in that its cells are not fixed in position, instead they move freely in the liquid portion of the blood, the plasma. Blood is a viscous (thick) fluid that varies in colour from bright to dark red, depending on how much oxygen it is carrying. Its quantity differs with the size of the person; the average adult male, weighing 70 kg has about 5-6 litres of blood. The circulating blood is of fundamental importance in maintaining the internal environment in a constant state (homeaostasis). Oxygen- from inhaled air diffuses into the blood through the thin lung membranes and is carried to all the tissue of the body. Carbon dioxide, a waste product of cell metabolism, is carried from the tissues to the lungs, where it is breathed out. These materials may inter the blood from the digestive system or may be released into the blood from body stores. The kidney removes excess water, minerals, and urea from protein metabolism and maintains the acid-base balance of the blood. The blood serves to regulate the amount of fluid in the tissues by means of substances (mainly proteins) that maintain the proper osmotic pressure 246 Human Anatomy and Physiology C. The blood transports heat that is generated in the muscles to other parts of the body thus aiding in the regulation of body temperature by the blood, thus aiding in the regulation of body temperature.

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For initial examination buy 100mg topamax mastercard, perform preliminary palipatory determination of systolic pressure 87 Basic Clinical Nursing Skills • Palpate the brachial artery with the finger tips • Close the valve on the pump by turning the knob clockwise topamax 200mg otc. Position the stethoscope appropriately • Insert the ear attachments of the stethoscope in your ears so that they tilt slightly fore ward. Key Terminology: 90 Basic Clinical Nursing Skills Hemoglobine Hematocrite Leukocyte Occult Stroke Urinalysis Specimen Collection Specimen collection refers to collecting various specimens (samples), such as, stool, urine, blood and other body fluids or tissues, from the patient for diagnostic or therapeutic purposes. General Considerations for Specimen Collection When collecting specimen, wear gloves to protect self from contact with body fluids. Get request for specimen collection and identify the types of specimen being collected and the patient from which the specimen collected. Give adequate explanation to the patient about the purpose, type of specimen being collected and the method used. Get the appropriate specimen container and it should be clearly labeled have tight cover to seal the content and placed in the plastic bag or racks, so that it protects the laboratory technician from contamination while handling it. Put the collected specimen into its container without contaminating outer parts of the container and its cover. All the specimens should be sent promptly to the laboratory, so that the temperature and time changes do not alter the content. Collecting Stool Specimen Purpose • For laboratory diagnosis, such as microscopic examination, culture and sensitivity tests. Equipments required o Clean bedpan or commode o Wooden spatula or applicator o Specimen container o Tissue paper 92 Basic Clinical Nursing Skills o Laboratory requests o Disposable glove, for patients confined in bed o Bed protecting materials o Screen Procedure i) For ambulatory patient Give adequate instruction to the patient to • Defecate in clean bedpan or commode (toilet) • Avoid contaminating the specimen by urine, menstrual period or used tissue papers, because these may affect the laboratory analysis. Obtain stool sample • Take the used bedpan to utility room/toilet container using spatula or applicator without contaminating the outside of the container. Timed urine specimen • It is two types Short period → 1-2 hours Long period → 24 hours Purpose • For diagnostic purposes - Routine laboratory analysis and culture and sensitivity tests Equipments Required • Disposable gloves • Specimen container • Laboratory requisition form (Completely filled) 95 Basic Clinical Nursing Skills • Water and soap or cotton balls and antiseptic solutions (swabs). Obtain urine specimen • Ask patient to void • Let the initial part of the voiding passed into the receptacle (bed pan or urinal) then pass the next part (the midstream) into the specimen container. Care of the specimen and the equipment • Handle and label the container correctly • Send the urine specimen to the laboratory immediately together with the completed laboratory requested forms • Empty the receptacles content properly • Give appropriate care for the used equipments 6. Collecting the urine • Usually it begin in the morning • Before you begin the timing, the patient should void and do not use this urine (It is the urine that has been in the bladder some time) • Then all urine voided during the specified time (e. Collecting sputum specimen Sputum is the mucus secretion from the lungs, bronchi and trachea, but it is different from saliva. The best time for sputum specimen collection is in the mornings up on the patient’s awaking (that have been accumulated during the night). If the patient fails to cough out, the nurse can obtain sputum specimen by aspirating pharyngeal secretion using suction. Purpose 99 Basic Clinical Nursing Skills Sputum specimen usually collected for: • Culture and sensitivity test (i. Patient preparation • Before collecting sputum specimen, teach pt about the difference between sputum and saliva, how to cough deeply to raise sputum. Obtain sputum specimen 100 Basic Clinical Nursing Skills • Put on gloves, to avoid contact with sputum particularly it hemoptysis (blood in sputum) present. Recomfort the patient • Give oral care following sputum collection (To remove any unpleasant taste) 4. Care of the specimen and the equipments used • Label the specimen container • Arrange or send the specimen promptly and immediately to laboratory. Document the amount, color, consistency of sputum, (thick, watery, tenacious) and presence of blood in the sputum. Collecting Blood Specimen 101 Basic Clinical Nursing Skills The hospital laboratory technicians obtain most routine blood specimens. Patient preparation 102 Basic Clinical Nursing Skills • Instruct the pt what to expect and for fasting (if required) • Position the pt comfortably 2. Obtain specimen of the venous to blood • Adjust the syringe and needles • Clean/disinfect the area with alcohol swab, dry with sterile cotton swab • Puncture the vein sites • Release the tourniquet when you are sure in the vein • Withdraw the required amount of venous blood specimen 103 Basic Clinical Nursing Skills • Withdraw the needle and hold the sites with dry cotton (to apply pressure) • Put the blood into the specimen container • Made sure not to contaminate outer part of the container and not to distract the blood cells while putting it into the container 4. Care of the specimen and the equipment • Label the container • Shake gently (if indicated to mix) • Send immediately to laboratory, accompanying the request • Give care of used equipments 6. Chart Definition: it is a written record of history, examination, tests, diagnosis, and prognosis response to therapy Purpose of Patients Chart a. For diagnosis or treatment of a patient while in the hospital (find after discharge) if patient returns for treatment in the future time b. For serving an information in the education of health personnel (medical students, interns, nurses, dietitians, etc) e. For promoting public health General Rules for Charting • Spelling Make certain you spell correctly 105 Basic Clinical Nursing Skills • Accuracy Records must be correct in all ways, be honest • Completeness No omission, avoid unnecessary words or statement • Exactness Do not use a word you are not sure of • Objective information Record what you see avoid saying (condition better) • Legibility Print/write plainly and distinctively as possible • Neatness No wrinkles, proper speaking of items Place all abbreviation, and at end of statement • Composition / arrangement Chart carefully consult if in doubt avoid using of chemical formulas • Sentences need to be complete and clear, avoid repetition • Don’t overwrite • Don’t leave empty spaces in between • Time of charting Specific time and date • Color of ink Black or blue (red for transfusion, days of surgery) 106 Basic Clinical Nursing Skills It should be recorded on the graphic sheet All orders should be written and signed. Verbal or telephone orders should be taken only in emergency verbal orders should be written in the order sheet and signed on the next visit. Laboratory and other diagnostic reports • Patients or relatives and friends of patients are not allowed to read the chart when necessary but can have access if allowed by patient. Purpose: • To replace fluid losses 107 Basic Clinical Nursing Skills • To provide maintenance requirements • To check for retention of body fluid Fluid balance sheet ♦ 24 hrs the intake out put should be compared and the balance is recorded ¾ Positive balance if intake >output Negative balance if out put >intake Study Questions 1. Closed bed: is a smooth, comfortable and clean bed, which is prepared for a new patient • In closed bed: the top sheet, blanket and bed spread are drawn up to the top of the bed and under the pillows.

Drainage of breast abscess Under general or local anesthesia purchase topamax 200 mg fast delivery, incision is sited in a radial direction over the affected segment cheap 200 mg topamax with mastercard. Every part of abscess is palpated against the point of hemostat and its jaw opened, all loculi that can be felt are entered. Finally the hemostat having been removed, a finger is introduced and any remaining septa are disrupted. The wound may then be lightly packed with gauze or drain inserted to allow dependent drainage. Carcinoma of the Breast Breast cancer is the commonest cause of death in middle-aged women in western countries. Risk factors • Geographical - it occurs commonly in the western world accounting for 3-5 percent of deaths but is rare tumor in Far East like Japan. Pathology: Breast cancer may arise from the epithelium of the duct system starting from the nipple to the end of lactiferous ducts which is in the lobule. It may be entirely in situ (with out breaching basement membrane) or may be invasive. The degree of differentiation of a tumor is usually described by three grades well differentiated, moderately or poorly differentiated. It tends to involve the skin and to penetrate the pectoral muscles, and even the chest wall. Involvement of lymph nodes is not necessarily a chronological event in the evolution of the carcinoma, but rather a marker of the metastatic potential of that tumor. In advanced diseases there may be involvement of supraclavicular nodes and of any contra lateral lymph nodes. It is by this route that skeletal metastasis occurs in decreasing frequency to the lumbar vertebra, femur, thoracic vertebra, rib and skull. Metastasis can also occur to the liver, lungs and brain and occasionally to the adrenal glands and ovaries. Clinical presentation While any portion of the breast may be involved, breast cancer commences most frequently in the upper outer quadrant. Prognosis of breast cancer: The best indicators of likely prognosis in breast cancer are tumor size and lymph node status. Other prognostic factors include: - Invasive and metastatic potential - Histological grade of tumor - Estrogen receptor status - Patient age and menopausal status are some of the factors Treatment of Breast Cancer: Treatment of breast cancer is a multi disciplinary approach. It largely depends on clinical stage and other tumor characteristics described previously. Modes of treatment include: • surgery • radiotherapy and • Medical therapy (including chemotherapy and hormonal therapy. A-20 year old female patient presents with a solitary painless lump in the breast. A thirty-five year-old nulliparous woman comes with history of swelling in the breast of 2-months duration. In association with this, the patient has moderate fever, decreased appetite and weight loss. List the most important laboratory investigations which help you confirm the diagnosis. On Physical examination, the tumor measured 4cm, its non-mobile and rough surfaced. Introduction Acute upper airway obstruction is a surgical emergency with no time to lose. Infants are vulnerable more than adults due to small diameter of the airway, longer soft palate, more posterior pharyngeal soft tissues, compliant epiglottis, etc. Generally, in any patient with thoracic problem, chest physiotherapy, that is incentive spirometry if available or inflating a glove or intravenous fluid bag with deep inspiration and expiration and early movement is of paramount importance for smooth recovery of the patient. It is usually characterized by stridor (noisy breathing); suprasternal retraction; tachycardia and cyanosis develop as obstruction becomes complete. If a foreign body aspiration is suspected, tilt the patient’s head down and slap the patient sharply across the back. Then, explore the pharynx and mouth by finger and if possible, urgent laryngoscopy should be done. If indicated, intubate the airway immediately, otherwise do emergency cricothyroidotomy (insert wide bore needle to the cricothyroid membrane) and give 100% oxygen until intubation or proper tracheostomy is done. It is indicated to by- pass upper airway obstruction, for drainage of the respiratory tract and to provide assisted ventilatory support. Tracheostomy should be performed in operating room under general anaesthesia with intubation, if possible, especially in case of children.