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By N. Aidan. Air University.
Undernutrition is also a common problem in response to the increased metabolic needs associated with severe head injury discount 75mg plavix otc blood pressure of 110/70. If the patient cannot eat buy plavix 75 mg line heart attack 32, enteral feedings or parenteral nutrition may be initiated within 48 hours after the injury to provide adequate calories and nutrients (Bader et al. Nutritional support in the form of early feeding after head injury is associated with better survival outcomes and decreased disability (Yanagawa, Bunn, Roberts, et al. Post-traumatic Seizures Patients with head injury are at an increased risk for post-traumatic seizures. Post- traumatic seizures are classified as immediate (within 24 hours after injury), early (within 1 to 7 days after injury), or late (more than 7 days after injury) (Somjen, 2004). Seizure prophylaxis is the practice of administering antiseizure medications to patients with head injury to prevent seizures. However, many antiseizure medications impair cognitive performance and can prolong the duration of rehabilitation. 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.
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High agglutinin titier Complication: Brucella spondylitis( Vertebral brucellosis) Lab generic 75mg plavix mastercard blood pressure low symptoms. Ulceroglandular tularemia: Ulceration of arms and hands with lymphadenitis after tick bite or direct contact of broken skin with infected tissue or blood 3 generic plavix 75 mg online blood pressure diastolic low. Oculoglandular tularemia: Accidental contamination of the conjunctiva with infected droplets/aerosols 4. Dignosis: Specimen: Skin lesion, lymphnodes, sputum, conjunctival scrapings Culture: grow in blood-cysteine-gextrose agar incubated at 37 0c under aerobic condition Serology: Agglutination test Single titer of ≥ 1:160 is highly suggestive of tularemia Paired serum samples collected two weeks apart can show a rise in agglutination titer Treatment: Streptomycin or gentamicin Tetracycline Prevention and control: Immunization of high risk persons (eg. Heat labile and sensitive to alcohol May interfere with agglutination by O antisera. Heat labile and may be associated with virulence May interfere with agglutination by O antisera. Colonization factor of the organism promote adherence to epithelial cells of small intestine followed by release of enterotoxin which causes toxin-mediated watery diarrhea in infants and young adults. Antibiotic prophylaxis can be effective but may increase drug resistance (Should not be uniformly recommended) 4. Produce food-borne illness in developed countries 234 Laboratory diagnosis: Specimen: Urine, pus, blood, stool, body fluid Smear: Gram-negative rods Culture: Lactose-fermenting mucoid colonies on mac conkey agar and some strains are hemolytic on blood agar. Serology: For serotyping (Epidemiologic information) Treatment: Base on antibiotic sensitivity pattern Genus: Klebsiella Characteristics: Non-motile, lactose-fermenting, capsulated, gram-negative rods. Enterobacter aerogens is associated with urinary tract infection, wound infection and septicaemia in immunocompromised and chronically deblitated patients. Citrobacter freundii is associated with urinary tract infection, wound infection and septicaemia in immunocompromised and chronically deblitated patients. Compromised local intestinal immmunity 237 Both manifest with persistent fever, headache, malaise, chills, enlargement of liver and spleen, and skin rashes. Paratyphoid fever is milder than typhoid fever Complications: Intestinal perforation Lower gastrointestinal bleeding Dissenmination to different body organs including meninges and brain Mortality rate Untreated cases: 10-15% Treated cases: < 1% 2. Gram reaction: Gram-negative rods Culture: Bacteriologic methods for salmonella isolation 1. Inhibit replication of normal intestinsl flora and permit replication of salmonella Egs. Selenite F broth Tetrathionate broth Non-lactose fermenting, H2S producing colonies in Mac conkey agar. Tube dilution agglutination test Used to determine antibody titers in patients with unknown illness 240 Method: • Serial dilutions of unknown serum are tested against antigens from representative salmonella species. Slide agglutination test/ Kauffman-White system Used to identify unknown cultures with known sera 241 Required: Salmoella O and H polyvalent antiserum Method:. Pathogenesis and Clinical features: Route of infection is fecal-oral route Inoculum dose: 103 organisms Pathogenicity determinant: Toxins: Endotoxin: irritate the bowel wall Exotoxin: Enterotoxin and neurotoxin S. Complication: Dehydration Electrolyte and acid-base disturbance High prevalence: Poor sanitation Poor personal hygiene Polluted water supply Young children are frequently affected. Laboratory diagnosis: Specimen: Stool,serum Gram reaction: Gram-negative non-motile rods. Laboratory diagnosis: Specimen: Urine, pus, blood, ear discharge Smear: Gram-negative rods Culture: Produce characteristic swarming growth over the surface of blood agar. Indole negative Serology: Cross react with Weil-fellix test Treatment: Based on sensitivity testing. Bubonic plague: Fever, vomiting, painful lymphadenitis(buboes) in the groin or axillae 2. Pneumonic plague: Ip is 1-3 days Profuse mucoid or bloody expectoration with signs of pneumonia 3. Septicemic plague Fever, vomiting, diarrhea, hypotension, altered mentation, renal and heart failure, intra vascular coagulopathy Lab. Formalin-killed vaccine for travellers to hyperendemic areas and high risk persons Yersinia enterocolitica and Yersinia pseudotuberculosis Non-lactose fermenting gram negative rods Urease positive Oxidase negative Y.
