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By R. Cyrus. Fisk University. 2018.
Hair grows on the head discount cozaar 50mg fast delivery diabetes type 1 research latest, and lanugo generic cozaar 25 mg without prescription diabetes mellitus type 2 and hypertension, a profusion of fine soft hair, covers the skin. The fetus is between 11 and 14 inches long and weighs a bit less than 1 ⁄12 pounds. During the seventh month, skin becomes smoother as the fetus gains subcuta- neous fat tissue. During the eighth month, subcutaneous fat increases, and the fetus shows more baby-like proportions. During the ninth month, the fetus plumps up considerably with additional sub- cutaneous fat. Much of the lanugo is shed, and fingernails extend all the way to the tips of the fingers. The average newborn at the end of the ninth month is 20 inches long and weighs about 7 ⁄12 pounds. The following practice questions deal with the development of the fetus during its 40 weeks in the womb: 59. By the 19th week of gestation Chapter 14: Carrying Life Forward: The Female Reproductive System 229 60. Describe one new fetal development for each month: 3rd month: ________________________________________________________________________ 4th month: ________________________________________________________________________ 5th month: ________________________________________________________________________ 6th month: ________________________________________________________________________ 7th month: ________________________________________________________________________ 8th month: ________________________________________________________________________ 9th month: ________________________________________________________________________ Growing, Changing, and Aging After a baby arrives, the female reproductive system goes into a different form of overdrive. Throughout the pregnancy, the placenta has been producing estrogen and progesterone to sustain the fetus. But after the baby is born, the sudden drop in hor- monal blood levels triggers the pituitary gland to release prolactin, a hormone that stimulates the woman’s mammary glands to secrete milk in a process called lactation. First, however, the glands produce colostrum, a thin, yellowish fluid rich in antibodies and minerals to sustain a newborn. Both colostrum and milk flow from a number of lobes inside the breast through lactiferous ducts that converge on the nipple. Faced with survival after its physical separation from the mother, a neonate must abruptly begin to process food, excrete waste, obtain oxygen, and make circulatory adjustments. Growth during this period is explosive under the stimulation of circulatory growth hormones from the pituitary gland, adrenal steroids, and thyroid hormones. The infant’s deciduous teeth, also called baby or milk teeth, begin to form and erupt through the gums. Influenced by growth hormones, growth continues its rapid pace as deciduous teeth are replaced by permanent teeth. Muscle coordination, language skills, and intellectual skills also develop rapidly. From puberty, which starts between the ages of 11 and 14, to adulthood, the child is called an adolescent. Girls achieve their maximum growth rate between the ages of 10 and 13, whereas boys experience their fastest growth between the ages of 12 and 15. Growth terminates when the epiphyseal plates of the long bones ossify some- time between the ages of 18 and 21. Motor skills and intellectual abilities continue to develop, and psychological changes occur as adulthood approaches. Physical development reaches its peak and adult responsibilities are assumed, often including a career, marriage, and a family. After about age 30, physical changes that indicate the onset of aging begin to occur. Gray hair, diminished physical abilities, and skin wrinkles are outward signs of aging. Women go through menopause, the cessation of monthly cycles, which is also known as climacteric or the change of life. With the cessation of menses comes a decrease in size of the uterus, shortening of the vagina, shrinkage of the mammary glands, disappear- ance of Graafian follicles, and shrinkage of the ovaries. For about six years prior to menopause, many women experience a stage called perimenopause during which increasingly irregular hormone secretions can cause fluctuations in menstruation and a sensation called hot flashes.
This can be a debilitating and uncom- fortable problem 25 mg cozaar with mastercard blood sugar xylitol, but there are a number of lifestyle recommendations that can help buy cozaar 50mg cheap metabolic disease otc. Note: See your doctor if you notice blood in your stool or have black stools, as this could signify a serious problem. Ex- amples include Dulcolax (bisacodyl), Senokot (senna), castor oil, and cascara. These drugs work quickly (overnight), but may cause abdominal cramping and are recom- mended for short-term (a few days) use only. Bulk-forming laxatives add bulk and water to the stools, which improves passage through the intestines. They are taken daily with plenty of fluids, and it may take a week to notice benefits. Stool softeners, such as Colace (docusate) cause water and fats to penetrate the stool, easing movement through intestines. Mineral oil makes the stool slippery to facilitate pas- sage; however, it should not be used regularly, as it can reduce the absorption of fat-soluble vitamins (A, D, E, and K). Those who take laxatives for a long time may need to go off them slowly to allow the bowels to return to normal function. Eat whole-grain breads and cereals (made with wheat bran, whole oats, rye, and flaxseed), fresh fruits (especially strawberries, apples, and rhubarb), dried fruits, vegetables, and legumes. Foods to avoid: • Refined and processed foods are high in sugar and contain little fibre. In one study, two-thirds of the infants had constipation that was relieved when cow’s milk was removed from their diet. Lifestyle Suggestions C • Increase physical activity, as exercise helps stimulate intestinal and bowel contractions. The longer you delay going to the toilet once you feel the urge, the more water that is absorbed from the stool and the harder it becomes. Top Recommended Supplements Fibre supplements: Products containing psyllium husks, flaxseed, oat bran, guar gum, glucommannan, and fenugreek are effective and can be taken regularly. Start with a small amount (one tablespoonful daily) and gradually increase to allow your bowels to adjust. Probiotics: Supplements containing these “friendly bacteria” help to restore the normal gut flora and have been shown in studies to relieve constipation. Complementary Supplements Aloe vera juice: Aids bowel movements by working as a stimulant and improving intestinal contractions. Magnesium: Aids intestinal function and helps stool retain water; may be deficient in those with constipation. These diseases affect the digestive system and cause the intestinal tissue to become inflamed, develop sores, and bleed. These diseases can be painful and debilitating and may lead to life-threatening complications, especially if untreated. Crohn’s disease and ulcerative colitis are very similar in that they both inflame the lining of your digestive tract and can cause severe bouts of watery or bloody C diarrhea and abdominal pain. Where they differ is that Crohn’s disease can occur anywhere in your digestive tract, often spreading deep into the layers of affected tis- sues whereas ulcerative colitis usually affects only the innermost lining of your large intestine (colon) and rectum. Symptoms may come and go and those affected may also experience long periods of remission. Stress can aggravate symptoms, and was once considered to be the underlying cause, but that is no longer the case. Many practitioners, especially those with knowledge of nutrition and preventative medicine, feel that diet may be responsible for triggering these diseases. Both diseases are rare in developing countries and among cultures that eat whole, unprocessed foods. As well, it wasn’t until the mid-1900s that these diseases became a problem in North America. Consumption of fast foods and processed and refined foods and ingestion of chemical food additives is common. It is also possible that the inflammation may stem from the immune system’s response to infection with a virus or bacterium. Since the diseases are more common among those with a family history, genetic mutations may also be to blame.
Life-lenses are strongly held beliefs or assumptions that you have about yourself generic 25mg cozaar overnight delivery diabetes insipidus in dogs treatment, your relationships with others cozaar 25mg low price diabetes symptoms undiagnosed, and your world. Life-lenses powerfully influence how you respond to, interpret, and feel about events, but you may not be aware that you look through them. On the other hand, you probably know a few folks who view the world through dark, gloomy shades. Your views of people, events, and even your self-image depend upon which lenses you look through. This chapter helps you realize whether your lenses are dirty, cracked, smoky, colored, or clear. A quiz shows you which lenses you look through and how they may cause you emotional trouble, and the exercises demonstrate how to change problematic life-lenses. For example, it’s not a bad idea to assume that day follows night, taxes must be paid, food is located at grocery stores, most drivers stop at red lights, and hard work usually pays off. Think about how snarled traffic would be if no one assumed that red means stop and green means go. Or just consider how much time you’d waste if you searched for food in department stores, schools, and libraries rather than assuming that you’d find it in grocery stores. These assumptions or beliefs color the way you feel about yourself and the things that happen to you. Or perhaps you have a vulnerable life-lens and thus assume that the world is a dan- gerous place. As we explore assumptions (that is, life-lenses) such as these, you can see that they form the foundation of your most distressing emotions, such as depression, anxiety, worry, irritability, apprehension, and even anger. These themes directly influ- ence the kinds of thoughts you have and, in turn, how you feel about what happens to you. Although Susan and Diane are both well qualified, a nurse from another hospital gets the job. Susan reacts with anger and comments, “I deserved that job; the administration had no right to give that job away. She feels gloomy and says, “I’m sure they made the right deci- sion picking someone else. She believes that she always deserves the best; Susan feels that the world owes her and that if she wants something, it should be hers. She thinks that she’s not good enough and that others have more skill and talent than she does. Diane assumes that she couldn’t do the job even though her supervisor told her she has the appropriate ability and background. Susan’s entitled life-lens makes her prone to tension and anger when her needs aren’t met. Diane’s inadequacy life-lens steers her in the direction of depression when her adequacy is called into question. Susan and Diane apply their respective life-lenses to many different events in their lives. For example, when they’re both caught in an unexpected traffic jam, they view the event through their own life-lenses and thus experience different thoughts and feelings. Susan’s entitled life-lens leads her to feel rage and have thoughts like, “No one in this town knows how to drive. After all, changing the way you feel starts with identifying your problematic life-lenses. If you aren’t aware of your own life-lenses, you’re powerless to do anything about them. The questionnaire in Worksheet 7-1 is designed to clarify which life-lenses may be causing you trouble. After you identify them, we tell you a little more about how they work, where they come from, and most importantly, what you can do about them. Before you start mark- ing the life-lenses in the worksheet that apply to you, consider the following tips: Answer as honestly as possible. Sometimes, people respond how they think they “should” answer rather than responding with honest self-appraisals. Take your time to reflect on various events and situations that have happened to you that are relevant to each lens. For example, in answering questions about abandonment-fearful versus intimacy-avoidant, ponder the relationships you’ve had and how you feel and react to those close to you.
Hosts and vectors of the medically important rickettsiae Organism Disease Hosts Vectors 1 order cozaar 25 mg mastercard diabetes mellitus type 2 risk for infection. It causes epidemic or louse-borne typhus and the milder recrudescence form cheap cozaar 25 mg with mastercard blood sugar 400 what to do, Brill-Zinser disease. Clinical Features: It is transmitted by self-inoculation of the organism by scratching after bite by infected louse(Pediculous humanus corporis and pediculous humanus capitis). The illness manifests with sudden onset of fever, headache, malaise, prostration and skin rash. Epidemics of the disease are associated with overcrowding, cold weather, lack of washing facilities and fuel, famine and war. The disease is milder than louse-borne typhus and occurs in those individuals living or working in highly rat-infested area. Laboratory diagnosis: Specimen: Serum for serological tests The serological tests to diagnose typhus are: 1. The smallest living micro-organism capable of free living in nature self-replicating on laboratory media. Highly pleomorphic due to absence of rigid cell wall, instead bounded by a triple-layered “unit membrane”. Have enzyme systems and make their own proteins, lipids, nucleic acids and vitamins. The elementary body is reorganized into reticulate body in the host cell which is specifically adapted for intracellular growth. The reticulate body grows and divides many times to form inclusions in the host cell cytoplasm. With in 24-48 hours of developmental cycle, the reticulate bodies rearrange them selves into infective elementary bodies and released after host cell rupture. Antigenic structure: Group-specific antigen Species-specific antigen Chlamydia trachomatis. Appearance in giemsa’s stain Elementary body -------- Purple Reticulate body---------- Blue Host cell cytoplasm----- Blue. Appearance in iodine stain Brown inclusions in host cell cytoplasm because of glycogen matrix surrounding the particle. Incubation period is 3-10 days Route of transmission is through indirect contact like eye-to- eye by infected fingers or sharing towels. It manifests as a chronic keratoconjunctivitis producing scarring and deformity of the eyelids, corneal vascularization and opacities which may lead to blindness. Laboratory diagnosis: Specimen: Conjunctival scraping from upper tarsal conjunctivae. Culture: Mac coy cells or embryonated eggs Serology: Immunofluorescent tests Treatment: Erythromycin Tetracycline Control measures:. Females------ Urethritis Cervicitis Pelvic inflamatory diseases If complicated in females, it causes infertility and ectopic pregnancy. Neonatal inclusion conjunctivitis and neonatal pneumonia Transmission is during passage through the infected birth canal. Laboratorydiagnosis: Specimen: Endocervical scraping Culture: mac coy cells Serology: Enzyme immunoassay for group-specific antigen. On the basis of their life habits, microorganism is classified as saprophytes or parasites. Saprophytes : Mode of life of free-living organisms which obtain their nourishment from soil and water. Commensalism: The ability to live on the external or internal surface of the body with out causing disease. Invasiveness of micro-organism A high degree of bacterial invasiveness is usually associated with severe infection. Mode of release from bacteria Excreted by released on bacterial death 295 living cell (Integral part of cell wall) 4. Collagenase: Degrade collagen, which is major protein of fibrous connective tissue. Hyaluronidase: (Early spreading factor) hydrolyzes hyaluronidic acid, which is the ground substance of connective tissue. Lecithinase: Splits lecithin of cell membrane into phosphorylcholine and glycerides. Many layered impermeable barrier to invasion of the tissues by microorganisms from the environment.
This material is intended for educational use only by practicing health care workers or students and faculty in a health care field cheap cozaar 25mg with amex diabetes type 1 thyroid. Since it comprises most of the contents of course outline on medical bacteriology to nursing purchase cozaar 25mg online managing your diabetes lilly, pharmacy and environmental science students, it can be used as a main learning material to these category of students. This lecture note gives emphasis on the knowledge and procedures of medical bacteriology to common pathogens in our country. At last but not least, the quality of this lecture note is kept updated by continous comments made by users of this lecture note. Dennis Carlson for his invaluable technical and moral support for the completion of this work. We also extend our appreciation to those individuals who reviewed this lecture note in different teaching institutions for the materialization of this lecture note. Identify the chemical meanses of sterilization and disinfection, and their effect on bacterial cell 6. It considers the microscopic forms of life and deals about their reproduction, physiology, and participation in the process of nature, helpful and harmful relationship with other living things, and significance in science and industry. Hippocratus, father of medicine, observed that ill health resulted due to changes in air, winds, water, climate, food, nature of soil and habits of people. Although Leeuwenhoek was not concerned about the origin of micro-organism; many other scientists were searching for an explanation for spontaneous appearance of living things from decaying meat, stagnating ponds, fermenting grains and infected wounds. Theory of Biogenesis 2 Theory of Abiogenesis deals with the theory of spontaneous generation; stating that living things originated from non-living things. He observed spontaneous existence of fishes from dried ponds, when the pond was filled with rain. Francesco Redi (1626-1697): He is the scientist who first tried to set an experiment to disprove spontaneous generation. He designed a large curved flask (Pasteur goose neck flask) and placed a sterile growth broth medium. Air freely moved through the tube; but dust particles were trapped in the curved portion of flask. Therefore Pasteur proved that micro-organisms entered to substrates through the air and micro-organisms did not evolve spontaneously. Discovery of streptococci The germ theory of disease The complete establishment of the germ theory of disease depended on the work of a German scientist, Robert Koch (1843- 1910). Koch’s postulates Koch’s postulates: proof of germ theory of disease A micro-organism can be accepted as a causative agent of an infectious disease only if the following conditions are satisfied. The micro-organism should be found in every case of the disease and under conditions which explain the pathological changes and clinical features. It should be possible to isolate the causative agent in pure culture from the lesion. When such pure culture is inoculated into appropriate laboratory animal, the lesion of the disease should be reproduced. It should be possible to reisolate the bacterium in pure culture from the lesion produced in the experimental animal. It has not been possible to fulfil every one of Koch’s postulates, but by adhering to them as closely as possible, serious errors have been prevented. Some microbes are very difficult or impossible to grow in vitro(in the laboratory) in artificial media. Certain diseases develop only when an opportunistic pathogen invades immunocompromised host. Classification is the assignment of organisms (species) into anorganised scheme of naming. The establishment of criteria for identifying organisms & assignment to groups (what belongs where) 5 2. At what level of diversity should a single species be split in to two or more species? Species) are more similar to each other than are members of higher level taxa (eg. Thus once you know that two individuals are member of the same taxon, you can inter certain similarities between the two organisms. Strain is the level below the species b) Two members of the same strain are more similar to each other than either is to an individual that is a member of a different strain, even if all three organisms are members of the same species Bacterial species - A bacterial species is defined by the similarities found among its members. Properties such as biochemical reactions, chemical composition, cellular structures, genetic characteristics, and immunological features are used in defining a bacterial species.
Overnight paradoxical Sensory imbalance 21 sleep progressively replaces stage 4 orthodox sleep (Guyton & Hall 1997) cheap cozaar 50 mg with visa diabetes diet chart xls, providing mental restoration purchase cozaar 50mg amex diabetes prevention guide. Whenever possible, clustering nursing actions to minimise physical disturbance can help to ensure undisturbed stretches of 2 hours (one sleep cycle). Awareness of the need for sleep has increased, and lights are now usually dimmed overnight to maintain circadian rhythm, but commencing nursing activities early each morning (e. One of the most valuable nursing interventions at night is usually to allow patients to sleep. Family and close friends may also suffer sleep deprivation from prolonged overnight vigils (Hodgson 1991); nurses should encourage visitors to get adequate sleep. Daytime sleep Sleep patterns alter during the day, although generally the quality of daytime sleep is poorer than night sleep (Wood 1993). Since the length of stage 2 sleep increases during daytime, less daytime sleep provides less tissue recovery than night-time sleep (Turnock 1990). Although not usually identified in literature, nightwork may alter hormone and sleep patterns; individual assessment of patients’ normal patterns will help nurses to plan appropriate individualised care (e. Times and figures given here are ‘averages’, and should be treated as guides rather than absolutes. Since most nurses working night duties experience the ebb Intensive care nursing 22 stage, high-risk actions (such as extubation) should be avoided during this period when they and their colleagues are likely to be least efficient. The risk of myocardial infarctions and strokes is therefore increased between 6 a. Reduced peripheral circulation may cause ischaemia (‘night cramps’); assessment should identify whether patients normally suffer from night cramps, and what they do for relief. Circadian rhythm adapts to environments; dimming lights can mimic day/night cycles, but ‘dimmed’ lighting often exceeds levels most nurses would choose for their own bedrooms at night. Daylight, rather than artificial light, helps psychological wellbeing, so fluorescent lighting is a poor substitute for lack of windows. Drug benefits may be increased by coinciding with circadian rhythm (chronotherapy); leucocyte count peaks and bacterial reproduction ebb make once daily antibiotics most effective in the early morning. Noise Noise (undesired sound) is subjective: what is useful or enjoyable for one person can annoy others (e. However, ‘unnecessary noise is the most cruel absence of care which can be inflicted on either sick or well’ (Nightingale [1859] 1980:5); nurses should actively seek to reduce unnecessary noise. Even whispers usually cause 30 dB, enough to disturb sleep (Wood 1993), and exceeding the International Noise Council’s night-time limit of 20 dB. Conversation cannot be avoided, and appropriate conversation can benefit patients, but volume, tone and pitch of speech vary between individuals, and nurses coordinating care should ensure that both content and timing of conversation is appropriate. Sensory imbalance 23 Suction catheters (with vacuum running) under pillows places noise near patients’ ears; suction units are also usually near patients’ heads. An average quiet bedroom at home might measure 20–30 dB overnight (Krachman et al. Children have fewer coping mechanisms than adults (Bood 1996) and so may be more susceptible to disturbed sleep. Childrens’ normal circadian rhythm and psychological health may be helped by play, an essential need during prolonged admissions (Palmer 1996), but adult nurses are often less able than paediatric nurses to meet children’s play and other needs, and may have less access to play therapists. Post-discharge support may include: ■ follow-up clinics ■ discharge liaison nurses ■ inviting patients to return or telephone the unit While potentially easing psychological trauma, nurses should be confident that they have the knowledge and skills needed to provide adequate support, including providing psychologically ‘safe’ environments (confidentiality, privacy) and meeting local ethical requirements; unit managers should be able to guide staff on such issues. Implications for practice ■ sensory imbalance is a symptom of psychological pain, provoking a stress response; alleviating pain provides both humanitarian and physiological benefits, so should be fundamental to nursing assessment and care ■ monitors should be sited unobtrusively ■ facilitating sleep is usually the nurse’s most important role overnight ■ sleep is individual, so each patient’s normal sleep pattern should be assessed ■ whenever possible, planned care should include 4 sleep cycles, each lasting at least 90 minutes (patients remaining undisturbed during this time) ■ circadian rhythm can be facilitated through daylight, interesting views and, overnight, by dimming lights as much as is safely possible ■ relatives should be encouraged to participate in care, and encouraged to share news and use touch. Maintaining sensory balance helps to maintain psychological health and reduces complications from stress responses. Many factors contribute to sensory imbalance, including sleep deprivation (quality or quantity) and noise. Nurses should assess each individual patient’s needs; while safety and physiological needs of critically ill patients necessarily compromise psychological care, nurses can humanise even the most technological environments. Sensory imbalance 25 Further Reading Much has been written on sensory imbalance: West (1996) and Granberg et al. Detrimental physiological effects of stress are described by Torpy and Chrousos (1997). Clinical scenario Edward Creighton is a 20-year-old university student admitted with bacterial meningitis.
A person who is drowsy and smells of alcohol may also have the following: • Diabetes • Epilepsy • Head injury • Drug intoxication or overdose • Stroke From Home Office purchase 50 mg cozaar mastercard diabetes mellitus type 2 algorithm. The Mini-Mental State Examination 407 Appendix 4 The Mini-Mental State Examination Score Orientation What is the (year) (season) (date) (day) (month)? Alternatively discount 50 mg cozaar with amex diabetes prevention statistics, if patient makes errors on serial subtraction: spell ‘world’ backwards: D L R O W. Have you ever neglected your obligations, your family or your work for more than 2 days in a row because you were drinking? Have you ever had a drink first thing in the morning to steady your nerves, or to get rid of a hang over (Eye-opener)? Some content that appears in print may not be available in electronic books Library of Congress Cataloging-in-Publication Data Thomas, Gareth, Dr. Ltd, Pondicherry, India Printed and bound in Great Britain by Antony Rowe Ltd This book is printed on acid-free paper responsibly manufactured from sustainable forestry, in which at least two trees are planted for each one used for paper production. C ontents Preface xi Acknowledgements xii Abbreviations/Acronyms xiii 1 Biological Molecules 1 1. It is also intended for students whose degree courses contain a limited reference to medicinal chemistry. The text assumes that the reader has a knowledge of chemistry at level one of a university life sciences degree. The text discusses the fundamental chemical principles used for drug discovery and design. Chapter 1 gives a brief review of the structures and nomenclature of the more common classes of naturally occurring compounds found in biological organ- isms. It is included for undergraduates who have little or no background knowledge of natural product chemistry. For students who have studied natural product chemistry it may be used as either a revision or a reference chapter. The basic approaches used to discover and design drugs are outlined in Chapters 3–6 inclusive. Chapter 7 is intended to give the reader a taste of main line medicinal chemistry. It illustrates some of the strategies used, often within the approaches outlined in previous chapters, to design new drugs. For a more encyclopedic coverage of the discovery and design of drugs for specific conditions, the reader is referred to appropriate texts such as some of those given under Medicinal Chemistry in the Selected Further Reading section at the end of this book. Chapters 8 and 9 describe the pharmacokinetics and metabolism respectively of drugs and their effect on drug design. Chapter 10 attempts to give an introductory overview of an area that is one of the principal objectives of the medicinal chemist. For a more in depth discussion, the reader is referred to the many specialized texts that are available on organic synthesis. Drug develop- ment from the research stage to marketing the final product is briefly outlined in Chapter 11. Answers, sometimes in the form of references to sections of the book, are listed separately. A list of recommended further reading, classified according to subject, is also included. Gareth Thomas A cknow ledgem ents I wish to thank all my colleagues, past and present without, whose help this book would have not been written. P Cox for the molecular model diagrams and his patience in explaining to me the intricacies of molecular modelling and Mr. I wish also to thank the following friends and colleagues for proof-reading chapters and supplying information: Dr. Finally, I would like to thank my wife for her support whilst I was writing the text. Some of these naturally occuring compounds and ions (endogenous species) are present only in very small amounts in specific regions of the body, whilst others, such as peptides, proteins, carbohydrates, lipids and nucleic acids, are found in all parts of the body.
