Wednesday, May 21, 2008
Wearing pinholes can improve vision in cases of Myopia, Presbyopia, Hyperopia, Cataracts and Astigmatism
Why are people shifting from prescription glasses to pinhole glasses? Studies show that concave prescribed lenses are closely studied for their negative effects. It can cause changes in your eyesight, it can also cause muscle to spasm and elevate the pressure in the vitreous chamber of our eyes. The use of concave lenses will create more pressure on the eyes and eventually result in Acquired Myopia. As opposed to pinhole glasses, it does not use lenses to improve vision they do not cause damage that prescription glasses inflict on the eyes. Thus, the website offers a great solution to the problem by offering a special offer for their pinhole eyeglasses. If you will check the prices slashed on their products, it will make it more affordable. Or if you want to improve your vision without using prescription glasses, or you are tired of changing it and spending much on buying new glasses, then here’s a treat for you. The website offers scientific way to restore clear vision. It’s completely natural, really effective, durable, and affordable. Try their pinhole glasses and you will be amazed with the result. It is not only effective in restoring vision, but for eye disorders as well such as myopia, cataract, and astigmatism.
Wednesday, May 7, 2008
Case Presentation on Syncope
Case Summmary:
This is a case of a 24-year-old man brought to the emergency department (ED) after several episodes of nearly blacking out. He also experienced palpitations with associated light-headedness. An electrocardiogram (ECG) is obtained, and a diagnosis of Syncope was considered. Proper Interventions were then given to prevent complications of the disease condition.
Chief Complaint:
Episodes of nearly blacking out, light-headedness, and palpitations.
History of Illness:
A 24-year-old man presents to the emergency department (ED) after several episodes of nearly blacking out that have occurred 3-4 times over the past 3 days. The patient states that he also felt his “heart beating really fast” and associated light-headedness. He smokes 2-4 packs of cigarettes per day and has done so for 5-6 years. No history of significant cardiac disease or sudden cardiac death in his family is noted.
II.Case Discussion
What is syncope?
Syncope (SIN'ko-pe) is temporary loss of consciousness and posture, described as "fainting" or "passing out." It's usually related to temporary insufficient blood flow to the brain.
It most often occurs when the blood pressure is too low (hypotension) and the heart doesn't pump a normal supply of oxygen to the brain.
Pathophysiology
Syncope occurs when cerebral perfusion globally decreases. Brain parenchyma depends on adequate blood flow to provide a constant supply of glucose, the primary metabolic substrate. Brain tissue cannot store energy in the form of high-energy phosphates found elsewhere in the body; therefore, a cessation of cerebral perfusion lasting only 3-5 seconds results in syncope. Cerebral perfusion is maintained relatively constant by an intricate and complex feedback system involving cardiac output, systemic vascular resistance, arterial pressure, cerebrovascular resistance with intrinsic autoregulation, and metabolic regulation. A clinically significant defect in any one of these or subclinical defects in several of these systems may cause syncope.
Any of the following may manifest as syncope. Cardiac output can be diminished secondary to mechanical outflow obstruction, pump failure, hemodynamically significant arrhythmias, or conduction defects. Systemic vascular resistance can drop secondary to vasomotor instability, autonomic failure, or vasodepressor/vasovagal response. Arterial pressure decreases with all causes of hypovolemia. A central nervous system (CNS) event, such as a hemorrhage or a seizure, can also present as syncope. Syncope can occur without reduction in cerebral blood flow in patients who have severe metabolic derangements (eg, hypoglycemia, hyponatremia, hypoxemia).
What causes syncope?
It may be caused by emotional stress, pain, pooling of blood in the legs due to sudden changes in body position, overheating, dehydration, heavy sweating or exhaustion. Syncope may occur during violent coughing spells (especially in men) because of rapid changes in blood pressure. It also may result from several heart, neurologic, psychiatric, metabolic and lung disorders. And it may be a side effect of some medicines.
Some forms of syncope suggest a serious disorder:
• those occurring with exercise
• those associated with palpitations or irregularities of the heart
• those associated with family history of recurrent syncope or sudden death
Management of Syncope
The majority of children and young adults with syncope have no structural heart disease or significant arrhythmia (abnormal heart rhythm). So, extensive medical work-up is rarely needed. A careful physical examination by a physician, including blood pressure and heart rate measured lying and standing, is generally the only evaluation required.
In other cases an electrocardiogram (EKG or ECG) is used to test for abnormal heart rhythms such as long Q-T syndrome. This is a genetic heart condition that can cause sudden cardiac death. Other tests, such as exercise stress test, Holter monitor, echocardiogram, etc. may be needed to rule out other cardiac causes of syncope.
If EKG and cardiac tests are normal, the person will undergo a tilt test. The blood pressure and heart rate will be measured while lying down on a board and after the board is tilted up. Someone who has NMS will usually faint during the tilt, due to the rapid drop in blood pressure and heart rate. As soon as the person is placed on his or her back again, blood flow and consciousness are restored.
To help prevent syncope, people with NMS should be on a high-salt diet and drink plenty of fluids to avoid dehydration and maintain blood volume. They should watch for the warning signs of fainting — dizziness, nausea and sweaty palms — and sit or lie down if they feel the warning signs. Some people also may need medication.
Prehospital Care
Prehospital management of syncope covers a wide spectrum of acute care and includes rapid assessment of airway, breathing, circulation, and neurologic status.
• Treatment may require the following:
• Intravenous access
• Oxygen administration
• Advanced airway techniques
• Glucose administration
• Pharmacologic circulatory support
• Pharmacologic or mechanical restraints
• Defibrillation or temporary pacing
• Advanced triage decisions, such as direct transport to multispecialty tertiary care centers, may be required in select cases.
Emergency Department Care
In patients brought to the ED with a presumptive diagnosis of syncope, appropriate initial interventions include intravenous access, oxygen administration, and cardiac monitoring. ECG and rapid blood glucose evaluation should be performed promptly. Syncope may be the manifestation of an acute life-threatening process but is generally not emergent. Clinically ruling out certain processes is important. The treatment choice for syncope is dependent upon the cause or precipitant of the syncope. Patients in whom a cause cannot be ascertained in the ED, especially if they have experienced significant trauma, warrant supportive care and monitoring.
• Situational syncope treatment focuses on educating patients about the condition. For example, in carotid sinus syncope, patients should be instructed not to wear tight collars, to use a razor rather than electric shaver, and to maintain good hydration status; they should also be informed of the possibility of pacemaker placement in the future.
• Orthostatic syncope treatment also focuses on educating the patient. Inform patients about avoiding postprandial dips in BP, teach them to elevate the head of their bed to prevent rapid BP fluctuations on arising from bed, and emphasize the importance of assuming an upright posture slowly. Additional therapy may include thromboembolic disease (TED) stockings, mineralocorticoids (eg, fludrocortisone for volume expansion), and other drugs such as midodrine (an alpha1-agonist with vasopressor activity). Patients' medications must be reviewed carefully to eliminate drugs associated with hypotension. Intentional oral fluid consumption is useful in decreasing frequency and severity of symptoms in these patients.
• Cardiac arrhythmic syncope is treated with antiarrhythmic drugs or pacemaker placement. Consider cardiologist evaluation or inpatient management since this is more commonly associated with poor outcomes. Trials assessing beta blockade to prevent syncope have conflicting results, but no clear effect has been demonstrated.
• Cardiac mechanical syncope may be treated with beta-blockade to decrease outflow obstruction and myocardial workload. Valvular disease may require surgical correction. This, too, is associated with increased future morbidity and mortality.
• Neurologic syncope may be treated in the same fashion as orthostatic syncope, or it may be treated with antiplatelet medications. Patients are recommended to have neurologic follow-up care to determine whether they need further neurovascular imaging.
Medications
Drug Category: Anticholinergics
These agents improve conduction through the AV node by reducing vagal tone via muscarinic receptor blockade. For patients with infranodal block, this therapy is ineffective.
Drug Category: Nutrient supplements
Parenterally injected dextrose is used in patients unable to sustain adequate oral intake. Its direct oral absorption results in a rapid increase in blood glucose concentrations.
Drug Category: Benzodiazepines
CNS agents of the 1,4-benzodiazepine class exert their effects by binding at stereo-specific receptors in the CNS. Their exact mechanism of action has not been clearly elucidated. Benzodiazepines cause a dose-related CNS depression, which varies from mild sedation to hypnosis.
Drug Category: Vasopressor
Midodrine forms an active metabolite, desglymidodrine, that is an alpha1-agonist acting upon receptors of the arteriolar and venous vasculature.
Deterrence/Prevention• Education may have a substantial impact on the prevention of recurrence, especially in situational and orthostatic syncope. Patients may be trained to avoid situations that prompt syncope in situational cases. In orthostatic syncope, patients should drink 500 mL of fluid each morning in addition to their usual routine and should avoid standing up too quickly.
III. Conclusion
The thorough history of the patient with syncope should begin with the observations of onlookers.
The history also should include the identification of aggravating and alleviating factors, especially the additions of new medications. Antiarrhythmic and antihypertensive medications raise the possibility of proarrhythmia or orthostasis. Phenothiazines and tricyclic medications predispose older patients to orthostasis. Over-the-counter medications and supplements also can contribute to syncope.
The physical examination of a patient with syncope should include measurements of blood pressure and pulse rate in the upper and lower extremities while the patient is in the supine and upright positions to identify orthostatic hypotension, autonomic dysfunction, or possible organic heart disease. Checking for carotid bruits can find impaired cerebral blood flow or underlying coronary artery disease. On examination, the physician also may find signs of pulmonary hypertension, left ventricular dysfunction, valvular heart disease, or other forms of organic heart disease. Neurologic disorder is suggested by abnormal cognition, speech, visual field, motor strength, sensation, tremor, or gait disturbance.
Syncope is not associated with increased mortality when no underlying heart disease is present. When the initial evaluation is normal, it is often challenging to discern the origin of syncope. Although many of the most serious possible causes of syncope can be excluded by a normal evaluation, the possibilities of neurocardiogenic syncope, carotid sinus hypersensitivity, paroxysmal bradyarrhythmia, supraventricular tachycardia, ventricular tachycardia, and many noncardiac causes still exist.
We, as future nurses should embody the knowledge, skills, and attitude in our everyday nursing practice to ensure patient’s safety and improvement of well-being.
Journal Article
Causes and Outcomes in Patients with Syncope
Syncope is a relatively common problem with a favorable prognosis in most patients. In one subgroup of patients, however, syncope denotes increased risk for serious cardiac or neurologic disease. Soteriades and coworkers used data from the Framingham Heart Study to provide some specific population-based numbers on the causes of syncope and its long-term outcomes.
The authors scanned records for 7,814 Framingham participants and found 822 subjects with reported syncope; follow-up data were available for 727 of these patients. Based on chart reviews, a physician committee excluded 120 other reported syncope cases as equivocal. To minimize recall bias, they also excluded 101 cases in which patients had not had a clinical examination in the previous four years. Other exclusions included 47 cases of syncope associated with head trauma and seven cases with incomplete records.
Four diagnostic groups were established for describing the cause of syncope: cardiac cause (e.g., ischemia, arrhythmias); neurologic cause (e.g., transient ischemic attack, stroke, seizure); unknown cause; and vasovagal or other cause (e.g., vasovagal syncope, orthostatic syncope, medication-induced syncope, syncope from cough or micturition, situational syncope).
The average age of the 822 study subjects reporting syncope was 65.8 years. The overall incidence of syncope was 6.2 cases per 1,000 person-years; the incidence increased with age and nearly doubled in the cohort of patients older than 70 years. The authors found that the most common diagnostic group was the group with vasovagal or other cause of syncope (44.9 percent), followed by the groups with unknown cause (36.6 percent), cardiac cause (9.5 percent), and neurologic cause (9.0 percent).
The average duration of follow-up available for review after a first report of syncope was 8.6 years (n = 2,181). After adjustments for age, sex, smoking, hypertension, diabetes, cardiovascular disease, use of cardiac medications, and several other relevant clinical variables, the overall risk of death from any cause was found to be 31 percent higher in the patients with syncope than in those without the diagnosis (i.e., hazard ratio of 1.31). Patients with a cardiac etiology of syncope had double the risk of death from any cause compared with patients who did not have syncope. The overall risk of death in patients with a neurologic or unknown cause of syncope was elevated to a lesser degree (hazard ratios of 1.54 and 1.32, respectively). Risk of death, myocardial infarction, or stroke was not found to be significantly elevated in the patients with vasovagal or other cause of syncope.
The authors noted that their findings supported a benign prognosis for syncope with a vasovagal cause. Their findings suggested that the small group of patients with cardiac causes of syncope should be closely monitored because of their high risk of morbidity and mortality. In addition, patients with syncope from an unknown cause may require further testing.
BILL ZEPF, M.D.
Source:
Soteriades ES, et al. Incidence and prognosis of syncope. N Engl J Med September 19, 2002;347:878-85, and Maisel WH, Stevenson WG. Syncope--getting to the heart of the matter [Editorial]. N Engl J Med September 19, 2002;347:931-3.
This is a case of a 24-year-old man brought to the emergency department (ED) after several episodes of nearly blacking out. He also experienced palpitations with associated light-headedness. An electrocardiogram (ECG) is obtained, and a diagnosis of Syncope was considered. Proper Interventions were then given to prevent complications of the disease condition.
Chief Complaint:
Episodes of nearly blacking out, light-headedness, and palpitations.
History of Illness:
A 24-year-old man presents to the emergency department (ED) after several episodes of nearly blacking out that have occurred 3-4 times over the past 3 days. The patient states that he also felt his “heart beating really fast” and associated light-headedness. He smokes 2-4 packs of cigarettes per day and has done so for 5-6 years. No history of significant cardiac disease or sudden cardiac death in his family is noted.
II.Case Discussion
What is syncope?
Syncope (SIN'ko-pe) is temporary loss of consciousness and posture, described as "fainting" or "passing out." It's usually related to temporary insufficient blood flow to the brain.
It most often occurs when the blood pressure is too low (hypotension) and the heart doesn't pump a normal supply of oxygen to the brain.
Pathophysiology
Syncope occurs when cerebral perfusion globally decreases. Brain parenchyma depends on adequate blood flow to provide a constant supply of glucose, the primary metabolic substrate. Brain tissue cannot store energy in the form of high-energy phosphates found elsewhere in the body; therefore, a cessation of cerebral perfusion lasting only 3-5 seconds results in syncope. Cerebral perfusion is maintained relatively constant by an intricate and complex feedback system involving cardiac output, systemic vascular resistance, arterial pressure, cerebrovascular resistance with intrinsic autoregulation, and metabolic regulation. A clinically significant defect in any one of these or subclinical defects in several of these systems may cause syncope.
Any of the following may manifest as syncope. Cardiac output can be diminished secondary to mechanical outflow obstruction, pump failure, hemodynamically significant arrhythmias, or conduction defects. Systemic vascular resistance can drop secondary to vasomotor instability, autonomic failure, or vasodepressor/vasovagal response. Arterial pressure decreases with all causes of hypovolemia. A central nervous system (CNS) event, such as a hemorrhage or a seizure, can also present as syncope. Syncope can occur without reduction in cerebral blood flow in patients who have severe metabolic derangements (eg, hypoglycemia, hyponatremia, hypoxemia).
What causes syncope?
It may be caused by emotional stress, pain, pooling of blood in the legs due to sudden changes in body position, overheating, dehydration, heavy sweating or exhaustion. Syncope may occur during violent coughing spells (especially in men) because of rapid changes in blood pressure. It also may result from several heart, neurologic, psychiatric, metabolic and lung disorders. And it may be a side effect of some medicines.
Some forms of syncope suggest a serious disorder:
• those occurring with exercise
• those associated with palpitations or irregularities of the heart
• those associated with family history of recurrent syncope or sudden death
Management of Syncope
The majority of children and young adults with syncope have no structural heart disease or significant arrhythmia (abnormal heart rhythm). So, extensive medical work-up is rarely needed. A careful physical examination by a physician, including blood pressure and heart rate measured lying and standing, is generally the only evaluation required.
In other cases an electrocardiogram (EKG or ECG) is used to test for abnormal heart rhythms such as long Q-T syndrome. This is a genetic heart condition that can cause sudden cardiac death. Other tests, such as exercise stress test, Holter monitor, echocardiogram, etc. may be needed to rule out other cardiac causes of syncope.
If EKG and cardiac tests are normal, the person will undergo a tilt test. The blood pressure and heart rate will be measured while lying down on a board and after the board is tilted up. Someone who has NMS will usually faint during the tilt, due to the rapid drop in blood pressure and heart rate. As soon as the person is placed on his or her back again, blood flow and consciousness are restored.
To help prevent syncope, people with NMS should be on a high-salt diet and drink plenty of fluids to avoid dehydration and maintain blood volume. They should watch for the warning signs of fainting — dizziness, nausea and sweaty palms — and sit or lie down if they feel the warning signs. Some people also may need medication.
Prehospital Care
Prehospital management of syncope covers a wide spectrum of acute care and includes rapid assessment of airway, breathing, circulation, and neurologic status.
• Treatment may require the following:
• Intravenous access
• Oxygen administration
• Advanced airway techniques
• Glucose administration
• Pharmacologic circulatory support
• Pharmacologic or mechanical restraints
• Defibrillation or temporary pacing
• Advanced triage decisions, such as direct transport to multispecialty tertiary care centers, may be required in select cases.
Emergency Department Care
In patients brought to the ED with a presumptive diagnosis of syncope, appropriate initial interventions include intravenous access, oxygen administration, and cardiac monitoring. ECG and rapid blood glucose evaluation should be performed promptly. Syncope may be the manifestation of an acute life-threatening process but is generally not emergent. Clinically ruling out certain processes is important. The treatment choice for syncope is dependent upon the cause or precipitant of the syncope. Patients in whom a cause cannot be ascertained in the ED, especially if they have experienced significant trauma, warrant supportive care and monitoring.
• Situational syncope treatment focuses on educating patients about the condition. For example, in carotid sinus syncope, patients should be instructed not to wear tight collars, to use a razor rather than electric shaver, and to maintain good hydration status; they should also be informed of the possibility of pacemaker placement in the future.
• Orthostatic syncope treatment also focuses on educating the patient. Inform patients about avoiding postprandial dips in BP, teach them to elevate the head of their bed to prevent rapid BP fluctuations on arising from bed, and emphasize the importance of assuming an upright posture slowly. Additional therapy may include thromboembolic disease (TED) stockings, mineralocorticoids (eg, fludrocortisone for volume expansion), and other drugs such as midodrine (an alpha1-agonist with vasopressor activity). Patients' medications must be reviewed carefully to eliminate drugs associated with hypotension. Intentional oral fluid consumption is useful in decreasing frequency and severity of symptoms in these patients.
• Cardiac arrhythmic syncope is treated with antiarrhythmic drugs or pacemaker placement. Consider cardiologist evaluation or inpatient management since this is more commonly associated with poor outcomes. Trials assessing beta blockade to prevent syncope have conflicting results, but no clear effect has been demonstrated.
• Cardiac mechanical syncope may be treated with beta-blockade to decrease outflow obstruction and myocardial workload. Valvular disease may require surgical correction. This, too, is associated with increased future morbidity and mortality.
• Neurologic syncope may be treated in the same fashion as orthostatic syncope, or it may be treated with antiplatelet medications. Patients are recommended to have neurologic follow-up care to determine whether they need further neurovascular imaging.
Medications
Drug Category: Anticholinergics
These agents improve conduction through the AV node by reducing vagal tone via muscarinic receptor blockade. For patients with infranodal block, this therapy is ineffective.
Drug Category: Nutrient supplements
Parenterally injected dextrose is used in patients unable to sustain adequate oral intake. Its direct oral absorption results in a rapid increase in blood glucose concentrations.
Drug Category: Benzodiazepines
CNS agents of the 1,4-benzodiazepine class exert their effects by binding at stereo-specific receptors in the CNS. Their exact mechanism of action has not been clearly elucidated. Benzodiazepines cause a dose-related CNS depression, which varies from mild sedation to hypnosis.
Drug Category: Vasopressor
Midodrine forms an active metabolite, desglymidodrine, that is an alpha1-agonist acting upon receptors of the arteriolar and venous vasculature.
Deterrence/Prevention• Education may have a substantial impact on the prevention of recurrence, especially in situational and orthostatic syncope. Patients may be trained to avoid situations that prompt syncope in situational cases. In orthostatic syncope, patients should drink 500 mL of fluid each morning in addition to their usual routine and should avoid standing up too quickly.
III. Conclusion
The thorough history of the patient with syncope should begin with the observations of onlookers.
The history also should include the identification of aggravating and alleviating factors, especially the additions of new medications. Antiarrhythmic and antihypertensive medications raise the possibility of proarrhythmia or orthostasis. Phenothiazines and tricyclic medications predispose older patients to orthostasis. Over-the-counter medications and supplements also can contribute to syncope.
The physical examination of a patient with syncope should include measurements of blood pressure and pulse rate in the upper and lower extremities while the patient is in the supine and upright positions to identify orthostatic hypotension, autonomic dysfunction, or possible organic heart disease. Checking for carotid bruits can find impaired cerebral blood flow or underlying coronary artery disease. On examination, the physician also may find signs of pulmonary hypertension, left ventricular dysfunction, valvular heart disease, or other forms of organic heart disease. Neurologic disorder is suggested by abnormal cognition, speech, visual field, motor strength, sensation, tremor, or gait disturbance.
Syncope is not associated with increased mortality when no underlying heart disease is present. When the initial evaluation is normal, it is often challenging to discern the origin of syncope. Although many of the most serious possible causes of syncope can be excluded by a normal evaluation, the possibilities of neurocardiogenic syncope, carotid sinus hypersensitivity, paroxysmal bradyarrhythmia, supraventricular tachycardia, ventricular tachycardia, and many noncardiac causes still exist.
We, as future nurses should embody the knowledge, skills, and attitude in our everyday nursing practice to ensure patient’s safety and improvement of well-being.
Journal Article
Causes and Outcomes in Patients with Syncope
Syncope is a relatively common problem with a favorable prognosis in most patients. In one subgroup of patients, however, syncope denotes increased risk for serious cardiac or neurologic disease. Soteriades and coworkers used data from the Framingham Heart Study to provide some specific population-based numbers on the causes of syncope and its long-term outcomes.
The authors scanned records for 7,814 Framingham participants and found 822 subjects with reported syncope; follow-up data were available for 727 of these patients. Based on chart reviews, a physician committee excluded 120 other reported syncope cases as equivocal. To minimize recall bias, they also excluded 101 cases in which patients had not had a clinical examination in the previous four years. Other exclusions included 47 cases of syncope associated with head trauma and seven cases with incomplete records.
Four diagnostic groups were established for describing the cause of syncope: cardiac cause (e.g., ischemia, arrhythmias); neurologic cause (e.g., transient ischemic attack, stroke, seizure); unknown cause; and vasovagal or other cause (e.g., vasovagal syncope, orthostatic syncope, medication-induced syncope, syncope from cough or micturition, situational syncope).
The average age of the 822 study subjects reporting syncope was 65.8 years. The overall incidence of syncope was 6.2 cases per 1,000 person-years; the incidence increased with age and nearly doubled in the cohort of patients older than 70 years. The authors found that the most common diagnostic group was the group with vasovagal or other cause of syncope (44.9 percent), followed by the groups with unknown cause (36.6 percent), cardiac cause (9.5 percent), and neurologic cause (9.0 percent).
The average duration of follow-up available for review after a first report of syncope was 8.6 years (n = 2,181). After adjustments for age, sex, smoking, hypertension, diabetes, cardiovascular disease, use of cardiac medications, and several other relevant clinical variables, the overall risk of death from any cause was found to be 31 percent higher in the patients with syncope than in those without the diagnosis (i.e., hazard ratio of 1.31). Patients with a cardiac etiology of syncope had double the risk of death from any cause compared with patients who did not have syncope. The overall risk of death in patients with a neurologic or unknown cause of syncope was elevated to a lesser degree (hazard ratios of 1.54 and 1.32, respectively). Risk of death, myocardial infarction, or stroke was not found to be significantly elevated in the patients with vasovagal or other cause of syncope.
The authors noted that their findings supported a benign prognosis for syncope with a vasovagal cause. Their findings suggested that the small group of patients with cardiac causes of syncope should be closely monitored because of their high risk of morbidity and mortality. In addition, patients with syncope from an unknown cause may require further testing.
BILL ZEPF, M.D.
Source:
Soteriades ES, et al. Incidence and prognosis of syncope. N Engl J Med September 19, 2002;347:878-85, and Maisel WH, Stevenson WG. Syncope--getting to the heart of the matter [Editorial]. N Engl J Med September 19, 2002;347:931-3.
A case study about Schizophrenia
Case Summary
This is a case of A.O., 30 years old, female, from Amamaros, Pototan, Iloilo, who was admitted at Pototan Mental Health Unit last February 10, 2008, with a chief complaint of behavioral changes and a working diagnosis of Schizophrenia. She’s under the supervision of Dr. Ali Robles.
Analysis of the Case
History of Past Illness
Two weeks PTA (prior to admission), A.O. together with her sister arrived at Iloilo. They came from Antipolo and they will stay at their Aunt’s house at Amamaros, Pototan.
Two days PTA, patient A.O. complained that she cannot sleep well and that she had sleep disturbances. The Aunt had also noticed that A.O. was exhibiting strange and peculiar behaviors in the past few days. She barely talks and was found to be staring blankly at the ceiling. Sometimes, she talked to herself, with words her Aunt can’t understand. One moment, she walked aimlessly inside their house.
There were also moments when she prefers to stay at one corner of her room.
1 day PTA, as the Aunt was about to go to sleep, she was startled when she heard A.O. yelling. She went to her room and found A.O. going wild. She was throwing her things and was yelling incoherent words. She was uncontrolled. Then Aunt forced her to take medication and after a few hours, she was calm.
Few hours PTA, the Aunt brought A.O. at Pototan Mental Health Unit for consultation. She was alarmed with the patient’s behaviors last night. Thus, she was admitted with a chief complaint of behavioral changes.
Review of Systems-Mental Status Examination
I. General Appearance and Behavior
o Physical Appearance
Patient A.O. is about 4’9’’ tall, wears appropriate dress; always attend to her hygiene; hair is short, black, wavy, on neck length, kempt; appearance is appropriate to situation and weather
o Facial Expressions
Most of the time has flat affect; sometimes stares blankly into space or at the student nurses; has poor eye contact. Odd mannerisms are crossing her hands, placing hands on face (as if wiping it), stretching hands, or legs and make some cracking sounds of bones. A.O. answers questions in a soft, sometimes barely audible voice.
o Manner of Client During Nurse-Patient Interaction
A.O. is passive; only talk if you student nurses talk first or when being asked. She never initiates to open a topic; changes the subject of discussion whenever the topic is about her family or the reason why she was admitted. A.O. is sometimes very unpredictable. One moment she is normal, the suddenly she would talk about weird things and would speak incoherent words. Sometimes she would answer in a monosyllabic speech even when asked with open-ended questions.
II. Characteristics of Speech Quantitative Speech
A.O. barely take the initiative to talk; answers open-ended questions with monosyllabic speech; sometimes would answer questions in a barley audible voice; the longest answer in about 4-5 words only.
Qualitative Speech
A.O. would sometimes answer questions inappropriately or completely irrelevant to the questions asked; neologisms was also noted; and talks about bizarre things like “barang” or “ninakaw ang kaluluwa”.
III. Mood and Affect
Most of the times A.O. does not exhibit any significant mood and has flat affect. Sometimes there are also sudden changes of mood. However, there are also times when A.O’s mood and affect is appropriate to the thought content.
IV. Thought Content
No significant themes were noted. Patient most of the times answer in a monosyllabic speech. Delusions were noted:
SN: “Sino po si Cesar manang?”
Pt.: “Cesar Montano…asawa ko…”
Patient has delusion of grandeur. She’s claiming that Cesar Montano is her husband.
V. Perception
Hallucination was also noted when she kept on insisting and pointing that there was something itchy under the table, though there was none.
VI. Sensorium Functions Patient is oriented to person, place and time.
Memory
1. Rote Memory- Patient rote memory is impaired
2. Recent Memory- Patient recent memory is intact. When she was asked what she did this morning, her answer coincides with the answer of the folk.
3. Remote Memory- Patient remote memory is intact as evidenced when asked when her birthday is and she answered Sept. 27, 1977. Her birthday is indeed September 27, 1977.
4. Immediate Memory- Patients’ immediate memory is impaired.
Attention and Concentration Patient’s attention and concentration is questionable. Student nurses cannot tell whether the attention is really impaired or the patient is just having difficulty to think.
Insight and Judgment
Insight:
Patient is aware of her condition. Though, she does not know that her condition is a serious matter and not merely “nerbiyos”.
Judgment:
Patient exhibits good judgment. Her decisions were appropriate to the situation given.
Past Health History-Contributory Factors to Condition:
A. History of Psychological Problems
A.O’s uncle in the father side has been thought to have a psychological disturbance because his wife left him. A.O’s aunt in the paternal side and her cousin’s father in the maternal side were diagnosed to have nervous breakdown. Her cousin on the maternal side also has a psychological problem, which is believe a cause of high level of intelligence.
B. Childhood Upbringing
A.O’s primary caregiver is not her mother but her yaya (an Aunt from the mother side). Though, her mother is the one who gives her milk. She’s cuddled and breastfed by her mother per demad. The mother cannot attend to all her necessities since she’s also busy doing household chores and taking care of her other children.
When A.O. entered high school, she was left in the care of her Aunts in the maternal side at Negros Occidental, whom supported her secondary education.
When she entered college, she stayed in a boarding house under the supervision of a family friend named Father A.
C. Frequent Relocations of the Family
Their original residence is at Amamaros, Pototan, Iloilo, where she stayed until she was 12 years old. She left Iloilo and went to Negros Occidental to study high school to the care of her Aunts in the maternal side. She moved back to Iloilo again when she was about to enter college and stayed in a boarding house.
Then, the family migrated to Antipolo, Manila last 2005. That is when she consulted a specialist to treat her psychological problems.
Two weeks PTC, she went back again to Pototan, to the care of her Aunt to continue her consultation at PMHU.
The family members would notice that every time they move into a new place, A.O. would have a hard time adjusting to the new environment.
D. Loses
She lost her father when she was just 7 years old. It was hard for her since she was closer to her father than her mother was. Until now, she would still mention her father.
E. Unachieved Desires or Frustrations
She really wanted to study since she excels in academics since she was in elementary. However, she was told to stop schooling due to the recurrence of the signs and symptoms and the relapse of her condition.
F. Altered Self-esteem
Among the five of them (patient has 4 siblings), she is the “not-so-pretty”. Her classmates in high school would tease her “law-ay”. She is very sensitive when it comes to that matter. Sometimes, the family members would find her crying in one corner.
G. Traumatic Experience
18 years PTC, A.O. had experienced a traumatic event. She was with her mother and an aunt. They came to Iloilo (from Negros) for a vacation. They were riding a public jeepney when a track loaded with bamboo poles crashed them. She witnessed the scene when a bamboo pole struck her Aunt right to her chest and declared dead upon arrival in the hospital. She was in state of shock for several weeks.
This is a case of A.O., 30 years old, female, from Amamaros, Pototan, Iloilo, who was admitted at Pototan Mental Health Unit last February 10, 2008, with a chief complaint of behavioral changes and a working diagnosis of Schizophrenia. She’s under the supervision of Dr. Ali Robles.
Analysis of the Case
History of Past Illness
Two weeks PTA (prior to admission), A.O. together with her sister arrived at Iloilo. They came from Antipolo and they will stay at their Aunt’s house at Amamaros, Pototan.
Two days PTA, patient A.O. complained that she cannot sleep well and that she had sleep disturbances. The Aunt had also noticed that A.O. was exhibiting strange and peculiar behaviors in the past few days. She barely talks and was found to be staring blankly at the ceiling. Sometimes, she talked to herself, with words her Aunt can’t understand. One moment, she walked aimlessly inside their house.
There were also moments when she prefers to stay at one corner of her room.
1 day PTA, as the Aunt was about to go to sleep, she was startled when she heard A.O. yelling. She went to her room and found A.O. going wild. She was throwing her things and was yelling incoherent words. She was uncontrolled. Then Aunt forced her to take medication and after a few hours, she was calm.
Few hours PTA, the Aunt brought A.O. at Pototan Mental Health Unit for consultation. She was alarmed with the patient’s behaviors last night. Thus, she was admitted with a chief complaint of behavioral changes.
Review of Systems-Mental Status Examination
I. General Appearance and Behavior
o Physical Appearance
Patient A.O. is about 4’9’’ tall, wears appropriate dress; always attend to her hygiene; hair is short, black, wavy, on neck length, kempt; appearance is appropriate to situation and weather
o Facial Expressions
Most of the time has flat affect; sometimes stares blankly into space or at the student nurses; has poor eye contact. Odd mannerisms are crossing her hands, placing hands on face (as if wiping it), stretching hands, or legs and make some cracking sounds of bones. A.O. answers questions in a soft, sometimes barely audible voice.
o Manner of Client During Nurse-Patient Interaction
A.O. is passive; only talk if you student nurses talk first or when being asked. She never initiates to open a topic; changes the subject of discussion whenever the topic is about her family or the reason why she was admitted. A.O. is sometimes very unpredictable. One moment she is normal, the suddenly she would talk about weird things and would speak incoherent words. Sometimes she would answer in a monosyllabic speech even when asked with open-ended questions.
II. Characteristics of Speech Quantitative Speech
A.O. barely take the initiative to talk; answers open-ended questions with monosyllabic speech; sometimes would answer questions in a barley audible voice; the longest answer in about 4-5 words only.
Qualitative Speech
A.O. would sometimes answer questions inappropriately or completely irrelevant to the questions asked; neologisms was also noted; and talks about bizarre things like “barang” or “ninakaw ang kaluluwa”.
III. Mood and Affect
Most of the times A.O. does not exhibit any significant mood and has flat affect. Sometimes there are also sudden changes of mood. However, there are also times when A.O’s mood and affect is appropriate to the thought content.
IV. Thought Content
No significant themes were noted. Patient most of the times answer in a monosyllabic speech. Delusions were noted:
SN: “Sino po si Cesar manang?”
Pt.: “Cesar Montano…asawa ko…”
Patient has delusion of grandeur. She’s claiming that Cesar Montano is her husband.
V. Perception
Hallucination was also noted when she kept on insisting and pointing that there was something itchy under the table, though there was none.
VI. Sensorium Functions Patient is oriented to person, place and time.
Memory
1. Rote Memory- Patient rote memory is impaired
2. Recent Memory- Patient recent memory is intact. When she was asked what she did this morning, her answer coincides with the answer of the folk.
3. Remote Memory- Patient remote memory is intact as evidenced when asked when her birthday is and she answered Sept. 27, 1977. Her birthday is indeed September 27, 1977.
4. Immediate Memory- Patients’ immediate memory is impaired.
Attention and Concentration Patient’s attention and concentration is questionable. Student nurses cannot tell whether the attention is really impaired or the patient is just having difficulty to think.
Insight and Judgment
Insight:
Patient is aware of her condition. Though, she does not know that her condition is a serious matter and not merely “nerbiyos”.
Judgment:
Patient exhibits good judgment. Her decisions were appropriate to the situation given.
Past Health History-Contributory Factors to Condition:
A. History of Psychological Problems
A.O’s uncle in the father side has been thought to have a psychological disturbance because his wife left him. A.O’s aunt in the paternal side and her cousin’s father in the maternal side were diagnosed to have nervous breakdown. Her cousin on the maternal side also has a psychological problem, which is believe a cause of high level of intelligence.
B. Childhood Upbringing
A.O’s primary caregiver is not her mother but her yaya (an Aunt from the mother side). Though, her mother is the one who gives her milk. She’s cuddled and breastfed by her mother per demad. The mother cannot attend to all her necessities since she’s also busy doing household chores and taking care of her other children.
When A.O. entered high school, she was left in the care of her Aunts in the maternal side at Negros Occidental, whom supported her secondary education.
When she entered college, she stayed in a boarding house under the supervision of a family friend named Father A.
C. Frequent Relocations of the Family
Their original residence is at Amamaros, Pototan, Iloilo, where she stayed until she was 12 years old. She left Iloilo and went to Negros Occidental to study high school to the care of her Aunts in the maternal side. She moved back to Iloilo again when she was about to enter college and stayed in a boarding house.
Then, the family migrated to Antipolo, Manila last 2005. That is when she consulted a specialist to treat her psychological problems.
Two weeks PTC, she went back again to Pototan, to the care of her Aunt to continue her consultation at PMHU.
The family members would notice that every time they move into a new place, A.O. would have a hard time adjusting to the new environment.
D. Loses
She lost her father when she was just 7 years old. It was hard for her since she was closer to her father than her mother was. Until now, she would still mention her father.
E. Unachieved Desires or Frustrations
She really wanted to study since she excels in academics since she was in elementary. However, she was told to stop schooling due to the recurrence of the signs and symptoms and the relapse of her condition.
F. Altered Self-esteem
Among the five of them (patient has 4 siblings), she is the “not-so-pretty”. Her classmates in high school would tease her “law-ay”. She is very sensitive when it comes to that matter. Sometimes, the family members would find her crying in one corner.
G. Traumatic Experience
18 years PTC, A.O. had experienced a traumatic event. She was with her mother and an aunt. They came to Iloilo (from Negros) for a vacation. They were riding a public jeepney when a track loaded with bamboo poles crashed them. She witnessed the scene when a bamboo pole struck her Aunt right to her chest and declared dead upon arrival in the hospital. She was in state of shock for several weeks.
Types of Bandages
Types of bandage
• Gauze bandage
The most common type of bandage is the gauze bandage, a simple woven strip of material which can come in any number of widths and lengths. A gauze bandage can be used for almost any bandage application, including holding a dressing in place.
• Compression bandage
The term 'compression bandage' describes a wide variety of bandages with many different applications.
• Short stretch compression bandages
are applied to a limb (usually for treatment of lymphedema or venous ulcers). This type of bandage that is capable of shortening around the limb after application and is therefore not exerting ever-increasing pressure during inactivity. This dynamic is called resting pressure and is considered safe and comfortable for long-term treatment. Conversely, the stability of the bandage creates a very high resistance to stretch when pressure is applied through internal muscle contraction and joint movement. This force is called working pressure.
• Long stretch compression bandages
have long stretch properties, meaning their high compressive power can be easily adjusted. However, they also have a very high resting pressure and must be removed at night or if the patient is in a resting position.
• Triangular bandage
A triangular bandage is a piece of cloth cut into a right-angled triangle. This is felt by many trainers to be the most versatile of the bandages available, as it can be used fully unrolled as a sling, folded as a normal bandage, or for specialist bandages such as on the head. has various sizes.
• Tube bandage
A tube bandage is applied using an applicator, and is woven in a continuous circle. It is used to hold dressings or splints on to limbs, or to provide support to sprains and strains.and it stops the bleed.
• Gauze bandage
The most common type of bandage is the gauze bandage, a simple woven strip of material which can come in any number of widths and lengths. A gauze bandage can be used for almost any bandage application, including holding a dressing in place.
• Compression bandage
The term 'compression bandage' describes a wide variety of bandages with many different applications.
• Short stretch compression bandages
are applied to a limb (usually for treatment of lymphedema or venous ulcers). This type of bandage that is capable of shortening around the limb after application and is therefore not exerting ever-increasing pressure during inactivity. This dynamic is called resting pressure and is considered safe and comfortable for long-term treatment. Conversely, the stability of the bandage creates a very high resistance to stretch when pressure is applied through internal muscle contraction and joint movement. This force is called working pressure.
• Long stretch compression bandages
have long stretch properties, meaning their high compressive power can be easily adjusted. However, they also have a very high resting pressure and must be removed at night or if the patient is in a resting position.
• Triangular bandage
A triangular bandage is a piece of cloth cut into a right-angled triangle. This is felt by many trainers to be the most versatile of the bandages available, as it can be used fully unrolled as a sling, folded as a normal bandage, or for specialist bandages such as on the head. has various sizes.
• Tube bandage
A tube bandage is applied using an applicator, and is woven in a continuous circle. It is used to hold dressings or splints on to limbs, or to provide support to sprains and strains.and it stops the bleed.
Tuesday, May 6, 2008
Beta-2-symphatomimetic Clenbuterol
Clenbuterol hydrochloride or otherwise known as clen is not a steroid hormone but a beta-2-symphatomimetic. Its effects however can by all means be compared to those of steroids. It is a lipolytic drug intended as a fat burner. Athletes often use it and bodybuilders who will help them lose fat by allowing your body to release and burn more stored fat. It has been used for decades in veterinary world to increase the lean yield of livestock. This kind of drug is used specifically for fat loss however it may also be used as repartitioning agent it means that it will increase your ratio of Fat Free Mass to Fat Mass. As a result, your body temperature will increase and your appetite will be slightly repressed. One of the major drawbacks of using clen is that it seems to stop working after couple of weeks it is at the same time not good to the heart for it will cause the enlargement of the ventricles. It is an asthma medication but studies show that it can reduce cardiovascular performance.
Necessary things for you to know in buying steroids
You can buy steroids at reasonable prices. You can select from Decca 250, Tren Fina 75, Winstroll, Clenbuterall, D-bolic, and Anvar 10. The Decca 250 is very effective in increasing receptor activation; the Tren Fina is effective in developing rock hard pumps; the Winstroll is the clear cut choice of bodybuilders; the D-bolic has been designed as a mass and strength building compound; and the Anvar is the favorite steroid for bodybuilders as well. These drugs are extremely strong anabolic steroids, thus they extreme caution is required in cycling them. They offer 100% legal, affordable, and effective anabolic compounds to give you the best result. No prescription is required in purchasing the products the shipping is discreet as well as billing and ordering. However, if you are below 18 years of age, you cannot buy the product. The information provided in the site is not intended to be substitute for doctor’s prescription. You should consult with your healthcare professional before planning to start a diet or medication.
Steroids
The history of steroids will date back on the year testosterone were discovered. Then in 19th century, scientists discovered that the removal of testicles from birds caused a disappearance of the male sexual properties. This discovery helped them to figure out how testosterone worked. Thus, it led scientists to the synthesizing of the testosterone as the first anabolic steroid. It was first tested on dogs, until it has been used by athletes. In fact the American weightlifting team in began using them in 1954 to enhance their strength. The used of steroids were banned by the Olympics committee and many sports council follow suit. The scandal is what has given steroids a bad name. However, the medical community found the medical use of anabolic steroids it has made good impact in the treatment of certain illness and ailment. Today, steroids are still being widely used in the United States.
Why people got hooked with anabolic steroids?
Anabolic steroids or otherwise known as anabolic androgenic steroids were developed in the 1930s to promote growth of skeletal muscle and to develop male sexual characteristics. “Anabolic” refers to muscle building, and “androgenic” refers to increased masculine characteristics. They are used to promote cell growth, which helps the growth of tissues. Anabolic steroid is a term, which describes the process of muscle building including the bone and other tissues. However, there are side effects attached to using this kind of steroids, such as the increasing of cholesterol level, kidney and liver problems, and elevated blood pressure. Although at the same time, it has favorable effects to the user, it includes the bone marrow stimulation, growth stimulation, treatment for chronic wasting, induction of puberty, and hormone replacement therapy. It is sad to note that anabolic steroids are always on the news because of the abusive use by athletes including teens who are into sports. Most users are bodybuilders or regular gym goers who want to change their physical appearance.
Bald no more
Hippocrates noted that castration saved the eunuchs in the Persian army from baldness — but stopped short of recommending it as a treatment. The belief that a hairless scalp is a sign of manliness has persisted. Doctors have spent decades searching for a way to reverse hair loss. Why haven't we found the ultimate remedy? Jeremy Laurance reports. But now you can say goodbye to baldness. Dr. Shapiro hair institute offers the leading edge in hair transplant. If you are interested you may call them and they will offer 100 free grafts. Over 10,000 cases performed with 17 years experience in hair transplant surgery. Dr. Shapiro exclusively specializes in micro mini grafts and he is the first doctor to do a strip incision. He has a highly trained medical staff and they also specialize in assisting hair replacement surgery. Hair restoration surgery relies on the genetics of hair growth. If you have already had hairline loss, hair transplants are the only solution for restoring natural hairlines. The "donor hair" is already genetically resistant to the male/female-pattern balding it can be used for the restoration of natural hairlines, which are also genetically resistant to balding. You can try their hair transplant Florida located at Ft. Lauderdale, Delray Beach, Pompano Beach, Hollywood, West Palm Beach, FL
and surrounding South East Florida locations. The Hollywood Hair Restoration Surgery Clinic, located at 3475 Sheridan St., #201 Hollywood, Florida 33021 and the Delray Beach Hair Restoration Surgery Clinic, located at 5050 W. Atlantic Avenue, Delray Beach, Florida 33445.
and surrounding South East Florida locations. The Hollywood Hair Restoration Surgery Clinic, located at 3475 Sheridan St., #201 Hollywood, Florida 33021 and the Delray Beach Hair Restoration Surgery Clinic, located at 5050 W. Atlantic Avenue, Delray Beach, Florida 33445.
Monday, May 5, 2008
Self-suggestion and alternative medicine
If you are really interested in what alternative medicine is about you should definitely take a look at or even taste miracle water that has a lot of benefits and actually is the only treatment from such troubles like bad luck or different illnesses. It is called an esoteric product that can be a good alternative to artificial supplements and traditional pills prescribed by doctors. Moreover, many physicians do recommend to turn to quality supplements that can be bought at vitamin shop and alternative medicine products when there is practically no chance to be healed by traditional ways. Anyway, even if it doesn't bring any improvements at least it won't do any harm to your health! This is just pure water energized with ions!
Outpatient radiology center in Pennsylvania claims that some hopeless patients diagnosed with incurable diseases and those who have lost hope tasted alternative medicine products - not just energized water but herbals and natural nutrition supplements and their condition improved! The results of the survey show that more than 60% of all patients became more tranquil, their blood pressure normalized and skin color has improved! This or that way, self-suggestion plays here not the last role as well.
Thursday, May 1, 2008
Why The World Should Ask 'Am I Number 12?
The word hepatitis (pronounced: heh-puh-tie-tus) means an inflammation of the liver, and it can be caused by one of many things - including a bacterial infection, liver injury caused by a toxin (poison), and even an attack on the liver by the body's own immune system. Hepatitis, an infectious liver disease, is more contagious than HIV, and just like HIV, there is no cure. Hepatitis infection can be serious, but knowing what puts you at risk can help protect you. There are around 500 million people worldwide are currently infected with hepatitis B or C and to educate people to the shocking fact statistic they have launch “Why The World Should Ask 'Am I Number 12
Helping you become a picture of Health
High blood pressure usually has no symptoms. The only way you can find out that your blood pressure is too high is to check it with a pressure monitor. The higher your blood pressure is, the more often you need to check it. In Healthscape, you can buy products that will help you become a picture of health. There are blood pressure monitors with such device it becomes easy for you to keep track of your blood pressure thus preventing heart attack and other stroke. Nebulization is gaining popularity as a treatment alternative. For those with history of Asthma acquiring a Nebulisers is a indeed needed as they are simple, compact, and battery-operated, meaning that they are silent and portable and can be used by ambulatory patients. Several devices are available to create the drug aerosol particles. These include jet nebulizers, ultrasonic nebulizers, metered-dose inhalers, and dry powder inhalers through which particles can reach the upper and lower respiratory tracts and be quickly absorbed into the bloodstream., When you are trying to stay at a healthy weight, a Body Fat Monitors can be a helpful tool, ecg machines, fertility and pregnancy, pain relief, digital thermometers, and stethoscope. For blood pressure monitors, they have the microlife 3ag1 blood pressure monitor, which is an economical upper-arm blood pressure monitor with BHS A/A grade accuracy, or you, may try or their microlife as easy as 123 blood pressure monitor. The website is a demo store which is a fully functional store that allows you to try X-shopping cart software. You can browse their products or put them in your cart and check their features. As of today, their most popular products are the fertility score male fertility test, microlife as easy as 123 blood pressure monitor, and microlife 3ag1 blood pressure monitor. You can sign in and register to make it easier to order for their new products. You are required to fill out their forms, such as your personal information, billing address, contact information, your username and password which will be confidential and kept. They also have a help zone wherein you can email them if you have questions or clarifications with regard to their products. You can visit Healthscape as well to learn more bout health issues, beauties, diet and nutrition, exercise and fitness, healthy living, medical, supplements, and other features stories.
Agents for Herpes and Cytomegalovirus
Herpes viruses account for a broad range of conditions, including cold sores, encephalitis, shingles and genital infections. Cytomegalovirus (CMV) although slightly different from the herpes virus can affect the eye, respiratory tract and liver and reacts to many of the same drugs.
1. Acyclovir (Zovirax) – is specific for herpes virus infections. Is excreted unchanged in the urine and therefore must be used cautiously in the presence of renal impairment. It crosses into breast milk and exposes the neonate to high levels of the drug.
2. Cidofovir (Vistide) – is used to treat CMV retinitis in patients with AIDS only. It is associated with severe renal toxicity and granulocytopenia. It is excreted unchanged in the urine and must be given with probenecid to increase renal clearance of the drug. Use in children with AIDS should be very cautious because of potential.
3. Famiciclovir (Famvir) – is most effective in treating herpes infections. It is well absorbed in the GI tract, reaching peak levels in 2 to 3 hours. It is metabolized in the liver and excreted in the urine and feces.
4. Foscarnet (Foscavir) – is available in intravenous (IV) form only. It can be highly toxic to the kidneys and is reserved for treatment of CMV retinitis in immunocompromised patients and for mucocutanneous acyclovir-resistant herpes simplex infections.
5. Ganciclovir (Cytovene) – which is available in IV and oral forms and is used for long term treatment and prevention of CMV infections. Primarily excreted unchanged in the feces with some urinary excretion. It is carcinogenic and should be used only with extreme caution in children.
6. Valacyclovir (Valtrex) – is an oral agent used for the treatment of herpes zoster and recurrent genital herpes. Rapidly absorbed from the GI tract and metabolized in the liver to acyclovir. Excretion occurs through the urine so caution should be used in patients with renal impairment.
7. Valganiclovir (Valcyte) – which is the oral prodrug of ganciclovir, is used for the treatment of CMV retinitis in AIDS patients. Primarily excreted unchanged in the feces with some urinary excretion.
Therapeutic Actions and Indications
Drugs that combat herpes and CMV inhibit viral DNA replication by competing with viral substrates to form shorter, noneffective DNA chains. This action prevents replication of the virus, but it has little effect on the host cells of human because their DNA uses different substrate. These antiviral agents indicated for treatment of the DNA viruses herpes simplex, herpes zoster and CMV.
Contraindications and Cautions
Drugs indicated for the treatment of herpes and CMV should not used during pregnancy or lactation or I patients with known allergies to antiviral agents, renal disease which could interfere with excretion of the drug or severe CNS disorders.
Adverse Effects
The adverse effects most commonly associated with these antivirals include nausea and vomiting, headache and depression and rash and hair loss. Rash and inflammation and burning often occur at sites of IV injection and topical application.
Clinically Important Drug-Drug Interactions
The risk of nephrotoxicity increases when agents indicated for the treatment of herpes and CMV are used in combination with other nephrotoxic drugs. The risk of drowsiness also rises when these antiviral agents are taken with zidovudine and anti retroviral agent.
Nursing Diagnoses
The patient receiving a DNA-active antiviral agent may have the following nursing diagnoses related to drug therapy:
· Acute pain related to GI, CNS, local effects of drug
· Disturbed Sensory Perception related to CNS
· Deficient knowledge regarding drug therapy
Implementation
· Ensure good hydration to decrease the toxic effects on the kidneys.
· Administer the drug as soon as possible after the diagnosis has been made to improve effectiveness of the antiviral activity.
· Ensure that the patient takes the complete course of the drug regimen to improve effectiveness and decrease the risk of the emergence of resistant viruses.
· Wear protective gloves when applying the drug topically to decrease risk of exposure to the drug and inadvertent absorption.
· Provide safety precautions if CNS effects occur (e.g., use side rails, appropriate lighting, orientation, assistance) to protect the patient from injury.
· Warn the patient that GI upset, nausea, and vomiting can occur, to prevent undue anxiety and increase awareness of the importance of nutrition.
· Monitor renal function tests periodically during treatment to detect and respond to renal toxicity as soon as possible.
· Provide the patient with instructions about the drug therapy and to promote compliance.
The patient should:
· Avoid sexual intercourse if genital herpes is being treated, because these drugs do not cure the disease.
· Wear protective gloves when applying topical agents.
· Avoid the driving and hazardous tasks dizziness and drowsiness occurs.
Evaluation
· Monitor patient response to the drug
· Monitor for adverse effects
· Evaluate effectiveness of the teaching plan
· Monitor for the effectiveness of comfort and safety measures and compliance with regimen
1. Acyclovir (Zovirax) – is specific for herpes virus infections. Is excreted unchanged in the urine and therefore must be used cautiously in the presence of renal impairment. It crosses into breast milk and exposes the neonate to high levels of the drug.
2. Cidofovir (Vistide) – is used to treat CMV retinitis in patients with AIDS only. It is associated with severe renal toxicity and granulocytopenia. It is excreted unchanged in the urine and must be given with probenecid to increase renal clearance of the drug. Use in children with AIDS should be very cautious because of potential.
3. Famiciclovir (Famvir) – is most effective in treating herpes infections. It is well absorbed in the GI tract, reaching peak levels in 2 to 3 hours. It is metabolized in the liver and excreted in the urine and feces.
4. Foscarnet (Foscavir) – is available in intravenous (IV) form only. It can be highly toxic to the kidneys and is reserved for treatment of CMV retinitis in immunocompromised patients and for mucocutanneous acyclovir-resistant herpes simplex infections.
5. Ganciclovir (Cytovene) – which is available in IV and oral forms and is used for long term treatment and prevention of CMV infections. Primarily excreted unchanged in the feces with some urinary excretion. It is carcinogenic and should be used only with extreme caution in children.
6. Valacyclovir (Valtrex) – is an oral agent used for the treatment of herpes zoster and recurrent genital herpes. Rapidly absorbed from the GI tract and metabolized in the liver to acyclovir. Excretion occurs through the urine so caution should be used in patients with renal impairment.
7. Valganiclovir (Valcyte) – which is the oral prodrug of ganciclovir, is used for the treatment of CMV retinitis in AIDS patients. Primarily excreted unchanged in the feces with some urinary excretion.
Therapeutic Actions and Indications
Drugs that combat herpes and CMV inhibit viral DNA replication by competing with viral substrates to form shorter, noneffective DNA chains. This action prevents replication of the virus, but it has little effect on the host cells of human because their DNA uses different substrate. These antiviral agents indicated for treatment of the DNA viruses herpes simplex, herpes zoster and CMV.
Contraindications and Cautions
Drugs indicated for the treatment of herpes and CMV should not used during pregnancy or lactation or I patients with known allergies to antiviral agents, renal disease which could interfere with excretion of the drug or severe CNS disorders.
Adverse Effects
The adverse effects most commonly associated with these antivirals include nausea and vomiting, headache and depression and rash and hair loss. Rash and inflammation and burning often occur at sites of IV injection and topical application.
Clinically Important Drug-Drug Interactions
The risk of nephrotoxicity increases when agents indicated for the treatment of herpes and CMV are used in combination with other nephrotoxic drugs. The risk of drowsiness also rises when these antiviral agents are taken with zidovudine and anti retroviral agent.
Nursing Diagnoses
The patient receiving a DNA-active antiviral agent may have the following nursing diagnoses related to drug therapy:
· Acute pain related to GI, CNS, local effects of drug
· Disturbed Sensory Perception related to CNS
· Deficient knowledge regarding drug therapy
Implementation
· Ensure good hydration to decrease the toxic effects on the kidneys.
· Administer the drug as soon as possible after the diagnosis has been made to improve effectiveness of the antiviral activity.
· Ensure that the patient takes the complete course of the drug regimen to improve effectiveness and decrease the risk of the emergence of resistant viruses.
· Wear protective gloves when applying the drug topically to decrease risk of exposure to the drug and inadvertent absorption.
· Provide safety precautions if CNS effects occur (e.g., use side rails, appropriate lighting, orientation, assistance) to protect the patient from injury.
· Warn the patient that GI upset, nausea, and vomiting can occur, to prevent undue anxiety and increase awareness of the importance of nutrition.
· Monitor renal function tests periodically during treatment to detect and respond to renal toxicity as soon as possible.
· Provide the patient with instructions about the drug therapy and to promote compliance.
The patient should:
· Avoid sexual intercourse if genital herpes is being treated, because these drugs do not cure the disease.
· Wear protective gloves when applying topical agents.
· Avoid the driving and hazardous tasks dizziness and drowsiness occurs.
Evaluation
· Monitor patient response to the drug
· Monitor for adverse effects
· Evaluate effectiveness of the teaching plan
· Monitor for the effectiveness of comfort and safety measures and compliance with regimen
Agents for HIV and AIDS
The human immunodeficiency virus (HIV) attacks the helper T cells within the immune system. This virus enters the helper T cells and multiplies within the cell. When the cell ruptures many new viruses are released to attack other helper TY cells. The end result is that the immune system loses an important monitor that propels the immune reaction into full force when the body is invaded.
Reverse Transcriptase Inhibitors
The reverse transcriptase inhibitors bind directly to HIV reverse transcriptase, blocking both RNA- and DNA-dependent DNA polymerase activities. They prevent the transfer of information that would allow the virus to replicate and survive.
1. Delavirdine (Rescriptor) – must be used in combination therapy regimens, because resistant strains develop rapidly when it is used alone. It is rapidly absorbed from the GI tract, with peak levels occurring within 1 hour.
2. Efavirenz (Sustiva) – is used in adults and in children in combination with other anti retrovural agents. It is absorbed rapidly from the GI tract, reaching peak levels in 3 to 5 hours. It is metabolized in the liver by the cytochrome P450 system and is excreted in the urine and feces with a half-life of 52 yo 76 hours.
3. Nevirapine (Viramune) – is recommended for use in adults and children. After rapid GI absorption, nevbirapine is metabolized by the cytochrome P450 system in the liver.
Protease Inhibitors
The protease inhibitors block protease activity within the HIV virus. Protease is essential for the maturation of infectious virus, without it an HIV particle is immature and non effective.
1. Amprenavir (Agenerase) – was approved in 1999 for the treatment of adults and children with HIV in combination with other antiretroviral agents. It is rapidly absorbed from the GI tract, reaching peak levels in 1 to 2 hours.
2. Indinavir (Crixivan) – is available for treatments of adults with HIV rapidly absorbed from the GI tract reaching peak levels in 0.8 hours.
3. Lopinavir (Kaletra) – is a fixed combination drug that combines lopinavir and ritonavir. This drug is approved for used in adults and children in combination with other antiretroviral agents for the treatment of HIV infection.
4. Nelfinavir (Viracept) – must be given in combination with other drugs and can be used in the treatment of children with HIV.
5. Ritonavir (Norvir) – can be used alone and is available for use in adults and children.
6. Saquinavir (Fortovase, Invirase) – is used in combination regimens for adults.
Nucleosides
Nucleosides interfere with HIV replication by inhibiting cell protein synthesis, leading to viral death.
1. Abacavir (Ziagen) – is used in combination therapy in adults and children.
2. Didanosine (Videx) – is used to treat advanced infections in adults and in children.
3. Lamnivudine (Epivir) – is recommended specifically for use with other antiretroviral agents as an oral solution.
4. Stavudine (Zerit) – is recommended specifically for used with other retroviral agents.
5. Tenafovir (Viread) – is a new drug that affects the virus at a slightly different point of replication- a nucleotide that becomes a nucleoside.
6. Zalcitabine (Hivid) – is used to treat advanced cases of HIV/AIDS in adults.
7. Zidovudune (Retrovir) – was one of the first drugs found to be effective in the treatment of AIDS.
Therapeutic Actions and Indications
The antiviral agents used to treat HIV and AIDS operate at various point in the life cycle of the virus and results in its death or inactivation. Use of these drugs in combination can affect more viral particles and reduce the number of mutant viruses that are formed and spread to non infected cells.
Contraindications and Cautions
Because these drugs are used in the treatment of a potentially fatal with no known cure, there are no true contraindications to their use. Zidovudine is the drug of choice during pregnancy to block maternal transmission of the virus. Cautions should be used with known allergies to any of these drugs, with hepatic or renal dysfunction which could lead to increased drug levels and toxicity and with pregnancy or lactation because of potential adverse effects on the neonate.
Adverse Effects
The adverse effects reported with the used of these drugs often are not distinguishable from the effects of ongoing disease process. Adverse effects are often reported include the CNS effects of headache, dizziness and myalpatic toxicity related to direct drug effects on the liver, fever and flu-like symptoms, rash and bone marrow depression including a granulocytosis and anemia.
Nursing Diagnoses
The patient receiving a DNA-active antiviral agent may have the following nursing diagnoses related to drug therapy:
· Acute pain related to GI, CNS, local effects of drugs
· Disturbed sensory perception related to CNS
· Deficient knowledge regarding drug therapy
Implementation
· Monitor renal and hepatic function before and periodically during therapy to detect renal or hepatic function changes.
· Ensure that the patient takes the complete course of the drug regimen and takes all drugs included in a particular combination.
· Administer the drug around the clock, if indicated, to provide the critical concentration needed for the drug to be effective.
· Monitor nutritional status if GI effects are severe, and take appropriate action to maintain nutrition.
· Stop drug if severe rush occurs, especially if accompanied by blisters, fever, and so on, to advert potentially serious reactions.
· Provide safety precautions (e.g., the use of side rails, appropriate lighting, orientation, assistance) if CNS effects occur, to protect patient from injury.
· Teach the patient about the drugs prescribed, to enhance patient knowledge about drug therapy and to promote compliance. Include as a teaching point the fact that these drugs do not cure the disease and therefore appropriate precautions should still be taken to prevent transmission.
The patient should:
Have regular medical care.
Have periodic blood tests, which are necessary to monitor the effectiveness and toxicity of the drug.
Realize that GI upset, nausea, and vomiting may occur but the efforts must be taken to maintain adequate nutrition.
Avoid driving and hazardous tasks if dizziness or drowsiness occurs.
Report extreme fatigue, severe headache, difficulty breathing, or severe rash ot a heath care provider.
Evaluation
· Monitor patient response to the drug.
· Monitor for adverse effects.
· Evaluate the effectiveness of the teaching plan.
· Monitor the effectiveness of comfort and safety measures.
Locally Active Antiviral Agents
1. Idoxuridine (Herplex) – which is applied directly to the eye and is used to treat herpes simplex keratitis.
2. Imiquimod (Aldara) – which is appli9ed locally for the treatment of genital and perinatal warts.
3. Formivirsen (Vitravene) – which is injected into the eye to treat CMV retinitis to patients with AIDS.
4. Ganciclovir (Vitrasert) – which is implanted into the eye every 5 to 8 months for treatment of patients with CMV retinitis.
5. Penciclovir (Denavir) – which is applied locally for the treatment of herpes labialis (cold sores) on the face and lips.
6. Trifluridine (Vitroptic) – which is applied locally to treat herpes simplex infections in the eye.
7. Vidarabine (Vira-A) – which is used locally to treat herpes simplex infections of the eye that are not responsive to idoxuridine.
Therapeutic Actions and Indications
These antiviral agents act on viruses by interfering with normal viral replication and metabolic processes. They are indicated for specific local viral infections.
Contraindications
Locally active antiviral drugs are not absorbed systematically but caution should be used in patients with known allergies reactions to any topical drugs.
Adverse Effects
Because these drugs are not absorbed systematically, the adverse effects of most commonly reported are local burning, stinging, and discomfort. These effects usually occur at the time of administration and pass with time.
Nursing Diagnoses
The patient receiving a topical antiviral drug may have the following nursing diagnoses related to drug therapy:
· Acute Pain related to GI, CNS, local effects of drug
· Deficient Knowledge regarding drug therapy
Implementation
· Ensure proper administration of the drug to improve effectiveness and decrease risk of adverse effects.
· Stop the drug if severe local reaction occurs or if open lesions occur near the site of administration, to prevent systemic absorption.
Evaluation
· Monitor patient response to the drug.
· Monitor adverse effects.
· Evaluate effectiveness of the teaching plan.
Reverse Transcriptase Inhibitors
The reverse transcriptase inhibitors bind directly to HIV reverse transcriptase, blocking both RNA- and DNA-dependent DNA polymerase activities. They prevent the transfer of information that would allow the virus to replicate and survive.
1. Delavirdine (Rescriptor) – must be used in combination therapy regimens, because resistant strains develop rapidly when it is used alone. It is rapidly absorbed from the GI tract, with peak levels occurring within 1 hour.
2. Efavirenz (Sustiva) – is used in adults and in children in combination with other anti retrovural agents. It is absorbed rapidly from the GI tract, reaching peak levels in 3 to 5 hours. It is metabolized in the liver by the cytochrome P450 system and is excreted in the urine and feces with a half-life of 52 yo 76 hours.
3. Nevirapine (Viramune) – is recommended for use in adults and children. After rapid GI absorption, nevbirapine is metabolized by the cytochrome P450 system in the liver.
Protease Inhibitors
The protease inhibitors block protease activity within the HIV virus. Protease is essential for the maturation of infectious virus, without it an HIV particle is immature and non effective.
1. Amprenavir (Agenerase) – was approved in 1999 for the treatment of adults and children with HIV in combination with other antiretroviral agents. It is rapidly absorbed from the GI tract, reaching peak levels in 1 to 2 hours.
2. Indinavir (Crixivan) – is available for treatments of adults with HIV rapidly absorbed from the GI tract reaching peak levels in 0.8 hours.
3. Lopinavir (Kaletra) – is a fixed combination drug that combines lopinavir and ritonavir. This drug is approved for used in adults and children in combination with other antiretroviral agents for the treatment of HIV infection.
4. Nelfinavir (Viracept) – must be given in combination with other drugs and can be used in the treatment of children with HIV.
5. Ritonavir (Norvir) – can be used alone and is available for use in adults and children.
6. Saquinavir (Fortovase, Invirase) – is used in combination regimens for adults.
Nucleosides
Nucleosides interfere with HIV replication by inhibiting cell protein synthesis, leading to viral death.
1. Abacavir (Ziagen) – is used in combination therapy in adults and children.
2. Didanosine (Videx) – is used to treat advanced infections in adults and in children.
3. Lamnivudine (Epivir) – is recommended specifically for use with other antiretroviral agents as an oral solution.
4. Stavudine (Zerit) – is recommended specifically for used with other retroviral agents.
5. Tenafovir (Viread) – is a new drug that affects the virus at a slightly different point of replication- a nucleotide that becomes a nucleoside.
6. Zalcitabine (Hivid) – is used to treat advanced cases of HIV/AIDS in adults.
7. Zidovudune (Retrovir) – was one of the first drugs found to be effective in the treatment of AIDS.
Therapeutic Actions and Indications
The antiviral agents used to treat HIV and AIDS operate at various point in the life cycle of the virus and results in its death or inactivation. Use of these drugs in combination can affect more viral particles and reduce the number of mutant viruses that are formed and spread to non infected cells.
Contraindications and Cautions
Because these drugs are used in the treatment of a potentially fatal with no known cure, there are no true contraindications to their use. Zidovudine is the drug of choice during pregnancy to block maternal transmission of the virus. Cautions should be used with known allergies to any of these drugs, with hepatic or renal dysfunction which could lead to increased drug levels and toxicity and with pregnancy or lactation because of potential adverse effects on the neonate.
Adverse Effects
The adverse effects reported with the used of these drugs often are not distinguishable from the effects of ongoing disease process. Adverse effects are often reported include the CNS effects of headache, dizziness and myalpatic toxicity related to direct drug effects on the liver, fever and flu-like symptoms, rash and bone marrow depression including a granulocytosis and anemia.
Nursing Diagnoses
The patient receiving a DNA-active antiviral agent may have the following nursing diagnoses related to drug therapy:
· Acute pain related to GI, CNS, local effects of drugs
· Disturbed sensory perception related to CNS
· Deficient knowledge regarding drug therapy
Implementation
· Monitor renal and hepatic function before and periodically during therapy to detect renal or hepatic function changes.
· Ensure that the patient takes the complete course of the drug regimen and takes all drugs included in a particular combination.
· Administer the drug around the clock, if indicated, to provide the critical concentration needed for the drug to be effective.
· Monitor nutritional status if GI effects are severe, and take appropriate action to maintain nutrition.
· Stop drug if severe rush occurs, especially if accompanied by blisters, fever, and so on, to advert potentially serious reactions.
· Provide safety precautions (e.g., the use of side rails, appropriate lighting, orientation, assistance) if CNS effects occur, to protect patient from injury.
· Teach the patient about the drugs prescribed, to enhance patient knowledge about drug therapy and to promote compliance. Include as a teaching point the fact that these drugs do not cure the disease and therefore appropriate precautions should still be taken to prevent transmission.
The patient should:
Have regular medical care.
Have periodic blood tests, which are necessary to monitor the effectiveness and toxicity of the drug.
Realize that GI upset, nausea, and vomiting may occur but the efforts must be taken to maintain adequate nutrition.
Avoid driving and hazardous tasks if dizziness or drowsiness occurs.
Report extreme fatigue, severe headache, difficulty breathing, or severe rash ot a heath care provider.
Evaluation
· Monitor patient response to the drug.
· Monitor for adverse effects.
· Evaluate the effectiveness of the teaching plan.
· Monitor the effectiveness of comfort and safety measures.
Locally Active Antiviral Agents
1. Idoxuridine (Herplex) – which is applied directly to the eye and is used to treat herpes simplex keratitis.
2. Imiquimod (Aldara) – which is appli9ed locally for the treatment of genital and perinatal warts.
3. Formivirsen (Vitravene) – which is injected into the eye to treat CMV retinitis to patients with AIDS.
4. Ganciclovir (Vitrasert) – which is implanted into the eye every 5 to 8 months for treatment of patients with CMV retinitis.
5. Penciclovir (Denavir) – which is applied locally for the treatment of herpes labialis (cold sores) on the face and lips.
6. Trifluridine (Vitroptic) – which is applied locally to treat herpes simplex infections in the eye.
7. Vidarabine (Vira-A) – which is used locally to treat herpes simplex infections of the eye that are not responsive to idoxuridine.
Therapeutic Actions and Indications
These antiviral agents act on viruses by interfering with normal viral replication and metabolic processes. They are indicated for specific local viral infections.
Contraindications
Locally active antiviral drugs are not absorbed systematically but caution should be used in patients with known allergies reactions to any topical drugs.
Adverse Effects
Because these drugs are not absorbed systematically, the adverse effects of most commonly reported are local burning, stinging, and discomfort. These effects usually occur at the time of administration and pass with time.
Nursing Diagnoses
The patient receiving a topical antiviral drug may have the following nursing diagnoses related to drug therapy:
· Acute Pain related to GI, CNS, local effects of drug
· Deficient Knowledge regarding drug therapy
Implementation
· Ensure proper administration of the drug to improve effectiveness and decrease risk of adverse effects.
· Stop the drug if severe local reaction occurs or if open lesions occur near the site of administration, to prevent systemic absorption.
Evaluation
· Monitor patient response to the drug.
· Monitor adverse effects.
· Evaluate effectiveness of the teaching plan.
ANTIVIRAL AGENTS
ANTIVIRAL AGENTS
Viruses cause a variety of conditions, ranging from warts, to the common cold and “flu”, to diseases such as chicken pox and measles. A single virus particle is composed of a piece of DNA or RNA inside a protein coat. To carry on any metabolic processes, including replication, a virus must enter a cell. Once a virus has injected his DNA or RNA into its host cell, that cell is altered and it is programmed to control the metabolic processes that the virus need to survive. The virus including the protein coat, replicates in the host cell. When the host cell can no longer carry out its metabolic functions because of the viral invader, the host cell dies and releases the new viruses into the body to invade other cells.
Agents for Influenza A and Respiratory Viruses
Influenza A and other respiratory viruses including Influenza B and respiratory syncytial viruses (RSV) invade the respiratory tract and cause the signs and symptoms of respiratory “flu”.
1. Amantadine (Symmetrel) – was first used to treat Parkinson’s disease. It is now used for both treatment and prevention of respiratory viral infections. It is slowly absorbed from the gastrointestinal tract reaching in peak levels of 4 hours.
2. Oseltamivir (Tamiflu) – effective in the treatment of uncomplicated influenza infections that have been symptomatic for less than 2 days. It is readily absorbed from the GI tract, extensively metabolized in the urine and excreted in the urine with a half-life of 6 to 10 hours.
3. Ribavirin (Virazole) – is effective against influenza A, RSV, and herpes virus. This agent has been used in the treatment of children with RSV and has been tested for used in several other viral conditions. Absorbed well in the respiratory tract and has a half-life of 9.5 hours.
4. Rimantadine (Flumandine) – a synthetic agent used for the prevention and treatment of Influenza A infections. It is absorbed in the GI tract with peak levels of 6 hours. Extensively metabolized and excreted in the urine. It is embryo toxic in animals. It should not be used by nursing mothers because it crosses into the breast milk and can cause toxic reactions to neonate.
5. Zanamivir (Relenza) – was approved in 1999 to treat uncomplicated influenza infections in adults and in children older than 12 years of age who have had symptoms for less than 2 days. It is absorbed through the respiratory tract and excreted unchanged in the urine with a half-life of 2.5 to 5.1 hours.
Therapeutic Actions and Indications
These viral agents prevent shedding of the viral protein coat and entry of the virus into the cell. This action prevents viral replications causing viral death. These antiviral drugs are indicated for prevention of Influenza A infection.
Contraindications and Cautions
Caution should be used when giving these antiviral agents to patients with a known allergy; to pregnant or lactating women or to patients with renal or liver disease which could alter metabolism and excretion of the drug.
Adverse Effects
Use of these antiviral agents is frequently associated with various adverse effects that may be related to possible effects on dopamine levels in the brain. These include light headedness, dizziness and insomnia, nausea, orthostatic hypotension and urinary retention.
Clinically Important Drug-Drug Interactions
Patients who received amantadine or rimantadine may experience increased atropine-like effects if either of these drugs is given with an anticholinergic drug.
Nursing Diagnoses
The patient receiving a respiratory antiviral drug may have the following nursing diagnoses related to drug therapy.
· Acute pain related to GI, CNS, GU effects of drug
· Disturbed sensory perception related to CNS effects of drug
· Deficient knowledge regarding drug therapy
Implementation
· Start drug regimen as soon after exposure to the virus as possible to achieve best effectiveness and decrease the risk of complications of viral infection.
· Administer Influenza A vaccine before the flu season begins if at all possible, to prevent the disease and decrease the risk of complications.
· Administer the full course of the drug to obtain the full beneficial effects.
· Provide safety provisions if CNS effects occur, to protect the patient from injury.
· Instruct the patient about the appropriate dosage scheduling regimen; safety precautions, including changing position slowly and avoiding driving and hazardous tasks, to take if CNS effects occur; and the need to report any difficulty walking or talking to enhance patient knowledge about drug therapy and to promote compliance.
Evaluation
· Monitoring patient response to the drug
· Monitor for adverse effects
· Evaluate the effectiveness of the teaching plan
· Monitor for the effectiveness of comfort and safety measures and compliance with regimen
Viruses cause a variety of conditions, ranging from warts, to the common cold and “flu”, to diseases such as chicken pox and measles. A single virus particle is composed of a piece of DNA or RNA inside a protein coat. To carry on any metabolic processes, including replication, a virus must enter a cell. Once a virus has injected his DNA or RNA into its host cell, that cell is altered and it is programmed to control the metabolic processes that the virus need to survive. The virus including the protein coat, replicates in the host cell. When the host cell can no longer carry out its metabolic functions because of the viral invader, the host cell dies and releases the new viruses into the body to invade other cells.
Agents for Influenza A and Respiratory Viruses
Influenza A and other respiratory viruses including Influenza B and respiratory syncytial viruses (RSV) invade the respiratory tract and cause the signs and symptoms of respiratory “flu”.
1. Amantadine (Symmetrel) – was first used to treat Parkinson’s disease. It is now used for both treatment and prevention of respiratory viral infections. It is slowly absorbed from the gastrointestinal tract reaching in peak levels of 4 hours.
2. Oseltamivir (Tamiflu) – effective in the treatment of uncomplicated influenza infections that have been symptomatic for less than 2 days. It is readily absorbed from the GI tract, extensively metabolized in the urine and excreted in the urine with a half-life of 6 to 10 hours.
3. Ribavirin (Virazole) – is effective against influenza A, RSV, and herpes virus. This agent has been used in the treatment of children with RSV and has been tested for used in several other viral conditions. Absorbed well in the respiratory tract and has a half-life of 9.5 hours.
4. Rimantadine (Flumandine) – a synthetic agent used for the prevention and treatment of Influenza A infections. It is absorbed in the GI tract with peak levels of 6 hours. Extensively metabolized and excreted in the urine. It is embryo toxic in animals. It should not be used by nursing mothers because it crosses into the breast milk and can cause toxic reactions to neonate.
5. Zanamivir (Relenza) – was approved in 1999 to treat uncomplicated influenza infections in adults and in children older than 12 years of age who have had symptoms for less than 2 days. It is absorbed through the respiratory tract and excreted unchanged in the urine with a half-life of 2.5 to 5.1 hours.
Therapeutic Actions and Indications
These viral agents prevent shedding of the viral protein coat and entry of the virus into the cell. This action prevents viral replications causing viral death. These antiviral drugs are indicated for prevention of Influenza A infection.
Contraindications and Cautions
Caution should be used when giving these antiviral agents to patients with a known allergy; to pregnant or lactating women or to patients with renal or liver disease which could alter metabolism and excretion of the drug.
Adverse Effects
Use of these antiviral agents is frequently associated with various adverse effects that may be related to possible effects on dopamine levels in the brain. These include light headedness, dizziness and insomnia, nausea, orthostatic hypotension and urinary retention.
Clinically Important Drug-Drug Interactions
Patients who received amantadine or rimantadine may experience increased atropine-like effects if either of these drugs is given with an anticholinergic drug.
Nursing Diagnoses
The patient receiving a respiratory antiviral drug may have the following nursing diagnoses related to drug therapy.
· Acute pain related to GI, CNS, GU effects of drug
· Disturbed sensory perception related to CNS effects of drug
· Deficient knowledge regarding drug therapy
Implementation
· Start drug regimen as soon after exposure to the virus as possible to achieve best effectiveness and decrease the risk of complications of viral infection.
· Administer Influenza A vaccine before the flu season begins if at all possible, to prevent the disease and decrease the risk of complications.
· Administer the full course of the drug to obtain the full beneficial effects.
· Provide safety provisions if CNS effects occur, to protect the patient from injury.
· Instruct the patient about the appropriate dosage scheduling regimen; safety precautions, including changing position slowly and avoiding driving and hazardous tasks, to take if CNS effects occur; and the need to report any difficulty walking or talking to enhance patient knowledge about drug therapy and to promote compliance.
Evaluation
· Monitoring patient response to the drug
· Monitor for adverse effects
· Evaluate the effectiveness of the teaching plan
· Monitor for the effectiveness of comfort and safety measures and compliance with regimen
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