...airway obstruction caused by bronchoconstriction. Thus, this should only be used for quick relief of asthma symptoms and not for every day use. Her son is experiencing nearly daily coughs that are persistent in the evenings that it is likely he now has moderate to severe asthma instead of mild asthma. Due to worsening asthmatic symptoms, it is best to add on another medication. We do not want to stop the Albuterol nebulizer, because all asthmatic patients must have a quick relief medication on hand. As discussed earlier, Jack has moderate to severe asthma that it is recommended to start an inhaled corticosteroid with a leukotriene modifier. An inhaled corticosteroid works to suppress inflammatory cell activation and function to decrease airway inflammation, prevent microvascular leakage to decrease airway edema, decrease mucus production,...
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...Rationale I have selected Bell’s palsy as a minor health subject for critical analysis for three principal reasons. Firstly, it is the most common disorder affecting the facial nerves (Ardour, 1978). Secondly, research has noted that there appears little consensus in the literature regarding the causes and management of Bell’s palsy. Additionally the diagnosis is one of elimination. Tiemstra and Khatkhate (2007) demonstrate there are many other conditions which can mimic symptoms (See appendix one). I therefore wanted to analyse the available literature in order to be able to competently and safely recognise the condition in the urgent unscheduled care environment. Background Petruzelli (1991) states that Bell’s palsy is an acute paralysis of the facial nerve first described by the Scottish surgeon and anatomist, Sir Charles Bell . Niparko (1993) elaborates that it is a generally unilateral paralysis or weakness of facial musculature consistent with facial nerve damage and dysfunction. The anatomy of the facial nerve can be found in appendix two. Pietersen (2002) states that the cause is unknown, however, whilst the exact aetiology of Bell’s palsy is still debated, viral infections, vascular ischaemia, autoimmune inflammatory disorders and heredity have been postulated as causative. (Adour 1982, Burgess 1984, Lorber 1996). Murakami et al (1996) proposed that reactivation of herpes simplex virus in the geniculate ganglia was causative. A herpes simplex cause is corroborated...
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...Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune disease that can damage any part of the body such as the joints, skin, or even organs. Paediatric-onset SLE accounts for about 10–20% of all patients with SLE (Malattia, 2013). Being a chronic disease, the signs and symptoms may last more than six weeks but a majority of the time they last for years or even a lifetime. In addition, SLE can affect any demographic but for this study we will focus on adolescents from birth to age 18 because, as said by Morgan, children present with a more severe illness, more aggressive disease course with higher disease activity over time greater burden of steroid and immunosuppressive therapies (2013). Currently, there is no cure for SLE. However...
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...Fluticasone Propionate (FP), a component of Advair Diskus, is a corticosteroid primarily used in the treatment of asthma, allergic rhinitis (AR), or chronic obstructive pulmonary disease (COPD).1,2,3,4 In patients with allergic rhinits, is it most often used intranasally, falling under the class of “intranasal corticosteroids”, or INS.3 However, in the case of asthma, the drug is classified as an “inhaled corticosteroid” or ICS.5 Typically short-acting β2 adrenoreceptor agonists are used to rapidly treat the symptoms of asthma, but corticosteroids like FP are utilized when long-term contol is required.6 FP has been obsered to have synergistic effects when used in co-therapy with these short-acting β2 adrenoreceptor agonists, yielding a greater improvement in lung treatment and symptom control than when either of the two drugs is adminstered alone.6 The corticosteroid drug class has been around...
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...Asthma Evidence Based Pharmacology Asthma is a chronic debilitating disease which affects children and adults. According to the National Heart, Lung, and Blood Institute (NHLBI), “asthma affects people of all ages, but it most often starts during childhood. In the United states, more than 25 million people are known to have asthma. About 7 million of these people are children.” Asthma is most commonly diagnosed during childhood. Pathophysiology and Age Continuum Implications Asthma is a disorder that affects the airways; it is an obstruction of the airways that takes place due to inflammation, chronic airway hyperactivity, and remodeling of the airway. According to Maddox & Schwartz (2002), “the etiology of asthma is complex and multifactorial. It involves the interaction between genetic factors and environmental stimuli” (p. 477). Therefore, patients suffering from asthma are not only susceptible to un-modifiable genetic factors but also environmental factors that trigger the airway obstructions. Essentially asthma is an inflammation of the airways in which there is an infiltration into the walls of the airway by mast cells, eosinophils, T-helper cell type two (Th2), and T-lymphocytes (Bonsignore, Profita, Gagliardo, Riccobono, Chiappara, Pace, and Gjomarkaj, 2015). According to Bonsignore, et al. (2015), “persistence of chronic inflammation may alter the homeostasis of lung tissue, leading to airway remodeling. Tissue remodeling includes epithelial alterations (epithelial...
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...reached their max, they still have that mindset of exceeding their goals and resort to a drug that has been around the 50s. When steroids first became available in the public market, the drug was unregulated and anyone could buy and use it for whatever they wanted. It took about forty years for it become regulated, regulations put steroids as a schedule 3 under the controlled substance act making its possession illegal without a prescription. Steroids are one of the most controversial substances to ever be made and are still common today. There are mainly two uses of steroids, medicinal and performance enhancing. Medicinally used steroids can be used to treat anything from a rash to asthma. There are about three names for steroids; corticosteroids, used medically, and anabolic steroids or HGH which in the athletic world is used to boost performance or in the medical field to replace sex hormones. All over the world steroids are being used to treat numerous illnesses. By many people when steroids are brought up they usually think of a big raging bodybuilder injecting steroids. In the bodybuilding building industry steroids are used to build huge muscles. When a natural bodybuilder is lifting weights, they are creating micro tears in their muscles allowing their muscles to...
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...planning, early detection and treatment. The patient’s function and comfort can be maintained through medical, surgical and rehabilitative approaches (Sussman, 2002). Prednisone and Deflazacort are corticosteroids that delay the loss of muscle strength. Corticosteroids alter the regulation of genes in muscle fibers, slow the rate of skeletal breakdown, reduce cytotoxic T cells and lower, cytosolic calcium concentrations. Some patients may benefit from the release of lower extremities contractures. In addition many patients with Duchenne muscle dystrophy are at a risk of severe scoliosis which can be prevented by early spinal fusion using segmental instrumentation (Sussman, 2002) . Current treatment There are significant milestones in management of this disorder including corticosteroids, support therapy, and novel therapies that would give affirmative outcome. Novel therapies include gene therapy through which there is use of viral vectors, antisense oligonucleotide exon skipping, read-through stop codon strategies, stem cell therapy, and utrophin. Prevention of DMD can be done by detection and counselling of carriers. The affected patients and their families are recommended for genetic counselling (Biggar, 2006). In conclusion, DSD is a lethal genetic disease with adverse effects such as death, Prevention of the disease is primal in addition to effective treatment of the patients with the disease. However, further research is needed to improve on the current treatment available...
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...The patient’s weight is needed because many medication doses are based per Kilogram (Kg). This also gives a baseline to indicate weight gain/loss during therapy. The age of the client is of importance because of the effects age has on metabolism of drugs. If the older client can’t metabolize drugs effectively, the chance of drug toxicity is increased. The patient needs to be monitored and the medications titrated to therapeutic blood levels to ensure safety. Taking vital signs (V/S) before drug administration will give the nurse a baseline to guide therapy. It can also be an indicator of when medications should be held, or of possible adverse reactions to a drug. Knowing any cognitive barriers will help the nurse in making safe choices for the patient. The education of the patient may need to extend to family members or care takers. If the patient cannot identify adverse reactions, the teaching will have to be shared with whoever is around to identify these signs and symptoms. The life-long and numerous medications that accompany RA can be difficult to manage. Someone besides the client may need to administer medications. The nurse can explain the use of pill dispensers, setting alarms on telephones, or boldly marking a calendar for use in remembering doses. Due to the metabolism...
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...Treatment is being able to manage the symptoms and palliative treatment; it includes use of corticosteroids, such as Prednisone for polymyositis at a high dose, until the CK levels return to normal ranges, with additional monitoring for the adverse effects of corticosteroids, such as weight gain, hypertension, osteopenia, and steroid myopathy. When patients do not show signs of improvement with cortico-steroids after a sensible period, immunotherapy can be used. Patients that have a poor prognostic, like difficulty swallowing, also tend to require immune therapy. In patients who develop adverse reactions to prednisone, methotrexate is the second choice of treatment. Intravenous immunoglobulin has also been used for short term treatment in patients that experience adverse reactions to steroids. Patients might benefit from a diet high in proteins, with supervised exercises. Other therapies might be used to prevent muscle contractures, such as heat/cold applications, and splints. Additionally, patients can receive physical therapy early in the disease to aid in range of...
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...ASTHMA PHARMACOTHERAPEUTICS ASTHMA CASE STUDY RICK, 44 YO MALE COMES TO CLINIC COMPLAINING OF ALLERGIES AND ASTHMA. HE HAS HAD MILD INTERMITTENT ASTHMA FOR YEARS THAT IS TRIGGERED BY ALLERGIES AND RESPIRATORY INFECTIONS. THE PAST FEW WEEKS HIS SEASONAL ALLERGIES HAVE BEEN BOTHERING HIM, HE HAS BEEN USING HIS ALBUTEROL A COUPLE TIMES A DAY FOR A WHEEZY COUGH. HAS BEEN TAKING BENADRYL FOR HIS ALLERGIES, BUT IT MAKES HIM SLEEPY AND HE CAN’T TAKE IT AT WORK. HE IS ABLE TO WORK, BUT HE CANNOT FINISH HIS ROUTINE 5-MILE RUN EACH DAY DUE TO COUGHING. PHYSICAL EXAM: AFEBRILE, 02 SAT 95% ROOM AIR, SPIROMETRY FEV1 75% MEDICATIONS: ALBUTEROL INHALER & BENADRYL ETIOLOGY OF ASTHMA • The complete causes of asthma are unknown. Heredity does seem to play a role as do allergens and environmental factors. Atopy – genetic predisposition for developing IgE-mediated response to common aeroallergens, is strongest predisposing factor for development of asthma. • Allergic/extrinsic asthma – result of antigen/antibody reaction on mast cells in respiratory tract. Causes release of inflammatory mediators from mast cells which elicit clinical response associated with an asthma attack. Usual onset 5 15 yrs. • Idiosyncratic asthma- neurological imbalance in ANS in which alpha and beta adrenergic as well as cholinergic sites of the ANS are not properly coordinated. Usual onset later in life. PATHOPHYSIOLOGY OF ASTHMA • Chronic inflammatory disorder of the airways...
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...Gluten-sensitive enteropathy, or coeliac disease, is an autoimmune condition in which the immune system has an adverse reaction to consuming food containing the protein gluten. This reaction involves directing antibodies to gluten, which results in an inflammation within the intestinal lining along with damaging the villi. Consequently, this results in a decline in the body’s ability in absorbing nutrients, leading to the person becoming malnourished. Despite the severity of this disease, however, there are still a series of steps that can be taken when treating coeliac disease. The first step, which is the conventional approach in treating coeliac disease, is avoiding food that contains gluten; examples include bread, pasta and cereals. This...
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...I. Introduction This is a case of a 74 year old woman who was diagnosed with Community Acquired Pneumonia. Pneumonia is an inflammation or infection of the lungs most commonly caused by a bacteria or virus. Pneumonia can also be caused by inhaling vomit or other foreign substances. In all cases, the lungs' air sacs fill with pus , mucous, and other liquids and cannot function properly. This means oxygen cannot reach the blood and the cells of the body. Most pneumonias are caused by bacterial infections.The most common infectious cause of pneumonia in the United States is the bacteria Streptococcus pneumoniae. Bacterial pneumonia can attack anyone. The most common cause of bacterial pneumonia in adults is a bacteria called Streptococcus pneumoniae or Pneumococcus. Pneumococcal pneumonia occurs only in the lobar form. An increasing number of viruses are being identified as the cause of respiratory infection. Half of all pneumonias are believed to be of viral origin. Most viral pneumonias are patchy and the body usually fights them off without help from medications or other treatments. Pneumococcus can affect more than the lungs. The bacteria can also cause serious infections of the covering of the brain (meningitis), the bloodstream, and other parts of the body. Community-acquired pneumonia develops in people with limited or no contact with medical institutions or settings. The most commonly identified pathogens areStreptococcus pneumoniae, Haemophilus influenzae, and...
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...can be indicated with with an incisional biopsy of the blister, but an immunofluorescence study is needed for definitive diagnosis. BP is usually a self- limiting disease with clinical symptoms that can last for months, or even years. Usually if left untreated the body will eventually heal itself from all manifestations, leaving no scarring. The main reasoning behind treatment is to manage the symptoms to the best of the practitioner’s ability without compromising the patient in other ways. During the active stage the morbidity rate is twice that of the normal elderly population. This usually due to the already declined health of the elderly, along with side effects of medications given to treat BP. Systemic steroids are established the best way to care for BP, other treatments can be used are topical corticosteroids, Azathioprine, anti-inflammatory antibiotics, Methotrexate, mycophenolate mofetil, dapsone and sulfonamides, intravenous immunoglobins, cholorambucil, cyclophosphamide and cyclosporine. Symptoms can also show due to use of certain medications which include furosemide, captopril, phenacetin, pennicillamine, NSAIDS, and systemic antibiotics. Role of the Dental Hygienist When a patient is displaying oral manifestations of BP it is imperative not to go ahead with any treatment until the manifestations have subsided. The bursting of any blisters will spread the disease. It is also important to go over impeccable at home care, as any additional plaque could irritate...
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...Corticosteroids depress the immune system, placing the client at risk for infection. Glucocorticoid methylprednisolone (Solu-Medrol). levothyroxine sodium (Synthroid). Levothyroxine sodium (Synthroid) should be withheld if the pulse is over 100 beats/min. To prevent insomnia, the daily dose should be taken early in the morning before breakfast, not at bedtime. Cholinesterase inhibitors work to increase the availability of acetylcholine at cholinergic synapses, which aids in neuronal transmission and assists in memory formation. Basing an explanation on this concept. Carbamazepine (Tegretol) Myelosuppression is the highest priority complication that can potentially affect clients managed with carbamazepine (Tegretol) therapy. The client requires close monitoring for this condition by weekly laboratory testing. Hepatic function may be altered. Older clients usually have a decline in lean body mass and total body water that causes water-soluble drugs to become distributed in fluid compartments, resulting in an increased concentration, so determining the drug's serum level for toxicity should be implemented first. Hemorrhagic cystitis (blood in the urine) is the characteristic adverse reaction of Cyclophosphamide (Cytoxan). Metoclopramide HCl (Reglan) blocks dopamine receptors in the brain, which can cause the extrapyramidal symptoms associated with Parkinson's disease. Bone marrow depression with granulocytopenia is a severe but common adverse effect of Zidovudine (Retrovir)...
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...Thesis Statement Writing Tuesday, Jun. 8th 2010 Before you familiarize yourself with thesis statement writing, you need to know what the statement is in the first place. This sentence basically sums up your main objective for writing the term paper, creates a simple guide for the reader and provides the basis for your argument. All in all thesis statement writing is quite simple, as long as you keep some tips and techniques in mind. The first thing you need to do is put together one question which is only possible if you compress the entire thesis. A great way to do this is examine the main topic and create a question out of it. It will give you a basic idea of what the statement should look like and how you should answer that question. The first sentence should introduce the topic and the objective and the next few should spell out how you plan to support your argument. Thesis statement writing, therefore, is about asking yourself the fundamental question that forms the essence of your paper. When you are done writing the statement, step back and examine in from another point of view to determine whether it is strong or weak. A strong statement is one which sparkles with confidence and focuses on one and only one aspect of the issue. This means that you can’t be vague or off-hand about the topic. If you have selected a theme, you should be ready to stand up for it- now is not the time to be diplomatic or meek. In addition to that, it should also spell out the basis for...
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