Sunday, August 31, 2008
I'M JUST A KIDI’M JUST A KID!!!!
So tell me, do you remember how fun and crazy it was being a kid? I do like I always do.
Today, I’m already a 19 year-old future doctor, and looking back, I wonder what is it about childhood that never lets you go; even when you’re so wrecked it’s hard to believe you were a child?
You see, here’s my theory: KIDS CHASE THE LOVE THAT ELUDES THEM, AND FOR ME, and THAT WAS THE ZAHIR’S LOVE. HE KEPT IT TUCKED AWAY, LIKE RAGGED CLOTHES ON A BRIEFCASE. AND I KEPT TRYING TO GET INSIDE THERE.
As an always-kid-at-heart, I’m such a mule: I’m too stubborn to listen to others saying. I don’t value any advice from anybody because I concluded that I am the one responsible for the thing that I chose, and so I did stand up for it! I chase and chase that love until I got left and die .Maybe it was the hormones or maybe it was that of what Erik Erikson describes in his PSYCHOSOCIAL DEVELOPMENT THEORY, but it ain’t any of that, IT WAS SOMETHING STRONG AND TRUE… Too big for a kid like me to feel such thing. Oh well! I never knew it either, how the hell would I know what’s happening inside my brain, I haven’t been on diagnostic imaging examination such at CT scan, PET scan or MRI. All I can understand is this feeling, all I can make sense of is the clarity of that thing… OH WHAT D’YOU CALL THAT THING AGAIN? OH GOD KNOWS WHAT’S THE NAME OF THAT THING! All I can remember is that the feeling was so intense, and magical, and all that mixed stuff you feel when you feel inspired, happy and superfluous.
So many frustrating scenes I’ve been through, however, I’m still holding on.. I dunno why the hell!!! I didn’t conspired it to be that way…
Looking back, it eas fate that I found him… It was so innocent, and so young and so PAST TENSE…… In time I stopped thinking that. In time I came to view that event
The way you view an old photograph, it’s like just some place you went a long time ago.
OH WHAT D’YOU CALL THAT THING AGAIN?
IT MUST HAVE BEEN LOVE. AND I’M DONE WITH IT.
Labels: Just Camille
15 eavesdropped
I’M JUST A KID!!!!
So tell me, do you remember how fun and crazy it was being a kid? I do like I always do.
Today, I’m already a 19 year-old future doctor, and looking back, I wonder what is it about childhood that never lets you go; even when you’re so wrecked it’s hard to believe you were a child?
You see, here’s my theory: KIDS CHASE THE LOVE THAT ELUDES THEM, AND FOR ME, and THAT WAS THE ZAHIR’S LOVE. HE KEPT IT TUCKED AWAY, LIKE RAGGED CLOTHES ON A BRIEFCASE. AND I KEPT TRYING TO GET INSIDE THERE.
As an always-kid-at-heart, I’m such a mule: I’m too stubborn to listen to others saying. I don’t value any advice from anybody because I concluded that I am the one responsible for the thing that I chose, and so I did stand up for it! I chase and chase that love until I got left and die .Maybe it was the hormones or maybe it was that of what Erik Erikson describes in his PSYCHOSOCIAL DEVELOPMENT THEORY, but it ain’t any of that, IT WAS SOMETHING STRONG AND TRUE… Too big for a kid like me to feel such thing. Oh well! I never knew it either, how the hell would I know what’s happening inside my brain, I haven’t been on diagnostic imaging examination such at CT scan, PET scan or MRI. All I can understand is this feeling, all I can make sense of is the clarity of that thing… OH WHAT D’YOU CALL THAT THING AGAIN? OH GOD KNOWS WHAT’S THE NAME OF THAT THING! All I can remember is that the feeling was so intense, and magical, and all that mixed stuff you feel when you feel inspired, happy and superfluous.
So many frustrating scenes I’ve been through, however, I’m still holding on.. I dunno why the hell!!! I didn’t conspired it to be that way…
Looking back, it eas fate that I found him… It was so innocent, and so young and so PAST TENSE…… In time I stopped thinking that. In time I came to view that event
The way you view an old photograph, it’s like just some place you went a long time ago.
OH WHAT D’YOU CALL THAT THING AGAIN?
IT MUST HAVE BEEN LOVE. AND I’M DONE WITH IT.
0 eavesdropped
Monday, August 11, 2008
NEUROGENIC BLADDERI. BIOGRAPHIC DATA
Name: Mr. URAGON
Address: Sucat, Paranaque
Age: 88 years old
Gender: Male
Religious Affliation: Catholic
Marital Status: Widow
Occupation: Retired farmer
Room and Bed #: Room 130 Bed A
Chief Complaint: Pain on his catheterization
Provisional Diagnosis: Neurogenic Urinary Bladder secondary to CerebroVascular Accident
Attending Physician: Dr.Marbella and Dr.Perez
II. NURSING HISTORY:
A. Past Health History
The client had experienced measles, chickenpox, and typhoid fever way back then on her adolescent years. He had no childhood immunizations but had anti-rabies virus and anti-tetanus vaccination when he was 50 years old. He does not have any allergies on foods and drugs .During the Japanese regime on the Philippines, he had Japanese friends who tattoed him with unknown means of procedure, uncertain if his Japanese tattoo artist friends used toxic-free ink and sterile needles. He encountered minor injuries and falls during his midlife but he viewed it as less serious malady. He was hospitalized last year for pain in urinating and was diagnosed having Benign Prostatic Hyperplasia. Last May 2008, he was hospitalized because of CerebroVascular Accident. He was given stool softeners and multivitamins. Currently, he is medicating Ciprofloxacin, Ceftriaxone and Arcoxia. Originally, he resides at Camarines Sur, Bicol but moved in Paranaque, Metro Manila last year.
B. History Of Present Illness
Upon his admission on Medical Center Paranaque, The client was complaining about the pain on his catheterization on his penis so his attending physician elected him to have Suprapubic Cystostomy tube insertion. He was diagnosed having Neurogenic Bladder secondary to CVA. The catheter is now draining his urine directly from his bladder.
C. FAMILY HISTORY
According to the client, he does not remember any familial or hereditary disease that runs in their family. His parents died due to “old age” as he stated.
D. OCCUPATIONAL HISTORY
The client worked as a farmer since he was 17 years old and retired at the age of 65. As far as the client can still remember, he’s been using fertilizer since it became popular on the Bicol region. His fertilizer container tank lodges on his back as if it was a backpack and then he pumps up and down using his arms.
III. PATTERNS OF FUNCTIONING
A. Psychological Health
Mr. Uragon describes himself as a strong and out-going kind of person. He is well-satisfied with his life and his family.
The client’s highest educational attainment is Elementary. His family usually makes decisions when it comes to his health and body. However, whenever it comes to his health he chooses to go to a physician whenever he feels sick. The client easily understands and answers questions clearly, simple and precise. At present the client has no problem with writing or reading but speaks with a little clarity since the muscles on his left side body is weak.
Interpretation and Analysis:
Over all, the client is currently happy and contented with his life. Even though he goes through physical “wear and tear” condition, he still views himself as a very strong man. His family gives him the overall support that he needed and highly prioritize his health.
B. Socio-Cultural Patterns
Mr. Uragon finds enjoyment in watching TV and playing with his grandkids. His grandkids often visit him with chocolates to give to their “Daddy”. They find leisure in going out, sharing thoughts and telling stories. According to him, he enjoys his stay at Paranaque as much as he enjoy his stay on Bicol
Interpretation and Analysis:
The client has a sound relationship on his family and environment.
C. Spiritual Patterns
The client is a Roman Catholic. He use to go to church weekly but stopped when he was catheterized. However, he often prays.
Interpretation and Analysis:
During this age, a person may not be an active member of the church because of the physical constraints.
IV. ACTIVITIES OF DAILY LIVING
ADL BEFORE HOSPITALIZATION DURING HOSPITALIZATION INTERPRETATION AND ANALYSIS
1. Nutrition No food restriction. Diet as tolerated. Low salt and low fat diet. To prevent water retention and plaque formation.
2. Elimination The client is catheterized and has stool softeners. . The client is catheterized and has stool softeners. Due to the pharmacologic effects of the drugs administer, it alleviate his burdens of urinating. Stool-softeners prevent him from straining during defecation.
3. Exercise The client undergoes physical therapy. The client is provided with ROM exercises. Due to hospitalization, he was unable to pursue his physical therapy session. But he still mobilizes his muscle by means of ROM exercise.
4. Hygiene The client takes a bath once a day cleans his dentures daily. The client is given Bed bath every day. Lessens the risk of acquiring infectious disease.
5. Substance Abuse The client drinks alcohol occasionally. The client used to be a smoker but last May 2008. The client stopped due to hospitalization. His pack years were unknown.
6. Sleep and Rest The client sleeps 4-6 hours a day. The client sleeps almost 9 hours. Due to hospitalization.
7. Sexual Activity Not Active. Not Active. The client chose not to be active.
V. PHYSICAL ASSESSMENT
Vital Signs Normal Findings Findings Analysis
Temperature 36.5 – 37.5 degrees Celsius 37.2 degrees Celsius Normal since it is in the usual range. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. 2004. pge 488)
Respiratory rate 15-20 cpm 18 cpm Normal since it is in the usual range. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. pge 506)
Pulse rate 60-100 bpm 96 bpm (radial) Normal since it is in the usual range. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. 2004. pge 499)
Blood pressure 120/80 mm/Hg 120/80 mm/Hg Normal
Appearance and Mental Status
Body build, height and weight Proportionate, varies with lifestyle. Endomorph Normal
Client’s posture, gait: sitting, walking and standing The client is relaxed and has a coordinated movement. The client cannot walk straightly or directly Due to the client’s general medical condition
Client’s overall hygiene and grooming. Relates these to the client’s activities prior to assessment. Clean, neat. Clean, neat. Normal
Body and breath odors No body odor or minor body odor relative to work or exercise; no breath odors. No body and breath odor Normal
Signs of distress No distress noted. Distress noted Not Normal- a highly stressed or anxious client could have an elevated body temperature. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. 2004. pge 488)
Signs of health or illness Healthy appearance. Sign of stress noted Not Normal- a highly stressed or anxious client could have an elevated body temperature. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. 2004. pge 488)
Client’s attitude Cooperative. Cooperative. Normal
Affect or mood Appropriate to situation. Appropriate to situation. Normal
Speech quantity, quality, and organization Understandable, moderate pace; exhibits thought association. Understandable, moderate pace; exhibits thought association. Normal
Thought relevance and organization Logical sequence; makes sense; has sense of reality. Logical sequence; makes sense; has sense of reality. Normal
Integumentary system
Skin • varies from light to deep
brown; from ruddy pink to
light pink; from yellow
overtones to olive • light brown Normal
• Generally uniform except in
areas exposed to the sun;
areas of lighter pigmentation
(palms, lip, nail, beds) in dark-
skinned people • Generally uniform except in
areas exposed to the sun; presence of tattoos on some body parts Sterility of the needles used is questionable
• No edema • No edema Normal
• Freckles, some birthmarks,
some flat and raised nevi; no
abrasions or other lesions • No Freckles, some birthmarks,
some flat and raised nevi; no
abrasions or other lesions Normal
• Moisture in skin folds and the
axillae (varies with the
environment temperature and
humidity, body temperature,
and activity) • Has moisture in skin folds and the
axillae Normal
• Uniform temperature; within
normal range • Uniform; Warm to touch Not Normal-a highly stressed or anxious client could have an elevated body temperature. (Kozier, Barbara et al. Fundamentals of Nursing. 7th edition. 2004. pge 488)
• When pinched, skin springs
back to previous state • When pinched, skin springs
Slowly back to previous state. Normally seen in geriartric patients
Hair • Evenly distributed hair • (+) alopecia Normally seen in geriartric patients
• Thick hair • Thin hair Normally seen in geriartric patients
Nails • Convex curvature; angle of nail about 160 degrees • Convex curvature; angle of nail about 160 degrees Normal
• Smooth texture • Smooth texture Normal
• Highly vascular and pink and
light-skinned client; dark-
skinned clients may have
brown or black pigmentation in
longitudinal streaks • Highly vascular and pink Normal
• Intact epidermis • Intact epidermis Normal
• Prompt return of pink or usual color (generally before 4 sec.) • Prompt return of pink or usual color before 4 sec. Normal
Head
Skull • Rounded ( normocephalic and
symmetrical, with frontal,
parietal, and occipital
prominences); smooth skull
contour • Rounded ( normocephalic and
symmetrical, with frontal,
parietal, and occipital
prominences); smooth skull
contour Normal
• Smooth, uniform consistency;
absence of nodules or masses • Smooth, uniform consistency;
absence of nodules or masses Normal
Face • Symmetric or slightly
symmetric facial features;
palpebral fissures equal in
size; symmetric nasolabial
folds • Symmetric symmetric facial features;
palpebral fissures equal in
size; symmetric nasolabial
folds Normal
• Eyes have no edema or
hollowness • Eyes have no edema or
hollowness normal
• Symmetric facial movements • Unilateral facial weakness Due to client’s general medical condition
Eyes
Eyebrows • Hair evenly distributed; skin
intact • Hair evenly distributed; skin
intact Normal
• Eyebrows symmetrically
aligned; equal movement • Eyebrows symmetrically
aligned; equal movement Normal
Eyelashes • Equally distributed; curled slightly
outward • Equally distributed; curled slightly
outward Normal
Eyelids • Skin intact; no discharges; no
discoloration • Skin intact; no discharges; no
discoloration Normal
• Lids close symmetrically • Lids close symmetrically Normal
• Approximately 15-20
involuntary blinks per minute;
bilateral blinking • Approximately 15-20
involuntary blinks per minute;
bilateral blinking Normal
• When lids open, no visible
sclera above corneas, and
upper and lower borders of the
cornea are slightly covered • When lids open, no visible
sclera above corneas, and
upper and lower borders of the
cornea are slightly covered Normal
Bulbar conjunctiva • Transparent; capillaries
sometimes evident • Transparent; capillaries
sometimes evident Normal
Palpebral conjunctiva • Shiny, smooth; pink or red • Shiny, smooth; pink Normal
Sclera • Appears white (yellowish in
dark-skinned clients) • Appears white Normal
Cornea • Transparent, shiny and
smooth; details of the iris are
visible • Transparent, shiny and
smooth; details of the iris are
visible Normal
Anterior chamber • Transparent; no shadows of
light on the iris; depth of
about 3 mm • Transparent; no shadows of
light on the iris; depth of
about 3 mm Normal
Pupils • Black in color; equal in size;
normally 3 to 7 mm in
diameter; round smooth
border
• Illuminated pupil constricts
(direct response);
Non- illuminated pupil
constricts (consensual
response).
• Pupils constricts when looking
at near object; pupils dilated
when looking at far objects
• Pupils converge when near
object is moved toward the
nose • Black in color; equal in size;
normally 3 to 7 mm in
diameter; round smooth
border
• Illuminated pupil constricts
(direct response);
Non- illuminated pupil
constricts (consensual
response).
• Pupils constricts when looking
at near object; pupils dilated
when looking at far objects
• Pupils converge when near
object is moved toward the
nose
• Pupils are equally round and reacts to light and accommodation Normal
Iris • Flat and round • Flat and round Normal
Lacrimal Gland, Lacrimal Sac, Nasolacrimal Duct • No edema or tenderness over
lacrimal gland • No edema or tenderness over
lacrimal gland Normal
Visual Fields • When looking straight ahead,
client can see objects in the
periphery. • When looking straight ahead,
client can see objects in the
periphery. Normal
Extraocular Muscle Tests • Both eyes coordinated, move
in unison, with parallel
alignment • Both eyes coordinated, move
in unison, with parallel
alignment Normal
Ears
Auricles • Color same as facial skin • Color same as facial skin Normal
• Symmetrical • Symmetrical Normal
• Auricles aligned with the outer
cantus of the eyes, about 10o
from vertical • Auricles aligned with the outer
cantus of the eyes, about 10o
from vertical Normal
• Mobile, firm, and not tender;
pinna recoils after it is folded • Mobile, firm, and not tender;
pinna recoils after it is folded Normal
Gross Hearing Acuity Test • Normal voice tone audible • Normal voice tone audible Normal
• Able to hear the ticking of
watch in both ears • Able to hear the ticking of
watch in both ears Normal
• The sound of the tuning fork is
heard in both ears or is
localized at the center of the
head (Weber negative) • The sound of the tuning fork is
heard in both ears or is
localized at the center of the
head (Weber negative) Normal
• Air-conducted (AC) hearing is
greater than bone-conducted
(BC) hearing (Rinne positive) • Air-conducted (AC) hearing is
5 seconds and bone-conducted
(BC) hearing is 3 seconds (Rinne positive)
• Air-conducted (AC) hearing is
greater than bone-conducted
(BC) hearing (Rinne positive) Normal
Nose
External Nose • Symmetrical and straight • Symmetrical and straight Normal
• No discharges or flaring • No discharges or flaring Normal
• Uniform color • Uniform color Normal
• No displacement of bone or
cartilage • No displacement of bone or
cartilage Normal
• No tenderness • No tenderness Normal
• No lesions • No lesions Normal
• No presence of masses • No presence of masses Normal
Nasal Cavities • Air moves freely when
breathing through the naris • Air moves freely when
breathing through the naris
• Nasal cavities are patent Normal
• Mucosa pink • Mucosa pink Normal
• Clear watery discharges • Clear watery discharges Normal
Normal
• No lesions • No lesions Normal
Nasal Septum • Intact and in the midline • Intact and in the midline Normal
Facial sinuses • Not tender • Not tender Normal
Mouth
Lips • Uniform pink color (freckled
brown pigmentation in dark
skinned clients) • Uniform pink color with a darker shade in the border of the lips Normal
• Soft, moist, smooth texture • dry Not normal since dry lips could indicate dehydration. (Kozier, Barbara, et al. Fundamentals of Nursing, 7th edition. 2004 pg. 679)
• Symmetry of contour • Symmetry of contour Normal
• Ability to purse lips • Ability to purse lips Normal
Buccal Mucosa • Moist, smooth, soft, glistening,
and elastic texture (drier oral
mucosa in elderly due to
decreased salivation. • Moist, smooth, soft, glistening,
and elastic texture Normal
Teeth • 32 adult teeth • 20 adult teeth Not normal since he has missing teeth due to tooth extraction which is considered to be a deviation from normal (Kozier, Barbara, et al. Fundamentals of Nursing, 7th edition. 2004 pg. 564)
• Smooth, white, shiny tooth
enamel • Smooth, yellowish, shiny tooth but with some black discoloration of enamel Not normal since black discoloration may indicate staining/ presence of caries (Kozier, Barbara, et al. Fundamentals of Nursing, 7th edition. 2004 pg. 564)
• No dental caries, permanent fillings, and missing teeth • Positive for permanent fillings and missing teeth Not normal – teeth enamel should be white, shiny and free from dental carries. Kozier, Barbara, et al. Fundamentals of Nursing, 7th edition. 2004 pg. 564)
• Use of dental apparatus • (+) dentures Normally seen in geriartric patients
Gums • Pink gums (bluish or dark
patches in dark-skinned client) • Pink gums Normal
• Moist, firm texture to gums • Moist, firm texture to gums Normal
• No retraction of gums (pulling
away from the teeth) • No retraction of gums (pulling
away from the teeth) Normal
• Smooth, intact dentures • Smooth, intact dentures Normal
Tongue • Central position • Central position Normal
• Raised papillae (taste buds) • Raised papillae (taste buds) Normal
• Smooth lateral margin; no
lesions • Smooth lateral margin; no
lesions Normal
• Pink color (some brown
pigmentation on tongue
borders in dark-skinned
clients); rough; thin whitish
coating • Pink color; rough; thin whitish
coating Normal
• Moves freely; no tenderness • Moves freely; no tenderness Normal
• Smooth tongue base with
prominent veins • Smooth tongue base with
prominent veins Normal
Floor of the mouth • Smooth with no palpable
nodules • Smooth with no palpable
nodules Normal
Salivary glands • Same as color of buccal
mucosa and floor of mouth • Same as color of buccal
mucosa and floor of mouth Normal
Palates • Light pink, smooth, soft
palate; Lighter pink hard
palate, more irregular texture • Light pink, smooth, soft
palate; Lighter pink hard
palate, more irregular texture Normal
Uvula • Positioned in the midline of
soft palate • Positioned in the midline of
soft palate Normal
Oropharynx • Pink and smooth posterior wall • Pink and smooth posterior wall Normal
Tonsils • Pink, smooth • Pink, smooth Normal
• No discharge • No discharge Normal
• Normal Size • Normal Size (Grade 1) Normal
Gag reflex • Present • Present Normal
Neck
Neck muscle • Muscle equal in size; head
centered • Unilateral body paralysis Due to client’s general medical condition
Head movement • Coordinated, smooth
movements with no discomfort • With a little weakness Due to client’s general medical condition
Muscle Strength • Equal in strength
(sternocleidomastoid;
trapezius) • Unequal in strength
(sternocleidomastoid;
trapezius) Due to client’s general medical condition
Lymph Nodes • Not palpable • palpable Indicates infection or inflammatory process
Trachea • Central placement in midline of
neck; space are spaces are
equal on the both • Central placement in midline of
neck; space are spaces are
equal on the both Normal
Thyroid Gland • Not visible • Not visible Normal
• Gland ascends during
swallowing but is not visible • Gland ascends during
swallowing but is not visible Normal
• Lobes may not be palpated. If palpated, lobes are small,
smooth, centrally located,
painless, and rise freely with
swallowing • Lobes are not palpable Normal
Thorax
Posterior Thorax • Anteroposterior to transverse
diameter in ratio of 1:2 • Anteroposterior to transverse
diameter in ratio of 1:2 Normal
• Chest symmetric • Chest symmetric Normal
• Spine vertically aligned • Spine vertically aligned Normal
• Spinal column is straight, right
and left shoulder and hips are
at same height • Spinal column is S in shape Indicates scoliosis
• Skin intact; uniform
temperature • Skin is crumpled; uniform
temperature Normally seen in geriartric patients
• Full symmetric chest
expansion • Full symmetric chest
expansion Normal
• Bilateral symmetry of vocal
fremitus • Bilateral symmetry of vocal
fremitus Normal
• Fremitus is heard most clearly
at the apex of the heart • Fremitus is heard most clearly
at the apex of the heart Normal
• Percussion notes resonate ,
except over scapula • Percussion notes resonate ,
except over scapula Normal
• Lowest point of resonance is at
the diaphragm • Lowest point of resonance is at
the diaphragm Normal
• Vesicular and bronchovesicular
breath sounds • Vesicular and bronchovesicular
breath sounds Normal
Anterior Thorax • Quiet, rhythmic and effortless
respirations • Quiet, rhythmic and effortless
respirations Normal
• Costal angles is less than 900
and the ribs insert into the
spine at approximately a 45
angle • Costal angles is less than 900
and the ribs insert into the
spine at approximately a 45
angle Normal
• Full symmetric excursion;
thumbs normally separate 3 to
5 cm • Full symmetric excursion;
thumbs separate about 3 cm Normal
• Same as posterior vocal
fremitus; fremitus is normally
decreased over the heart and
breast tissue • Same as posterior vocal
fremitus; fremitus is normally
decreased over the heart and
breast tissue Normal
• Percussion notes resonate
down to the sixth rib at the
level of the diaphragm but are
flat over the areas of heavy
muscle and bone, dull on areas
over the heart and the liver,
and tympanic over the
underlying stomach. • Percussion notes resonate
down to the sixth rib at the
level of the diaphragm but are
flat over the areas of heavy
muscle and bone, dull on areas
over the heart and the liver,
and tympanic over the
underlying stomach. Normal
• Bronchial and tubular breath
sounds over the trachea • Bronchial and tubular breath
sounds over the trachea Normal
• Bronchial and tubular breath
sounds over the anterior
thorax • Bronchial and tubular breath
sounds over the anterior
thorax Normal
Cardiovascular
Precordium • No pulsations (aortic and
pulmonic areas) • No pulsations (aortic and
pulmonic areas) Normal
• No pulsations; no lifts or
heaves (tricuspid area) • No pulsations; no lifts or
heaves (tricuspid area) Normal
• Pulsations in the apical • Pulsations in the apical Normal
• Aortic pulsations in the
epigastric • Aortic pulsations in the
epigastric Normal
Carotid arteries • Symmetric pulse volumes • Irregular pulse volumes Could suggest an underlying cardiovascular problem
• Full pulsations; thrusting
quality • irregular rhythm and quality Could suggest an underlying cardiovascular problem
• No sound heard on
auscultation • No sound heard on
auscultation Normal
Jugular Vein • Veins not visible • Veins not visible Normal
Abdomen
Abdomen • Unblemished skin • Unblemished skin Normal
• Uniform in color • Uniform in color Normal
• Silver white striae (stretch
marks) or surgical scars • No silver white striae (stretch
marks) or surgical scars Normal
• Flat, round (convex), or
scaphoid (concave) • Scaphoid (concave) Normal
• No evidence of enlargement of
liver or spleen • No evidence of enlargement of
liver but spleen is palpable and enlarge Normally, spleen is unpalpable. Elargement of the skin indicated infection
• Symmetric contour • Symmetric contour Normal
• Symmetric movements caused
by respiration • Symmetric movements caused
by respiration Normal
• Visible peristalsis in very lean
people • No visible peristalsis in very lean
people Normal
• Aortic pulsations in thin
persons at epigastric pattern • No aortic pulsations at epigastric pattern Normal
• No visible vascular pattern • No visible vascular pattern Normal
• Audible bowel sounds • Audible bowel sounds Normal
• Absence of arterial bruit • Absence of arterial bruit over the aorta, renal artery, iliac artery, and femoral arteries Normal
• Absence of friction rub • Absence of friction rub Normal
• Tympany over the stomach
and gas-filled bowels; dullness
especially over the liver and
spleen, or a full bladder • Tympany over the stomach
and gas-filled bowels; dullness
especially over the liver and
spleen, or a full bladder Normal
• No tenderness; relaxed
abdomen with smooth,
consistent tension • No tenderness; relaxed
abdomen with smooth,
consistent tension Normal
Liver • May not be palpable • Not palpable Normal
Bladder • Not palpable • Not Applicable to palpate due to presence of suprapubic cystostomy. N/A
Musculoskeletal System
Muscles • Equal in size on both sides of
body • Equal in size on both sides of
body Normal
• No contractures • No contractures Normal
• No fasciculation or tremors • With fascuculations on the left arm Due to general medical conditon
• Normally firm • Normally firm Normal
• Smooth coordinated
movements • Uncoordinated body movements Due to general medical conditon
• Equal strength on each body
side • Unequal strength on each body
side Due to general medical conditon
Bones • No deformities • No deformities Normal
• No tenderness or swelling • No tenderness or swelling Normal
Joints • No deformities • No deformities Normal
• No tenderness or swelling • No tenderness or swelling Normal
LABORATORY RESULTS:
A. Urinalysis
Routine Actual Findings Normal Findings Analysis/ Interpratation
Color
Transparency
Specific Gravity
Sugar
Protein
Pus cells
Red cells
Epithelial cells
Amorphous Urates
Bacteria
Yellow
Hazy
0.015
Negative
Trace
Many
3/hpf
Few
Few
Many
Staw- dark yellow
Clear
1.016 – 1.022
Negative
Negative
Occasional
Female: 0-2/hpf
Male: 0/hpf
Occasional
Occasional
Negative
NORMAL
Turbidity or smokiness may be due to RBC. The presence of increased number of epithelial cells may also account for turbidity. Spermatozoa and Prostatic fluid may cause turbidity.
(Prostatic fluid normally contains a few leukocytes and other formed elements.)
Urines of low specific gravity are called HYPOSTHENUEIC.
The measurement of Specific Gravity should give an indication of Urinary total solute concentration.
Normal
Trace amounts doesn’t necessarily indicates glumerular or tubular diseases in kidney.
Indicates bacterial infection.
Increased RBC may indicate Renal disease or UTI or extrarenal disease or toxic reactions.
Normal
Normal
Confirms bacterial infection.
B. CBC (prior to blood transfusion)
Blood Component Actual Findings Normal Findings Interpretation/Analysis
Hgb
Hct
RBC
WBC
Platelet
Differential count:
Segmmenters
Lymphocyte
Eosinophils 109
0.33
3.88
4.70
Adequate
0.75
0.25
0.01 140-170 gm/L
0.41-0.51 gm/L
4.6-5.2 x 10 /L
4.5 X 10 /L
200-400 mg/dl
0.55-0.65
0.25-0.35
0.00-0.05 Decreased oxygenation in tissues.
Anemia
Anemia
Normal
Normal
Indicates infection
Normal
Normal
DRUG STUDY
Generic/Trade name Dosage/ Frequency Classification Indication Contraindication Side effects Nursing responsibilities
ciprofloxacin
Ceftriaxone
ETOROCOXIB
(Arcoxia)
500 mg/tab
BID
PO
Chronic bacterial prostatitis: 500 mg PO q 12 hr for 28 days or 400 mg IV q 12 hr for 28 days.
Complicated UTIs: 500 mg PO q 12 hr for 7–14 days or 400 mg IV q 12 hr or 1,000 mg (ER tablets) PO daily for 7–14 days
1 gram IV OD
60mg/tab
PO
BID Antibacterial
Fluoroquinolone
Anti bacterial
3rd greneration cephalosporin
Analgesic Indications
• For the treatment of infections caused by susceptible gram-negative bacteria, including E. coli, P. mirabilis, K. pneumoniae, Enterobacter cloacae, P. vulgaris, P. rettgeri, M. morganii, P. aeruginosa, Citrobacter freundii, S. aureus, S. epidermidis, group D streptococci
Treatment of uncomplicated UTIs caused by E. coli, K. pneumoniae as a one-time dose in patients at low risk of nausea, diarrhea (Proquin XR)
Otic: Treatment of acute otitis externa
Treatment of chronic bacterial prostatitis
IV: Treatment of nosocomial pneumonia caused by Haemophilus influenzae, K. pneumoniae
Oral: Typhoid fever
Oral: STDs caused by N. gonorrheae
Prevention of anthrax following exposure to anthrax bacilla (prophylactic use in regions suspected of using germ warfare)
Acute sinusitis caused by H. influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis
Lower respiratory tract infections caused by E. Coli, Klebsiella, Enterobacter species, P. mirabilis, P. aeruginosa, H. influenzae, H. parainfluenzae, S. pneumoniae
Unlabeled use: Effective in patients with cystic fibrosis who have
pulmonary exacerbations
UTIs caused by S. pneumoniae, P. vulgaris, P.mirablis, Morganella Morganii,
Perioperative prophylaxis for Pts. Undergoing CABG and contaminated or potentially contaminated surgical procedures.
Tx of
Acute and chronic OA and RA.
Tx of acute gouty arthritis and primary dysmenorrheal.
For PostOperative pain.
• Contraindicated with allergy to ciprofloxacin, norfloxacin or other fluoroquinolones, pregnancy, lactation.
Use cautiously with renal dysfunction, seizures, tendinitis or tendon rupture associated with fluoroquinolone use.
Contraindicated with allergy to cephalosporins or penicillins
Use cautiously with renal failure, lactation and pregnancy.
Do not take Arcoxia if:
• you have an allergy to Arcoxia or any of the ingredients listed at the end of this leaflet
• the packaging is torn or shows signs of tampering
• the expiry date on the pack has passed.
If you take this medicine after the expiry date has passed, it may not work.
• You have had heart failure, a heart attack, bypass surgery, chest pain (angina), narrow or blocked arteries of the extremities (peripheral arterial disease), a stroke or mini stroke (TIA or transient ischaemic attack).
• You have high blood pressure that is not well controlled on blood pressure medication.
• You are having major surgery and have conditions which increase your risk of coronary artery disease or atherosclerosis such as high blood pressure, diabetes, high cholesterol or smoking.
• You are having major surgery on you heart or arteries.
Contraindicated with allergy to ciprofloxacin, norfloxacin or other fluoroquinolones, pregnancy, lactation.
Use cautiously with renal dysfunction, seizures, tendinitis or tendon rupture associated with fluoroquinolone use.
CNS: headache, dizziness, lethargy
G.I: Pseudomembranous colitis
Hematologic: Bone marrow depression- decreased WBC, decreased platelets, decreased Hct
Hypersensitivity: Anaphylactic shock
Other: Superinfections
• feeling sick (nausea), vomiting
• heartburn, indigestion, uncomfortable feeling or pain in the stomach
• diarrhoea
• swelling of the legs, ankles or feet
• high blood pressure
• dizziness
• headache
Additionally, the following have been reported:
• allergic reactions including rash, itching and hives
• severe skin reactions, which may occur without warning
• taste alteration
• wheezing
• insomnia
• anxiety
• drowsiness
• mouth ulcers
• diarrhoea
• severe increase in blood pressure
• confusion
• hallucinations
• platelets decreased
Assessment
History: Allergy to ciprofloxacin, norfloxacin or other quinolones; renal dysfunction; seizures; lactation
Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes, bowel sounds; LFTs, renal function tests
Interventions
Arrange for culture and sensitivity tests before beginning therapy.
Continue therapy for 2 days after signs and symptoms of infection are gone.
Be aware that Proquin XR is not interchangeable with other forms.
Ensure that the patient swallows ER tablets whole; do not cut, crush, or chew.
Ensure that patient is well hydrated.
Give antacids at least 2 hr after dosing.
Monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and sensitivity.
Encourage patient to complete full course of therapy.
ASSESSMENT
Liver and renal dysfunction, lactation and pregnancy.
Use cautiously with renal failure, lactation and pregnancy
INTERVENTION:
GCSC
DO NOT MIX WITH ANTIMICROBIAL DRUG
Have vitamin K available in case hypoprothrombenia occurs
DC if reaction occurs.
Before you start to taking Arcoxia tell your nurse or doctor if:
• you are pregnant or intend to become pregnant
Arcoxia is not recommended for use during late pregnancy. If there is a need to consider using Arcoxia during your pregnancy, your doctor will discuss with you the benefits and risks of using it.
• you are breast-feeding or plan to breast-feed
It is not known if Arcoxia passes into breast milk. You and your doctor should discuss whether you should stop breast-feeding or not take Arcoxia.
• you have or have had any medical conditions, especially the following:
history of angina, heart attack or a blocked artery in your heart
narrow or blocked arteries of the extremities
kidney disease
liver disease
heart failure
high blood pressure
• you have had an allergic reaction to aspirin or other anti-inflammatory medicines (commonly known as NSAIDs)
Symptoms of an allergic reaction may include asthma, pinkish itchy swellings on the skin (hives), runny or blocked nose.
• you have an infection
If you take Arcoxia while you have an infection, it may hide fever and may make you think, mistakenly, that you are better or that your infection is less serious than it might be.
• you have any allergies to any other medicines or any other substances, such as foods, preservatives or dyes.
• you have a history of stroke or mini stroke
• you have conditions which increase your risk of coronary artery disease or atherosclerosis such as high blood pressure, diabetes, high cholesterol or smoking.
Ecologic Model
The disease was caused by the patient’s pre-existing medical condition, CEREBROVASCULAR ACCIDENT. Prolonged lack of blood supply to the brain caused lesion/s to the central nervous system or peripheral nervous system.
Host- The host is a geriatric patient. Because of the theory of physical WEAR AND TEAR, the host has been more susceptible to the underlying cause of the disease.
Agent- The main agent is the client’s previous medical condition, which is CEREBROVASCULAR ACCIDENT. CVA produced the lesion/s in the cortico-regulatory particularly in upper motor neuron part of the Nervous system. The end results of the CVA cause lesion and so it produce bladders that are SPASTIC.
Environment- Stressors present in the environment may aggravate the symptom.
Conclusion:
The term neurogenic bladder refers to several dysfunctions caused by lesions of the central or peripheral nervous system. Their manifestation depends on the site of lesion. An upper motor neuron lesion (above S2 to S4) causes spastic neurogenic bladder, with spontaneous contractions of the detrusor muscles, elevated intravesical voiding pressure, bladder wall hypertrophy with trabeculation, and urinary sphincter spasms. On the patient’s case, it us classified as SPASTIC NEUROGENIC BLADDER. SPASTIC NEUROGENIC BLADDER may produce involuntary or frequent scanty urination without a feeling of bladder fullness and possibly spontaneous spasm of the arms and legs. Anal sphincter tone may be increased.
(SOURCE: Springhouse’s HANDBOOK OF DISEASES 2nd edition. Pages 582-583)
Ranking Nursing Problems Identified Cues Justification
1 Acute pain and discomfort related to surgical incision as manifested by restlessness and verbalization of pain at the operative site.
- The client stated that his cystostomy site really hurts and he feels uncomfortable. The problem is ranked number one among the problems presented since this is the most life-threatening among all.
2 Risk for infection due to impaired skin integrity. Flabby, soft, with four postoperative incisions:
First incision through the abdominal wall in the umbilicus.
Second and third incision is through the abdominal wall in the right upper quadrant right subcoastal.
Fourth incision is through th abdominal wall left lower quadrant.
All post operative dressings dry and intact.
This problem is ranked second because if infections increase there may be a possibility to cause more problems
3
Activity intolerance r/t bedrest and post surgical incision The client has limited physical mobility because of his flat on bed position that was ordered by the physician after the operation and he has physical limitations; she cannot do strenuous activities for the mean time.
The only exercise the client performed were the deep breathing exercises after her operation. The problem is highly prioritized because her personal and hygienic needs must be taken care of.
Labels: NCM
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PCR
(Polymerase Chain Reaction)
Medical Author: Frederick Hecht, MD, FAAP, FACMG
Medical Editor: Leslie J. Schoenfield, M.D., Ph.D.
What is PCR (Polymerase Chain Reaction)?
How is PCR done?
What is the purpose of doing a PCR?
How was PCR discovered?
What is HCV PCR?
What is RT PCR?
What is PCR (Polymerase Chain Reaction)?
PCR (Polymerase Chain Reaction) is a key technique in molecular genetics that permits the analysis of any short sequence of DNA (or RNA) without having to clone it. PCR is used to reproduce (amplify) selected sections of DNA. Previously, amplifying was done in bacteria, and took weeks. But now, with PCR done in test tubes, it takes only a few hours. PCR is highly efficient so that untold numbers of copies can be made of the DNA. What is more, PCR uses the same molecules that nature uses for copying DNA:
Two "primers" that flag the beginning and end of the DNA stretch to be copied;
An enzyme called polymerase that walks along the segment of DNA, reading its code and assembling a copy; and
A pile of DNA building blocks that the polymerase needs to make that copy.
How is PCR done?
As illustrated in the animated picture of PCR, three major steps are involved in a PCR. These three steps are repeated for 30 or 40 cycles. The cycles are done on an automated cycler, which rapidly heats and cools the test tubes containing the reaction mixture. Each step -- denatauration (alteration of structure), annealing (joining), and extension -- takes place at a different temperature:
1. Denaturation: At 94°C, the double-stranded DNA melts and opens into single-stranded DNA.
2. Annealing: At 54°C, hydrogen bonds form and break between the single-stranded "primer" and the single-stranded "template." (The template provides the pattern to be copied.) The more stable bonds last longer and on that little length of double-stranded DNA (the joined primer and template), the polymerase attaches and starts copying the template.
3. Extension: At 72°C, the polymerase works best. As a result, the attraction, created by the hydrogen bonds, of the primers to the template is stronger than the forces breaking these attractions. The upshot is that bases complementary to the template are coupled to the primer.
What is the purpose of doing a PCR?
To do PCR, the original DNA that one wishes to copy need not be pure or abundant. It can be pure but it also can be a minute part of a mixture of materials. So, PCR has found widespread and innumerable uses -- to diagnose genetic diseases, do DNA fingerprinting, find bacteria and viruses, study human evolution, clone the DNA of an Egyptian mummy, etc.. Accordingly, PCR has become an essential tool for biologists, DNA forensics labs, and many other laboratories that study genetic material.
How was PCR discovered?
PCR was invented by Kary Mullis. At the time he thought up PCR in 1983, Mullis was working in Emeryville, California for Cetus, one of the first biotechnology companies. There, he was charged with making short chains of DNA for other scientists. Mullis has written that he conceived of PCR while cruising along the Pacific Coast Highway 128 one night on his motorcycle. He was playing in his mind with a new way of analyzing changes (mutations) in DNA when he realized that he had instead invented a method of amplifying any DNA region. Mullis has said that before his motorcycle trip was over, he was already savoring the prospects of a Nobel Prize. He shared the Nobel Prize in chemistry with Michael Smith in 1993.
As Mullis has written in the Scientific American: "Beginning with a single molecule of the genetic material DNA, the PCR can generate 100 billion similar molecules in an afternoon. The reaction is easy to execute. It requires no more than a test tube, a few simple reagents, and a source of heat."
What is HCV PCR?
HCV PCR (polymerase chain reaction) is a test for the hepatitis C virus (HCV). There are three types of HCV PCR tests:
1. The HCV PCR viral detection test: This qualitative test is designed to detect whether the hepatitis C virus is or is not present.
2. The HCV PCR viral load test: This quantitative test looks for the virus and estimates the number of HCV viruses per ml of blood.
3. The HCV PCR genotype test: This test looks for the virus and determines the particular subtype of HCV.
The three different HCV PCR tests serve different purposes. The qualitative test is done to confirm the presence of HCV in the blood of a person with positive HCV antibody test. The quantitative test is done to estimate the length of treatment that will be needed and to monitor the effectiveness of that treatment. The genotype test is usually done before the start of treatment because it can differentiate each of the major subtypes of HCV. Knowing the subtype can be important because, for example, treatment with interferon is more often effective for people with genotype subtypes 2 or 3 than for those with genotype 1.
What is RT PCR?
RT-PCR (Reverse transcriptase-polymerase chain reaction) is a highly sensitive technique for the detection and quantitation of mRNA (messenger RNA). The technique consists of two parts:
1) The synthesis of cDNA (complementary DNA) from RNA by reverse transcription (RT) and
2) The amplification of a specific cDNA by the polymerase chain reaction (PCR).
RT-PCR has been approved by the FDA as a test to measure viral load with HIV. It may also be used with other RNA viruses such as measles, mumps, and metapneumovirus.
Labels: Learning Medical Technology
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What is a transient ischemic attack (TIA)?
The primary role of the brain is to send signals to the body for motor function and through the five senses (sight, hearing, touch, smell, and taste), to receive signals and return the appropriate response. The brain processes information through conscious thought and unconsciously through nerve systems that control basic bodily functions, like heart rate, temperature control and balance.
For the most part, the brain is arranged so that the right side of the brain controls the left side of the body and the left side of the brain controls the right of the body. Vision is located in the back of the brain (occiput) and balance and coordination is located at the bottom of the brain (cerebellum). Blood supply to the brain comes from the carotid arteries that are located in the front of the neck and the vertebral arteries that run in the back of neck through small canals in the bony spine (vertebrae) of the neck.
When a portion of the brain loses its blood supply, it becomes oxygen deficient and can become damaged. The part of the body that the brain controls stops functioning. This is called a stroke or a cerebro-vascular accident (CVA). If the brain is able to regain its blood supply quickly, then the CVA symptoms may resolve; this is known as a transient ischemic attack (TIA).
What are the causes of transient ischemic attack (TIA)?
Loss of blood supply to portions of the brain can occur for a variety of reasons. A blood vessel can get blocked and blood supply to a part of the brain is lost, or a blood vessel leaks blood into the brain (brain hemorrhage). Most commonly, the blood vessel is blocked. The blockage can be caused by a blood clot that forms in the blood vessel (thrombosis) or it can be caused by a clot or debris that floats downstream (embolus).
Atherosclerosis or "hardening of the arteries" can cause fatty plaque formations in he blood vessel wall. The plaque can rupture and causes a small blood clot to form and occlude the blood vessel. Blockage can also occur when debris from narrowing of a carotid artery breaks off, and floats downstream to cause the occlusion. Sometimes, in people with an irregular heart beat called atrial fibrillation, small blood clots can be formed and travel to the brain to cause the obstruction.
Picture of Carotid Artery Disease and Plaque Buildup
Brain hemorrhage or bleeding in the brain can be due to an aneurysm, a weak spot in a blood vessel that ruptures and spills blood into the brain tissue, or it may be due to spontaneous bleeding caused by poorly controlled hypertension (high blood pressure). Such bleeding more commonly results in a true stroke (CVA), as opposed to a TIA.
What are the risk factors for transient ischemic attack (TIA)?
The risk factors for TIA or stroke are the same as those for other vascular disease, similar to heart attack (coronary artery disease) or peripheral vascular disease which causes decreased blood flow to the legs. Aside from family history, other risk factors that the patient can influence include:
smoking,
high blood pressure,
high cholesterol, and
diabetes.
Also, any condition that results in stagnant blood flow and or clotting may result in a TIA due to embolization of a blood clot. Such conditions may include atrial fibrillation, large heart attacks, and severe weakness of the heart muscle.
What are the symptoms of transient ischemic attack (TIA)?
The intensity and location of the blood limitation to the brain will determine what symptoms will present as a result of a stroke or TIA. Many people present with confusion, weakness, and lethargy. If the loss of blood supply is in an area supplied by the carotid arteries, a classic presentation may include weakness or paralysis and numbness of one side of the body. The whole side may be affected, or just one limb. Often there is a facial droop. If the stroke is on the left side of the body where the speech centers are located, there may be difficulty understanding words or speaking. Partial vision loss may also be part of the constellation of symptoms.
Strokes involving the vertebral arteries decrease blood supply to the base of the brain and may cause a drop attack (a sudden fall while walking or standing, and then a quick recovery), an unexpected collapse, incoordination or difficulty walking.
The important distinction between stroke and TIA is resolution of the symptoms. By definition, the symptoms of a TIA must completely resolve. And, while this most often occurs within the first few minutes after symptom onset, it may take up to 24 hours to have complete return to normal.
A special type of TIA is amaurosis fugax. Transient blindness in one eye occurs because debris from a narrowed carotid artery clogs the artery (ophthalmic artery) that supplies blood to the back of the eye.
How is transient ischemic attack (TIA) diagnosed?
TIA is diagnosed by history and physical examination. Since most often the symptoms have resolved, the physician will need to take a good history from the patient and family or friends who witnessed the event. The physical exam will include careful attention to the neurologic examination. This may include:
Assess mental status to make certain the patient is alert and oriented.
Check eye range of motion and facial movement to evaluate the cranial nerves (the short nerves that run from the brain to the face and neck).
Listen to the neck with a stethoscope to detect abnormal sounds that may signal narrowing of the blood vessel (carotid bruits).
Check for a regular heart rhythm to rule out the presence of atrial fibrillation.
Examine the arms and legs for tone, power, and sensation.
Check coordination and balance.
If the diagnosis of TIA is made, further urgent testing is usually recommended, including:
Electrocardiogram (EKG) to confirm a regular heart rate
Computerized tomography (CT scan) of the brain to look for bleeding
Carotid ultrasound to look for narrowing of the large blood vessels in the neck
Routine blood tests may include a complete blood count (CBC) to look for anemia or low red blood cell count or too few platelets (thrombocytopenia). If the patient takes warfarin (Coumadin), a blood thinner, then an international normalized ratio (INR - a blood test that measures the degree of blood thinning) or prothrombin time (PT), may be performed to assess blood clotting measurements.
If there is concern that the heart is the source of blood clot or debris, then an echocardiogram or sound wave tracing of the heart may be considered.
What is the treatment for a transient ischemic attack (TIA)?
TIA Therapy
Treatment for a transient ischemic attack is aimed at preventing a second stroke. Since there is no way of determining the severity of future episodes and no guarantee that the symptoms will resolve, prevention of a future TIA or CVA is crucial.
Treatment guidelines address a variety of targeted goals.
Anti-platelet therapy
If the patient was not taking aspirin when the TIA occurred, it needs to be started (325mg per day).
If the patient was taking aspirin, then another anti-platelet drug called dipyridamole needs to be added. Aggrenox is a combination of aspirin and dipyridamole.
If the patient cannot tolerate aspirin, then clopidogrel (Plavix) should be used.
High blood pressure therapy
Even if the patient does not have hypertension or high blood pressure, there may be benefit in taking anti–hypertensive medications.
Two classes of drugs are recommended to be started at the same time, a diuretic and an ACE inhibitor.
The goal for normal blood pressure is 120/80.
Cholesterol lowering therapy
Guidelines recommend that a statin drug be started, even if cholesterol levels are normal.
Risk modification
Smoking, excessive alcohol, obesity and lack of physical activity are considered risks for future stroke. The following recommendations are now suggested:
Smoking: Counseling, smoking cessation aids like nicotine gum or medications like varenicline (Chantix) should be considered. Environmental smoke should be avoided.
Alcohol: Intake should be limited to two or fewer drinks a day for men and one or less for women.
Obesity: Overweight people should try to lose weight using a combination of diet, exercise and counseling. The goal is a BMI of 18.5-24.9 and a waist line of 35 inches or less for women and 40 inches or less for men.
Exercise: 30minutes of moderate exercise daily is recommended for those who are able. For patients with disabilities, a tailored exercise program to their capabilities should be arranged.
What is the prognosis for transient ischemic attack (TIA)?
A transient ischemic attack should be considered a major warning sign of an impending future stroke. Up to 10% of people will experience a stroke within three months of TIA. Since there is no way of predicting whether the next episode will resolve, the patient needs to be educated - that should symptoms occur, they need to access medical care immediately. Activating the emergency medical Services system and calling 911 is recommended.
If a stroke occurs, there is a very short period of time where thrombolytic (clot dissolving) drugs, [for example, alteplase (TPA)], can be used to reverse a stroke. In most hospitals, the drug can only be given within three hours of onset of stroke symptoms. In that three hours, the patient needs to get to the hospital, the diagnosis needs to be made, laboratory tests and head CT scans need to be performed, neurologic consultation needs to occur, and the drug administered. The longer the delay, there is a higher the risk that the drug won't work and that complications like bleeding into the brain will occur.
Specialized interventional radiologists can inject TPA directly into the clot that has blocked the blood vessel in the brain. This can extend the time frame to six hours, but currently this treatment is not widely available.
TIAs should be considered the equivalent of angina of the brain. In heart disease, angina is the heart pain that warns of potential heart attack. When heart muscle is damaged, it cannot be replaced or repaired. Similarly, brain tissue is at risk when there is decreasePrognosis
Patients diagnosed with a TIA are sometimes said to have had a warning for an approaching stroke. If the time period of blood supply impairment lasts more than a few minutes, the nerve cells of that area of the brain die and cause permanent neurologic deficit. One third of the people with TIA later have recurrent TIAs and one third have a stroke due to permanent nerve cell loss.
The ABCD2 score can predict likelihood of subsequent stroke.[2][3]
The score is calculated as:
• Age ≥ 60 years = 1 point
• Blood pressure at presentation ≥ 140/90 mm Hg = 1 point
• Clinical features
unilateral weakness = 2 points
speech disturbance without weakness = 1 point
• Duration of attack
≥ 60 minutes = 2 points
10–59 minutes = 1 point
• Diabetes = 1 point
Interpretation of score, the risk for stroke:
• Score 0-3 (low)
o 2 day risk = 1.0%
o 7 day risk = 1.2%
• Score 4-5 (moderate)
o 2 day risk = 4.1%
o 7 day risk = 5.9%
• Score 6–7 (high)
o 2 day risk = 8.1%
o 7 day risk = 11.7%
d blood supply and it, too, cannot be replaced.
Labels: NEUROLOGY
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Ginseng, Fish, Berries, or Caffeine?
Listen to the buzz about foods and dietary supplements and you'll believe they can do everything from sharpen focus and concentration, to enhance memory, attention span, and brain function. But do they really work? There's no denying that as we age chronologically, our body ages right along with us. The good news? You can increase your chances of maintaining a healthy brain -- if you add "smart" foods and beverages to your diet.
Caffeine Can Make You More Alert
There's no magic bullet to boost IQ or make you smarter -- but certain substances, like caffeine, can energize and help you focus and concentrate. Found in coffee, chocolate, energy drinks, and some medications, caffeine gives you that unmistakable wake-up buzz -- though the effects are short term. And more is often less: Overdo it on caffeine and it can make you jittery and uncomfortable.
Sugar Can Enhance Alertness
Sugar is your brain's preferred fuel source -- not table sugar, but glucose, which your body metabolizes from the sugars and carbohydrates you eat. That's why a glass of something sweet to drink can offer a short-term boost to memory, thinking processes, and mental ability. Consume too much, however, and memory can be impaired -- along with the rest of you. Go easy on the sugar so it can enhance memory, without packing on pounds.
Protein & Brain Function Connection?
One of the great benefits of protein is that it generally makes you feel satisfied longer than carbohydrates and fats. Eating a diet rich in lean and low-fat protein is good for weight loss and overall health -- though it's hard to draw a connection with brain function.
Fish Really is Brain Food
A protein source associated with a great brain boost is fish -- rich in omega 3 fatty acids, essential for brain function and development. These healthy fats have amazing brain power: higher dietary omega 3 fatty acids are linked to lower dementia and stroke risks; slower mental decline; and may play a vital role in enhancing memory, especially as we get older. For brain and heart health, eat two servings of fish weekly.
Add a Daily Dose of Nuts, Chocolate
Nuts and seeds are good sources of the antioxidant vitamin E, which is associated with less cognitive decline as you age. Dark chocolate also has powerful antioxidant properties, and contains natural stimulants like caffeine, which can enhance focus and concentration. Enjoy up to an ounce a day of nuts and dark chocolate to provide all the benefits you need without excess calories, fat, or sugar.
Blueberries Are Super Nutritious
Research in animals shows that blueberries help protect the brain from oxidative stress and may reduce the effects of age-related conditions such as Alzheimer's disease or dementia. Studies also show that diets rich in blueberries significantly improved both the learning capacity and motor skills of aging rats, making them mentally equivalent to much younger rats.
Benefits of a Healthy Diet
It may sound trite but it's true: If your diet lacks essential nutrients, it can decrease your ability to concentrate. Eating too much or too little can also interfere with your ability to focus. A heavy meal may make you feel lethargic, while too few calories can result in distracting hunger pangs. Benefit your brain: Strive for a well-balanced diet chock full of a wide variety of healthy, wholesome foods.
Vitamins, Minerals, Supplements?
Store shelves groan with supplements claiming to boost health. Although many of the reports on the brain-boosting power of supplements like vitamins B, C, E, beta-carotene, and magnesium are promising, they're inconclusive. Researchers are cautiously optimistic about ginseng, gingko, or vitamin, mineral, and herb combinations and their impact on the brain. A daily multivitamin is OK, but check with your doctor before taking other supplements.
Get Ready for a Big Day
Want to power up your ability to concentrate? Start with a meal of 100% fruit juice, a whole grain bagel with salmon, and a cup of coffee. In addition to eating a well-balanced meal, experts also advise:
Get a good night's sleep.
Exercise to help sharpen thinking.
Meditate to clear thinking and relax.
Labels: NUTRITION AND YOU
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Homocysteine
Medical Author: Siamak Nabili, MD, MPH
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
What is homocysteine?
Why is it important to monitor homocysteine levels?
What are the possible symptoms or features of elevated homocysteine levels?
What is considered a high level for homocysteine?
What causes elevated homocysteine levels?
Can elevated homocysteine levels be genetic?
Can nutritional problems cause elevated homocysteine levels?
How common is hyperhomocysteinemia?
How can homocysteine levels be lowered?
How many vitamins should I take to lower my homocysteine level?
Does lowering homocysteine levels prevent heart attacks and strokes?
What should I do to prevent heart attacks and strokes?
Who should undergo testing for homocysteine blood levels?
What is homocysteine?
Homocysteine is an amino acid that is produced by the body, usually as a byproduct of consuming meat. Amino acids are naturally made products, which are the building blocks of all the proteins in the body.
Why is it important to monitor homocysteine levels?
Elevated levels of homocysteine (>10 micromoles/liter) in the blood may be associated with atherosclerosis (hardening and narrowing of the arteries) as well as an increased risk of heart attacks, strokes, blood clot formation, and possibly Alzheimer's disease.
In 1969, Dr. Kilmer S. McCully reported that children born with a genetic disorder called homocystinuria, which causes the homocysteine levels to be very high, sometimes died at a very young age with advanced atherosclerosis in their arteries. However, it was not until the 1990's that the importance of homocysteine in heart disease and stroke was appreciated.
What are the possible symptoms or features of elevated homocysteine levels?
Theoretically, an elevated level of homocysteine in the blood (hyperhomocysteinemia) is believed to cause narrowing and hardening of the arteries (atherosclerosis). This narrowing and hardening of the vessels is thought to occur through a variety of ways involving elevated homocysteine. The blood vessel narrowing in turn leads to diminished blood flow through the affected arteries.
Elevated levels of homocysteine in the blood may also increase the tendency to excessive blood clotting. Blood clots inside the arteries can further diminish the flow of blood. The resultant lack of blood supply to the heart muscles may cause heart attacks, and the lack of blood supply to the brain causes strokes.
Elevated homocysteine levels also have been shown to be associated with formation of blood clots in veins (deep vein thrombosis and pulmonary embolism). The mechanism is complex, but it is similar to the way that they contribute to atherosclerosis. In some studies, even moderate levels of homocysteine level showed higher rates of repeated incidence of blood clot formation. (1,2)
What is considered a high level for homocysteine?
Homocysteine levels are measured in the blood by taking a blood sample. Normal levels are in the range between 5 to 15 micromoles (measurement unit of small amount of a molecule) per liter. Elevated levels are classified as follows:
15-30 micromoles per liter as moderate
30-100 micromoles per liter as intermediate
Greater than 100 micromoles per liter as severe
What causes elevated homocysteine levels?
Homocysteine is chemically transformed into methionine and cysteine (similar amino acids) with the help of folic acid, vitamin B12, and vitamin B6. This transformation utilizes a set of mediator molecules (called enzymes) and happens via a delicate sequence of specific steps.
Therefore, insufficient amounts of these vitamins in the body can hamper the natural breakdown of homocysteine. In addition, if there are any deficiencies in the mediator molecules, the breakdown is also hampered. This can cause homocysteine to accumulate in the blood because its breakdown is slow and inadequate.
Can elevated homocysteine levels be genetic?
Homocysteine levels in the blood may be elevated for many reasons as briefly described in the above section. More specifically, these can be divided into severe genetic causes and other milder causes.
In the genetic condition called homocystinuria, there is a deficiency or lack of an important mediator molecule (enzymes) in the complicated homocysteine breakdown pathway. This leads to severely elevated levels of homocysteine. In this rare and serious condition, there is a constellation of symptoms that include developmental delay, osteoporosis (thin bones), visual abnormalities, formation of blood clots, and advanced atherosclerosis (narrowing and hardening of blood vessels). This condition is mainly recognized in childhood.
Milder genetic variations are more common causes of elevated homocysteine levels (hyperhomocysteinemia). In these conditions, the mediator molecules malfunction and are less efficient because of minor abnormality in their structure. They also lead to elevation of homocysteine levels, although much milder than in homocystinuria, by slowing down the breakdown of homocysteine.
Can nutritional problems cause elevated homocysteine levels?
The other more common (5%-7% of the population) and less severe type of elevated homocysteine level may be caused by nutritional deficiencies in folate, vitamin B6 and vitamin B12, chronic (long-term) kidney disease, and cigarette smoking.
As mentioned above, these vitamins are essential in the breakdown of homocysteine. In some studies, lower levels of these vitamins, especially folate, have been demonstrated in people with elevated homocysteine levels. On the other hand, other studies have suggested that adequate intake of folate, Vitamin B6, and Vitamin B12 have resulted in lowering of the homocysteine level. (3)
How common is hyperhomocysteinemia?
Mild hyperhomocysteinemia levels are seen in about 5%-12% of the general population. In specific populations such as, alcoholics (due to poor vitamin intake) or patients with chronic kidney disease, this may be more common. The severe genetic form, homocystinuria, is rare.
How can homocysteine levels be lowered?
The consumption of folic acid supplements or cereals that are fortified with folic acid, and to a lesser extent vitamins B6 and B12, can lower blood homocysteine levels. These supplements may even be beneficial in people with mild genetic hyperhomocysteinemia to lower their homocysteine levels. However, it is noteworthy that so far there is no compelling data to support the treatment of hyperhomocysteinemia for prevention of heart disease or treatment of known heart disease or blood clots. There are many studies underway to determine whether there may be any benefit to treat high levels of homocysteine in patients with known heart disease or blood clots. Further recommendations may be available when these studies are completed. (4)
How many vitamins should I take to lower my homocysteine level?
Daily recommended doses of folate, B vitamins, and multivitamins are generally sufficient in regard to lowering homocysteine levels. These daily doses are recommended by the Food and Drug Administration (FDA) and the doses in a specific product are printed on the label of the vitamin bottle by the manufacturer. Usually, folate supplementation is recommended at 1 milligram daily; vitamin B6 is recommended at 10 milligram per day; and vitamin B12 at one-half milligram per day.
Does lowering homocysteine levels prevent heart attacks and strokes?
Currently, there is no direct proof that taking folic acid and B vitamins to lower homocysteine levels prevents heart attacks and strokes. However, in a large population study involving women, those who had the highest consumption of folic acid (usually in the form of multivitamins) had fewer heart attacks than those who consumed the least amount of folic acid. In this study, the association between dietary intake of folate and vitamin B6 and risk of heart disease was more noticeable than between dietary intake of vitamin B12 and heart disease, which was minimal.
Many other observational studies have been performed to assess the effect of folate and the other B vitamins on heart disease. Most of these studies have concluded that oral intake of folate has been associated to lower risk of heart disease, possibly because due to lowering of homocysteine levels. The relation between oral intake of vitamin B12 and B6 and heart disease was not as obvious in many of these studies. (5,6,7)
In one study, it was concluded that even in people with elevated homocysteine levels due to genetic reasons, oral intake of folate and possibly the other B vitamins was related to lower incidence of heart disease. (5,6,7)
Most of these data, however, are obtained from observational studies rather than purely controlled scientific data. Therefore, it is important to mention that despite these studies suggesting an association between the intake of these vitamins and the lower incidence of heart disease, in general, there is no compelling clinical evidence to treat hyperhomocysteinemia other than homocystinuria (the severe genetic form) in regards to What should I do to prevent heart attacks and strokes?
Losing excess weight, exercising regularly, controlling diabetes and high blood pressure, lowering the bad LDL cholesterol, and stopping cigarette smoking are crucial steps in preventing heart attacks and strokes. The association between homocysteine levels and atherosclerosis is generally weaker compared to the known risk factors of diabetes, high blood pressure (hypertension), high cholesterol level, and cigarette smoking.
It is recommended that healthy adults eat more fresh fruits and vegetable, eat less saturated fat and cholesterol, and take one multivitamin daily. One multivitamin will supply 400 mcg (microgram or one-one thousandth of a gram)/day of folic acid in addition to vitamins B6, B12, and other important vitamins.
Who should undergo testing for homocysteine blood levels?
Some doctors screen for elevated homocysteine levels in patients with early onset of blood clot formation, heart attacks, strokes, or other symptoms related to atherosclerosis, especially if these patients do not have typical risk factors, such as smoking cigarettes, diabetes, high blood pressure, or high LDL cholesterol levels.
Currently, there are no official recommendations as to who should undergo testing for homocysteine blood levels. Before more scientific data become available from the currently ongoing studies, many experts do not recommend a screening test for blood homocysteine levels, even in patients with unexplained blood clot formation. In addition, the consensus recommendation is against treating elevated homocysteine levels with vitamins to prevent heart disease.
There is also no consensus as to the optimal dose of folic acid and other B vitamins for the treatment of elevated blood homocysteine levels. (For example, treatment of patients with high homocysteine levels may require higher doses of folic acid and other B vitamins than the amounts contained in a multivitamin.) Therefore, a decision regarding testing should be individualized after consulting with your doctor.
References:
1. Ray, JG. Meta-analysis of hyperhomocysteinemia as a risk factor for venous thromboembolic disease. Arch Intern Med 1998; 158:2101.
2. den Heijer, M, Rosendaal, FR, Blom, HJ, et al. Hyperhomocysteinemia and venous thrombosis: a meta-analysis. Thromb Haemost 1998; 80:874.
3. Vermeulen, EG, Stehouwer, CD, Twisk, JW, et al. Effect of homocysteine-lowering treatment with folic acid plus vitamin B6 on progression of subclinical atherosclerosis: a randomised, placebo- controlled trial. Lancet 2000; 355:517.
4. Eikelboom, JW, Lonn, E, Genest, J Jr, et al. Homocyst(e)ine and cardiovascular disease: a critical review of the epidemiologic evidence. Ann Intern Med 1999; 131:363
5. Robinson, K, Arheart, K, Refsum, H, et al. for the European COMCAC Group. Low circulating folate and vitamin B6 concentrations. Risk factors for stroke, peripheral vascular disease, and coronary artery disease. Circulation 1998; 97:437.
6. He, K, Merchant, A, Rimm, EB, et al. Folate, vitamin B6, and B12 intakes in relation to risk of stroke among men. Stroke 2004; 35:169.
7. McNulty, H, Dowey le, RC, Strain, JJ, et al. Riboflavin lowers homocysteine in individuals homozygous for the MTHFR 677C->T polymorphism
heart disease, stroke, or blood clots.
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I was interested to see that this section on dizzy spells was visited more often that any other section on this website - it is obviously a common problem! The brain is the most biochemically complex, metabolically active organ of the whole body. A large section of the brain, the cerebellum, is mainly concerned with balance and co-ordination. So it is not surprising that dizzy spells are a common symptom/
The first thing to establish is what is exactly meant by dizzy spells, what causes them, what improves them. These details all throw light on the cause.
Do you feel faint? As if about to pass out? The cause of this is either low blood pressure (postural hypotension) or low blood sugar (hypoglycaemia) or poor oxygen supply.
Postural hypotension often causes faintness: if you suddenly stand up, especially if you have been lying down for some time in a warm bed. if you have been standing still (and the blood pools in the legs) if you get very hot (too much blood to the skin, not enough to the head) if you have been a bit shocked, for example by taking blood or the sight of blood if you are anaemic
Autonomic neuropathy can cause low blood pressure Adrenal insufficiency can cause low blood pressure. Complete failure (Addison’s disease) is a life threatening condition requiring urgent hospital admission.
Anaemia - see page on anaemia Poor oxygen supply - see hyperventilation
Low blood sugar causing faintness or dizziness may occur: if you have missed a meal (often late afternoon) if you eat sweet things all the time, but have missed a snack if you have exercised hard (exercise burns up the sugar in the blood)
If the symptoms are improved by eating or drinking something sweet then you are probably hypoglycaemic.
Ear disease - balance is sensed by the inner ear. Any disturbance of this may cause vertigo. Vertigo is a symptom described as “the world going round”. Funnily enough wax in the ear can cause dizzy spells, but I’m not sure why.
Hyperventilation can certainly cause dizzy spells. In this case there is often a feeling of being spaced out and “not with it” Suspect this if the symptom occurs with stress.
Are there any allergies? Allergy is the great mimic. It can produce almost any symptom. Chemical sensitivity
Are you being poisoned? Think of addictions or withdrawals symptoms from caffeine, alcohol, psychoactive drugs such as cannabis and Speed (amphetamine), prescription drugs, poisonings by pesticides, heavy metals, volatile organic compounds (solvents), gas fumes and carbon monoxide (free standing gas stoves, poorly vented stoves) etc, sick building syndrome. Multiple chemical sensitivity often causes dizzy spells.
Are you getting enough, quality sleep? See sleep problems
Any hormonal disturbances? See hypothyroidism – I think of thyroid disorders for almost any symptom!
Physical activity is vital Anybody who has been confined to bed for one week with, say, ‘flu will feel weak and dizzy when they first get going. For the body to work properly it has to practice continuously (ask any athlete). One week of lack of practice can cause unsteadiness on standing.
Link articles Hypoglycaemia Allergies Vertigo Poisons and toxins Sleep problems Hypothyroidism Postural hypo-tension (low blood pressure) Low blood sugar (hypoglycaemia) Autonomic neuropathy The general approach to treating problems of the brain, whatever the diagnosis may be Hyperventilation
Link tests Tests of nutritional status Hypothyroidism Tests of toxic stress: Hair analysis for heavy metals Pesticide screening Adrenal stress profile
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