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Pedal (Dorslais Pedis): palpated by feeling the dorsum (upper surface) of the foot on an imaginary line drawn from the middle of nd the ankle to the surface between the big and 2 toes Method Pulse: is commonly assessed by palpation (feeling) or auscultation (hearing) The middle 3 fingertips are used with moderate pressure for palpation of all pulses except apical discount 80 mg super cialis amex; the most distal parts are more sensitive order super cialis 80mg with visa, Assess the Pulse for • Rate • Rhythm • Volume • Elasticity of the arterial wall Pulse Rate • Normal 60-100 b/min (80/min) • Tachycardia – excessively fast heart rate (>100/min) • Bradycardia < 60/min Pulse Rhythm • The pattern and interval between the beats, random, irregular beats – dysrythymia Basic Nursing Art 65 Pulse Volume: the force of blood with each beat • A normal pulse can be felt with moderate pressure of the fingers and can be obliterated with greater pressure. Hyperventilation: very deep, rapid respiration Hypoventilation: very shallow respiration Two Types of Breathing 1. Costal (thoracic) • Involves the external muscles and other accessory muscles (sternoclodio mastoid) • Observed by the movement of the chest up ward and down ward 2. Diaphragmatic (abdominal) • Involves the contraction and relaxation of the diaphragm, observed by the movement of abdomen. Basic Nursing Art 66 Assessment • The client should be at rest • Assessed by watching the movement of the chest or abdomen. Rhythm: is the regularity of expiration and inspiration Normal breathing is automatic & effortless. Systolic pressure: is the pressure of the blood as a result of contraction of the ventricle (is the pressure of the blood at the height of the blood wave); 2. Pulse pressure: is the difference between the systolic and diastolic pressure Blood pressure is measured in mm Hg and recorded as fraction. Conditions Affecting Blood Pressure Fever Increase Stress " Arteriosclerosis " Obesity " Hemorrhage Decrease Low hematocrit " External heat " Exposure to cold Increase Sites for Measuring Blood Pressure 1. Leg using posterior tibial or dorsal pedis Methods of Measuring Blood Pressure Blood pressure can be assessed directly or indirectly 1. Direct (invasive monitoring) measurement involves the insertion of catheter in to the brachial, radial, or femoral artery. The flush methods Basic Nursing Art 68 The auscultatory method is the commonest method used in health activities. Phase 1: The pressure level at which the 1st joint clear tapping sound is heard, these sounds gradually become more intense. Prepare and position the patient appropriately • Make sure that the client has not smoked or ingested caffeine, with in 30 minutes prior to measurement. The arm should be slightly flexed with the palm of the hand facing up and the fore arm supported at heart level • Expose the upper arm 2. The bladder inside the cuff must be directly over the artery to be compressed if the reading to be accurate. For initial examination, perform preliminary palipatory determination of systolic pressure • Palpate the brachial artery with the finger tips • Close the valve on the pump by turning the knob clockwise. Position the stethoscope appropriately • Insert the ear attachments of the stethoscope in your ears so that they tilt slightly fore ward. Basic Nursing Art 70 • Place the diaphragm of the stethoscope over the brachial pulse; hold the diaphragm with the thumb and index finger. The arm found to have the higher pressure, should be used for subsequent examinations 8. Specimen Collection Specimen collection refers to collecting various specimens (samples), such as, stool, urine, blood and other body fluids or tissues, from the patient for diagnostic or therapeutic purposes. General Considerations for Specimen Collection When collecting specimen, near gloves to protect self from contact with body fluids. Get request for specimen collection and identify the types of specimen being collected and the patient from which the specimen collected. Get the appropriate specimen container and it should be clearly labeled have tight cover to seal the content and placed in the plastic bag or racks, so that it protects the laboratory technician from contamination while handling it. Give adequate explanation to the patient about the purpose, type of specimen being collected and the method used. When collecting specimen wear gloves to protect self from contact with the specimen (body fluids in particular) 6. Put the collected specimen into its container without contaminating outer parts of the container and its cover. All the specimens should be sent promptly to the laboratory, so that the temperature and time changes do not alter the content. Collecting Stool Specimen Basic Nursing Art 72 Purpose • For laboratory diagnosis, such as microscopic examination, culture and sensitivity tests. Equipments required • Clean bedpan or commode • Wooden spatula or applicator • Specimen container • Tissue paper • Laboratory requests • Disposable glove, for patients confined in bed • Bed protecting materials • Screen • Hand washing sets Procedure i) For ambulatory patient Give adequate instruction to the patient to • Defecate in clean bedpan or commode (toilet) • Avoid contaminating the specimen by urine, menstrual period or used tissue papers, because these may affect the laboratory analysis. Obtain stool sample • Take the used bedpan to utility room/toilet container using spatula or applicator without contaminating the outside of the container.

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The outer gloves are then discarded and the inner gloves remove the disinfected head cover and the inner gown buy 80 mg super cialis otc. The head cover is discarded generic super cialis 80mg visa, the AirMate‘ tubing is pasteurized and the belt pack wiped down with disinfectant. If masking the patient is not feasible, the patient should be asked to cover his/her mouth with a disposable tissue when coughing, talking or sneezing. Separate the patient from others in the reception area as soon as possible, preferably in a private room with negative pressure relative to the surrounding area. If the patient is unable to wear a surgical mask, it may be prudent for household members to wear sur- gical masks when in close contact with the patient. Household mem- bers in contact with the patient should be reminded of the need for careful hand hygiene including hand washing with soap and water; if hands are not visibly soiled, alcohol-based handrubs may be used as an alternative to hand washing. After contact with patients with respiratory symp- toms, careful hand hygiene is necessary, including washing with soap and water. These recommen- dations are based on the experience in the United States to date and may be revised as more information becomes available. During this time, infection control precautions should be used, as described below, to minimize the potential for transmission. Immediately after activities involving contact with body fluids, gloves should be removed and discarded and hands should be cleaned. Environmental surfaces soiled by body fluids should be cleaned with a household disinfectant according to www. As a precautionary measure, persons who might come into contact with these species or their products, including body fluids and excretions, should be aware of the possible health risks, particularly Kamps and Hoffmann (eds. After the Outbreak When the Toronto epidemic was already thought to be over, an undi- agnosed case at the North York General Hospital led to a second out- break among other patients, family members and healthcare workers. In addition, staff were no longer required to wear masks or respirators routinely throughout the hospital or to maintain distance from one another while eating. Conclusion One of the most important lessons learned to date is the decisive power of high-level political commitment to contain an outbreak even when sophisticated control tools are lacking. All of these measures contributed to the prompt detection and isola- tion of new sources of infection – a key step on the way to breaking the chain of transmission. Cluster of Severe Acute Respiratory Syndrome Cases Among Protected Health-Care Workers - Toronto, Canada, April 2003. Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report. Evaluation of concurrent shedding of bovine coronavirus via the respiratory tract and enteric route in feedlot cattle. Epidemiological determinants of spread of causal agent of severe acute respira- tory syndrome in Hong Kong. Hiding in the Bunker: Challenges for a radiation oncology de- partment operating in the Severe Acute Respiratory Syndrome outbreak. Clinicians are advised that patients should not have their case defini- tion category downgraded while still awaiting results of laboratory testing or on the basis of negative results. Exclusion criteria A case should be excluded if an alternative diagnosis can fully explain their illness. In these cases, an antibody test of a specimen obtained more than 28 days after the onset of illness is needed to determine infection. It peaks in respiratory specimens and in stools at around day 10 after the onset of the clinical illness. In order to make an early diagnosis, it is therefore necessary to use highly sensitive tests that are able to detect the low levels of viral genome present during the first days of illness. Positive laboratory test results for other known agents that are able to cause atypical pneumonia such as Legionella pneumophila, influenza and parainfluenza viruses, Mycoplasma pneumoniae etc. It does not mean, however, that the virus present is infectious, or that it is present in a large enough quantity to infect another person. Virus isolation The presence of the infectious virus can be detected by inoculating suitable cell cultures (e.

Collecting Ducts and Recovery of Water Solutes move across the membranes of the collecting ducts buy super cialis 80 mg otc, which contain two distinct cell types purchase super cialis 80mg amex, principal cells and intercalated cells. As in other portions of the nephron, there is an array of micromachines (pumps and channels) on display in the membranes of these cells. By varying the amount of water that is recovered, the collecting ducts play a major role in maintaining the body’s normal osmolarity. If the blood becomes hyperosmotic, the collecting ducts recover more water to dilute the blood; if the blood becomes hyposmotic, the collecting ducts recover less of the water, leading to concentration of the blood. Another way of saying this is: If plasma osmolarity rises, more water is recovered and urine volume decreases; if plasma osmolarity decreases, less water is recovered and urine volume increases. As the ducts descend through the medulla, the osmolarity surrounding them increases (due to the countercurrent mechanisms described above). If aquaporin water channels are present, water will be osmotically pulled from the collecting duct into the surrounding interstitial space and into the peritubular capillaries. By also stimulating aldosterone production, it provides a longer-lasting mechanism to support blood pressure by maintaining vascular volume (water recovery). As + + + the pump recovers Na for the body, it is also pumping K into the forming urine, since the pump moves K in the opposite + + direction. When aldosterone decreases, more Na remains in the forming urine and more K is recovered in the circulation. Still other channels in the principal cells secrete K into the collecting duct + in direct proportion to the recovery of Na. This rate determines how much solute is retained or discarded, how much water is retained or discarded, and ultimately, the osmolarity of blood and the blood pressure of the body. Sympathetic Nerves The kidneys are innervated by the sympathetic neurons of the autonomic nervous system via the celiac plexus and splanchnic nerves. Reduction of sympathetic stimulation results in vasodilation and increased blood flow through the kidneys during resting conditions. When the frequency of action potentials increases, the arteriolar smooth muscle constricts (vasoconstriction), resulting in diminished glomerular flow, so less filtration occurs. Under conditions of stress, sympathetic nervous activity increases, resulting in the direct vasoconstriction of afferent arterioles (norepinephrine effect) as well as stimulation of the adrenal medulla. The adrenal medulla, in turn, produces a generalized vasoconstriction through the release of epinephrine. This includes vasoconstriction of the afferent arterioles, further reducing the volume of blood flowing through the kidneys. Autoregulation The kidneys are very effective at regulating the rate of blood flow over a wide range of blood pressures. This is due to two internal autoregulatory mechanisms that operate without outside influence: the myogenic mechanism and the tubuloglomerular feedback mechanism. Arteriole Myogenic Mechanism The myogenic mechanism regulating blood flow within the kidney depends upon a characteristic shared by most smooth muscle cells of the body. When you stretch a smooth muscle cell, it contracts; when you stop, it relaxes, restoring its resting length. When blood pressure increases, smooth muscle cells in the wall of the arteriole are stretched and respond by contracting to resist the pressure, resulting in little change in flow. When blood pressure drops, the same smooth muscle cells relax to lower resistance, allowing a continued even flow of blood. This mechanism stimulates either contraction or relaxation of afferent arteriolar smooth muscle cells (Table 25. Specialized macula densa cells in this segment of the tubule respond to changes in the fluid flow rate and Na concentration. It is produced in the lungs but binds to the surfaces of endothelial cells in the afferent arterioles and glomerulus. It acts systemically to cause vasoconstriction as well as constriction of both the afferent and efferent arterioles of the glomerulus. Its release is usually stimulated by decreases in blood pressure, and so the preservation of adequate blood pressure is its primary role. At the + + same time that aldosterone causes increased recovery of Na , it also causes greater loss of K. It binds to the aldosterone receptor and weakly stimulates Na reabsorption and increased water recovery. It may cause increased retention of water during some periods of the menstrual cycle in women when progesterone levels increase.

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