By K. Porgan. University of Northern Colorado.
Injection sites include the outer sur- face of the upper arm safe acivir pills 200mg, anterior surface of the thigh, and lower abdominal wall. Bunch up the skin between the thumb and forefinger so that the subcutaneous tissue is off the underlying muscle. Warn the patient that there will be “pinch” or “sting,” and insert the needle firmly and rapidly at a 45-degree angle until a sudden release signifies penetration of the dermis. Release the skin, and aspirate to make certain a blood vessel has not been entered and inject slowly. Low risk of radial nerve injury unless the needle strays into the middle or lower third of the arm. Draw an imaginary line from the femoral head to the posterior superior iliac spine. This site 13 (upper outer quadrant of the buttocks) is safe for injections because it is away from the sciatic nerve and superior gluteal artery. The only disadvantage of this site is that the firm fascia lata overlying the muscle can make needle insertion somewhat more painful. Position the patient in the dorsal lithotomy position (knees flexed and abducted), and per- form an aseptic perineal prep with sterile vaginal lubricant or povidone–iodine spray. Remove the catheter from the sterile package, and place the guide tube through fingers around the presenting part into the uterine cavity. Complications Infection, placental perforation if low lying IV TECHNIQUES Indication 13 • To establish an intravenous access for the administration of fluids, blood, or medica- tions • (Other techniques include Central Venous Catheters, page 253 and PICC lines (page 292) Materials • IV fluid • Connecting tubing • Tourniquet • Alcohol swab • Intravenous cannulas (a catheter over a needle [eg, Angiocath, Insyte] or a butterfly needle) • Antiseptic ointment, dressing, and tape Technique 1. It helps to rip the tape into strips, attach the IV tubing to the solution, and flush the air out of the tubing before you begin. Using a catheter–needle assembly (Angiocath, etc) often helps to “break the seal” between the needle and catheter prior to the time that the catheter is in the vein so that dislodging the catheter is less likely.
Rapid administration Phenytoin will probably not restore normal sinus can produce transient hypotension that is the combined rhythm and may dangerously accelerate the ventricular result of peripheral vasodilation and depression of myo- rate buy 200 mg acivir pills with amex. These effects are due to direct ac- tions of phenytoin on the vascular bed and ventricular Drug Interactions myocardium. If large doses are given slowly, dose-related Plasma phenytoin concentrations are increased in the decreases in left ventricular force, rate of force develop- presence of chloramphenicol, disulﬁram, and isoniazid, ment, and cardiac output can be observed, along with an since the latter drugs inhibit the hepatic metabolism of increase in left ventricular end-diastolic pressure. Pharmacokinetics The pharmacokinetic characteristics of phenytoin: Tocainide Oral bioavailability Slow and variable Tocainide (Tonocard) is an orally effective antiarrhyth- Onset of action 1–2 hours mic agent with close structural similarities to lidocaine. No signiﬁcant alterations in heart rate, excretion der as metabolites right ventricular ERP or the excitation thresholds of Therapeutic serum 10–18 g/mL atrial or ventricular muscle were observed in these concentration subjects. Clinical Uses Hemodynamic Effects Phenytoin, like lidocaine, is more effective in the treat- The acute hemodynamic effects are slight and transient ment of ventricular than supraventricular arrhythmias. The pharmacokinetic characteristics of tocainide: Phenytoin ﬁnds its most effective use in the treat- ment of supraventricular and ventricular arrhythmias Oral bioavailability Approximately 100% associated with digitalis intoxication. The ability of Onset of action Not known phenytoin to improve digitalis-induced depression of Peak response 0. Plasma half-life 15 hours 16 Antiarrhythmic Drugs 179 Primary route of Hepatic Hemodynamic Effects metabolism Although its cardiovascular toxicity is minimal, mexile- Primary route of Renal (40% unchanged) tine should be used with caution in patients who are hy- excretion potensive or who exhibit severe left ventricular dys- Therapeutic serum 3–11 g /mL concentration function. Clinical Uses Pharmacokinetics Tocainide is indicated for the treatment of symptomatic The pharmacokinetic characteristics of mexiletine: ventricular arrhythmias refractory to more conventional therapy. Serious noncardiac adverse effects limit its use Oral bioavailability 90% to patients with life-threatening arrhythmias. Primary route of Primarily biliary; 10% renal Overall, however, approximately 20% of patients pre- excretion scribed tocainide discontinue therapy because of such Therapeutic serum 0. Serious immune-based side effects, such as pul- concentration monary ﬁbrosis, have been reported, and blood dyscrasias, such as agranulocytosis and thrombocytope- Clinical Uses nia, may occur in up to 0.
Couples interested in these options should have genetic ORGANIZATIONS counseling to carefully explore all of the benefits and National Organization for Rare Disorders (NORD) buy discount acivir pills 200mg on-line. The retina receives the image produced by the “Entry 300100: Adrenoleukodystrophy; ALD. At or near this same locus is the gene responsible for micropthalmia with linear skin defects (MLS) and the A-gammaglobulinemia tyrosine kinase see gene responsible for Goltz syndrome. Because only one Bruton A-gammaglobulinemia tyrosine male has ever been diagnosed with Aicardi syndrome, it kinase (BKT) is assumed that Aicardi syndrome is dominant and X- linked with near 100% fetal mortality in males. Nearly all Aganglionic megacolon see Hirschsprung of the cases of Aicardi syndrome are believed to result from de novo mutations (new mutations that occur after disease conception) since parents of affected individuals have normal chromosomes. Agenesis of clavicales and cervical vertebral and talipes equinovarus see Demographics Crane-Heise syndrome Approximately 300 to 500 individuals, all female except for one, have been diagnosed with Aicardi syn- drome worldwide. IAicardi syndrome Because it is an X-linked dominant trait, it is observed almost exclusively in females. Definition Aicardi syndrome is a rare genetic disorder that Signs and symptoms causes defects of the eyes and brain. Aicardi syndrome is Aicardi syndrome is characterized by abnormalities named after Dr. Jean Aicardi, who first described this of the connection between the left and right hemispheres syndrome in 1965. It is these abnormalities of the brain, Agenesis of Corpus Callosum (ACC) with Chorioretinal including the corpus callosum, that lead to the observable Abnormality because of the associated abnormal forma- symptoms of seizures and developmental delays. Aicardi tion of the connection between the right and left hemi- syndrome may also be complicated by brain tumors, spheres of the brain (the corpus callosum) and abnormal benign tumors of the scalp (lipomas) and cancer of the development of the choroid and retinal sections of the blood vessels (angiosarcoma). The onset of infantile spasms in individuals affected The eye is composed of three layers: the sclera, the with Aicardi syndrome is generally observed between the choroid, and the retina. It is at this time that the outer coat of the eyeball; it is unaffected in individuals final connections (neural synapses) are made in the GALE ENCYCLOPEDIA OF GENETIC DISORDERS 39 ing of muscles.
A study of chronic fatigue syndrome py gain more weight and have shorter hospital stays than subjects found that a group receiving massage therapy infants who are not massaged discount acivir pills 200 mg amex. A study of 40 low-birth- had lower depression, emotional distress, and somatic weight babies found that the 20 massaged babies had a symptom scores, more hours of sleep, and lower epi- 47% greater weight gain per day and stayed in the hospi- nephrine and cortisol levels than a control group. Cocaine-exposed, preterm in- fants given massage three times daily for a 10 day period The generally accepted standard for training is a showed significant improvement. Training should in- massaged infants had fewer postnatal complications and clude anatomy, physiology, pathology, massage theory exhibited fewer stress behaviors during the 10 day peri- and technique, and supervised practice. Most massage od, had a 28% greater daily weight gain, and demonstrat- therapists also take additional courses and workshops ed more mature motor behaviors. In the United States, massage therapists are current- A study comparing 52 hospitalized depressed and ad- ly licensed by 29 states, the District of Columbia, and a justment disorder children and adolescents with a control number of localities. Most states require 500 or more group that viewed relaxation videotapes, found massage classroom hours of training from a recognized training therapy subjects were less depressed and anxious, and had program and passing an examination. A national certification program was inaugurated in Another study showed massage therapy produced June 1992 by the National Certification Board for Thera- relaxation in 18 elderly subjects, demonstrated in mea- peutic Massage and Bodywork (NCBTMB). The sures such as decreased blood pressure and heart rate and NCBTMB program is accredited by the National Com- increased skin temperature. Those cer- jects with traumatically induced spinal pain led to signif- tified can use the title Nationally Certified in Therapeutic icant improvements in acute and chronic pain and in- Massage and Bodywork (NCTMB). Department of Education, currently rally control pain by stimulating the brain to produce en- recognizes about 70 training programs. Fibromyalgia is an example of a condition Commission of Career Schools and Colleges of Technolo- that may be favorably affected by this effect. A pilot study of five subjects with symptoms of ten- sion and anxiety found a significant response to massage Resources therapy in one or more psycho-physiological parameters of heart rate, frontalis and forearm extensor electromyo- BOOKS grams (EMGs) and skin resistance, which demonstrate Beck, Mark F. Massage Therapy Career Guide for Hands- Lymph drainage massage has been shown to be On Success.