By T. Giacomo. New Mexico State University.

MS care is extremely costly as is the cost of the illness over a lifetime buy cheap amantadine 100 mg on-line. Disease-modifying therapy, while costly, may result in sustained employment over a lifetime with MS. The goal is to promote independent living with MS with a desired quality of life. This page intentionally left blank Chapter 18 Primary Care Needs Objectives: Upon completion of this chapter, the learner will: Describe the importance of the maintenance of a balanced health state Discuss primary care needs in MS Cite specific wellness activities in MS for men and womenAnnual physical examinations are essential for men and women with MS. Pregnancy (there is a 70% reduction in risk of exacerbation during pregnancy and a 70% increase the 3 to 8 months postpartum) 1. Education should include assessment of: The patient’s capabilities before conception Available supports for the postpartum period Considerations regarding breast feeding versus bottle feeding, issues of fatigue, DMAs The family’s living situation and economic resources 91 92 NURSING PRACTICE IN MULTIPLE SCLEROSIS: A CORE CURRICULUMMenstrual cycle assessment should include normal cycle, premenstrual syndrome, cramping, bloating, current medications. Current information about hormone replacement therapy (HRT) is confusing regarding risk reduction for osteoporosis and for coronary heart disease (CHD) and osteoporosis. Maintain body coolness with cooling devices, cool drinks, and cool showers if ambient temperature is high. Cool down frequently when exercising, and exercise in a cool environment. Assessment should include bone density study (DXA); a z-score of less than –2. Exercise is recommended for the prevention and treatment of osteoporosis 3. Protective pads should be worn around the outer thigh cov- ering the trochanteric region of the hip 4. Optimal calcium intake with Vitamin D (400 IU for those under 65; 600–800 for those who are older) 5. Estrogen therapy is controversial at this time (results of the Women’s Health Initiative) 6. Bisphosphonates are the drugs of choice aldendronate (daily or weekly) risedronate research studies: ✧ calcitonin ✧ parathyroid hormone CHAPTER 18: PRIMARY CARE NEEDS 93 8. Conclusion—preventing bone loss and vertebral fractures can be attained to some degree with any of the currently approved medications, exercise, and possibly diet.

Men are also susceptible to breast cancer generic amantadine 100 mg free shipping, but are a major issue of controversy because of questions regarding it is 100 times more frequent in women. Breast cancer in men individual rights (those of the mother and those of the fetus), the is usually fatal. The causes of breast cancer are not known,but women who are most susceptible are those who are over age 35,who have a family history of breast cancer,and who are nulliparous Diseases of the Vagina and Vulva (never having given birth). The early detection of breast can- Pelvic inflammatory disease (PID) is a general term for inflamma- cer is important because the prognosis worsens as the disease tion of the female reproductive organs within the pelvis. If the mammogram suggests breast cancer, a through the vagina during coitus, induced abortion, or childbirth. The surgical treatment for breast cancer is generally cause of the acidity of the vaginal secretions. A simple mastectomy is ever, localized infections and inflammations do occur. These are removal of the entire breast but not the underlying lymph nodes. The symptoms breast, the lymphatic drainage, and perhaps the pectoralis major of vaginitis are a discharge of pus (leukorrhea) and itching (pruri- muscle. The two most common organisms that cause vaginitis are the the pectoralis major muscle is always removed, as well as the pec- protozoan Trichomonas vaginalis and the fungus Candida albicans. Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 Chapter 21 Female Reproductive System 749 (a) (b) FIGURE 21. These contraceptives usually consist of a people, but the popularity of this technique has declined as more synthetic estrogen combined with a synthetic progesterone in successful methods of contraception have been introduced the form of pills that are taken once each day for 3 weeks after (fig. In the rhythm method, an attempt is made to pre- the last day of a menstrual period.

The most obvious diagnos- The tibialis posterior muscle is located deep to the soleus tic procedure is a clinical examination of the patient amantadine 100 mg amex. Its distal tendon passes be- this, it may be necessary to test muscle function using elec- hind the medial malleolus and inserts on the plantar surfaces of tromyography (EMG) to measure conduction rates and motor the navicular, cuneiform, and cuboid bones, and the second, unit activity within a muscle. A biopsy is perhaps the rior plantar flexes the ankle joint, inverts the foot, and lends sup- most definitive diagnostic tool. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 286 Unit 4 Support and Movement TABLE 9. Plantaris Lateral supracondylar ridge of Calcaneus Plantar flexes foot at ankle Tibial n. Obviously, overuse or disease will cause a change der may be either inborn or acquired. The immediate effect of overexertion on mus- A condition called rigor mortis (rigidity of death) affects cle tissue is the accumulation of lactic acid, which results in fa- skeletal muscle tissue several hours after death, as depletion of tigue and soreness. Excessive contraction of a muscle can also ATP within the fibers causes stiffness of the joints. This is similar damage the fibers or associated connective tissue, resulting in a to physiological contracture, in which muscles become incapable of strained muscle. A cramp within a muscle is an involuntary, painful, pro- When skeletal muscles are not contracted, either because longed contraction. Cramps can occur while muscles are in use the motor nerve supply is blocked or because the limb is immobi- or at rest. They may result from general dehydration, deficiencies of is resumed, as after a healed fracture, but tissue death is in- calcium or oxygen, or from excessive stimulation of the motor evitable if the nerves cannot be stimulated. Muscular System © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 9 Muscular System 287 FIGURE 9. The fibers in healthy muscle tissue increase in size, or hy- column, where there are extensive aponeuroses.

The assessment of the analgesic effectiveness of opioids in both animals and in patients is complicated by the fact that the type of neuropathy and the extent discount amantadine 100 mg with visa, duration and intensity of the symptoms will vary. There is no real consensus from clinical studies on the efficacy of morphine in neuropathic pain states. Dose escalation with morphine was shown to produce good analgesia in one study and others have reported that, in general, morphine could be effective in a group of patients with neuropathy. Another study concluded that opioids were entirely ineffective and finally, opioid analgesia was less in PAIN AND ANALGESIA 467 468 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION neuropathic pain patients as compared to a group with nociceptive pain. Resolution of this problem has important implications yet a similar series of discrepant results can be found in the animal literature. Following the description and then isolation of opioid receptors, there were three known receptors for the opioids, the mu, delta and kappa opioid receptors, but a novel fourth receptor, the orphan receptor, has been characterised very recently. This newly discovered opioid receptor-like (ORL-1) receptor appears to be linked to an inhibitory receptor despite the endogenous agonist having been named nociceptin (orphanin FQ). The receptor system does not appear to be anything like the traditional opioids. The central effects of nociceptin include a low abuse potential compared to morphine, and so provide an opportunity for the development of alternative analgesics to morphine. However, sufficiently selective tools for the receptor are lacking; the peptide itself is the only agonist available at present, and the putative antagonist appears to be at best a partial agonist. The apparently paradoxical site-dependent antinociceptive/hyperalgesic effects of this peptide are yet to be resolved. The actions of all clinically used opiates can now be explained in terms of their acting as agonists at one of the four opiate receptors found in the brain, spinal cord and peripheral nervous system.

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