By N. Shawn. Tulane University.

Phototherapy can involve natural sunlight purchase propecia 1mg without prescription hair loss in men xosbextliyi, which is highly Also buy discount propecia 1 mg on line hair loss cure uk, some powders (eg, cornstarch) may lead to sec- effective. Most clients with psoriasis notice some remission ondary infections by promoting growth of bacteria and during summer months. However, creams or ointments may be used for dry, crusted le- sions, and powders may be used for drying effects. Rosacea • Topical vaginal medications may be applied as douche Mild skin cleansers (eg, Cetaphil), oral tetracycline, and top- solutions, vaginal tablets, or vaginal creams used with ical metronidazole are commonly used; oral isotretinoin and an applicator. These medications • Anorectal medications may be applied as ointments, prevent or treat acneiform lesions; they have little to no effect creams, foams, and rectal suppositories. Few guidelines have been developed for Principles of topical drug therapy are generally the same as drug therapy of these disorders. In addition, topical corticosteroids should children, have more permeable skin and are more likely to ab- be used with caution on thinned or atrophic skin. In addition, absorption is in- creased in the presence of broken or damaged skin. Home Care With topical corticosteroids, suppression of the HPA axis (see Chap. When a home care nurse is involved, responsibili- paired adrenal function may include delayed growth and ties may include assessing clients, other members of the house- low plasma cortisol levels. Signs of intracranial hyper- hold, and the home environment for risks of skin disorders; tension may include headaches and swelling of the optic teaching preventive or treatment measures; assisting with treat- nerve (papilledema) on ophthalmoscopic examination. Because children are at high risk for development of sys- Nursing Notes: Apply Your Knowledge temic adverse effects with topical corticosteroids, these drugs should be used only if clearly indicated, in the smallest effec- tive dose, for the shortest effective time, and usually without You are making a home visit to young parents of a 6-month-old occlusive dressings. The teenage mother is home alone with the baby when you be used initially in infants and in intertriginous areas of older visit. She states that the baby has had a severe diaper rash for the last 2 weeks. If a more potent drug is required for severe dermati- ment data do you need to collect? What general principles should tis, the child should be examined often and the strength of the you include in your teaching about diaper rash? NURSING Dermatologic Drugs ACTIONS NURSING ACTIONS RATIONALE/EXPLANATION 1. Use the correct preparation for the intended use (ie, derma- Preparations may differ in drug contents and concentrations. For topical application to skin lesions: (1) Wash the skin, and pat it dry. To avoid bacterial cross-contamination between clients (5) Wash hands before and after application. Wash hands before to avoid exposing the client to infection; wash hands afterward to avoid transferring the drug to your own face or eyes and causing adverse reactions. Observe for therapeutic effects Therapeutic effects depend on the medication being used and the disorder being treated. With dermatologic conditions, observe for healing of skin With acne and rosacea, improvement may require 6 to 12 wk of lesions. With vaginal disorders, observe for decreased vaginal dis- charge and pruritus. Observe for adverse effects Incidence of adverse effects is low with topical agents. Local ef- fects may occur with most topical agents but may be more likely a. Local irritation or inflammation—burning on application, with antiseptics, local anesthetics, and antimicrobials. Allergic and irritant reactions to preservatives, fragrances, and other ingredients may prevent healing or worsen dermatitis. In ad- dition, children are at higher risk because they may absorb pro- portionally larger amounts and be more sensitive to systemic toxicity. Little adrenal suppression is likely to occur with doses less than 50 g weekly for an adult and 15 g weekly for a small child, unless occlusive dressings are used. With topical antibiotics, superinfection and sensitization Superinfection with drug-resistant organisms may occur with any may occur. Sensitization may cause serious al- lergic reactions if the same drug is given systemically at a later time. With oral retinoids, observe for hypervitaminosis A (nausea, Adverse effects commonly occur with usual doses but are more vomiting, headache, blurred vision, eye irritation, conjunctivi- severe with higher doses. Observe for drug interactions Clinically significant drug interactions rarely occur with topical agents.

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We often hold many of our tensions in our stomach; this meditation al- lows us to release those tensions and gain greater health in the process generic propecia 5mg amex hair loss viviscal. Unlike the previous meditation quality propecia 1 mg hair loss cure vitamin, this one does not require any visualization— just feel the hands rise and fall on the stomach. Finish up by bringing your attention back from the stomach to the breath, and from there back to your surroundings. But how we deal with pain is at least as important as searching for a way to get rid of it. These two final meditations are designed to recognize and deal with your pain, whether it is emotional, mental, or physical in nature. Be forewarned that these meditations can bring out some strong emotional reactions such as crying and sob- bing. We will be taking a tour of our life through this meditation, starting at the earliest point of our youth that we can recall. See yourself, as you were, whether it was happy and carefree or sad and burdened. Give yourself a mental hug and send loving compassion to that little child. Repeat this inspection and expression of compassion for yourself at the subse- quent life stages of older child, puberty, young adult, all the way to your present self. At this last stage, give yourself an especially big hug (use your hands and arms if you like! For many of us, compassion- ate feelings for ourselves are secondary to our concern for others. Start in your usual position, observe your breath for a few minutes, and then pick out a minor pain that you have in your physical body. It can be a headache, some low-back pain, arthritis in the fingers—whatever you choose—but start with a minor one, not a major one. Put your focus on the pain while you continue your deep, relaxed breathing. See it as perhaps a red area on your body, with little lightning bolts issuing from it. Imagine the pain begin- ning to soften as you watch it—the red color growing pale pink, the lightning bolts slowing and finally stopping. Incorporate some relaxation meditation techniques here—feel yourself growing heavy in your chair, switch back and forth from watch- ing your breath to watching the pain. If we can control or eliminate our pain by using our minds, the possibilities are endless. These internal aspects help bring forth a holistic, mind/body healing modality that can be used effectively in conjunction with Western medicine or, in some cases, by itself. Again, here in the West we have been trained to place our confidence in purely physical cures, disregarding the role that the mind plays in the healing equation. Another Western perspective is that Qi does not exist, because it cannot be found on X-rays or CAT scans. To divorce one from the other is to treat the symptoms, but not the root cause of the pain. On the positive side, patient empowerment and self-care, as well as medical cost-reduction possibilities have a special potential to transform medicine as it is practiced in the Western world. In external Qigong, the practitioner or Qigong doctor does non- touch energy assessment of the patient and actually projects or conducts Qi, in a treatment mode, to the patient. In assessment, rather than asking questions, taking pulses, observing the tongue, palpating reflexes, and ordering lab tests, the practitioner uses concentration, intu- ition, and reading of the Qi with off-the-body diagnostic scanning. In treatment, the practitioner actually projects the Qi to another to have a clinical effect. However, research is revealing that there may be authentic, explainable, and demonstrable natural laws and mecha- nisms in operation during these events. Therapeutic Touch, an assessing and heal- ing technique that uses an off the body technique called unruffling the field has experienced a tremendous swell of interest in the nursing community. The re- search of developer Delores Krieger, RN, demonstrated that in-vivo hemoglobin values (an essential blood-quality component) were significantly affected by the administration of this energy-based technique. An October 1986 article in the Los Angeles Times tells the story of the Beijing practice of Master Xun Yunkun who treats medical cases including terminal can- cer and paralysis following stroke with Qi projection. There is a tremendous wave of interest in this aspect of Qigong in the Western world and a number of very respectable research organizations are currently ex- pending substantial budgets on Qigong-related projects. There is a tremendous amount of research attempting to explain this phenomenon. Zheng Rong, and Stanford physicist Professor William Tiller are doing a collaborative research project on biolumines- cence and Qigong with a focus on satisfying the rational research model. In 1988, 128 research papers were presented at the First World Conference for the Aca- demic Exchange of Medical Qigong that was sponsored by the China Medical As- sociation, Chinese Ministry of Health, China Qigong Research Institutes, and the Beijing College of Traditional Chinese Medicine and was attended by representa- tives from 17 countries.

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In higher plasma concentrations of verapamil order propecia 1 mg without prescription hair loss in men jewelry, diltiazem discount propecia 1 mg mastercard hair loss cure 2010, nifedi- this case, more enzymes are available and the drug is metab- pine, and amlodipine. This is attributed to decreased hepatic olized more rapidly, possibly reducing therapeutic effects of metabolism of the drugs, probably because of decreased hepatic a given dose. In addition, older adults may experience more times given to counteract the drug tolerance (reduced hemo- hypotension with verapamil, nifedipine, and felodipine than dynamic effects) associated with chronic use. Blood pressure should be monitored with metabolism of nitroglycerin and isosorbide dinitrate nor- these drugs. Thus, if metabolism is re- CHAPTER 53 ANTIANGINAL DRUGS 785 duced by liver impairment, drug effects may be decreased Use in Critical Illness and shorter in duration. With calcium channel blockers, impairment of liver Antianginal drugs have multiple cardiovascular effects and function has profound effects on the pharmacokinetics and may be used alone or in combination with other cardio- pharmacodynamics of most of these drugs. They are probably should be used with caution, dosages should be substan- used most often to manage severe angina, severe hypertension, tially reduced, and clients should be closely monitored for or serious cardiac dysrhythmias. For example, IV nitroglycerin drug effects (including periodic measurements of liver en- may be used for angina and hypertension; an IV beta blocker zymes). These recommendations stem from the following or calcium channel blocker may be used to improve cardio- effects: vascular function with angina, hypertension, or supraventricu- • An impaired liver produces fewer drug-binding plasma lar tachydysrhythmias. This means that a greater pro- be carefully titrated and clients must be closely monitored for portion of a given dose is unbound and therefore active. Both of these effects heart failure, hypotension, or other conditions that impair increase plasma levels of drug from a given dose (es- blood flow to the gastrointestinal tract or skin. The effects result from shunting of blood around the liver so that drug molecules circu- lating in the bloodstream do not come in contact with Home Care drug-metabolizing enzymes and therefore are not me- tabolized. Initially, the nurse should double and their clearance is approximately one third assess the frequency and severity of anginal attacks and how that of clients without cirrhosis. In addition, the nurse can assess the • Although hepatotoxicity is uncommon, clinical symp- home setting for lifestyle and environmental factors that may toms of hepatitis, cholestasis, or jaundice and elevated precipitate myocardial ischemia. When causative factors are liver enzymes (eg, alkaline phosphatase, creatine kinase identified, plans can be developed to avoid or minimize them. These changes resolve if the causative drug ensure a constant supply; and discussing circumstances for is stopped. NURSING Antianginal Drugs ACTIONS NURSING ACTIONS RATIONALE/EXPLANATION 1. Check blood pressure and heart rate before each dose of an Hypotension is an adverse effect of antianginal drugs. Withhold the drug if systolic blood pressure dia is an adverse effect of propranolol and nadolol. If the dose is omitted, record and report to justments may be necessary if these effects occur. Give antianginal drugs on a regular schedule, at evenly To increase effectiveness in preventing acute attacks of angina spaced intervals. If oral nitrates and topical nitroglycerin are being used con- To minimize risks of additive hypotension and headache currently, stagger times of administration. For sublingual nitroglycerin and isosorbide dinitrate, in- struct the client to place the tablets under the tongue until they dissolve. For oral isosorbide dinitrate, regular and chewable tablets are available. For sublingual nitroglycerin, check the expiration date on Sublingual tablets of nitroglycerin are volatile. To apply nitroglycerin ointment, use the special paper to The measured paper must be used for accurate dosage. Place the ointment on a nonhairy part of the is used to apply the ointment because the drug is readily absorbed body, and apply with the applicator paper. Plastic wrap or tape aids absorption vious ointment before applying a new dose. Application sites should be rotated because the ointment can irritate the skin. For nitroglycerin patches, apply at the same time each day To promote effective and consistent drug absorption. Rotate not as well absorbed from distal portions of the extremities be- sites. Avoid applying below the knee or elbow or in areas of cause of decreased blood flow. For intravenous (IV) nitroglycerin, dilute the drug and give The drug should not be given by direct IV injection. The drug is by continuous infusion, with frequent monitoring of blood potent and may cause hypotension. Use only with the special administra- according to response (pain relief or drop in systolic blood pres- tion set supplied by the manufacturer to avoid drug adsorption sure of 20 mm Hg).

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