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Nursing care includes carefully assessing and cleansing the skin anxiety quotes bible 25 mg phenergan, reducing superficial bacteria anxiety help purchase phenergan 25mg, controlling bleeding anxiety symptoms electric shock discount 25mg phenergan otc, reducing odor, and protecting the skin from pain and further trauma. The patient and family require assistance and guidance to care for these skin lesions at home. Anorexia, malabsorption, and cachexia are examples of nutritional problems that commonly occur in cancer patients; special attention is needed to prevent weight loss and promote nutrition. Anorexia Among the many causes of anorexia in the cancer patient are alterations in taste, manifested by increased salty, sour, and metallic taste sensations, and altered responses to sweet and bitter flavors, leading to decreased appetite, decreased nutritional intake, and protein-calorie malnutrition. Taste alterations may result from mineral (eg, zinc) deficiencies, increases in circulating amino acids and cellular metabolites, or the administration of chemotherapeutic agents. Patients undergoing radiation therapy to the head and neck may experience "mouth blindness," which is a severe impairment of taste. Alterations in the sense of smell also alter taste; this is a common experience of patients with head and neck cancers. Anorexia may occur because the person feels full after eating only a small amount of food. This sense of fullness occurs secondary to a decrease in digestive enzymes, abnormalities in the metabolism of glucose and triglycerides, and prolonged stimulation of gastric volume receptors, which convey the feeling of being full. Psychological distress, such as fear, pain, depression, and isolation, throughout illness may also have a negative impact on appetite. The person may develop an aversion to food because of nausea and vomiting after treatment. Malabsorption Many cancer patients are unable to absorb nutrients from the gastrointestinal system as a result of tumor activity and cancer treatment. They secrete hormones and enzymes, such as gastrin; this leads to increased gastrointestinal irritation, peptic ulcer disease, and decreased fat digestion. Chemotherapy and radiation can irritate and damage mucosal cells of the bowel, inhibiting absorption. Radiation therapy can cause sclerosis of the blood vessels in the bowel and fibrotic changes in the gastrointestinal tissue. Surgical intervention may change peristaltic patterns, alter gastrointestinal secretions, and reduce the absorptive surfaces of the gastrointestinal mucosa, all leading to malabsorption. Cachexia Cachexia is common in patients with cancer, especially in advanced disease. Cancer cachexia is related to inadequate nutritional intake along with increasing metabolic demand, increased energy expenditure due to anaerobic metabolism of the tumor, impaired glucose metabolism, competition of the tumor cells for nutrients, altered lipid metabolism, and a suppressed appetite. It is characterized by loss of body weight, adipose tissue, visceral protein, and skeletal muscle. Patients who are cachectic complain of loss of appetite, early satiety, and fatigue. General Nutritional Considerations Whenever possible, every effort is used to maintain adequate nutrition through the oral route. Family members are included in the plan of care to encourage adequate food intake. Patients often tolerate larger amounts of food earlier in the day rather than later, so meals can be planned accordingly. Pain, nausea, and other symptoms that may interfere with nutrition are assessed and managed. Medications such as corticosteroids or progestational agents such as megestrol acetate have been used successfully as appetite stimulants. If adequate nutrition cannot be maintained by oral intake, nutritional support via the enteral route may be necessary. However, if nutritional support is needed beyond several weeks, a gastrostomy or jejunostomy tube may be inserted. Patients and families are taught to administer enteral nutrition in the home setting.

Syndromes

• Acute cholecystitis
• More nutritious food
• Do NOT use a donut-shaped or ring-shaped cushions. They interfere with blood flow to that area and cause complications.
• Tilt table study to check if the nervous system is properly controlling blood pressure
• Medication side effects
• Hallucinations
• Take appropriate safety precautions when working at heights
• Death
• Allergic reactions to medicines you receive before or during surgery
• Blisters

Establishing rapport anxiety xanax side effects 25mg phenergan for sale, answering questions anxiety 247 25mg phenergan with visa, listening to anxiety symptoms at bedtime cheap 25mg phenergan overnight delivery fears and concerns, clarifying misconceptions, and providing information about what to expect are interventions the nurse uses to prepare the patient and family emotionally for the surgery and for the postoperative events. If there is fear of the unknown, other surgical experiences that the patient has had can be compared with the impending surgery. If the patient has already had a cardiac catheterization, the similarities and differences between that procedure and the surgery may be compared. The patient is encouraged to talk about any concerns related to previous experiences. A comparison is made between the pain experienced with cardiac surgery and other pain experiences. The preoperative sedation, the anesthetic, and the postoperative pain medications are described. The nurse reassures the patient that the fear of pain is normal, that some pain will be experienced, that medication to relieve pain will be provided, and that the patient will be closely observed. Patients who have a fear of scarring from surgery are encouraged to discuss this concern, and misconceptions are corrected. It may be helpful to indicate that the health care team members will keep the patient informed about the healing process. The patient and family are encouraged to talk about their fear of the patient dying. For those who only hint about this concern despite efforts to encourage them to talk about their fear, coaching may be helpful (eg, "Are you worrying about not making it through surgery? After the fear is expressed, the patient and family can be helped to explore their feelings. Preparing the family for the events to come helps them to cope, be supportive to the patient, and participate in postoperative and rehabilitative care (Chart 28-9). The patient who develops angina usually responds to normal angina therapy, most commonly nitroglycerin. Some patients require oxygen and intravenous nitroglycerin drips (see the Angina Pectoris section). The fears most often expressed are fear of the unknown, fear of pain, fear of body image change, and fear of dying. During the assessment, the nurse determines how much the patient and family know about the impending surgery and the expected postoperative events. They are encouraged to ask questions and to indicate how much information they wish to receive. Some patients prefer not to have detailed information, whereas others want to know as much as possible. Patients are approached as unique individuals with their own specific learning needs, learning styles, and levels of understanding. Patients requiring emergency heart surgery may have cardiac catheterization and surgery within several hours of admission. The nurse will have little opportunity to assess and meet their emotional and learning needs before surgery. As a result, patients will need extra help after surgery to adjust to the situation. Most patients have a nursing diagnosis of decreased cardiac output (see Cardiac Failure in Chap. Based on the assessment data, potential complications that may develop include: Angina or anginal pain equivalent Severe anxiety requiring an anxiolytic (anxiety-reducing) medication Cardiac arrest Chapter 28 Management of Patients With Coronary Vascular Disorders 747 Chart 28-9 Ethics and Related Issues When Is Withholding or Withdrawing Life Support Discussed with Patients and Families? Situation Life support includes the use of intraaortic balloon pumps and ventricular assist devices, ventilators, vasoactive infusions, cardiopulmonary resuscitation, and antibiotics. Patients who receive these treatments include those who are acutely, chronically, and terminally ill. At what point is the sensitive issue of withholding or withdrawing life support discussed?

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A bedside commode may be used to anxiety disorder key symptoms phenergan 25 mg line decrease the energy required by the patient and to anxiety symptoms in men purchase 25 mg phenergan mastercard reduce the resultant increase in cardiac workload induced by getting on and off a bedpan anxiety medicine for dogs purchase phenergan from india. Fluid balance in some patients is very brittle; they easily become hypovolemic or hypervolemic with small changes in the amount of circulating fluid. Falling blood pressure, increasing heart rate, and decreasing urine output indicate that the circulatory system is not tolerating diuresis and that measures must be taken to reverse the fluid imbalance that has occurred. It also can occur with cardiac tamponade, pulmonary embolism, cardiomyopathy, and dysrhythmias. The patient is positioned upright, preferably with the legs dangling over the side of the bed. This has the immediate effect of decreasing venous return, lowering the output of the right ventricle, and decreasing lung congestion. If the patient is unable to sit with the lower extremities dependent, the patient may be placed in an upright position in bed. Reassuring the patient and providing skillful anticipatory nursing care are integral parts of the therapy. Because this patient feels a sense of impending doom and has an unstable condition, the nurse must remain with the patient. The degree of shock is proportional to the extent of left ventricular dysfunction. The inadequate emptying of the ventricle also leads to increased pulmonary pressures, pulmonary congestion, and pulmonary edema, exacerbating the hypoxia, causing ischemia of vital organs, and setting a vicious cycle in motion. The systemic vascular resistance is elevated because of the sympathetic nervous system stimulation that occurs as a compensatory response to the decrease in blood pressure. The decreased blood flow to the kidneys causes a hormonal response (ie, increased catecholamines and activation of the renin-angiotensin-aldosterone system) that causes fluid retention and further vasoconstriction. The reduction in blood volume delivered to the tissues results in an increase in the amount of oxygen that is extracted from the blood that is delivered to the tissues (to try to meet the cellular demand for oxygen). The increased systemic oxygen extraction results in decreased venous (mixed and central) oxygen saturation. When the cellular oxygen needs cannot be met by the systemic oxygen delivery and the oxygen extraction, anaerobic metabolism and the resulting build up of lactic acid occur. Continuous central venous oximetry and measurement of blood lactic acid levels may assist in assessing the severity of the shock as well as the effectiveness of treatment. The patient becomes unresponsive, severe hypotension ensues, and the patient develops shallow respirations; cold, cyanotic or mottled skin; and absent bowel sounds. Arterial blood gas analysis shows metabolic acidosis, and all laboratory test results indicate organ dysfunction. Chapter 15 presents in more detail the pathophysiology and management of cardiogenic shock. The major approach to treating cardiogenic shock is to correct the underlying problems, reduce any further demand on the heart, improve oxygenation, and restore tissue perfusion. For example, if the ventricular failure is the result of an acute myocardial infarction, emergency percutaneous coronary intervention may be indicated (Webb et al. Ventricular assist devices may be implanted to support the pumping action of the heart (Barron et al. Major dysrhythmias are corrected because they may have caused or contributed to the shock. If the patient has hypoxemia, as detected by pulse oximetry or arterial blood gas analysis, oxygen administration is increased, often under positive pressure when regular flow is insufficient to meet tissue demands. Because of the decreased perfusion to the gastrointestinal system and the need to adjust the dosage quickly, most medications are administered intravenously. Many pressor medications are catecholamines, such as norepinephrine (Levophed) and highdose (>10 µg/kg per minute) dopamine (Intropin). Their purpose is to promote perfusion to the heart and brain, but they compromise circulation to other organs (eg, kidney). Because they also tend to increase the workload of the heart by increasing oxygen demand, they are not administered early in the cardiogenic shock process.

Diseases

• Sharp syndrome
• Brachydactyly mesomelia mental retardation heart defects
• Aqueductal stenosis
• Genital dwarfism, Turner type
• Hypoparathyroidism nerve deafness nephrosis
• Criss cross syndrome
• Melanoma, malignant
• Hyperlysinemia
• Hyperlipoproteinemia