| Tranexamic Acid Posted: 01 Mar 2011 06:55 PM PST 
Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin Classification: Anti-fibrinolytic, antihemorrhagic Indications: Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas: - Treating heavy menstrual bleeding
- Hemorrhage following dental and/or oral surgery in patients with hemophilia
- Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures.
- Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues.
- Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia
- Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage
- Effective in promoting hemostasis in traumatic injuries.
- Preventing hemorrhage after orthopedic surgeries.
Mechanism of Action Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Anti-fibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogen-plasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis. Contraindications - Allergic reaction to the drug or hypersensitivity
- Presence of blood clots (eg, in the leg, lung, eye, brain), have a history of blood clots, or are at risk for blood clots
- Current administration of factor IX complex concentrates or anti-inhibitor coagulant concentrates
Precautions - Pregnancy. Tranexamic acid crosses the placenta.
- Lactation. Tranexamic acid is distributed into breast milk; concentrations reach approximately 1% of the maternal plasma concentration.
- Contraceptives, estrogen-containing, oral or Estrogens. Concurrent use with tranexamic acid may increase the potential for thrombus formation.
- Renal function impairment (medication may accumulate; dosage adjustment based on the degree of impairment is recommended)
- Hematuria of upper urinary tract origin (risk of intrarenal obstruction secondary to clot retention in the renal pelvis and ureters if hematuria is massive; also, if hematuria is associated with a disease of the renal parenchyma, intravascular precipitation of fibrin may occur and exacerbate the disease)
Nursing Responsibilities - Unusual change in bleeding pattern should be immediately reported to the physician.
- For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period.
- Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed.
- The medication can be taken with or without meals.
- Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing.
- If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once.
- Inform the client that he/she should inform the physician immediately if the following severe side effects occur:
- Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue
- Calf pain, swelling or tenderness
- Chest pain
- Confusion
- Coughing up blood
- Decreased urination
- Severe or persistent headache
- Severe or persistent body malaise
- Shortness of breath
- Slurred speech
- Slurred speech
- Vision changes
image courtesy of openrussia.ru Related posts: - Disseminated Intravascular Coagulation (DIC)
- Serum Uric Acid Test
- Parahemophilia (Factor V Deficiency)
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| Epiglottitis Posted: 01 Mar 2011 06:50 PM PST 
Definition The epiglottis is a flap of tissue covering the opening of the larynx to keep out the food and fluid from entering the respiratory tract. Epiglottitis is the inflammation and the infection of the epiglottis. It is a rare case, however, epiglottitis is an emergency condition as the swollen epiglottis cannot rise and allow the airway to open. Frequency - The inflammation of epiglottitis occurs most frequently in children from 2 to about 7 years of age.
Cause Epiglottitis can either be bacterial or viral in origin. The following causes the occurrence of this condition: - H. influenzae type B
- Pneumococci
- Streptococci
- Staphylococci
- Echovirus
- Respiratory syncytial virus
Signs and Symptoms - Severe inspiratory stridor
- High fever
- Hoarseness or voice
- Sore throat
- Difficulty swallowing or dysphagia
- Drooling
- Tongue protrusion to increase free movement in the pharynx
- Throat – seen as a cherry-red structure and edematous
- Muffled cough
- Leukocytosis
- Cyanosis – severe cases
Management - Moist air to reduce the epiglottal inflammation.
- Oxygen if cyanosis is present.
- Antibiotic therapy such as a second-generation cephalosporin – CEFUROXIME.
- The antibiotic such as Cefuroxime may be prescribed to the patient for a full 7 to 10 days. After the antibiotic therapy the epiglottal inflammation recedes rapidly.
- To maintain hydration in patients with epiglotitis, intravenous fluid therapy is needed since these children cannot swallow.
- It is important that the nurse should prepare a tracheostomy or entracheal intubation set at the bedside. Children with epiglotitis may need a prophylactic tracheostomy or necessitate endotracheal intubation to prevent total airway obstruction.
- IMPORTANT REMINDER: Never attempt to visualize the epiglottis directly with a tongue depressor because the gagging procedure causes complete obstruction of the glottis and results to respiratory failure.
- Throat culture should NOT be done UNLESS a means of providing an artificial airway such as a tracheostomy or endotracheal intubaton is readily available.
image courtesy of mountnittany.org Related posts: - What is Anaphylaxis?
- Direct Laryngoscopy
- CEFUROXIME SODIUM
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| Anatomy and Physiology: Muscular System Posted: 28 Feb 2011 09:36 PM PST 
Muscles – "machines" of the body Muscle make up nearly half the body's mass. The essential function of muscle is contraction or shortening. This unique characteristic sets muscle apart from other tissues in the body. All body movements depend on the muscles. Thus, muscles can be viewed as the "machines" of the body. Functions of the muscles - Produces movement. All movements of the human body are result of muscular contraction.
- Maintaining posture. The skeletal muscles in the body maintain posture.
- Stabilizing joints. Presence of muscle tendons reinforces and stabilizes joints that have poorly fitting articulating surfaces.
- Generating heat. Heat is a by-product of muscle activity. This heat is essential in maintaining normal body temperature.
Types of muscles Skeletal muscles Also called: voluntary muscle, striated muscle This type of muscle attaches to the body's skeleton. Because of their attachment to the bony part of the body smoother contours of the body are formed. Skeletal muscle fibers are cigar-shaped, multi-nucleate cells and are the largest of the muscle fiber types. This is the only muscle type that can be controlled consciously, thus it is a voluntary muscle. Since its fibers appear to be striped it is known as striated muscle. Summary of the characteristic of Skeletal Muscles: - Subject to conscious control.
- Multinucleated.
- Cigar-shaped.
- Attaches to the body's skeleton
- Soft and fragile.
- Its tissue can rapidly contract and with great force.
- Tires easily.
- Contraction is abrupt and rapid.
What is the reason why skeletal muscles are not ripped apart as they exert effort? Skeletal muscles do not rip apart after exerting effort because thousands of skeletal muscle fibers are bundled together by connective tissues which are responsible for providing strength and support to the muscle as a whole. Structure or Parts of Skeletal Muscle - Endomysium – a delicate connective tissue sheath that encloses each skeletal muscle fiber.
- Perimysium – a coarse fibrous membrane that wraps the sheathed muscle fibers.
- Fascicle – bundle of fibers formed from group of sheathed muscle fibers wrapped by perimysium.
- Epimysium – a tough overcoat of connective tissue that bounds together fascicles. This is the connective tissue that covers the entire muscle.
- Tendons – these are cordlike structures that are formed from epimysia. These are composed of mostly collagenic fibers that can cross rough bony projections. Aside from anchoring muscles, tendons are very important in providing durability.
- Aponeuroses – these are sheet like structures that attaches muscles indirectly to bones, cartilages or connective tissue coverings of each other.
Related posts: - Anatomy and Physiology: Tissues
- Anatomy and Physiology: Tissues
- Anatomy and Physiology: Cells
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| Crisis Intervention Posted: 28 Feb 2011 09:20 PM PST 
Definition of Crisis Crisis is a situation or period in an individual's life that produces an overwhelming emotional response. This event occurs when an individual is confronted by a certain life circumstance or stressor that he or she cannot effectively manage by using his or her usual coping skills. Crisis is an unexpected event that can create uncertainty to an individual and has been viewed as a threat to a person's important goals. Stages of Crisis The first stage of crisis occurs when the person is confronted by a stressor. Exposure to this stressor would result to anxiety. The individual then tries to handle things by using his or her customary coping skills. Second stage of crisis occurs when the person realizes that his usual coping ability is ineffective in dealing with anxiety. As the person becomes aware of his unsuccessful effort in dealing with the perceived stressor, he moves on to the next stage of crisis where the individual tries to deal with the crisis using new methods of coping. The fourth stage of crisis takes place when the person's coping attempts of resolving the crisis fail. The individual then experiences disequilibrium and significant distress. Types of crisis - 1. Maturational crisis – also called developmental crisis. These are predictable events in a person's life which includes getting married, having a baby and leaving home for the first time.
- Situational crises – unexpected or sudden events that imperils ones integrity. Included in this type of crisis are: loss of a job, death of a loved one or relative and physical and emotional illness of a family member or an individual.
- Adventitious crisis – also called social crisis. Included in this category are: natural disasters like floods, earthquakes or hurricanes, war, terrorist attacks, riots and violent crimes such as rape and murder.
Crisis Intervention Crisis intervention refers to the methods used to offer immediate, short-term help to individuals who experience an event that produces emotional, mental, physical, and behavioral distress or problems. Guide for an effective crisis intervention: - Assist the person to view the event or issue in a different perspective.
- Assist the individual to use the existing support systems. It is vital to help the person find new sources of support that can help in decreasing the feelings of being alone or overwhelmed.
- Assist the individual in learning new methods of coping that will help resolve the current crisis and give him or her new coping skills to be used in the future when dealing with another overwhelming situation.
image courtesy of economiccrisis.us Related posts: - Types of Sickle Cell Crisis
- Hypertensive Crisis
- Kubler-Ross Stages of Dying or Grief
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| Nephrotic Syndrome Posted: 28 Feb 2011 09:00 PM PST 
Definition Nephrotic syndrome is a kidney disease characterized by: - A marked increase in protein in the urine (proteinuria)
- A decrease of albumin the blood (hypoalbuminemia)
- Edema (swelling, especially around the eyes, feet, and hands)
- A high cholesterol and low density lipoproteins (hyperlipidemia)
This clinical disorder is seen in any condition that seriously damages the glomerular capillary membrane and results in increased glomerular permeability. Causes Primary causes of nephrotic syndrome include, in approximate order of frequency: - Minimal-change nephropathy
- Focal glomerulosclerosis
- Membranous nephropathy
- Hereditary nephropathies
Nephrotic syndrome is caused by various disorders that cause damage to the kidneys, specifically the basement membrane of the glomerulus. This immediately causes abnormal excretion of protein in the urine. In children, the most common cause of nephritic syndrome is minimal change disease while inadults membranous glomerulonephritis is the most common cause. Aside from the mentioned caiuses, this clinical disorder can also occur as a result of infection such as strep throat, hepatitis or monocnucleosis. Use of certain drugs, genetic disorders and immune disorders can also result to nephrotic syndrome. Diseases that affect multiple body systems can also cause nephrotic syndrome. These are the secondary causes of nephrotic syndrome: - Chronic glomerular nephritis
- Diabetes mellitus with intercapillary glomerulosclerosis
- Amyloidosis of the kidney
- Systemic lupus erythematosus
- Renal vein thrombosis
Frequency - Nephrotic syndrome can affect all age groups.
- In children, it is most common from age 2 to 6.
- This disorder occurs slightly more often in males than females.
Clinical Manifestations - The major manifestation of nephrotic syndrome is edema. It is usually soft and pitting, and is most commonly found around the eyes (periorbital), in dependent areas (sacrum, ankles and hands) and in the abdomen (ascites).
- Foamy appearance of the urine
- High blood pressure
- Weight gain from fluid retention
- Poor appetite
- Malaise
- Head ache
- Irritability
- Fatigue
Diagnostic Evaluation - Urinalysis – shows microscopic hematuria, urinary casts, large amounts of protein and other abnormalities.
- Needle biopsy of the kidney – for histology examination of renal tissue to confirm the diagnosis
- Creatinine clearance, BUN, creatine blood test, albumin blood test (may be low)
Management - Keep the patient on bed rest for a few days to promote diuresis, thereby, reducing edema.
- Low-sodium diet (for severe edema)
- Prednisone (adrenocorticosteroids) – to reduce proteinuria
- Diuretics – for severe edema
- ACE inhibitors or angiotensin receptor blockers (ARBs) – to control hypertension. ACE inhibitors may also help decrease the amount of protein loss in the urine.
Related posts: - Pediatric Nephrotic Syndrome
- Nursing Care Plan – Nephrotic Syndrome
- Glomerulonephritis
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