By Z. Marcus. Felician College.
Large doses of minerals are may contain 50% to 100% of the amounts recommended toxic (see Chap buy discount super avana 160mg on line. In healthy people who eat a well-balanced • Vitamins are often marketed in combination products diet, nutrient needs may be exceeded. Congenital abnormalities may occur in newborns whose mothers took excessive vitamin A during pregnancy. Acute toxicity, with in- creased intracranial pressure, bulging fontanels, and vomit- ing, may occur in in- fants who are given vitamin A. Excessive intake of vita- Fatigue, nausea, head- min E, which is rare ache, blurred vision, with dietary intake but diarrhea can occur with overuse of vitamin E supple- ments Vitamin K Inadequate intake, ab- Abnormal bleeding Unlikely to occur from di- Clinical manifestations sorption, or use. However, caused by inadequate hematuria, epistaxis, when vitamin K is given when vitamin K is given intake after infancy. After infancy, deficiency usually results from diseases that interfere with absorption (biliary tract and GI disorders) or use (hepatic cirrho- sis and hepatitis). In alcoholics, deficiency commonly occurs and probably results from decreased intake and impaired use. Drug- induced deficiency oc- curs with oral coumarin (continued) 458 SECTION 5 NUTRIENTS, FLUIDS, AND ELECTROLYTES TABLE 31–2 Vitamin Imbalances (continued) Deficiency States Excess States Causes Signs and Symptoms Causes Signs and Symptoms anticoagulants and some other drugs that act as vitamin K antago- nists. Also, antibiotics reduce bacterial synthe- sis of vitamin K in the intestine, but this is a rare cause of deficiency. WATER-SOLUBLE VITAMINS Megadoses of pharma- Signs and symptoms ceutical vitamin of excess states not supplements established for most water-soluble vitamins Biotin Inadequate intake or Anorexia impaired absorption. Muscle pain Dermatitis Cyanocobalamin Usually impaired absorp- Megaloblastic or perni- (vitamin B12) tion from a lack of cious anemia: hydrochloric acid or Decreased numbers of intrinsic factor in the RBCs stomach Abnormally large, immature RBCs Fatigue Dyspnea With severe deficiency, leukopenia, thrombo- cytopenia, cardiac ar- rhythmias, heart failure, or infections may occur. Neurologic signs and symptoms: Paresthesias in hands and feet; unsteady gait Depressed deep-tendon reflexes With severe deficiency, loss of memory, con- fusion, delusions, hal- lucinations, and psychosis may occur. Folic acid Inadequate diet Megaloblastic anemia Impaired absorption that cannot be distin- (intestinal disorders) guished from the ane- Greatly increased mia produced by B12 requirements (preg- deficiency nancy, lactation, Impaired growth in children hemolytic anemias) Glossitis Ingestion of folate GI problems (folic acid antagonist drugs deficiency does not pro- (eg, methotrexate) duce neurologic signs Alcoholism is a common and symptoms as B12 cause. Niacin (vitamin B3) Inadequate diet or im- Pellagra: Large doses (2–6 g daily) Flushing, pruritus, hyper- paired absorption Erythematous skin used to treat hyperlipi- glycemia, hyper- lesions demia uricemia, increased liver enzymes CHAPTER 31 VITAMINS 459 TABLE 31–2 Vitamin Imbalances (continued) Deficiency States Excess States Causes Signs and Symptoms Causes Signs and Symptoms GI problems (stomatitis, glossitis, enteritis, diarrhea) Central nervous system problems (headache, dizziness, insomnia, depression, memory loss) With severe deficiency, delusions, hallucina- tions, and impair- ment of peripheral motor and sensory nerves may occur. Pantothenic acid No deficiency state (vitamin B5) established Pyridoxine (vitamin B6) Inadequate intake or Skin and mucous mem- impaired absorption brane lesions (sebor- rheic dermatitis, intertrigo, glossitis, stomatitis) Neurologic problems (convulsions, periph- eral neuritis, mental depression) Riboflavin (vitamin B2) Inadequate intake or im- Glossitis and stomatitis paired absorption.
Effects include may impair fetal growth 160 mg super avana fast delivery, impair neurologic development, and increased fetal, neonatal, and infant mortality; decreased birth increase the risk of spontaneous abortion during the first and weight and length; shortened gestation; and increased com- second trimesters. During the third trimester, cocaine causes plications of pregnancy (eg, placental abruption, spontaneous increased uterine contractility, vasoconstriction and decreased abortion; preterm delivery). These effects are attributed to de- blood flow in the placenta, fetal tachycardia, and increased risk creased flow of blood and oxygen to the placenta and uterus. These life-threatening Nicotine causes vasoconstriction and decreases blood flow to (text continues on page 970) Conception LMP 14 days Parturition (280 days) 31 days – heart, CNS Classic teratogenic period Palate, ear 71 days Brain growth Internal organ development Figure 67–1 The gestational clock show- ing the classic teratogenic risk assessment. For most drugs, adequate studies have not been done in seem to be safe, although they have not been studied extensively pregnant women and effects on the fetus are unknown. They have shorter half-lives, lower serum con- be used only if potential benefit to the mother justifies potential centrations, and a faster rate of elimination in pregnancy. Adrenergics Aminoglycosides (FDA category D) cross the placenta and Adrenergics are cardiac stimulants that increase rate and force of fetal serum levels may reach 15% to 50% of maternal levels. These drugs are common fetus or neonate have not been reported with other aminoglyco- ingredients in over-the-counter decongestants, cold remedies, and sides, but there is potential harm because the drugs are nephrotoxic appetite suppressants. Oral and parenteral adrenergics may inhibit uterine contractions Clindamycin (Cleocin) should be used only when infection with during labor; cause hypokalemia, hypoglycemia, and pulmonary Bacteroides fragilis is suspected. Erythromycin crosses the placenta to reach fetal Oral albuterol and oral or intravenous terbutaline relax uterine serum levels up to 20% of maternal levels, but no fetal abnormali- muscles and inhibit preterm labor. In animal studies, adverse fetal effects were Analgesics, Opioid reported with clarithromycin and dirithromycin but not with Opioids rapidly cross the placenta and reach the fetus. Clarithromycin is contraindicated if a safer alterna- diction and neonatal withdrawal symptoms result from regular use. Use of codeine during the first trimester has been associated with Nitrofurantoin should not be used during late pregnancy be- congenital defects.
Nurses may have in- if the products are shelved or stored next to each other order super avana 160 mg fast delivery. Clients/Consumers People may take drugs from several prescribers; fail to inform one Circumstances physician about drugs prescribed by another; get prescriptions Prescribers, pharmacists, and nurses may have a heavy workload, filled at more than one pharmacy; fail to get prescriptions filled or with resultant rushing of prescribing, dispensing, or administering refilled; underuse or overuse an appropriately prescribed drug; medications. They may also experience distractions by interrup- take drugs left over from a previous illness or prescribed for some- tions, noise, and other events in the work environment that make one else; fail to follow instructions for drug administration or stor- it difficult to pay needed attention to the medication-related task. Occasionally, verbal or telephone orders are accept- DRUG PREPARATIONS AND able. Some drugs are available in only one dosage pharmacy staff prepare a computer-generated MAR for each form; others are available in several forms. For clients in ambulatory care settings, the procedure is es- Dosage forms of systemic drugs include liquids, tablets, sentially the same for drugs to be given immediately. For drugs capsules, suppositories, and transdermal and pump delivery to be taken at home, written prescriptions are given. Systemic liquids are given orally (PO) or by injec- tion to the previous information, a prescription should include tion. Prescriptions for drug plus binders, colorants, preservatives, and other sub- Schedule II controlled drugs cannot be refilled. Capsules contain active drug enclosed in a gelatin cap- To interpret medication orders accurately, the nurse must sule. Most tablets and capsules dissolve in the acidic fluids of know commonly used abbreviations for routes, dosages, and the stomach and are absorbed in the alkaline fluids of the upper times of drug administration (Table 3–1). Tablets for sublingual or buccal ad- ministration must be specifically formulated for such use.
The show taught me that many men and women—perhaps you are one of them—are looking for a quick fix and a fast way to transform their bodies buy cheap super avana 160mg. I told my clients that they had to stick with me for at least six weeks before they would see major results. The Extreme Makeover challenge of training and transforming four women in a short period of time opened up a new universe to me. I realized that many people, given the right exercise and nutrition plan, can achieve stunning results in as little as two weeks. Even more important, if they stick with the right maintenance plan, something the Extreme Makeover show does not develop, they can maintain these results for life. The basic philosophy of the show not only included diet and exercise (which I would be in charge of), but also extensive plastic sur- gery, including nose jobs, brow lifts, liposuction, and face-lifts. That said, I agreed to participate, and the process helped me to develop the program that eventually grew into this book. I felt that I could show these women and millions of viewers that one could have a makeover, and a pretty comprehensive one at that, by adhering to the sound eating and exercise principles of my program. Not only was I going to transform their bodies, but I was going to empower them by teaching them how to maintain their results throughout their lives. I was asked to help women completely make over their bodies in just 14 to 21 days. Generally, I suggest a much longer program for body transformation, one that lasts about six weeks. Yet, because the Extreme Makeover show wanted extreme results in an extremely short period of time, I modified the 1 IIII Copyright © 2005 David Kirsch.
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