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Echocardiographic Features That Suggest Potential Need for Surgical Intervention
Persistent vegetation after systemic embolization
Anterior mitral leaflet vegetation, particularly with size >10 mm* embolic events during first 2 wk of antimicrobial therapy*
Increase in vegetation size despite appropriate antimicrobial http://circ.ahajournals.org/math/dagger.gif
Acute aortic or mitral insufficiency with signs of ventricular http://circ.ahajournals.org/math/dagger.gif
Heart failure unresponsive to medical http://circ.ahajournals.org/math/dagger.gif
Valve perforation or http://circ.ahajournals.org/math/dagger.gif
Valvular dehiscence, rupture, or http://circ.ahajournals.org/math/dagger.gif
New heart http://circ.ahajournals.org/math/dagger.gif
Large abscess or extension of abscess despite appropriate antimicrobial http://circ.ahajournals.org/math/dagger.gif
See text for more complete discussion of indications for surgery based on vegetation characterizations.
Surgery may be required because of risk of embolization.
Surgery may be required because of heart failure or failure of medical therapy.
Echocardiography should not be the primary modality used to detect or monitor heart block.
V. Nursing Care
According to the work of Estlow (1998) in the work…… [Read More]
Endocarditis, a heart condition, "is an infection of the inner lining of the heart," the inner lining being the endocardium (Mayo Clinic Staff). According to the Mayo Clinic, the condition "typically occurs when bacteria or other germs from another part of [one's] body....spread through the bloodstream and attach to damaged areas in [the] heart" (Mayo Clinic Staff, 2011). Endocarditis has the ability to damage or completely destroy the heart when left untreated and can also lead to life-threatening complications; there are treatments that include antibiotics and, in sometimes more severe cases, surgery (Mayo Clinic Staff, 2011). To truly understand the heart condition, it would be useful to evaluate some causes, symptoms, risk factors, explore some clinical trials on the condition, and ultimately, treatments for the condition and prevention methods.
Foremost, the causes, symptoms and risk factors of endocarditis are important to explore in detail to better understand the heart condition.…… [Read More]
Quality Development in Advanced Practice field knowledge in nursing: Proposal on Enhancing the dental health of children suffering Congenital Heart Disease
One of the most prevalent development abnormalities found in children is heart disease, and it occurs in about 8-10 in every 1, 000 births. Dental supervision of children with congenital heart problems calls for special care, due to their increased susceptibility to contagious endocarditis, which is associated with bacteremia caused by persistent dental processes. Additionally, these patients always have developmental enamel abnormalities that raises caries risk, and always have deprived oral health. This latter condition may be said to be due to cardiac health problems, whose care and attention may lead to the under-estimation of oral health and inadequate consideration. Additionally, continual administration of liquid drugs containing sucrose as sweetener may cause caries and gingivitis cases in children (Andersson et al. 2013a). Dental ailment may cause dental extractions in…… [Read More]
Clicking on the links reveals that some of the topics provide more information and information in different formats than others. For example, the Aging Driver topic lists the following clickable PDF files:
Tips for Safe Driving, How to Help the Older Driver, Getting by Without Driving, Am I a Safe Driver?, and Successful Aging Tips.
Other topics, such as Health Disparities, do not provide information directly but only link the user to external resources and other databases. This might discourage many users, especially those unfamiliar with online research hoping to find printable information with a minimum of further searching online. Meanwhile, another topic, Breastfeeding, does provide easily accessible information that includes illustrative diagrams along with the text-based information, as depicted below.
How should I hold my baby while breastfeeding?
You can hold your baby in a number of ways. Your baby shouldn't have to turn his or her head or…… [Read More]
Vancomycin should be given for at least 60 minutes. The initial dosage for pediatrics with renal impairment is not less than 15 mg/kg per day or 15 times the GF in mL/min. Premature infants should have longer dosing intervals. PO administration should be 40 mg/kg/day in 3-4 divided doses for 7-10 days. The maximum is 2,000 mg/day, which may be diluted in 1 oz of water or administered through an NG tube (PD).
Vancomycin is contraindicated to patients with hypersensitivity to vancomycin (Drug.com, 2012). Commercially prepared frozen Vancomycyn Hydrochloride injections in 5% dextrose may also be contraindicated to those with known allergic reaction to corn or corn products (Drug.com).
The patient should inform the doctor or pharmacist of all prescription and non-prescription or herbal products currently used (Medicine Net, 2012; Levinson, 2012). Aminoglycosides, amphotericin B, other antibiotics, and live bacterial vaccines are special mentions. If treatment requires…… [Read More]
Treatment to Patients
The main objective of providing treatment to patients is to relieve symptoms along with decreasing the progression of the disease as well as the mortality or morbidity. However, in some cases, this objective is not fully achieved, especially in the case of the patients who are admitted to the ICU with some serious and almost always a terminal stage of the disease. For example, when old patients are admitted in the ICU, their immunity is extremely low and this is the perfect time for the opportunistic infections to make matters worse for these patients. There are many infections that are specifically associated with patients admitted in the hospitals. Pseudomonas Aurigeonosa is a micro-organism that is well documented to cause bacterial pneumonia and bacteremia in the patients who are terminally ill and are receiving treatment in the hospital setting. Since most of the patients in the ICU are…… [Read More]
This became more so with the advancement of molecular iology Tests. Subsequently a group of clinicians met in Ghent elgium and came up with the current diagnostic criteria known as the Ghent Nosology. (De Paepe et al. 1996) Similar to the erlin Nosology the Ghent criteria was based on clinical findings in the various organ systems as well as the nature of family history and relationships, a major criteria was classified as which has a high diagnostic specificity because it was less frequent in other conditions and in the general population. A point of divergence from the erlin Nosology was the conversion of minor criteria in the skeletal system into major criteria. For one to be diagnosed with Marfan's the patient must have a first degree relative diagnosed with the disease in addition two systems must be involved with one having a major sign. In the absence of a family…… [Read More]
Another caution that exists for people suffering from lupus is to exercise caution before and after receiving dental treatment. Lupus patients could develop serious heart infections from the streptococci that might be released into their bloodstream during routine dental procedures, even bi-annual teeth cleanings (Blau and Schultz, 174). The infection can travel to the heart when the patient has certain other manifestations of lupus, and, if the patient has developed a condition called verrucous endocarditis, then it can be deadly if the streptococci infect the heart (Blau and Schultz, 174). Therefore it is strongly recommended that prior to and following dental procedures and cleanings that lupus patients receive antiobiotics that can help them to be prepared to defend their body against the streptococci (Blau and Schultz, 174-175).
The antibiotic -- usually amoxicillin, or another member of the penicillin family, or erythromycin in cases of penicillin allergy -- is taken an…… [Read More]
One possible explanation for the differences observed in the studies could be that the strengths of the chlorhexidine solution were different. It could also be that over time more effective techniques have been developed in the application of the solution, as the results do appear to improve over time.
There are limitations to the methodology of the study which are centered on the use of secondary data for analysis. The use of secondary data allows a wider range of data to be gathered from across the U.S. than would be practical from primary data collection which is the reason for the choice in this study. However this puts the control of several variables beyond the researcher. The results of the techniques may have been affected by the application of different individuals, departments and hospitals, all of whom may vary techniques and other factors influencing the success of these techniques. The…… [Read More]
prokaryotes consist of millions of genetically distinct unicellular organisms. A procaryotic cell has five essential structural components: a genome (DNA), ribosomes, cell membrane, cell wall, and some sort of surface layer which may or may not be an inherent part of the wall (1). Functional aspects of procaryotic cells are related directly to the structure and organization of the macromolecules in their cell make-up, i.e., DNA, RNA, phospholipids, proteins and polysaccharides. Diversity within the primary structure of these molecules accounts for the diversity that exists among procaryotes (1). Identifiable groups of prokaryotes are assembled based on easily observed phenotypic characteristics such as Gram stain, morphology (rods, cocci, etc.), motility, structural features (e.g. spores, filaments, sheaths, appendages, etc.), and on distinguishing physiological features (e.g. anoxygenic photosynthesis, anaerobiasis, methanogenesis, lithotrophy, etc.). Prokaryotes are commonly known as bacteria, and it is estimated that bacteria have been around for at least 3.5 billion years…… [Read More]
Acupuncture is an ancient practice of the East with a long history, which has been incorporated into modern Western use, and has been met with mixed reviews by the public and scientific communities.
The History of Acupuncture
The Origins of Acupuncture
Early tools and methods
Evolution of Acupuncture
F. Development of schools and comprehensive Texts
Eastern Medicine Meets the Modern West
Medical Missionaries to China
Adoption of Western Practice
The Decline of Acupuncture
Communist Support for Acupuncture
Regrowth and new methods
Acupuncture in Use Today
FDA Approved Needles
Universities and Physicians
New variations on Acupuncture
E. Why Western Medicine Fails
Arguments Against Acupuncture
A. The skeptics
C. How to avoid Risks
Scientific Proof and Conclusion
A. Studies have varying conclusions
. Remains widely used by prestigious medical institutions and private practitioners
C. Acupuncture makes people feel better, therefore it works
Although there…… [Read More]
Tetralogy of Fallot: Literature eview
Tetralogy of Fallot is a congenital heart defect associated with systemic cyanosis, accounting for approximately 5 to 6% of all cases of congenital heart disease and is characterized by; ventricular septal defect, aortic override, pulmonary stenosis and right ventricular hypertrophy. It is the most common cause of blue baby syndrome with children diagnosed developing Tet spells. Sudden increases in cyanosis followed by syncope characterize Tet spells and may result in hypoxic brain injury and death. Environmental and genetic disorders are other causes of TOF; always associated with chromosome 22 deletions and DiGeorge syndrome and occurs slightly more often in males than in females. If left untreated, Tetralogy of Fallot rapidly results in progressive right ventricular hypertrophy due to the increased resistance on the right ventricle. This progresses to dilated cardiomyopathy which begins in the right heart chambers often leading to left heart failure. Actuarial survival…… [Read More]
The Gram-negative, motile, rod-shaped bacterium Pseudomonas aeruginosa is an opportunistic killer that takes advantage of people suffering from medical problems (Van Delden and Iglewski, 1998).For this reason, P. aeruginosa is one of the most common nosocomial infection that occurs in hospitals. P. aeruginosa is responsible for causing 16% of pneumonia cases, 12% of urinary tract infections, 10% of bloodstream infections, and 8% of surgical infections due to hospital care. Patients who are immune-compromised are also susceptible to P. aeruginosa infections, such as patients undergoing chemotherapy, suffering from HIV / AIDS, recovering in burn units, and suffering from cystic fibrosis. With death rates ranging from 30 to 60% for these patients, P. aeruginosa is considered to be a significant threat to patient health.
P. aeruginosa can switch between a free-swimming planktonic form and colonies enclosed within slime-protected biofilms attached to surfaces (Baltch and Smith, 1994,…… [Read More]
Women and AIDS in New York City:
Hidden Cases, Hidden Problems
Ask most people what group of people you think of when you think of AIDS, and most people will name gay men. While it's undeniable that the AIDS epidemic was first noticed among gay men, AIDS has become an equal opportunity illness, and currently women represent the fastest growing sector of people with HIV / AIDS in the United States. This fact is true in New York City as well.
The growth in the rate of HIV / AIDS among women in New York City is a growing concern for a variety of reasons. Worse than the increase in infection among women is the death rate. Although overall, the death rate from AIDS has dropped significantly, the death rate for women with AIDS is significantly higher than that of men.
How widespread is the problem?
A look at recent…… [Read More]
drives under the influence of alcohol, it is a criminal offense abbreviated as driving under the influence (DUI). However alcohol is but one of the many substances that can interfere with one's driving capability. DUI charges can also be pressed against individuals who are driving under the influence of other kinds of drugs, including illegal drugs and even prescription medication. Taking drugs and driving at the same time, whether the drugs are just prescription muscle relaxers or medicinal marijuana is illegal and a DUI offense. The argument that one took drugs because of doctor's orders is not a defense to DUI charges. Various drugs have different effects on drivers. The drugs that impair concentration, judgment, alertness and/or motor skills are regarded as dangerous and in several cases even more dangerous than alcohol. Driving while having a blood alcohol concentration (BAC) of more than 0.08% or higher is illegal in the…… [Read More]
Generics, Biologics, and Biosimilars
Properties of Generic Drugs, Biologics, and Biosimilars, with Examples and Usage
Generic drugs denote pharmaceutical products that are typically meant to be substituted with some innovator product manufactured with no license from innovator, and sold in the markets after exclusive rights (such as patents) expire (WHO, 2016). Some of the properties of these drugs include;
Generic drugs are usually sold at prices considerably lower than branded price; and They are bioequivalent or identical to branded drugs in their strength, form, dosage, safety, quality, administration route, intended use, and performance characteristics.
Some generic medicine examples, together with their usage:
Paracetamol: this is the chemical constituent of numerous branded painkillers; it is, however, marketed as generic medicine, too, and utilized for pain alleviation.
Ibuprofen: his is employed for reducing fever and treating inflammation (swelling/irritation) or pain resulting from a number of conditions, including headache, back ache,…… [Read More]
The digestive fluids that are secreted by the stomach glands aimed at breaking down solid food and to kill bacteria in the stomach are referred to as gastric juices. Gastric acid is produced by the gastric parietal cell located on the walls of the stomach. The region where the gastric juices are secreted into the lumen is the most acidic environment in the human body and is known as the secretory canaliculus (Schubert & Peura, 2008). The secretion of the gastric acid into the lumen occurs in response to a variety of messages from the paracrine, hormonal, and neurocrine inputs. Gastrin, produced by the G cells that are located in the pyloric mucosa of the stomach is the primary hormonal stimulation for gastric acid production. There are various inputs that will stimulate the parietal cells in order for them to secrete hydrogen ions that will flow into the gastric lumen,…… [Read More]
Nursing - Asthma
The limitation of airflow in asthma is reported as "recurrent and caused by a variety of changes in the airway." (Expert Panel eport 3, National Heart, Lung, and Blood Institute, 2007, p.1) Those changes include: (1) bronchoconstriction; (2) airway edema; (3) airway hyperresponsiveness; and (4) airway remodeling. Expert Panel eport 3, National Heart, Lung, and Blood Institute, 2007, p.1) Airway edema occurs with the progression of the disease and the inflammation is more progressive and exacerbated by "edema, inflammation, mucus hypersecretion and the formation of inspissated mucus plugs as well as structural changes including hypertrophy and hyperplasia of the airway smooth muscle." (Expert Panel eport 3, National Heart, Lung, and Blood Institute, 2007, p.1) Airway hyperresponsivenss is reported to be "an exaggerated bronchoconstrictor response to a wide variety of stimuli. Airway modeling speaks of the permanent structural changes in the airway reported to be associated with "loss…… [Read More]
The main factor of the pathophysiology for Jennifer is a marked pain in her throat. Her throat has become sore, specifically her cervical nodes (which is a sign clearly indicative of disease). Thus it is difficult to eat, which explains why she neglected to eat her breakfast. Another capital aspect of Jennifer’s pathophysiology which is particularly revealing is her fever, which is common in children (de Pont, 2015, p. 2). Initially her fever was low grade. However, in just a matter of days it exceeded 103 degrees. Her body is attempting to counteract the effects of the malady afflicting it via the fever. One of the foremost associated alterations of her adaptive responses is the current state of her skin. Her skin is desiccated and warm, which is indicative of the fever the child has experienced over the past couple of days. Her skin will likely continue to…… [Read More]
Comparison of pathophysiology of CVI and DVT
The pathogenesis of CVI is not completely understood; however, it's based on both venous reflux and obstruction; or an amalgamation of the two. Though venous reflux is actually based on a number of mechanisms, the key elements are venous valve ineffectiveness, vessel wall swelling, hemodynamic elements and additionally venous hypertension. These systems could be further exasperated by dysfunctional pumping devices (vascular and/or muscle pump), for example, in inert patients or even individuals with stiff joints (Goerge and Santler, 2017). Similarly, Deep Venous Thrombosis (DVT) is actually blood clotting in a deep vein of a limb (normally pelvis or the thigh or calf). Low-level extremity DVT frequently results from damaged venous return (for instance, in inert patients), endothelial injury or even dysfunction (for example post fractures of leg) as well as, hypercoagulability. Concurrently, upper-level extremity DVT frequently outcomes from endothelial injury because of pacemakers,…… [Read More]