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Compare and contrast how tube feedings are the same and different for an infant and adult safe zanaflex 2mg. Thus cheap zanaflex 2 mg without prescription, nutritional care should be indi- health best zanaflex 2 mg, to prevent illness buy zanaflex 2 mg without prescription, and to promote recovery from illness vidualized generic 2 mg zanaflex visa. The first four nutrients are discussed in this chapter; tionists advise about dietary matters, it is often the nurse who vitamins and minerals are discussed in the following chapters. Water, carbohydrates, proteins, and fats are necessary for Consequently, this chapter discusses the use of products to im- life. Water is required for cellular metabolism and excretion of prove nutritional status in clients with deficiency states and spe- metabolic waste products; 2000 to 3000 mL are needed daily. Proteins are basic anatomic and physiologic components of all body cells and tissues; the recommended amount for adults is 50 to 60 g daily. Carbohydrates and fats serve pri- NUTRITIONAL DEFICIENCY STATES marily as sources of energy for cellular metabolism. Energy is measured in kilocalories (kcal) per gram of food oxidized Nutritional deficiencies result from inadequate amounts of in the body. Carbohydrates and proteins supply 4 kcal/g; fats water, carbohydrates, proteins, or fats. Causes and symptoms 434 CHAPTER 30 NUTRITIONAL SUPPORT PRODUCTS AND DRUGS FOR OBESITY 435 of water imbalances are listed in Table 30–1; those of protein- Carbohydrate, Protein, calorie imbalances are listed in Table 30–2. TABLE 30–2 and Fat Imbalances Nurses encounter many clients who are unable to ingest ad- equate fluid and food because of illness. Debilitating illnesses Protein-Calorie Deficit such as cancer, acquired immunodeficiency syndrome, and Causes Signs and Symptoms chronic lung, kidney, or cardiovascular disorders often inter- fere with appetite and gastrointestinal (GI) function. Weight loss with eventual peutic drugs often cause anorexia, nausea, vomiting, diarrhea, tein, carbohydrate, and fat loss of subcutaneous fat 2. Nutritional deficiencies may impair the func- absorb, or use nutrients 2. Increased susceptibility to tion of essentially every body organ, impair wound healing, 3. Acidosis for dietary intake in clients who cannot ingest, digest, absorb, 10. Protein-Calorie Excess Additional water must be given to meet fluid needs. Some products contain extra protein, fiber, calories, or other nu- Causes Signs and Symptoms trients. Obesity fats TABLE 30–1 Water Imbalances Water Deficit Some products are formulated for clients with particular organ impairments (eg, renal insufficiency) or disease processes Causes Signs and Symptoms (eg, diabetes mellitus), and some are contraindicated for clients 1. Oliguria and concentrated and caregivers who purchase the products over-the-counter people who are comatose, urine should read labels carefully or consult a nutritionist. Excessive fluid loss due to membranes tionally incomplete and are designed for short-term use when vomiting, diarrhea, fever, 5. Fever must be provided parenterally for more than a few days, a strenuous physical activity, 8. A combination of from mild confusion to delir- can be designed to meet all nutritional needs or to supplement 1 and 2 ium, convulsions, and coma other feeding methods. Hypovolemic shock if the supply additional calories and essential fatty acids. For nutritional deficiencies due to malabsorption of carbohydrates, protein, and fat, pancreatic Causes Signs and Symptoms enzymes may be given. Low serum sodium and due to endocrine, renal, hematocrit Pancreatin and pancrelipase are commercial preparations cardiovascular, or central 6. Disorientation of pancreatic enzymes (eg, lipase, protease, and amylase). Circulatory overload and pul- The preparations are used to aid digestion and absorption of monary edema if water excess is severe or develops rapidly dietary carbohydrate, protein, and fat in conditions charac- terized by pancreatic enzyme deficiency. These conditions 436 SECTION 5 NUTRIENTS, FLUIDS, AND ELECTROLYTES TABLE 30–3 Intravenous Fluids Type/Characteristics Uses Comments Dextrose Injection Available in preparations containing To provide water and calories The dextrose in D5W is rapidly 2. They are hypertonic and must be given through a central or subclavian catheter. Dextrose and Sodium Chloride Injection Available in several concentrations Maintenance fluids, usually with Frequently used are 5% dextrose in added potassium chloride, in 0. Crystalline Amino Acid Solutions (Aminosyn, Freamine) Contain essential and nonessential As a component of peripheral or Special formulations are amino acids central IV parenteral nutrition, available for use in patients with concentrated dextrose with renal or hepatic failure.

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Since then buy 2 mg zanaflex fast delivery, he has had multiple intervertebral discs partially or completely removed order zanaflex 2mg without prescription. Over the past two to three years buy zanaflex 2 mg amex, his pain has been worsening discount zanaflex 2mg online, and his functional status has been decreasing order 2mg zanaflex with visa. He does not want to take narcotics, as they interfere with his ability to stay sharp and active, and stomach problems prohibit the use of many non-narcotic medications. Although it has become more difficult, he still takes his wife dancing on Saturday nights. The worst part about the pain is that it is chang- ing—getting worse—and he is uncertain of its future trajectory. He reminds me that he is privileged because he has connections and acts as his own advocate. These assets have allowed him to expand his healthcare options and seek out the best providers and top institutions. He is also well informed and assertive and has been an active participant in his healthcare. Although his overall experience in the healthcare system has been favor- able, many instances of care have been less than ideal. Roberts observed that the lack of communication between providers is a huge problem. He has multiple specialists who care for different parts of his body; however, no one person is mindful of how these systems inter- act to create the whole person or illness. The physicians never seem inclined to dig deeply or communicate as team members treating one person. On many occasions, physicians have recommended therapies that have already been tried and failed. On other occasions, they disagree on an approach to his problem and leave Mr. Despite the fact that physicians take copious notes, the information is not put to use. But within a few minutes of the encounter, it is apparent that the consultant has not reviewed the chart or absorbed any of the information. His gastroenterologist was away on vacation for four weeks and there was no covering physician. The thought of amassing his patient records for transfer to another physician (who would 20 The Healthcare Quality Book likely not review them and suggest the same tests and therapies) was so dis- tasteful that he chose to go without care. Roberts states that he spends much of his energy as a patient facilitating communication between providers and transferring informa- tion gained from one physician to another. If all the providers could come together and discuss the problem as a group, redundancies and mistakes could be elim- inated. Instead, much time and money are wasted reproducing ineffec- tive therapeutic plans and not treating his illness in an efficient, effective, safe, or timely manner. In addition, effective communication between providers and patients is lacking. Roberts has undergone multiple sur- geries that have not resolved his pain, many new doctors he sees are quick to offer surgery as the solution to his problem. Seldom do physicians lis- ten to his full story or elicit his thoughts before jumping to conclusions. This problem was painfully illustrated by the recent death of his brother, who died on the operating room table while undergoing a second spinal surgery for similar back problems. Roberts suggested that physicians carefully analyze their therapeutic personalities. They cannot assume that all patients are alike or that they will react the same to a given interven- tion. Roberts is particularly concerned with the inability of patients to know the true qualifications of their physicians or judge their prescriptions. Assuming these symptoms were related to his spine, he sought the advice of a highly rec- ommended chief of neurosurgery at a premier academic center. The following day, an anesthesiologist came into the room to obtain his consent for sur- gery. He asked to speak to the neurosurgeon and insisted on some other con- sultations. Three days later, a hand surgeon reassured him that his prob- lem was likely self-limiting tendonitis and prescribed conservative therapy.

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The TCM pattern discrimination was kidney qi insufficiency in 43 cases and spleen qi vacuity in 25 cases cheap zanaflex 2mg with mastercard. When stimulating Qi Hai and Guan Yuan buy zanaflex 2mg otc, the patient was expected to feel distention radiating into the genital area proven zanaflex 2mg. When stimulating San Yin Jiao order zanaflex 2 mg on line, the results were better if the patient felt distention radiating up to the knee cheap 2 mg zanaflex mastercard. Then the needles were res- timulated every three minutes after the initial stimulation. This treat- ment was done once per day, and 10 days equaled one course of treatment. From Clinical Observations on Treating 62 Cases of Pediatric Enuresis with Acupuncture by Bao Zhao-gui, Zhong Yi Za Zhi (Journal of Chinese Medicine), 1993, #1, p. The patients were between 5-17 years old, with the majority of the patients between 6-10 years old. Thirty-five cases had enuresis 1-2 Chinese Research on the Treatment of Pediatric Enuresis 139 times per night, 17 cases had enuresis 3-4 times per night, and 10 cases had enuresis one time per night. Treatment method: The acupoints used in this protocol were: Tong Li (Ht 5) Da Zhong (Ki 4) Guan Yuan (CV 4) After the qi was obtained, Tong Li was drained and Da Zhong was supplemented. After this acupuncture, moxibustion was used for 3-5 min- utes on Guan Yuan. This was done one time per day, and six days equaled one course of treatment. Study outcomes: Thirty-five cases were cured, 21 cases markedly improved, four cases improved, and two cases did not improve. According to the book, Bai Zheng Fu (Ode on the Hundreds of Symptoms), [For] tiredness to speak and liking to lie down, Tong Li and Da Zhong brightens [these]. The author uses this concept to treat enuresis because children with enuresis are often heavy sleepers and diffi- cult to wake up. The treatment of the kidney and heart channels with the points above promotes the interaction between the heart and the kidney and restrains the bladder. Moxibustion on Guan Yuan makes the kidneys exuberant and boosts the kidney qi, securing and containing the lower origin. From The Treatment of 38 Cases of Enuresis with Acupuncture & Moxibustion on the Point Hui Yin (CV 1) by Xu Yi-jing et al. Treatment method: The patient lied down on his or her back with both knees flexed. After disinfecting the point Hui Yin (CV 1), it was needled perpen- dicularly to a depth of 1-1. Then moxibustion was applied for five minutes until the patient felt heat coursing upward to the face and head. Then the needle was inserted at a 15˚ angle under the skin forward, after which it was moxaed for another five min- utes. Now the patient was supposed to feel a warm sensation in their lower abdomen. Finally, the needle was inserted at a 15˚ angle under the skin backward, and again the point was moxaed for five minutes. At this time, the patient was supposed to feel warmth in their lumbar region. One treatment lasted approximate- ly 20 minutes, and this treatment was given once per day for three times. Study outcomes: All 38 cases in this study were cured in 1-2 courses of treatment. Discussion: Hui Yin is the meeting place of the conception vessel, the sea of yin, the governing vessel, the sea of yang, and chong mai, the sea of blood. Therefore, acupuncture and moxibustion on this point can regulate yin and yang and harmonize qi and blood as well as having an effect on the cerebral cortex. From A Comparison Study of Acupuncture & Massage and Chinese Medicinals in the Treatment of Occult Spina Bifida Enuresis by Xue Hong & Hu Jun-xia, Liao Ning Zhong Yi Za Zhi (Liaoning Journal of Chinese Medicine), 2001, #8, p. These patients were randomly divided into two equal groups—an acupuncture massage treatment group and a Chinese medicine comparison group.

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