Eriacta

By S. Rasarus. Southeastern University.

The Adrenal Glands The adrenal (suprarenal) glands are paired yellowish masses of tissue situated at the superior pole of each kidney buy eriacta 100 mg overnight delivery. Each gland consists of two distinct entities−an outer adrenal cortex and an inner adrenal medulla−that differ in embryologic origin, character, and function. It remains functionally associated with the sympathetic nervous system, being essentially a modified sympathetic ganglion whose postganglionic neurons have lost their axons and become secretory. The medullary cells, often termed chromaffin cells because their granules possess affinity for chromium salts, secrete the catecholamine hormones epinephrine (adrenaline) and norepinephrine (noradrenalin). The principal secretory product is epinephrine, with norepinephrine normally accounting for only 20% of the total secretion. Adrenal medullary secretion of the catecholamines is physiologically controlled by the posterior hypothalamus. The catecholamines also elevate the metabolic rate (calorigenic action), stimulate the central nervous system, increase alertness, and stimulate respiration. The cells of the adrenal cortex, which are arranged in continuous cords separated by capillaries, are characterized by an abundance of mitochondria, endoplamic reticulum, and accumulation of lipid. Adrenal cortical tissue is structurally arranged into three concentric regions or zones: a thin outer zona glomerulosa, a thick middle zona fasciculate, and an inner zona reticularis bordering on the adrenal medulla. The adrenocorticoid hormones are usually divided into three functional groups: the mineralocorticoids, such as aldosterone, which regulate electrolyte and water balance; the glucocorticoids, such as cortisol, which affect carbohydrate, protein, and fat metabolism; and the adrenogenital steroids or sex hormones. The adrenogenital steroids are of three types: androgens (such as dehydroepiandrosterone), estrogens (such as estradiol), and progestins (such as progesterone). Excessive secretion of adrenal androgens results in precocious pseudopuberty in boys, and causes masculinization of females (adrenogenital syndrome). The plasma 236 Human Anatomy and Physiology concentrations of sodium and potassium are involved in the control of aldosterone secretion. Hyperkalemia (elevated plasma potassium) exerts a direct stimulating effect on the zona glomerulosa, whereas hyponatremia (low plasma sodium) activates the rennin-angiotensin mechanism. Aldosterone plays a major physiologic role in the maintenance of electrolyte and fluid balance by promoting the renal tubular reabsorption of sodium and the secretion of potassium and hydrogen. A similar sodium-retaining, potassium-excreting action is exerted on other target tissues, including salivary glands and sweat glands. A similar sodium-retaining, potassium-excreting action is exerted on other target tissues, including salivary glands and sweat glands. When present in large amounts, these hormones favor redistribution of adipose stores by promoting loss of fat from the extremities, and accumulation of fat depots in central body regions (e. Other permissive effects include support for the metabolic actions (particularly lipolysis) of the catecholamines and glucagons. These hormones also stimulate erythropoiesis and elevate circulating levels of platelets and neutrophils. The Sex Glands The sex glands, the ovaries of the female and the testes of the male, not only produce the sex cells but are also important 239 Human Anatomy and Physiology endocrine organs. The hormones produced by these organs are needed in the development of the sexual characteristics, which usually appear in the early teens and for the maintenance of the reproductive apparatus once full development has been attained. The main androgen produce by the male sex glands, testosterone, is responsible for the growth of and functioning of the male reproductive tract. Testosterone is also responsible for male secondary sex characteristics such as a deep voice and facial hair. In the female, the hormones that most nearly parallel testosterone in their actions are the estrogens. Estrogens contribute to the development of the female secondary sex characteristics and stimulate the development of the mammary glands, the onset of menstruation, and the development and functioning of the reproductive organs. The other hormone produced by the female sex glands, called progesterone, assists in the normal development of pregnancy. Through the production of a hormone called thymosin, it helps in the development of certain white blood cells, called T- lymphocytes that help protect the body against foreign organisms. Because this gland is most active before birth and early in life, it is large during childhood but gradually shrinks in size as one reach adulthood. The Pineal Gland The pineal gland, a small, flattened, cone-shaped structure located between the two parts of the thalamus, produces a hormone called melatonin in a number of animals and also in humans. Melatonin, or some other hormone from the pineal, is thought to regulate the release of certain substances from the hypothalamus, which may in turn regulate the secretion of gonadotropins from the pituitary. There is evidence from animal studies that the production of melatonin is regulated by the amount of light in the environment. Selected Key Terms The following key terms are defined in the Glossary: Anastomosis Diastole Leukaemia Systole Aorta Endocardium Leukocyte Valve Arteriole Endothelium Murmur Vein Artery Epicardium Myocardium Vena cava Atrium Erythrocyte Pericardium Ventricle Capillary Fibrin Plasma Venule Coagulation Haemoglobin Platelet Coronary Hematocrit Pulse Deptum Hemolysis Serum 244 Human Anatomy and Physiology The cardiovascular system is the transport system of the body by which food, oxygen, water and all other essentials are carried to the tissue cells and their waste products are carried away.

Enseñar la auscultación de las principales arterias y las heridas en trayecto vascular generic eriacta 100mg visa. Debemos empezar con este necesario momento en el proceso diagnóstico, no debemos precipitadamente pretender un examen físico y mucho menos, dispararnos a indicar complementarios, sin conocer en qué sentido dirigirnos, en los que no estaría claro qué pretenderíamos buscar. El interrogatorio brinda, digamos, 80 % de los elementos para acercarnos al diagnóstico de la enfermedad que aqueja a nuestro enfermo. De este racional esquema extraeremos para realizar el examen físico de las enfermedades vasculares periféricas tres aspectos fundamentales, que habitualmente escribimos aparte, en la llamada sección de Angiología: 15 1. Sistema arterial El examen físico aporta al proceso diagnóstico, sin ser matemáticos, alrededor de 15 %. Sólo deben surgir en el pensamiento del médico después de la conversación y el examen físico. Existe una desacertada tendencia de indicar estos estudios casi en el mismo momento en que el enfermo se sienta enfrente del médico buscando su ayuda. Esta práctica, un tanto generalizada dada la novedosa y cada vez más segura tecnología, de indicar complementarios antes que todo, es absurda y los convierte en “suplementarios”, porque de esa manera no complementarían nuestro pensamiento lógico, sino que lo suplirían. En la práctica diaria, en el consultorio, la mayoría de los enfermos no necesitan ningún tipo de complementario. Un número relativamente pequeño de pacientes necesitarán unos pocos complementarios “habituales”, como un hemograma, un análisis de orina o una radiografía de tórax. Finalmente, un paciente en un grupo numeroso de enfermos, no completamente cuantificado, necesitará de algún complementario sustentado por alta tecnología, que no debemos desgastar innecesariamente por comodidad, superficialidad o complacencia. Para completar esta relativa cuenta, puede decirse que los complementarios aportan 5 % del proceso diagnóstico. En el caso de las inferiores debemos conocer que son las “dos columnas” en las que se erige “el edificio” corporal. El cuerpo humano es el único edificio levantado sobre dos columnas y la posición erecta no es para nada el resultado estático de dos cilindros sustentando uno mayor, sino una combinación sutil de estructuras y funciones que se ponen de acuerdo mediante contracciones agónicas y antagónicas que de forma imperceptible, automática y casi desconocida logran la bipedestación. En esta mirada general deben coincidir en altura y casi tocarse: tobillos, pantorrillas y rodillas. Luego precisamos los hallazgos de abajo hacia arriba: El pie El pie es una compleja estructura de sostén y marcha. Estos dedos mal denominados “artejos” por la práctica diaria, pueden estar en “gatillo”, engarrotados. En este caso la superficie de su última falange apoya con gran fricción sobre el zapato en ocasión de la marcha y la trastornan, al tiempo que se lesionan. Su base articula con la cabeza del primer metatarsiano que es el punto de apoyo común para ambos arcos del pie, el transversal y el longitudinal. Su base, al ser punto de apoyo, es particularmente resentida por las neuropatías, con mayor frecuencia la diabética. Proporcionalmente recibe menos sangre que los restantes que la reciben también desde los lados. Al estar en el extremo interno, los zapatos nuevos, o apretados, lo erosionan, en ocasiones gravemente. Los 3 puntos de apoyo son: las cabezas de los metatarsianos 1ro y 5to y el calcáneo. Los 2 arcos son: transversal entre las cabezas, longitudinal entre la cabeza del 1ro y el calcáneo. Esta configuración, de la que no dispone quien tiene el pie plano, asegura una marcha mullida, elástica y elegante. Aumento de volumen Si al examen físico una extremidad, solo una, está aumentada de volumen, entonces sin lugar a dudas, tiene: 1. Trastorno en el retorno venoso o linfático o ambos Si son las dos extremidades las aumentadas de volumen, entonces esta posibilidad pasa al quinto lugar: 1. Trastorno en el retorno venoso o linfático o ambos Cambios de coloración ¾ Palidez En una extremidad: sugiere enfermedad arterial. El sistema venoso de las extremidades tiene un componente profundo y otro superficial En los miembros inferiores, cuando se afecta el sistema profundo es en general por las trombosis. En las trombosis venosas profundas el aumento de volumen de la pierna o de toda la extremidad es el signo más frecuente y evidente. A partir de este párrafo hacemos nuestro juramento ético: “Juro por mi honor de médico que nunca más inventaré los pulsos arteriales” El sistema arterial se explora con el paciente acostado. La mano derecha del explorador sobre la pedia derecha, la mano izquierda sobre la pedia izquierda. La arteria pedia se busca en el dorso del pie, hacia su porción superior, por fuera del tendón del extensor del dedo grueso. Más bien es que su tronco se divide en las ramas terminales antes de alcanzar el dorso del pie.

There are also mesangial cells in the filtration membrane that can contract to help regulate the rate of filtration of the glomerulus purchase eriacta 100 mg visa. Overall, filtration is regulated by fenestrations in capillary endothelial cells, podocytes with filtration slits, membrane charge, and the basement membrane between capillary cells. The result is the creation of a filtrate that does not contain cells or large proteins, and has a slight predominance of positively charged substances. In response to the concentration of Na in the fluid flowing past them, these cells release paracrine signals. In other words, when osmolarity goes up, filtration and urine formation decrease and water is retained. When osmolarity goes down, filtration and urine formation increase and water is lost by way of the urine. A second function of the macula densa cells is to regulate renin release from the juxtaglomerular cells of the afferent arteriole (Figure 25. Active renin is a protein comprised of 304 amino acids that cleaves several amino acids from angiotensinogen to produce angiotensin I. Aldosterone + stimulates Na reabsorption by the kidney, which also results in water retention and increased blood pressure. Simple cuboidal cells form this tubule with prominent microvilli on the luminal surface, forming a brush border. These microvilli + – create a large surface area to maximize the absorption and secretion of solutes (Na , Cl , glucose, etc. Loop of Henle The descending and ascending portions of the loop of Henle (sometimes referred to as the nephron loop) are, of course, just continuations of the same tubule. They run adjacent and parallel to each other after having made a hairpin turn at the deepest point of their descent. The descending loop of Henle consists of an initial short, thick portion and long, thin portion, whereas the ascending loop consists of an initial short, thin portion followed by a long, thick portion. As you will see later, these are important differences, since different portions of the loop have different permeabilities for solutes and water. Collecting ducts merge as they descend deeper in the medulla to form about 30 terminal ducts, which empty at a papilla. Most, if not all, cells of the body contain aquaporin molecules, whose channels are so small that only water can pass. The function of all aquaporins is to allow the movement of water across the lipid-rich, hydrophobic cell membrane (Figure 25. You will discover that different parts of the nephron utilize specific processes to produce urine: filtration, reabsorption, and secretion. You will learn how each of these processes works and where they occur along the nephron and collecting ducts. The physiologic goal is to modify the composition of the plasma and, in doing so, produce the waste product urine. On average, this liter results in the production of about 125 mL/min filtrate produced in men (range of 90 to 140 mL/min) and 105 mL/min filtrate produced in women (range of 80 to 125 mL/min). Ninety-nine percent of this filtrate is returned to the circulation by reabsorption so that only about 1–2 liters of urine are produced per day (Table 25. Calculating Urine Formation per Day Flow per minute Calculation (mL) Cardiac output is about 5000 mL/minute, of which 21 percent flows through the Renal kidney. Recall that filtration occurs as pressure forces fluid and solutes through a semipermeable barrier with the solute movement constrained by particle size. Osmosis is the movement of solvent (water) across a membrane that is impermeable to a solute in the solution. This creates a pressure, osmotic pressure, which will exist until the solute concentration is the same on both sides of a semipermeable membrane. Glomerular filtration occurs when glomerular hydrostatic pressure exceeds the luminal hydrostatic pressure of Bowman’s capsule. There is also an opposing force, the osmotic pressure, which is typically higher in the glomerular capillary. To understand why this is so, look more closely at the microenvironment on either side of the filtration membrane. You will find osmotic pressure exerted by the solutes inside the lumen of the capillary as well as inside of Bowman’s capsule. Since the filtration membrane limits the size of particles crossing the membrane, the osmotic pressure inside the glomerular capillary is higher than the osmotic pressure in Bowman’s capsule. Recall that cells and the medium-to-large proteins cannot pass between the podocyte processes or through the fenestrations of the capillary endothelial cells. This means that red and white blood cells, platelets, albumins, and other proteins too large to pass through the filter remain in the capillary, creating an average colloid osmotic pressure of 30 mm Hg within the capillary. The absence of proteins in Bowman’s space (the lumen within Bowman’s capsule) results in an osmotic pressure near zero. Thus, the only pressure moving fluid across the capillary wall into the lumen of Bowman’s space is hydrostatic pressure.

Collecting Blood Specimen 101 Basic Clinical Nursing Skills The hospital laboratory technicians obtain most routine blood specimens generic eriacta 100 mg on line. Patient preparation 102 Basic Clinical Nursing Skills • Instruct the pt what to expect and for fasting (if required) • Position the pt comfortably 2. Obtain specimen of the venous to blood • Adjust the syringe and needles • Clean/disinfect the area with alcohol swab, dry with sterile cotton swab • Puncture the vein sites • Release the tourniquet when you are sure in the vein • Withdraw the required amount of venous blood specimen 103 Basic Clinical Nursing Skills • Withdraw the needle and hold the sites with dry cotton (to apply pressure) • Put the blood into the specimen container • Made sure not to contaminate outer part of the container and not to distract the blood cells while putting it into the container 4. Care of the specimen and the equipment • Label the container • Shake gently (if indicated to mix) • Send immediately to laboratory, accompanying the request • Give care of used equipments 6. Chart Definition: it is a written record of history, examination, tests, diagnosis, and prognosis response to therapy Purpose of Patients Chart a. For diagnosis or treatment of a patient while in the hospital (find after discharge) if patient returns for treatment in the future time b. For serving an information in the education of health personnel (medical students, interns, nurses, dietitians, etc) e. For promoting public health General Rules for Charting • Spelling Make certain you spell correctly 105 Basic Clinical Nursing Skills • Accuracy Records must be correct in all ways, be honest • Completeness No omission, avoid unnecessary words or statement • Exactness Do not use a word you are not sure of • Objective information Record what you see avoid saying (condition better) • Legibility Print/write plainly and distinctively as possible • Neatness No wrinkles, proper speaking of items Place all abbreviation, and at end of statement • Composition / arrangement Chart carefully consult if in doubt avoid using of chemical formulas • Sentences need to be complete and clear, avoid repetition • Don’t overwrite • Don’t leave empty spaces in between • Time of charting Specific time and date • Color of ink Black or blue (red for transfusion, days of surgery) 106 Basic Clinical Nursing Skills It should be recorded on the graphic sheet All orders should be written and signed. Verbal or telephone orders should be taken only in emergency verbal orders should be written in the order sheet and signed on the next visit. Laboratory and other diagnostic reports • Patients or relatives and friends of patients are not allowed to read the chart when necessary but can have access if allowed by patient. Purpose: • To replace fluid losses 107 Basic Clinical Nursing Skills • To provide maintenance requirements • To check for retention of body fluid Fluid balance sheet ♦ 24 hrs the intake out put should be compared and the balance is recorded ¾ Positive balance if intake >output Negative balance if out put >intake Study Questions 1. Closed bed: is a smooth, comfortable and clean bed, which is prepared for a new patient • In closed bed: the top sheet, blanket and bed spread are drawn up to the top of the bed and under the pillows. Open bed: is one which is made for an ambulatory patient are made in the same way but the top covers of an open bed are folded back to make it easier of a client to get in. To conserve patient’s energy and maintain current health status 110 Basic Clinical Nursing Skills Anesthetic bed: is a bed prepared for a patient recovering from anesthesia ⇒ Purpose: to facilitate easy transfer of the patient from stretcher to bed Amputation bed: a regular bed with a bed cradle and sand bags ⇒ Purpose: to leave the amputated part easy for observation Fracture bed: a bed board under normal bed and cradle ⇒ Purpose: to provide a flat, unyielding surface to support a fracture part Cardiac bed: is one prepared for a patient with heart problem ⇒ Purpose: to ease difficulty in breathing General Instructions 1. Linen for one client is never (even momentarily) placed on another client’s bed 111 Basic Clinical Nursing Skills 5. Soiled linen is placed directly in a portable linen hamper or a pillow case before it is gathered for disposal 6. Soiled linen is never shaken in the air because shaking can disseminate secretions and excretions and the microorganisms they contain 7. When stripping and making a bed, conserve time and energy by stripping and making up one side as completely as possible before working on the other side 8. To avoid unnecessary trips to the linen supply area, gather all needed linen before starting to strip bed 9. Vertical - make a fold in the sheet 5-10 cm 1 to the foot Horizontal – make a fold in the sheet 5-10 cm across the bed near the foot 10. Bed spread Note • Pillow should not be used for babies • The mattress should be turned as often as necessary to prevent sagging, which will cause discomfort to the patient. Closed Bed • It is a smooth, comfortable, and clean bed that is prepared for a new patient Essential Equipment: • Two large sheets • Rubber draw sheet • Draw sheet • Blankets • Pillow cases • Bed spread Procedure: • Wash hands and collect necessary materials • Place the materials to be used on the chair. Turn mattress and arrange evenly on the bed • Place bottom sheet with correct side up, center of sheet on center of bed and then at the head of the bed 113 Basic Clinical Nursing Skills • Tuck sheet under mattress at the head of bed and miter the corner • Remain on one side of bed until you have completed making the bed on that side • Tuck sheet on the sides and foot of bed, mitering the corners • Tuck sheets smoothly under the mattress, there should be no wrinkles • Place rubber draw at the center of the bed and tuck smoothly and tightly • Place cotton draw sheet on top of rubber draw sheet and tuck. The rubber draw sheet should be covered completely • Place top sheet with wrong side up, center fold of sheet on center of bed and wide hem at head of bed • Tuck sheet of foot of bed, mitering the corner • Place blankets with center of blanket on center of bed, tuck at the foot of beds and miter the corner • Fold top sheet over blanket • Place bed spread with right side up and tuck it • Miter the corners at the foot of the bed • Go to other side of bed and tuck in bottom sheet, draw sheet, mitering corners and smoothening out all wrinkles, put pillow case on pillow and place on bed • See that bed is neat and smooth • Leave bed in place and furniture in order • Wash hands 114 Basic Clinical Nursing Skills B. Occupied Bed Purpose: to provide comfort, cleanliness and facilitate position of the patients Essential equipment: • Two large sheets • Draw sheet • Pillow case • Pajamas or gown, if necessary Procedure: • If a full bath is not given at this time, the patient’s back should be washed and cared for • Wash hands and collect equipment • Explain procedure to the patient • Carry all equipment to the bed and arrange in the order it is to be used • Make sure the windows and doors are closed • Make the bed flat, if possible • Loosen all bedding from the mattress, beginning at head of the bed, and place dirty pillow cases on the chair for receiving dirty linen • Have patient flex knees, or help patient do so. With one hand over the patient’s shoulder and the shoulder hand over the patient’s knees, turn the patient towards you 115 Basic Clinical Nursing Skills • Never turn a helpless patient away from you, as this may cause him/her to fall out bed • When you have made the patient comfortable and secure as near to the edge of the bed as possible, to go the other side carrying your equipment with you • Loosen the bedding on that side • Fold, the bed spread half way down from the head • Fold the bedding neatly up over patient • Roll dirty bottom sheet close to patient • Put on clean bottom sheet on used top sheet center, fold at center of bed, rolling the top half close to the patient, tucking top and bottom ends tightly and mitering the corner • Put on rubber sheet and draw sheet if needed • Turn patient towards you on to the clean sheets and make comfortable on the edge of bed • Go to the opposite side of bed. Taking basin and wash cloths with you, give patient back care • Remove dirty sheet gently and place in dirty pillow case, but not on the floor • Remove dirty bottom sheet and unroll clean linen • Tuck in tightly at ends and miter corners • Turn patient and make position comfortable • Back rub should be given before the patient is turned on his /her back • Place clean sheet over top sheet and ask the patient to hold it if she/he is conscious 116 Basic Clinical Nursing Skills • Go to foot of bed and pull the dirty top sheet out • Replace the blanket and bed spread • Miter the corners • Tuck in along sides for low beds • Leave sides hanging on high beds • Turn the top of the bed spread under the blanket • Turn top sheet back over the blanket and bed spread • Change pillowcase, lift patient’s head to replace pillow. Loosen top bedding over patient’s toes and chest • Be sure the patient is comfortable • Clean bedside table • Remove dirty linen, leaving room in order Wash hands Bed Making Making a post operative bed o The entire bed need clean linen. Fanfold the top linens to the side so that they lay opposite from where you will place the client’s stretcher. Rational: A pillow may be contraindicated for a client, usually the physician or charge nurse will determine when it is safe for the client to have one. Mouth Care Purpose • To remove food particles from around and between the teeth • To remove dental plaque to prevent dental caries • To increase appetite • To enhance the client’s feelings of well-being • To prevent sores and infections of the oral tissue • To prevent bad odor or halitosis Equipments • Toothbrush (use the person’s private item. If patient has none use of cotton tipped applicator and plain water) • Tooth paste (use the person’s private item. If patient has none of use cotton tipped applicator and plain water) • Cup of water • Emesis basin • Towel • Denture bowel (if required) • Cotton tipped applicator, padded applicator • Vaseline if necessary Procedure 1.