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Ureteric • Calculi purchase floxin 400 mg with mastercard antibiotics for uti safe for pregnancy, blood clot discount floxin american express antibiotic resistance food safety, sloughed papillae buy floxin discount antibiotic doxycycline, cancer, external compression. Pathophysiology: • Hypovolemia leads to glomerular hypoperfusion, but filtration rate are preserved during mild hypoperfusion through several compensatory mechanisms. Urine and blood Chemistry: most of these tests help to differentiate prerenal azotemia, in which tubular reabsorption function is preserved from acute tubular necrosis where tubular reabsorption is severely disturbed. Thus, a high ratio is highly suggestive of prerenal disease as long as some other cause is not present. Radiography/imaging • Ultrasonography: helps to see the presence of two kidneys, for evaluating kidney size and shape, and for detecting hydronephrosis or hydroureter. Preliminary measures • Exclusion of reversible causes: Obstruction should be relived, infection should be treated • Correction of prerenal factors: intravascular volume and cardiac performance should be optimized • Maintenance of urine output: although the prognostic importance of oliguria is debated, management of nonoliguric patients is easier. High doses of loop diuretics such as Furosemide (up to 200 to 400 mg intravenously) may promote diuresis in patients who fail to respond to conventional doses. Initial rates of replacement are guided by estimates of bicarbonate deficit and adjusted thereafter according to serum levels. Absolute indications for dialysis include: ¾ Symptoms or signs of the uremic syndrome ¾ Refractory hypervolemia 313 Internal Medicine ¾ Sever hyperkalemia ¾ Metabolic acidosis. Chronic Renal Failure Learning objectives: at the end of this lesson the student will be able to : 1. Refer patients with Chronic renal failure to better facilities, Definitions Chronic Renal failure : progressive and irreversible reduction of the renal function, over a period of more than 6 months, to a level less than 20 % of the normal, as a result of destruction of significant number of nephrons. Prerenal causes • Sever long standing renal artery stenosis • Bilateral renal artery embolism 2. Early additional clinical and laboratory manifestations of renal insufficiency may occur. These may include nocturia, mild anemia and loss of energy, decreasing appetite and early disturbances in nutritional status. Fluid, electrolyte and acid base disturbance a) Volume expansion and contraction (edema, dehydration) • As long as water intake does not exceed the capacity for free water clearance, the extra cellular fluid volume expansion will be isotonic and the patient will remain normonatremic. On the other hand, hyponatremia will be the consequence of excessive water ingestion. With advancing renal failure, total urinary net daily acid excretion is usually reduced markedly. Renal osteodetrophy and Metabolic bone disease: • Is due to disturbance in bone phosphate and calcium metabolism. Note that the low serum level of Ca is attributed to secondary hyperparathyroidism. The abnormal vitamin D metabolism may be related to the renal disease itself (since the active vitamin D metabolite is normally produced in the proximal tubule) and to the hyperphosphatemia, which has a suppressive effect on the renal 1α-hydroxylase enzyme. Some of the resulting bony abnormalities are o Ostitis fibrosa cystica : is due to osteoclastic bone resorption of specially terminal phalanges, long bones and distal end of clavicle o Renal rickets ( Osteomalacia ) o Osteosclerosis : enhanced bone density in the upper and lower margins of vertebrae 3. Cardiovascular complications a) Congestive heart failure and/or pulmonary edema : it may be due to • Volume over load • Increase pulmonary capillary permeability b) Hypertension : • Is the most common complication of end stage renal disease. Neuromuscular abnormalities Early stage: irritability, inability to concentrate drowsiness, insomnia Intermediate stage: • Mild behavioral change, poor judgment • Neuromuscular irritability: hiccup, cramps, fasciculation, twitching of muscles Terminal stage: • Asterixis, myoclonus, chorea, seizure • Stupor which may even lead to coma • Peripheral neuropathy : distal sensory polyneuropathy o Restless leg syndrome : ill defined sensation of discomfort on the legs 6. Gastro intestinal abnormalities • Early symptoms : anorexia, hiccup, nausea and vomiting • Uremic fetor: the patient’s breathe smells like urine. Endocrine and Metabolic abnormalities • Hypogonadism is common o In men : decreased plasma testosterone level, impotence m oligospermia o In women: amenorrhea, inability to carry pregnancy to term. Dermatologic abnormalities ; • Pallor due to anemia • Echymosis, hematoma ++ 0 • Pruritis, and excoriation (Ca deposits and 2 hyperparathyroidism) • Yellowish declaration of skin : urochromes • Uremic frost: is seen in advanced uremia o It is due to high concentration of urea in the sweat, and after evaporation of the sweat, a fine white powder can be found on the skin surface. Physical Examination: - • Particular attention should be paid to: • Blood pressure • Funduscopy • Precordial examination • Examination of the abdomen for bruits and palpable renal masses • Extremity examination for edema • Neurologic examination for the presence of asterixis, muscle weakness, and neuropathy • In addition, the evaluation of prostate size in men and potential pelvic masses in women should be undertaken by appropriate physical examination. Diagnostic work up • These should also focus on a search for clues to an underlying disease process and its continued activity. The occurrence of normal kidney size suggests the possibility of an acute rather than chronic process. However in some diseases, chronic renal failure may be present with normal sized or even enlarged kidneys. Amyloidosis, polycystic kidney diseases, Diabetic nephropathy Management of chronic renal failure the general management of the patient with chronic renal disease involves the following issues 1) Treatment of reversible causes of renal dysfunction 2) Preventing or slowing the progression of renal disease 3) Treatment of the complications of renal dysfunction 4) Identification and adequate preparation of the patient in whom renal replacement therapy will be required 1. Treating reversible causes of renal dysfunction – In addition to exacerbation of their original renal disease, patients with chronic renal disease, with a recent decrease in renal function may be suffering from an underlying reversible process such as : o Hypotension or dehydration o Administration of nephrotoxic drugs o Urinary tract obstruction 323 Internal Medicine o Sever hypertension o Infection • Correcting these reversible causes can improve the renal function. Treatment of the complications of renal dysfunction : a) Volume overload – • Dietary sodium restriction • Diuretic therapy, usually with a loop diuretic given daily. An intake of 324 Internal Medicine about 800 mg/day may be desirable but can be accomplished only by limiting protein intake. Thiazide diuretics have additive effect when administered with a loop diuretic for refractory edema. Overall, the diet of most patients with chronic renal failure should provide approximately 30 to 35 kcal/kg per day. Preparation for renal replacement Therapy o Education o Informed choice of renal replacement therapy i. Urinary Tract infection Learning Objective: At the end of this unit the student will be able to 1. Describe the most commonly used tests for the diagnosis of urinary tract infections. In most instances, growth of more than 10 organisms per milliliter from a properly collected midstream "clean-catch" urine sample indicates infection. Chronic pyelonephritis: refers to chronic interstitial nephritis believed to result from bacterial infection of the kidney. Catheter-associated (or nosocomial) infections and • the vast majority of acute symptomatic infections involve young women. Ascent of bacteria from the bladder may follow and is probably the pathway for most renal parenchymal infections. Whether bladder infection ensues depends on interacting effects of the pathogenicity of the strain, the inoculum size, and the local and systemic host defense mechanisms. Metastatic staphylococcal or candidal infections of the kidney may follow bacteremia or fungemia, spreading from distant foci of infection in the bone, skin, vasculature, or elsewhere. Gender and Sexual Activity: • the female urethra appears to be particularly prone to colonization with colonic gram-negative bacilli because of its proximity to the anus, its short length (about 4 cm), and its termination beneath the labia. Pregnancy: • Is clearly associated with altered uretheral smooth muscle function and higher incidence of asymptomatic bacteriuria and 20 to 30% of pregnant women with asymptomatic bacteriuria subsequently develop pyelonephritis. Symptomatic upper urinary tract infections, in particular, are unusually common during pregnancy. Vesicoureteral reflux: • Defined as reflux of urine from the bladder cavity up into the ureters and sometimes into the renal pelvis. Obstruction: Any impediment to the free flow of urine caused tumor, stricture, stone, or prostatic hypertrophy results in hydronephrosis.

Interventions/implementation • Collect stool properly; inform the client about the sample • Type • Time • Volume/ amount • Number of sample • Administer medication as prescribed buy genuine floxin online antibiotics youtube. Mebendazole buy online floxin antibiotics for sinus infection ceftin, Niclosamide • Give health education on how to prevent parasitic infection on: • Personal hygiene • Breast feeding • Environmental sanitation • Boiling water • Mobilize the community to act together purchase floxin once a day antimicrobial clothing. Make sure that the necessary understanding and motivation are attained to prevent diseases. Active participation is expected from nurses to prevent transmission of intestinal parasitosis and promote health. Evaluation- use outcome criteria for achievement of goals, as follows: - Client will regain normal bowel function and resume regular nutritional intake. Which of the following information is irrelevant during the collection of stool specimens for the diagnosis of intestinal parasites? Which of the following is neither a promotive nor a preventive measure for intestinal parasitosis? During evaluation of treatment outcomes in patients with intestinal parasites the nurse should expect all the following except: A. Task Analysis - Take brief history of the patient including present and past medical history. Purpose and brief description of the module This satellite module on intestinal parasitosis, unlike the core module, is specific to the field of environmental health. Thus, its purpose is to equip environmental health students with the basic knowledge of preventing and controlling the diseases caused by medically important intestinal parasites, special emphasis being given to those prevalent in Ethiopia. The module is also believed to help the instructor to prepare and deliver lecture easily, saving ample time for discussion, as this will also give the students a chance to read these materials prior to the classroom sessions. Directions for use Students are advised to go first through the core module for a general understanding of the subject matter. Then read and understand the learning objectives of the satellite module and their significance. Read through the topics of the satellite module & refer to the core module where ever necessary. Do the post test and re-evaluate yourself, compare your answers with the answer keys given at the end. Significance and brief description of the problem Most intestinal parasitic infections are discussed under the core module in detail. Thus, students are advised to refer to it prior to reading this satellite module and whenever necessary. Gastrointestinal diseases including those caused by intestinal parasites rank first among the prevalent communicable diseases in Ethiopia, as in other developing countries. Thus, the first strategy in fighting against such communicable diseases should be prevention through environmental sanitation interventions. This entails the concerted effort of all categories of health workers, whereas environmental health workers are supposed to play significant roles. These 108 roles of environmental sanitation, especially safe and adequate water supply and proper excreta disposal, have been shown to be effective in the prevention and control of parasitic diseases. This in turn necessitates equipping the environmental health students with the required knowledge and skill, for which this satellite module (together with the core module) is designed to achieve this major objective. Which of the following are possible source(s) of fecal contamination of food and water? Which of the following is not true about the prevention of Intestinal protozoan infection? Which of the following is the possible mode of transmission of intestinal nematodes? Which of the following is not true about the prevention and control of intestinal nematode infection? Which of the following preventive measure is most effective in controlling all intestinal cestodes? Which of the following environmental factor is related to the transmission of intestinal trematodes? Which of the following methods of prevention and control of intestinal trematodes is the most effective one? Which of the following category of professionals is necessary for effective prevention and control of intestinal trematode infection? Multi-sectoral approach in the eradication of the intermediate hosts & treatment of patients. Describe the medically important intestinal parasites in terms of reservoir hosts and modes of transmission. Identify those environmental factors that are associated with the transmission of intestinal parasitosis 3. Plan and implement preventive and control measures, more focus being given to environmental sanitation and environmental management. Intestinal protozoa Definition- See core module Etiology - See core module Pathogenesis- See core module Epidemiology - See core module Clinical manifestations - See core module Diagnosis - See core module Treatment - See core module Prevention and Control 1) Primary prevention. I) Environmental sanitation the measures aimed at primary prevention centre around preventing contamination of water, food, vegetables and fruits with human faeces. A) Sanitation: Safe disposal of human excreta coupled with the practice of washing hands after defecation and before eating are crucial factors in the prevention and control of intestinal protozoa. Prevention is possible through: • Sand filtration of the water to remove cysts • Boiling of drinking water to kill cysts • Chlorination of water (disinfection of water) the cysts are not killed by chlorine in amounts used for water disinfection. Therefore, the concentration of chlorine should be increased; especially for emergency water supplies. C) Food hygiene: Environmental measures should also include the protection of food and drink against contamination. Uncooked vegetables and fruits can be disinfected with aqueous solution of acetic acid (5-10 percent) or full strength vinegar. In most instances, thorough washing with detergents in running water will remove cysts from fruits and vegetables. Since food handlers are major transmitters of protozoa’s, they should be periodically examined, treated and educated in food hygiene practices such as hand washing. Fly control and protection of foods against fly contamination by proper screening and other appropriate means to prevent flies which act as cyst carriers. If a common vehicle is identified such as water or food; appropriate measures should be taken to correct the situation. Intestinal nematodes Definition- See core module Etiology - See core module Pathogenesis- See core module Epidemiology - See core module Clinical manifestations - See core module Diagnosis - See core module Treatment - See core module Prevention and control A. Preventing the fecal contamination of top soil by: • Sanitary disposal of human excreta through installation of sewage disposal system and promoting the use of “sanitary latrines”.

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The support group provides information that arms the patient with tools to manage his condition order floxin 400mg free shipping bacteria pilorica, and offers encouragement to reach goals (i order 200mg floxin visa antibiotics buy online. Goals can also be related to identity in the sense that they take into account the individual’s definitions of commitments and responsibilities in relation to other people and their social relationships with these people purchase floxin 400 mg with mastercard antibiotics for acne cost. Identity levels include the supernormal social identity that reflects an identity that requires extraordinary behavior and achievement; the restored self that reconstructs identities prior to the illness; the contingent personal identity that hinges on the uncertainty of identity due to the illness; and the salvaged self that one retains because that part of identity was 26 valued at some point. Other identities, such as mother, wife and teacher may supersede the illness identity, in terms of motivational influence to engage in self- care, or the roles associated with these other identities may cause the individual 24 to push themselves beyond their bodily limitations. Self-efficacy can be enhanced through role modeling or finding models with whom the person can identify and also by increasing persuasive communication that can improve the individual’s 92 confidence. The influence of self-esteem on goal setting has been demonstrated in 96 studies of employees, and the same concepts can be applied to patients to encourage goal setting with respect to taking medications and achieving acceptable HbA1c levels. A strong social identity is a part of an individual’s high self-esteem and can be viewed as a moderator of self-set goals. Social identification interacts with the self-esteem of in-group members to influence goals. Goal setting defines the basic motivation for and gives purpose to one’s 96 behavior. Self-esteem (how favorable an individual’s characteristic self- evaluation is) has also been linked to setting goals. Individuals with high self- esteem place more demand on their abilities to perform and set more difficult goals. In self-set goals (goals that the individual sets for himself), individuals, 96 regardless of self-esteem, set equivalent goals. A study on 422 patients with type 2 diabetes with the objective of determining the frequency and effectiveness of goal choices in managing diabetes was conducted using mail and telephonic support over a period of six 82 94 months. The hypotheses of the study were that self-selection of goals and behavioral specificity is key to enhancing persistence of goals. By allowing patients to choose their goal, the patient will choose the goal that corresponds to an area that they need the most improvement in and also will result in a greater change in behavior. Goals included to reduce fat intake (<30% of calories consumed per day), to increase fruit and vegetable consumption (5-9 per day) or to increase physical activity (150 minutes of moderate-intensity physical activity per week). Goals were selected, barriers were identified and strategies to overcome barriers using an interactive computer program. Goal-related feedback was given during a counseling session with a trained medical assistant. A follow-up phone call was conducted two weeks later to review progress and provide feedback. Almost half of the population chose activity goals, one quarter chose increase in fruit and vegetable consumption and to reduce fat intake. For each goal, there were significant differences whereby the individuals who selected a particular goal were different from those that did not, because they were not currently achieving that particular goal. All participants significantly reduced the amount of fat in their diet, but those that selected that goal had a larger decrease. Participants that chose to increase fruit and vegetable consumption significantly increased consumption. There was a significant increase in physical activity for participants that selected that goal. Some limitations of this study are that the goals selected for the study were very narrow and there were only three to choose from, which may have limited the population and also not represent the goals for all patients with diabetes. The “self- 83 selection” process used in the study and the limited number and scope of goals (dietary and physical activity) might not mimic a true self-selection process that would allow for even more specific goals. The literature on goal setting states that setting goals is effective for changing and maintaining new behaviors. For patients with diabetes, whether they are newly diagnosed and have to change diet and lifestyle behaviors, or for longtime patients that are struggling to manage their condition, goal setting could 94 play an important role in the self-management of this chronic condition. Personality attributes most oft studied in persons with diabetes include locus of control, the self-concept or self-esteem, and coping mode. Research on self- concept has shown that positive self-esteem results in better psychosocial adjustment to diabetes. Positive self-concept has also been correlated with 97,98 adherence Goal setting increases the patient’s self-efficacy in self-management behaviors. Goal setting support should help make the patient responsible and 93 accountable for managing his health. When monitoring goals, adjustments in strategies or effort may be needed over time. Self efficacy has received much empirical support in its relationship to health behaviors, particularly medication taking behaviors. Individuals with greater levels of self- efficacy were less likely to skip doses of medication. Self-efficacy explained 4- 10% of the variance in diabetes self-care behaviors in a total of 309 patients with 100 type 2 diabetes. Self-efficacy was found to be a significant predictor of adherence to diabetes treatment for both insulin-dependent and non-insulin dependent patients with diabetes. Self-efficacy has been shown to predict behavior change that is maintained over a period of time. Self-efficacy was measured by asking the confidence level of the participants regarding adherence 101 to a diabetes treatment regimen over an eight week period. Self efficacy has received much empirical support in its relationship to health behaviors, particularly medication taking behaviors. Individuals with greater levels of self- efficacy were less likely to skip doses of medication. Self-efficacy explained 4- 10% of the variance in diabetes self-care behaviors in a total of 309 patients with 100 type 2 diabetes. Goals can be related to identity because they account for the individual’s commitment and responsibility to other people, which can be preserved, if the person achieves the goal. For the purpose of this study, goals in the model and hypotheses refer to the patient’s and potentially the group’s goals with respect to 85 self-managing diabetes. This study intends to focus on the support that the patient receives from other patients with diabetes and diabetes educators and/or moderators of diabetes support groups. The hypotheses suggest that individuals who identify with a support group are more likely to socially identify with their illness, and receive the support necessary to increase self-esteem and self- efficacy to set goals. Due to the nature of self-efficacy and the ability to modify one’s self- efficacy, any interventions that center on improving self-efficacy can have tremendous implications for improving health outcomes for chronically ill 102 patients. As a possible intervention, incorporating the use of a support group in chronic disease management can improve self-efficacy in many ways.

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