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The hospital buildings should be structurally sound for ensuring safety for patients with physical limitations such as celexa 20mg line, blind order celexa 20mg visa, aged or handicapped order celexa 10mg online. The nursing personnel must be safety conscious and they should take all efforts to prevent accidents in the hospital. High temperature and humidity, poor ventilation too much noise, unpleasant odours and glaring lighting make the patient uncomfortable. For relaxation of abdominal muscles, when patients are in pain or after an abdominal operation, knees can be kept flexed by means of a knee rest. Other devices used as comfort measures are air rings or cotton rings and air cushions air mattress, water mattress are to prevent pressure ulcer. Mechanical Devices for comfort measures : To hospitals use many mechanical devices for ensuring safety/patients. Patients who require this safety measure are post operative patients, unconscious, semi­conscious mentally disturbed, sedated, blind or children or very old patients. Foot­boards: (Foot ­ rests): These are made of wood and are L shaped, so that one end can be slipped under the mattress to hold the other end in a firm upright position. The patient is placed in supine position to rest the bottoms of the feet flat against the surface of the foot­board (covered with sheet). Sand­bags: These are canvas, rubber or plastic bags filled with sand and are 1,5 and 10 lbs in weight. On either side of the feet to maintain the position of the feet on the foot board, immobilize the fractured limb. Hand rolls: These are made of cloth that is rolled into a cylinder about 4­5 inches long and 2­3 inches in diameter and stuffed firmly. These are used to keep the fingers form being held in a tight fist leading to flexion contracture in patients who are unable to move the hands due to paralysis, injury or disease. Thigh rolls: These are made by folding a sheet to a desired length of 2­3 feet and then rolled into a tight cylinder. These are used to support the hips and thighs, preventing them outward rotation and keeping the feet in good alignment, in case of paralysis, fracture of the femur or hip surgery. To use the roll, place the lose end (flap) under the patients hips and thighs with the role under the flap end and then tucking snugly along the hip and thigh. To use the cradle, Place it over the bottom bedclothes and the top bedclothes are then brought over the cradle. Restraints are devices used to prevent agitated patients, persons who get out of bed at night in their sleep and small children, from falling out of bed. Safety Measures : Patients should be safeguarded from fire accidents and from careless application of heat. Patient may get injured from careless application of hot water bags, electric pads and application of medications on the skin. Activities usually performed in an day like eating, dressing, grooming, bathing, brushing etc are called activities of daily living. When a person is not meet these activities, it is the care giver responsibilities to meet their needs. According to their health status the degree of assistance required will vary those who are recording sick needs total assistance in order to meet their daily needs. Exercise is the performance of physical exertion for improvement of health or the correction of physical deformity. Benefits of exercise : (1) Exercise strengths muscles (2) Helps to prevent constipation (3) Increases appetite (4) Improves sleep (5) Stimulates blood circulation (6) Improves lung ventilation (7) Prevents obesity (8) Promotes physical and mental well being. They are Active exercise: Active exercise is a type of physical activity accomplished by the patient without assistance. The performance of certain nursing procedures such as bathing the patient, giving back care and changing the position etc. An important point you have to bear in mind while moving patients is that you must observe correct body mechanic for your patients as well as for yourself. One nurse places her one hand under the patient’s shoulder and the other hand under the lumbar region. Then keep one arm under the lumbar region and the other under the thighs and move the middle part of the body of the side of the bed. Lastly place one arm under the things and the other under the ankles and move the lower part of the body to the side of the bed. Flex the right knee slightly keep one hand on the patient’s right shoulder and the other on his right hip and gently roll him to left lateral position. Moving patients from stretcher to bed: Keep the head of the stretcher at right angles to the foot of the bed. All stand on the same side of the stretcher one nurse places her arms under the patient’s head and shoulders, another keeps her anus under the hips, the third has her arms under the things and legs.

Sintayehu Abebe & Ato Dawit Yidegu respectively discount celexa 20mg visa, for their encouragement during the preparation purchase 10mg celexa. The valuable comments made during intra &inter-institutional review meetings by Hawassa & different university lecturers in the department of pharmacology &medical laboratory strengthened the lecture note trusted 40mg celexa. We like to thank also our secretory W/o Tadelech Beriso for her dedication in writing the drafts. At last our gratitude also extends to those who provided support &comments on various drafts during the preparation. Average life expectancy rose, due to better control of epidemics and infectious diseases. However, increased industrialization and agricultural development were the chief cause of pollution that had profound influences on our lives. Man, the other animals, & the plants in the modern world are increasingly being exposed to chemicals of an enormous variety. Nearly everyone is at risk of toxic exposures to hazardous substances in the ambient environment. In recent years, awareness of the problem of human & animal exposure to potentially toxic chemicals in our environment 1 Toxicology has grown. So toxicology has a very important role to play in modern society & consequently it is now growing rapidly as a new subject. It also deals with food and cosmetics for public consumption both in alive or dead victims. Paracelsus summarized his concept in the following famous phrase “All substances are poisons; there is none that is not a poison. From then on toxicology began in a more scientific manner & began to include the study of the mechanism of action of poisons. There are marked improvements in toxicological diagnosis (that ranges from screening to confirmatory tests), & management (production of antidote for them). Epidemiology The following toxicological data are derived from American association of poison control center. It is very difficult to find the primary data of poisoning in our country because most of the screening & confirmatory tests are not done routinely in our set up. Today, poisoning (both accidental and intentional), is a significant contributor to mortality and morbidity. It has been estimated that 7% of all emergency room visits are the result of toxic exposures. Household cleaner, over-the-counter 3 Toxicology and prescription drugs, cosmetics, and solvents comprise the most frequent human toxic exposures. Young children and elderly are most likely to be accidentally exposed to drugs or household chemicals at home. During adolescence and young adulthood the exposures are more likely to be intentional, either through suicide attempts or experimentation with drugs or alcohol. However, adult men have been reported to be more at risk of occupational exposures than adult woman. Route of entry of exposures reported was by mouth in most cases: 77% were the result of ingestion, 7. In general, nearly everyone is at risk of acute and chronic toxic exposures to hazardous substances in the ambient environment. Toxicologic terms and definitions A) Important toxicologic terms  Toxin- a poison of natural origin. It is a qualitative term which depends on the amount of chemical absorbed, severity of the exposure, dose & others. It can be acute (toxic event which occurs soon after acute or limited exposure), or chronic (apply to an event which occurs many weeks, months or years after exposure). B) Presence of mixtures Humans normally come in contact with several (or many) different chemicals concurrently or sequentially. The resulting biologic effect of combined exposure to several agents can be characterized as synergistic, additive, Potentiation & antagonistic Synergism-when the effect of two chemicals is greater than the effect of individual chemicals e. Antagonism -is the phenomenon of opposing actions of two chemicals on the same system e. Basic classification of toxicology Toxicology is broadly divided into different classes depending on research methodology, socio-medical & organ/specific effects. Descriptive toxicology Descriptive toxicology deals with toxicity tests on chemicals exposed to human beings and environment as a whole. Mechanistic toxicology Mechanistic toxicology deals with the mechanism of toxic effects of chemicals on living organisms. Instead of organophosphates, drugs which reversibly bind to cholinesterase would be preferable in therapeutics) 6 Toxicology C.

The hair root ends deep in the dermis at the hair bulb buy celexa 20 mg on-line, and includes a layer of mitotically active basal cells called the hair matrix order celexa 10 mg without a prescription. The hair bulb surrounds the hair papilla purchase celexa 10mg on line, which is made of connective tissue and contains blood capillaries and nerve endings from the dermis (Figure 5. Just as the basal layer of the epidermis forms the layers of epidermis that get pushed to the surface as the dead skin on the surface sheds, the basal cells of the hair bulb divide and push cells outward in the hair root and shaft as the hair grows. The medulla forms the central core of the hair, which is surrounded by the cortex, a layer of compressed, keratinized cells that is covered by an outer layer of very hard, keratinized cells known as the cuticle. Hair texture (straight, curly) is determined by the shape and structure of the cortex, and to the extent that it is present, the medulla. As new cells are deposited at the hair bulb, the hair shaft is pushed through the follicle toward the surface. Keratinization is completed as the cells are pushed to the skin surface to form the shaft of hair that is externally visible. Furthermore, you can cut your hair or shave without damaging the hair structure because the cut is superficial. Most chemical hair removers also act superficially; however, electrolysis and yanking both attempt to destroy the hair bulb so hair cannot grow. The cells of the internal root sheath surround the root of the growing hair and extend just up to the hair shaft. It is made of basal cells at the base of the hair root and tends to be more keratinous in the upper regions. The glassy membrane is a thick, clear connective tissue sheath covering the hair root, connecting it to the tissue of the dermis. The hair follicle is made of multiple layers of cells that form from basal cells in the hair matrix and the hair root. Hair serves a variety of functions, including protection, sensory input, thermoregulation, and communication. The hair in the nose and ears, and around the eyes (eyelashes) defends the body by trapping and excluding dust particles that may contain allergens and microbes. Hair also has a sensory function due to sensory innervation by a hair root plexus surrounding the base of each hair follicle. Hair is extremely sensitive to air movement or other disturbances in the environment, much more so than the skin surface. This feature is also useful for the detection of the presence of insects or other potentially damaging substances on the skin surface. Each hair root is connected to a smooth muscle called the arrector pili that contracts in response to nerve signals from the sympathetic nervous system, making the external hair shaft “stand up. This is visible in humans as goose bumps and even more obvious in animals, such as when a frightened cat raises its fur. Of course, this is much more obvious in organisms with a heavier coat than most humans, such as dogs and cats. The first is the anagen phase, during which cells divide rapidly at the root of the hair, pushing the hair shaft up and out. The catagen phase lasts only 2 to 3 weeks, and marks a transition from the hair follicle’s active growth. The basal cells in the hair matrix then produce a new hair follicle, which pushes the old hair out as the growth cycle repeats itself. Hair loss occurs if there is more hair shed than what is replaced and can happen due to hormonal or dietary changes. Hair Color Similar to the skin, hair gets its color from the pigment melanin, produced by melanocytes in the hair papilla. Different hair color results from differences in the type of melanin, which is genetically determined. As a person ages, the melanin production decreases, and hair tends to lose its color and becomes gray and/or white. Nails The nail bed is a specialized structure of the epidermis that is found at the tips of our fingers and toes. The nail body is formed on the nail bed, and protects the tips of our fingers and toes as they are the farthest extremities and the parts of the body that experience the maximum mechanical stress (Figure 5. The nail body forms at the nail root, which has a matrix of proliferating cells from the stratum basale that enables the nail to grow continuously. The nail fold that meets the proximal end of the nail body forms the nail cuticle, also called the eponychium. The nail bed is rich in blood vessels, making it appear pink, except at the base, where a thick layer of epithelium over the nail matrix forms a crescent-shaped region called the lunula (the “little moon”). Sweat glands develop from epidermal projections into the dermis and are classified as merocrine glands; that is, the secretions are excreted by exocytosis through a duct without affecting the cells of the gland. These glands are found all over the skin’s surface, but are especially abundant on the palms of the hand, the soles of the feet, and the forehead (Figure 5. They are coiled glands lying deep in the dermis, with the duct rising up to a pore on the skin surface, where the sweat is released. This type of sweat, released by exocytosis, is hypotonic and composed mostly of water, with some salt, antibodies, traces of metabolic waste, and dermicidin, an antimicrobial peptide.

Protocols should empower the nurses to refer patients to relevant services such as echocardiography when there is a 9 history of a heart murmur order celexa 10mg line, or pulmonary function tests for chest disease cheap 20mg celexa otc. These protocols should be written by senior anaesthetic staff and should be regularly reviewed and updated 40mg celexa sale. In-clinic spirometry is useful and easy to perform, and may decrease the number of patients referred for formal pulmonary function tests. Pre-operative assessment nurses should co-operate closely with primary care services, particularly when administration of specific medication is required, such as subcutaneous anticoagulation or optimisation of diabetic treatment. Liaison with secondary care diabetes teams and medical outreach teams can be particularly helpful and may prevent unnecessarily long stays in hospitals, both pre- and post- operatively. It is important that pre-operative assessment nurses have readily available communication channels with pre-operative assessment anaesthetists; they should be able to discuss specific cases and receive feedback from the anaesthetist. The anaesthetist in the pre-operative assessment clinic Senior anaesthetists with a specialist interest in pre-operative assessment and optimisation should staff pre-operative assessment clinics with the number of sessions needed being dependent on the throughput of the hospital and its casemix. These anaesthetists should see all patients who are potentially at high risk, make an assessment of the risks and benefits of surgery and ensure that patients: • Are confident that they want surgery. The pre-operative assessment anaesthetist therefore needs to be skilled at assessing and managing these risks, and in communicating them both to the patient and to the treating surgeon. Consultant-to-consultant communication between anaesthetists, surgeons and critical care physicians is essential, particularly when the patient is high-risk and the benefits of surgery may be outweighed by the risks to the patient. Multidisciplinary meetings should help anaesthetic consultants identify and manage high-risk cases, particularly when major surgery is planned. Risk prediction can be used to guide the patient’s pre-operative care and determine whether the patient needs to see an anaesthetist in the pre-operative assessment clinic. These thresholds can be used as markers to help hospitals determine the level of resources they need to invest to provide their catchment patient population with adequate pre-operative services. Diagnosed peripheral arterial disease Pre-operative and post-operative risks of mortality and morbidity can be estimated with these variables when adjusted for surgical disease and surgical procedures respectively (see Appendix 2). Resources and funding Setting up pre-operative services where none exist requires a substantial time commitment in order to put in place the infrastructure, to recruit staff and to oversee the organisation, administration and processes at all levels. This may well require in the region of 5-10 programmed activities per week but this may vary with the caseload and casemix of the organisation, and will require the appropriate level of administrative support. A time commitment is necessary for the lead anaesthetist adequately to manage the pre-operative service. This role includes liaison with surgeons, clinicians in other specialties, doctors in training, primary care, other anaesthetists, theatres and critical care. The proportion of patients who would benefit from consultant pre-operative assessment depends on the type of surgery undertaken at the hospital, the age and socioeconomic status of the population and the size of catchment area. The pre-operative assessment clinic provides valuable opportunities for teaching – of both undergraduate and 13 postgraduate personnel. This may necessitate increased clinic resources with regard to both the time taken and the space for trainees and students to see patients. Cardiopulmonary exercise testing, when undertaken by trained personnel, takes about 30 minutes to perform and a similar time to discuss the results with the patient. A specialist anaesthetist working with a technician should be able to assess between four and seven patients in a programmed clinical activity. After planned admission Anaesthetists are central to ensuring the safety of patients in the peri-operative period. Operating sessions must be planned to allow time for the anaesthetist responsible for an individual’s care to visit him/ her pre-operatively. It is the responsibility of the individual anaesthetist giving the anaesthetic to ensure that the pre-operative assessment is adequate and that the patient has sufficient information to make a reasoned decision. It is the responsibility of the Trust to ensure that sufficient time is made available for this, as a matter of routine and without undue pressure. Pre-operative anaesthetic assessment is an integral part of the surgical process, and must be included in the estimates of time required for the operating list. The pre-operative assessment process should have identified and addressed problems with individual patients, and provided the patient with appropriate information on the probable peri- operative course. As a part of the pre-operative visit the anaesthetist should: • Establish a rapport with the patient and when relevant the patient’s family. Anaesthetists in training and non-consultant grades should discuss high-risk patients with consultant colleagues. The consultant contacted should ensure that the patient is cared for by an anaesthetist with the expertise required for that particular situation. Failure of the pre-operative service to match personnel to the need of the patient may result in surgery being postponed until the necessary expertise is available. Where possible, department protocols should be adhered to and cancellations for idiosyncratic reasons discouraged. Occasionally, anaesthetists will cancel surgery in patients who have been assessed and prepared by another senior anaesthetist. Anaesthetists should alert their colleagues if there is a failure in following protocol or when the protocol has been ineffective. Differences of opinion should be discussed within a department with the aim of avoiding future cancellations, and protocols modified accordingly.