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Also teach the • Develop a consistent pattern of diet and exercise client to report any lesions on the feet to the physician generic 30 gm v-gel with visa. Interventions Evaluation Use nondrug measures to improve control of diabetes and • Check blood sugar reports regularly for normal or ab- to help prevent complications order v-gel 30 gm with amex. Self- monitoring of blood glucose levels allows the client to see Goals of Therapy the effects of diet buy 30 gm v-gel fast delivery, exercise, and hypoglycemic medications on blood glucose levels and may promote compliance. For most clients, the goals of treatment are to maintain blood Several products are available for home glucose mon- glucose at normal or near-normal levels; promote normal me- itoring. All involve obtaining a drop of capillary blood tabolism of carbohydrate, fat, and protein; prevent acute and from a ﬁnger with a sterile lancet. The blood is placed on long-term complications; and prevent hypoglycemic episodes. The There is strong evidence that strict control of blood sugar amount of blood glucose can be read with various ma- delays the onset and slows progression of complications of di- chines (eg, glucometers). In addition to glycemic control, other measures can be • Test urine for ketones when the client is sick, when blood used to help prevent end-stage renal disease. Administration glucose levels are above 200 mg/dL, and when episodes of angiotensin-converting enzyme (ACE) inhibitors (eg, cap- of nocturnal hypoglycemia are suspected. Also teach topril) has protective effects on the kidneys in both type 1 and clients and family members to test urine when indicated. Although ACE inhibitors are also used in the treat- by observing for signs and symptoms of urinary tract ment of hypertension, their ability to delay nephropathy seems infection, peripheral vascular disease, vision changes, to be independent of antihypertensive effects. Teach clients sures to preserve renal function include effective treatment of CHAPTER 27 ANTIDIABETIC DRUGS 395 CLIENT TEACHING GUIDELINES Antidiabetic Drugs General Considerations If you take acarbose (Precose) or miglitol (Glyset) along ✔ Wear or carry diabetic identiﬁcation (eg, a Medic-Alert neck- with insulin, glimepiride (Amaryl), glipizide (Glucotrol), lace or bracelet) at all times, to aid treatment if needed. Few other diseases require as much adap- glucose (or glucagon) for treatment. Sucrose (table sugar) tation in activities of daily living, and you must be well and other oral carbohydrates do not relieve hypoglycemia informed to control the disease, minimize complications, because the presence of acarbose or miglitol prevents and achieve an optimal quality of life. Although much in- their digestion and absorption from the gastrointestinal formation is available from health care providers (physi- (GI) tract. If American Diabetes Association you take insulin, glucagon should be available in the 1660 Duke St. Alexandria, VA 22314 ✔ The best way to prevent, delay, or decrease the severity 1-800-ADA-DISC of diabetes complications is to maintain blood sugar at Other measures include ✔ In general, a consistent schedule of diet, exercise, and regular visits to health care providers, preferably a team medication produces the best control of blood sugar lev- of specialists in diabetes care; regular vision and glau- els and the least risk of complications. In addition, if you ✔ Diet, weight control, and exercise are extremely impor- have hypertension, treatment can help prevent heart tant in managing diabetes. Exercise helps body tissues use insulin better, counter drugs unless these are discussed with the physi- which means that glucose moves out of the bloodstream cian treating the diabetes because adverse reactions and and into muscles and other body tissues. For example, nasal decongestants more normal blood glucose levels and decreases long- (alone or in cold remedies) and asthma medications may term complications of diabetes. In addition, liquid cold remedies to take a medication, notify a health care provider. To and cough syrups may contain sugar and raise blood glu- control blood sugar most effectively, medications are bal- cose levels. If you take insulin, you need ✔ If you wish to take any kind of herbal or dietary supple- to know what type(s) you are taking, how to obtain more, ment, you should discuss this with the health care and how to store it. Regular and NPH insulins and mix- provider who is managing your diabetes. There has been tures (eg, Humulin) are available over-the-counter; Hu- little study of these preparations in relation to diabetes; malog, NovoLog, and Lantus require a prescription. If you start a supplement, you need to allow for weather or other conditions that might prevent replacement of insulin or other supplies when needed. Testing should be done more often glycemia may indicate a need to change some aspect of when medication dosages are changed or when you are ill. Speciﬁc recommendations should (hypoglycemia): sweating, nervousness, hunger, weak- be individualized and worked out with health care providers ness, tremors, and mental confusion.
From The Empirical Treatment of 36 Cases of Enuresis Mainly by Using Self-devised He Che Gu Quan San (Placenta Secure the Stream Powder) by Yang Dong-shan & Cao Sheng- you 30gm v-gel with mastercard, Gan Su Zhong Yi (Gansu Chinese Medicine) 30 gm v-gel sale, 2000 purchase v-gel 30gm overnight delivery, #1, p. The shortest course of disease was one year, and the longest was 20 years. All these patients had enuresis 1-2 times per night, and eight cases also had enuresis during their daytime nap. The TCM pattern presented by these patients was central qi vacuity in 18 cases, yang vacuity in 11 cases, damp heat in five cases, and blood stasis in two cases. Treatment method: He Che Gu Quan San (Placenta Secure the Stream Powder) was composed of: Zi He Che (Placenta Hominis) 1 (after washing the placenta and allowed to dry) Niu Yin Jing (bull penis) 1 Huang Qi (Radix Astragali), 50g Yi Zhi Ren (Fructus Alpiniae Oxyphyllae), 30g scorched Du Zhong (Cortex Eucommiae), 30g Shu Di (cooked Radix Rehmanniae), 30g Sang Piao Xiao (Ootheca Mantidis), 30g Shan Zhu Yu (Fructus Corni), 30g Gou Qi Zi (Fructus Lycii), 30g stir-fried Bai Zhu (Rhizoma Atractylodis Macrocephalae), 30g Fu Ling (Poria), 20g Sha Ren (Fructus Amomi), 20g If there was shortness of breath, disinclination to talk, lack of strength in the four limbs, a pale tongue, and a weak pulse, 30 Chinese Research on the Treatment of Pediatric Enuresis 65 grams of Ren Shen (Radix Ginseng) and 20 grams of Sheng Ma (Rhizoma Cimicifugae) were added. If there was lumber pain, a bitter taste in the mouth, a red tongue with slimy, yellow fur, and a slippery pulse, 30 grams each of Long Dan Cao (Radix Gentianae) and Yi Yi Ren (Semen Coicis) were added. If there was a dark facial complexion, dark, blue-green tongue body with static spots on the side, and a choppy or rough pulse, 30 grams each of Tao Ren (Semen Persicae) and Di Long (Pheretima) were added. These medicinals were all ground into a fine powder and placed in a glass bottle for storage. Children under 12 years of age took 6- 10 grams of this powder, two times per day mixed in 80-100 milli- liters of hot water and taken warm. One dose was given before breakfast and another was given before dinner. During treatment, the patients were asked to avoid fatty, greasy, sweet, or spicy food, alcohol, and cigarettes. From The Treatment of 78 Cases of Pediatric Enuresis by the Method of Regulating Both the Lungs & Kidneys by Li Xiang Dong, He Bei Zhong Yi (Hebei Chinese Medicine), 2003, #4, p. The course of disease was as short as two months and as long as 11 years. These patients had enuresis less than three times per day in 52 cases and more than three times in 26 cases. Nine cases were deter- mined to have occult spina bifida by an x-ray of their lumbosacral area. Treatment method: All the patients received the following Chinese medicinal formula: 66 Treating Pediatric Bed-wetting with Acupuncture & Chinese Medicine mix-fried Ma Huang (Herba Ephedrae), 9g Fu Ping Zi (Herba Spirodelae), 9g Gao Ben (Rhizoma Ligustici), 9g Shi Chang Pu (Rhizoma Acori Tatarinowii), 9g Jin Ying Zi (Fructus Rosae Laevigatae), 9g mix-fried Gan Cao (Radix Glycyrrhizae), 5g If there was lower origin vacuity cold, nine grams each of Tu Si Zi (Semen Cuscutae) and Bu Gu Zhi (Fructus Psoraleae) were added. If there was spleen-lung dual qi vacuity, nine grams each of Tai Zi Shen (Radix Pseudostellariae), Bai Zhu (Rhizoma Atractylodis Macrocephalae), and Shan Yao (Radix Dioscoreae) and six grams of Chen Pi (Pericarpium Citri Reticulatae) were added. If there was liver channel damp heat, nine grams each of Zhi Mu (Rhizoma Anemarrhenae) and Huang Bai (Cortex Phellodendri) were added. One packet of these medicinals was decocted per day until the medicinal liquid was reduced to 150 milliliter of liquid. Study outcomes: Thirty-two cases were cured, 41 cases improved, and five cases did not improve. Li believes that enuresis is often caused by insufficiency of the kidneys and lungs and their consequent inability to perform their physiological functions. Because of this, the author employs the method of regulating both the lungs and kidneys to treat enuresis. Within the above formula, mix-fried Ma Huang and Gao Ben enter the lung and bladder channels. They diffuse and free the flow of the lung qi and regulate the waterways. Shi Chang Pu, when combined with Ma Huang, has the ability to arouse the spir- it and open the orifices. Jin Ying Zi is a sour and astringent medic- inal which is able to constrain and contain the urine and stop enuresis, while Gan Cao regulates and harmonizes all the other medicinals in the formula. From The Treatment of Pediatric Enuresis Based on Experience [Using] Chinese Medicinals by Hou Ge-ping, Zhe Jiang Zhong Yi Xi Yi Jie He Za Zhi (Zhejiang Journal of Integrated Chinese-Western Medicine Journal), 1998, #6, p. If the case was considered mild, the child would wet the bed 3-4 times each week, while serious cases would wet the bed 1-2 times a night or even 3-4 times a night.
Contraindicated in clients with hypersen- sitivity to trimethoprim or megaloblastic anemia due to folate deﬁciency buy 30 gm v-gel amex. Adjunctive treatment order 30gm v-gel with mastercard, with other antimicrobials buy discount v-gel 30 gm on-line, in the treatment of pelvic inﬂammatory disease and sexually Nursing Process transmitted diseases. Tetracyclines inter- General aspects of the nursing process in antimicrobial drug fere with the production of free fatty acids and decrease therapy, as described in Chapter 33, apply to the client re- Corynebacterium in sebum. These actions decrease ceiving tetracyclines, sulfonamides, and urinary antiseptics. Assessment Tetracyclines may be effective in treating syphilis when penicillin cannot be given. They should not be substi- With tetracyclines, assess for conditions in which the drugs tuted for penicillin in treating streptococcal pharyngitis must be used cautiously or are contraindicated, such as im- because microbial resistance is common, and tetracy- paired renal or hepatic function. In addition, they With sulfonamides, assess for signs and symptoms of should not be substituted for penicillin in any serious disorders for which the drugs are used: staphylococcal infection because microbial resistance • For UTI, assess urinalysis reports for white blood cells commonly occurs. Demeclocycline may be used to inhibit antidiuretic • For burns, assess the size of the wound, amount and type hormone in the management of chronic inappropriate of drainage, presence of edema, and amount of eschar. Additional uses include ulcerative colitis and uncommon infections such as chancroid, Nursing Diagnoses lymphogranuloma venereum, nocardiosis, toxoplasmosis, and • Risk for Injury: Hypersensitivity reaction, kidney, liver, trachoma. Topical sulfonamides are used in prevention of burn or blood disorders with sulfonamides wound infections and in treatment of ocular, vaginal, and other • Deﬁcient Knowledge: Correct administration and use of soft tissue infections. For speciﬁc clinical indications of indi- tetracyclines, sulfonamides, and urinary antiseptics vidual drugs, see Drugs at a Glance: Sulfonamide Preparations. The client will: • Receive or self-administer the drugs as directed Contraindications to Use • Receive prompt and appropriate treatment if adverse ef- fects occur Both tetracyclines and sulfonamides are contraindicated in clients with renal failure. Tetracyclines are also contraindi- Interventions cated in pregnant women and in children up to 8 years of • During tetracycline therapy for systemic infections, mon- age. In the fetus and young child, tetracyclines are deposited itor laboratory tests of renal function for abnormal values. If given during ac- • During sulfonamide therapy, encourage sufﬁcient ﬂuids tive mineralization of these tissues, tetracyclines can cause to produce a urine output of at least 1200 to 1500 mL permanent brown coloring (mottling) of tooth enamel and daily. A high ﬂuid intake decreases the risk of crystalluria can depress bone growth. With the exception of doxycy- (precipitation of drug crystals in the urine). The urinary Increased photosensitivity is a common side effect, and tract is normally sterile except for the lower third of the clients should be warned to take precautions against sun- urethra. Introduction of any bacteria into the bladder may burn while on these drugs. With in- than 2 months of age (except for treatment of congenital dwelling catheters, bacteria colonize the bladder and toxoplasmosis), and people who have had hypersensitivity produce infection within 2 to 3 weeks, even with metic- reactions to them or to chemically related drugs (eg, thi- ulous care. Sulfasalazine • When indwelling catheters must be used, measures to (Azulfidine) is contraindicated in people who are allergic decrease UTI include using a closed drainage system; to salicylates and people with intestinal or urinary tract keeping the perineal area clean; forcing ﬂuids, if not con- obstruction. CHAPTER 36 TETRACYCLINES, SULFONAMIDES, AND URINARY AGENTS 543 levels (12 to 15 mg/100 mL) more rapidly. The amount traindicated, to maintain a dilute urine; and removing the is usually twice the maintenance dose. Urine pH is important in drug therapy with sulfonamides and irrigate the catheter unless obstruction is suspected. With sulfonamide therapy, alkaline urine increases • Force ﬂuids in anyone with a UTI unless contraindicated. In ad- also increases the rate of sulfonamide excretion and dition, emptying the bladder frequently allows it to reﬁll the concentration of sulfonamide in the urine.
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