PHAR2822 Lecture Notes - Lecture 1: Prostaglandin, Asthma, Antiplatelet Drug

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greenoyster75

28 Aug 2018

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When to refer: bleeding requires assessment, symptoms severe or lasting for (cid:859) weeks or more, recurrent vomiting with constipation may indicate intestinal blockage urgent, severe abdominal pain with fever. Electric, cutting, throbbing, pulsing, flickering, flashing, shooting, prickling, stabbing, cutting, pressing, crushing, cramping, pulling, wrenching, hot, scalding, searing, tingling, itchy, stinging, dull, ache, heavy, tender, taut, crystalline, exhausting, nauseating, suffocating, blinding, radiating, penetrating, piercing, tight, numb, cold. Superficial: skin, subcutaneous tissue, mucosa: eg burns, lacerations. Deep: bones, joints, muscles, tendons, ligaments, organ capsules: eg muscular, oa. Visceral: organs, deep tumour masses, lymph nodes: eg apendicitis, am), endometriosis. Generally: hot, sharp, stinging, dull, aching, throbbing, deep. Eg herpes zoster (shingles), postherpetic neuralgia, diabetic neuropathy, (cid:494)phantom pain(cid:495), spinal cord injury or compression, sciatica, (cid:494)nerve pain(cid:495) Generally: pins and needles, tingling, burning, stinging, shooting, radiating. Breakthrough and incident pain describe pattern of pain: Breakthrough occurs between regular doses of analgesic, from occasional fluctuation in pain, or inadequate baseline analgesia.

Related Questions

Case-3: Patient History

T.J. is a 46-year-old science professor brought to urgent care this afternoon by his wife. T.J. has been at home for 3 days with severe diarrhea and vomiting. His youngest daughter was hospitalized earlier in the week with similar symptoms. T.J. has no significant medical history and takes no medications. Examination reveals an ill-appearing, pale, diaphoretic man who is having difficulty concentrating and answering questions. He has diffuse abdominal pain. Vital signs are as follows: LyingâHR 100, BP 100/80, resp 26, temp 100. SittingâHR 136, BP 90/60. He has not urinated since yesterday morning.

Analyze this case study and answer the next three questions that follow.

Case-3: Question-1

What other laboratory or clinical data would be helpful in assessing T.J.âs fluid-electrolyte and acid-base status? (select all that apply)

Blood test to assess the level of glucose.

A chemistry panel would be helpful in assessing for imbalances of serum sodium, potassium, and bicarbonate.

Further assessment could include inspection of mucous membranes for dryness, skin turgor, status of neck veins, and presence of dizziness with position change.

Assessment of body temperature.

Case-3: Question-2

Which assessment data should be monitored during fluid replacement therapy to determine when adequate volume has been restored? (select all that apply)

Mental status should be assessed and expected to improve with adequate fluid replacement.

Vital signs should be monitored for resolution of tachycardia and postural symptoms, as well as intake and output.

Skin turgor and mucous membranes should be monitored for improvement of dehydration.

Electrolytes should be monitored for resolution of any electrolyte imbalance.

Case-3: Question-3

How might persistent vomiting and diarrhea alter acid-base balance? (select all that apply)

Metabolic alkalosis may occur as a result of persistent diarrhea.

Vomiting may contribute to metabolic acidosis.

Metabolic acidosis may occur as a result of persistent diarrhea.

Vomiting may contribute to metabolic alkalosis.

Provides substantial and thoughtful response, reflection â in-depth and detailed for the following post. Please don't copy past from the web

Yellow Fever â Another Reason to Hate Mosquitos

Out of the blue one day you begin to run a fever. The fever expands into loss of appetite and vomiting. A few days later, the vomiting continues and you develop jaundice; you even begin to bleed from your mouth, nose, and eyes. Eventually you die. This is the experience of 7% of the individuals who are infected by Yellow Fever (WHO, 2017).

Yellow Fever is a preventable disease that is spread through mosquitos. The disease has the potential to kill its victim (WHO, 2017). It has an inexpensive vaccine that provides a lifelong immunity to the disease (WHO - French Guiana). As of 2016, there have been reported outbreaks of Yellow Fever in six countries; three in Africa, and three in South America (Yellow Fever in Africa and the Americas, 2016).

According to the World Health Organization, Yellow Fever is spread through mosquitos. A mosquito bites an infected carrier (either a person or monkey). The same mosquito then bites an uninfected person or monkey and spreads the disease to that individual. Yellow Fever will incubate in the new carrier for three to six days before symptoms begin to show. The symptoms begin as body aches, fever, nausea and vomiting. It is at this point that the disease is often misdiagnosed as other illnesses and diseases such as poisoning, malaria, hepatitis, etc. Within another three to four days, most patients improve. However, 15% of infected patients will progress to a second stage of symptoms that are much more severe. This stage exhibits symptoms such as jaundice, continued vomiting, and even bleeding out of the mouth, nose, and eyes. The patientâs kidney functions deteriorate and half of these patients will even die (WHO, 2017).

Thankfully, there is a vaccine for Yellow Fever. The vaccine requires ten days to become affective and it will last the entire life span of the patient. The only issue is getting the vaccine to the affected areas and raising awareness of the disease and the vaccine to the population in that area (WHO - French Guiana).

A 2017 report in the Weekly Epidemiological Record, says that in 2016, the world saw six countries where there was a Yellow Fever outbreak. The three African countries where the outbreak occurred are Angola, Uganda, and the Democratic Republic of the Congo. Africa had 130 confirmed deaths from Yellow Fever as a result of that outbreak. The death rate was 13.4% of the confirmed cases; this is about double the expected death rate (Yellow Fever in Africa and the Americas, 2016). This high death rate might be attributed to the poor sanitation and lack of access to medical treatment in those areas. According to the World Health Organization, the only way to treat Yellow Fever is with hydration, antibiotics, and supportive care for respiratory failure (WHO, 2017). These treatments are likely less common in East-Central African countries.

The other three countries listed in the 2017 report were in South America. These countries are Brazil, Columbia, and Peru. There were less cases of Yellow Fever in these countries when compared with Africa, but the death rate was a shocking 28.2% (Yellow Fever in Africa and the Americas, 2016)! The same reasons for the high death rate likely apply to these countries as well (poor sanitation and lack of access to medical treatment).

Yellow Fever is a preventable disease that has a simple method of exposure. Most of its victims do not die, and it is currently limited to countries where the mosquito population is less controlled and there is limited access to medical treatment. The World Health Organizations advice is to limit travel to countries where a Yellow Fever outbreak has occurred, but if a person does travel there, they should receive the vaccine ten days prior to their travel. Additionally, the World Health Organization stresses limiting exposure to mosquitos. The World Health Organization proposes that the citizens in these areas should be educated on the disease and its vaccine (WHO - French Guiana). By following these instructions, Yellow Fever should likely be contained to a few countries throughout the world, and possibly even eradicated one day.

References:

Yellow Fever in Africa and the Americas, 2016. Weekly Epidemiological Record, 32, 442-452. Retrieved fromhttp://web.b.ebscohost.com.proxy195.nclive.org/ehost/pdfviewer/pdfviewer?vid=2&sid=1b24418c-8c06-466d-8578-4bd75e665959%40sessionmgr104

World Health Organization (August 30, 2017). Yellow Fever âFrance-French Guiana. Retrieved from http://www.who.int/csr/don/30-august-2017-yellow-fever-french-guiana/en/

World Health Organization. Yellow Fever. Retrieved from http://www.who.int/csr/disease/yellowfev/en/

violetdinosaur513

Chronic Diarrhea in a Traveler

Patient History

A 21-year-old male presents with a 6-week history of watery diarrhea and crampy abdominal pain. He reports that the diarrhea has not been constant and has alternated with periods of constipation. For the past 2 weeks, the diarrhea has been blood streaked, and he has had several weeks of mid-epigastric pain. He spent the last 6 months in a rural community in Guatemala participating in a community service project sponsored by his college. He returned from Guatemala just 10 days ago. While there, he drank the water and ate the food available in the local community, and he did not regularly boil the water for drinking. He denies antibiotic exposure but was taking mefloquine weekly for malaria prophylaxis. Two separate stool specimens taken by student health when he returned were reported as negative for Salmonella, Shigella, Campylobacter, E. coli 0157:H7, Yersinia, Aeromonas, and Plesiomonas, as well as Giardia lamblia. On physical examination, he appeared well-nourished and well-developed but reported an 8â10 pound weight loss. He was afebrile with a blood pressure of 110/80 mm Hg, pulse rate of 84/min, respirations of 14/min, and his lungs were clear. The abdominal examination was significant for tenderness localized to the right upper quadrant without rebound tenderness, but no mass or hepatomegaly was appreciated.

Travelerâs diarrhea is loose, watery diarrhea that occurs within the first week of arriving in a new country. The diarrhea is usually accompanied by nausea, vomiting, abdominal cramps, and fever; however, the disease is self-limited, and the average length of illness is 3â5 days. Because his symptoms have persisted for 6 weeks, the patient is unlikely to have travelerâs diarrhea. Infectious and noninfectious causes include bacteria, parasites, ulcerative colistis, diverticulitis, and carcinoma. As the symptoms have persisted longer than a week, consider parasites as an infectious cause.

Assignment

Provide a 1-page report on this case study. For the report, describe methods of appropriate specimen collection, examination of specimen, and a likely causative agent.

For the causative agent, describe pathogenesis of the organism, treatment, and prevention.

Under pathogenesis, describe how the agent is acquired, its reservoir, its life cycle, likely hosts, and infection process.

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PHAR2822 Lecture Notes - Lecture 1: Prostaglandin, Asthma, Antiplatelet Drug

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