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By N. Trano. Northern State University. 2018.

Cutaneous ulcerations are usually caused by trauma and im- • Folliculitis is an infection of the hair follicles that most paired circulation buy cheap decadron 0.5 mg line acne neck. They usually occur in the neck decadron 1mg on-line acne toner, face, axillae, who are immobilized, incontinent, malnourished, and de- buttocks, thighs, and perineum. Common sites include the sacrum, trochanters, Carbuncles involve many hair follicles and include ankles, and heels. Healing of carbuncles • Venous stasis ulcers, which usually occur on the legs, often produces scar tissue. Other signs of • Impetigo is a superficial skin infection caused by strep- venous insufficiency include edema, varicose veins, sta- tococci or staphylococci. An especially contagious form sis dermatitis, and brown skin pigmentation. Acne Fungal Infections Fungal infections of the skin and mucous membranes are Acne is a common disorder characterized by excessive pro- most often caused by Candida albicans. It often occurs as a superinfection after the expand and form comedones (blackheads and whiteheads). Acne lesions vary from small comedones to acne vulgaris, the • Candidiasis of the vagina and vulva occurs with sys- most severe form, in which follicles become infected and irri- temic antibiotic therapy and in women with diabetes tating secretions leak into surrounding tissues to form inflam- mellitus. Most clients have a • Intertrigo involves skin folds or areas where two skin variety of lesion types at one time. Acne occurs most often on the face, upper back, and chest • Tinea infections (ringworm) are caused by fungi (der- because large numbers of sebaceous glands are located in matophytes). One etiologic factor is increased secretion of (tinea capitis), the body (tinea corporis), the foot (tinea male hormones (androgens), which occurs at puberty in both pedis), and other areas of the body. Other causative factors may in- Viral Infections clude medications (eg, phenytoin, corticosteroids) and stress, Viral infections of the skin include verrucal (warts) and herpes whose mechanism may involve stimulation of androgen se- infections. There is no evidence that lack of cleanliness or cer- Type 1 usually involves the face or neck (eg, fever blisters or tain foods (eg, chocolate) cause acne. External otitis is an infection of the external ear characterized • Keratolytic agents (eg, salicylic acid) are used to re- by pain, itching, and drainage. The external ear is lined with move warts, corns, calluses, and other keratin-containing epidermal tissue, which is susceptible to the same skin dis- skin lesions. External otitis is • Retinoids are vitamin A derivatives that are active in pro- most often caused by Pseudomonas aeruginosa and Staphy- liferation and differentiation of skin cells. These agents lococcus aureus organisms and may be treated with anti- are commonly used to treat acne, psoriasis, aging and microbial ear drops for approximately 7 to 10 days. Retinoids (eg, etretinate and isotretinoin) are contra- indicated in women of childbearing potential unless the Anorectal Disorders women have negative pregnancy tests; agree to use effec- tive contraception before, during, and after drug therapy; Hemorrhoids and anal fissures are common anorectal disorders and agree to take the drugs as prescribed. Derma- TYPES OF DERMATOLOGIC DRUGS tologists recommend sunscreen preparations that block both UVA and UVB and have a sun protection factor Many different agents are used to prevent or treat dermatologic value of 30 or higher. Most agents fit into one or more of the following are especially needed by people who are fair skinned, categories: allergic to sunlight, or using medications that increase • Antimicrobials are used to treat infections caused by skin sensitivity to sunlight (eg, estrogens, tetracycline). When used in dermatologic infections, antimicrobials may be administered locally (topically) or systemically Application of Dermatologic Drugs (orally or parenterally). Skin surfaces should be clean before application have been developed for topical application of drugs to various of antiseptics. Basic • Astringents (eg, dilute solutions of aluminum salts) are components of topical agents are one or more active ingredi- used for their drying effects on exudative lesions. Many topical preparations contain other They are most often applied topically, but also may be additives (eg, emollients, dispersing agents) that further facil- given orally or parenterally. Commonly • Emollients or lubricants (eg, mineral oil, lanolin) are used vehicles and dosage forms include ointments, creams, used to relieve pruritus and dryness of the skin. Many topical drug preparations are available ulcers, and venous stasis ulcers. Topical medications are used primarily for local effects; • Immunomodulators are newer drugs with immuno- systemic effects are usually undesirable. They are not ence percutaneous absorption of topical agents include the steroids, do not cause the adverse effects associated following: with corticosteroids, and may be used as corticosteroid • Degree of skin hydration. They are used to treat moderate to severe cutaneous absorption are increased when keratin in the atopic dermatitis. Two of these drugs are currently available, tacrolimus • Drug concentration.

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You will make some gains in passive and active flexibility (especially if you opt for the stretches from this book) but there are far more superior methods discount decadron 0.5 mg online skin care for winter, e decadron 1mg visa skin care doctors. It is unfortunate that youth coaches and other people who should know better do not appreciate this simple fact. One must keep in mind that girl gymnasts frequently have a so-called active insufficiency. They cannot reach a great range of motion not for the lack of elasticity of the muscles and ligaments, but because of insufficient strength of the muscles which propel the movement. In other words, the existing anatomical mobility of the joints cannot be fully taken advantage of. It becomes quite obvious that one must work on simultaneous strength and flexibility development to reach a maximal movement amplitude. Fillipovich goes as far as to state that children younger than ten or eleven, girls and boys, should not do any passive stretching at all; no contract-relax, no relaxed stretching, nothing of the sort! It also makes sense from the psychological point of view: youngsters just do not have the patience and body control necessary for sophisticated methods such as Forced Relaxation or tedious ones such as Waiting out the Tension (see Relax into Stretch). I must make a point that when one decides to place a heavy emphasis on active flexibility exercises for the legs, that is various slow leg raises and kicks, serious abdominal work must be undertaken first. In fact, until ten or eleven your gremlins should stay away from various forward and especially backward bends! On the other hand, the hip and ankle joints at this age are generally prepared for more serious stretching. Women who are pregnant or had a child within a few months should be especially careful with stretching and seek advice of their doctor. Delivery of a child requires extraordinary flexibility and the womans body releases the hormone relaxin to loosen the ligaments. They will not tear easily, but will stretch beyond the norm leading to joint instability. Adults should do it all: Relax into Stretch drills that teach their stiff muscles to yield to stretches, as well as Super Joints active stretches and mobility drills. Ditto for the older folks with more emphasis on mobility training than anything else. Youngsters must make active flexibility drills such as Reach the Mark and the Pink Panther their first, and sometimes only, priority. Kids should be especially careful in their stretching and other athletic pursuits when undergoing the growth spurt. Adolescent hormones try their best to keep the ligaments pliable to accommodate the mushrooming bones, but the best is not always good enough. Physical therapists have two definitions to describe a problem such as slouched shoulders: stretch weakness and tight weakness. When a muscle is habitually kept in an abnormally lengthened position, it experiences the former. The habit of having overly slack muscles of the upper back flicks a few switches in the spinal cord where muscular length and tension are regulated. The muscle starts perceiving your decidedly unmilitary bearing as the norm and becomes unwilling to contract and shorten. Once you force them too, they test pathetically weak in the stretched position. An effective muscle has no trouble going from a near cramp to great length and can display great strength anywhere in this range. They simultaneously address the weakness of the overstretched muscles and the tightness of their antagonists. Understand that these recommendations apply only to postural problems resulting from bad habits rather than a medical condition. You should have no trouble finding the appropriate stretches to address your problem in this book. The following two popular Russian posture improving complexes will give you an idea of how to put together an effective routine of your own. Simultaneously touch the wall with the back of your head, your shoulder blades, your glutes and your heels.

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Although ACE inhibitors are also used in the treat- by observing for signs and symptoms of urinary tract ment of hypertension cheap 1mg decadron fast delivery skin care steps, their ability to delay nephropathy seems infection discount 1 mg decadron with mastercard acne 7 days past ovulation, 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. Although each person needs individualized instruc- are alert and able to swallow, take 4 oz of fruit juice, 4 to tions, some general guidelines include the following: 6 oz of a sugar-containing soft drink, a piece of fruit or ✔ Continue your antidiabetic medications unless in- 1⁄ cup of raisins, two to three glucose tablets (5 grams structed otherwise. Additional insulin also may be 3 each), a tube of glucose gel, 1 cup of skim milk, tea or cof- needed, especially if ketosis develops. Ketones (ace- fee with 2 teaspoons of sugar, or eight Lifesaver candies. Insulin is absorbed test urine for ketones when the blood glucose level fastest from the abdomen. If unable within 2 inches of the belly button or into any skin to test urine, have someone else do it. About 15 g of carbohydrate every dosage of both insulins unless measured very care- 1 to 2 hours is usually enough and can be provided fully. Commercial mixtures are also available for some by 1⁄ cup of apple juice, applesauce, cola, cranberry 2 combinations. Water, tea, broths, clear soups, diet soda, or ration for immediate use if a hypoglycemic reaction carbohydrate-containing fluids are acceptable. Recommendations usually ber of times you urinate, vomit, or have loose stools. Starting with a small dose and in- creasing it gradually helps to prevent bloating, gas ✔ Use correct techniques for injecting insulin: pains, and diarrhea.

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This trend is attributed mainly to obesity and inadequate ex- • Rotation of injection sites is important in infants and ercise because most children with type 2 are seriously over- young children because of the relatively small areas weight and have poor eating habits 1mg decadron amex skin care usa. In addition decadron 1 mg free shipping skin care essential oils, most are 402 SECTION 4 DRUGS AFFECTING THE ENDOCRINE SYSTEM members of high-risk ethnic groups (eg, African American, Oral drugs. Sulfonylureas and their metabolites are ex- Native American, or Hispanic) and have relatives with dia- creted mainly by the kidneys; renal impairment may lead betes. These children are at high risk for development of seri- to accumulation and hypoglycemia. They should be used ous complications during early adulthood, such as myocardial cautiously, with close monitoring of renal function, in infarction during their fourth decade. Management involves clients with mild to moderate renal impairment, and are exercise, weight loss, and a more healthful diet. Alpha- glucosidase inhibitors are excreted by the kidneys and accumulate in clients with renal impairment. However, Use in Older Adults dosage reduction is not helpful because the drugs act locally, within the GI tract. Metformin requires assess- General precautions for safe and effective use of antidiabetic ment of renal function before starting and at least annu- drugs apply to older adults, including close monitoring of ally during long-term therapy. In addition, older adults may have im- initially if renal impairment is present; it should be paired vision or other problems that decrease their ability to stopped if renal impairment occurs during treatment. They but increments should be made cautiously in clients with also may have other disorders and may take other drugs that renal impairment or renal failure requiring hemodialysis. For example, renal insuf- ficiency may increase risks of adverse effects with antidiabetic drugs; treatment with thiazide diuretics, corticosteroids, estro- Use in Hepatic Impairment gens, and other drugs may cause hyperglycemia, thereby in- creasing dosage requirements for antidiabetic drugs. There may be higher blood levels of insulin in With oral sulfonylureas, drugs with a short duration of ac- clients with hepatic impairment because less insulin tion and inactive metabolites are considered safer, especially may be degraded. Careful monitoring of blood glucose with impaired liver or kidney function. Therapy usually should levels and insulin dosage reductions may be needed to start with a low dose, which is then increased or decreased prevent hypoglycemia. Sulfonylureas should be used cautiously and Few guidelines have been developed for the use of newer liver function should be monitored. Insulin analogs appear to lized in the liver and hepatic impairment may result in have some advantages over conventional insulin. Acarbose, higher serum drug levels and inadequate release of he- miglitol, and metformin may not be as useful in older adults patic glucose in response to hypoglycemia. With glip- as in younger ones because of the high prevalence of impaired izide, initial dosage should be reduced in clients with renal function. Glyburide may cause hypoglycemia in clients with renal insufficiency because they have a longer clients with liver disease. With metformin, dosage should require no precautions with hepatic impairment because be based on periodic tests of renal function and the drug acarbose is metabolized in the GI tract and miglitol is not should be stopped if renal impairment occurs or if serum lac- metabolized. In addition, dosage should not be titrated to the clients with clinical or laboratory evidence of hepatic maximum amount recommended for younger adults. With the impairment because risks of lactic acidosis may be in- glitazones, older adults are more likely to have cardiovascu- creased. Meglitinides should be used cautiously and lar disorders that increase risks of fluid retention and conges- dosage increments should be made very slowly, because tive heart failure. With meglitinides, effects were similar in serum drug levels are higher, for a longer period of time, younger and older adults during clinical trials. Glitazones have been associated with hepatoxicity and require monitoring of liver enzymes. The drugs should Use in Renal Impairment not be given to clients with active liver disease or a serum alanine aminotransferase (ALT) >2. It is difficult to pre- ated, liver enzymes should be measured every 2 months dict dosage needs because, on the one hand, less insulin for 1 year, then periodically.

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