Mefenamic

"Buy mefenamic 250 mg fast delivery, xiphoid spasms".

By: S. Yugul, M.B. B.CH., M.B.B.Ch., Ph.D.

Associate Professor, California Health Sciences University

Re- • Observe undernourished clients for quantity and quality quirements for nutrients vary with age 303 muscle relaxant reviews purchase cheap mefenamic online, level of activity muscle relaxant 503 buy mefenamic 500 mg, of nutrient intake muscle spasms youtube buy mefenamic 250mg online, weight gain, and improvement in lab- level of health or illness, and other factors that must be con- oratory tests of nutritional status (eg, serum proteins, sidered when designing appropriate therapy. High-protein, high- • Observe children for quantity and quality of food intake calorie foods can be included in many diets and given as and appropriate increases in height and weight. If the client cannot ingest • Interview and observe for signs and symptoms of com- enough food and fluid, many of the commercial nutritional plications of enteral and parenteral nutrition. Cold formu- ✔ Nutrition is extremely important in promoting health and las may cause abdominal cramping. For people who are unable to take ✔ Do not take or give more than 1 pint (500 mL) per in enough nutrients because of poor appetite or illness, feeding, including 2 to 3 oz of water for rinsing the nutritional supplements can be very beneficial in improv- tube. This helps to avoid overfilling the stomach and ing their nutritional status. With intermittent feedings, rinse all ferent flavors, and trying several different ones may be equipment after each use, and change at least every helpful. Most tube feeding formulas are milk based client does not like, ask for the names of others with com- and infection may occur if formulas become con- parable nutritional value. Water can be mixed with the tube feeding formula, given after the tube feeding, Self- or Caregiver Administration or given between feedings. Be sure to include the amount of water used for rinsing the tube in the total ✔ For oral supplemental feedings: daily amount. When not ✔ Mix powders or concentrated liquid preparations in available, some tablets may be crushed and some cap- preferred beverages, when possible. Some can be sules may be emptied and mixed with 1 to 2 table- mixed with fruit juice, milk, tea, or coffee, which may spoons of water. Ask a health care provider the best way of check- ication to get the medication through the tube and to ing placement for your type of tube. Measures to improve taste may prevent GI atrophy, maintain GI function, and maintain im- include chilling, serving over ice, freezing, or mixing with mune system function. For long-term feedings, a gas- Refer to instructions, usually on the labels, for appropriate trostomy tube may be placed percutaneously (called percuta- diluting and mixing of beverages. Nasointestinal several oral supplements are available and may be preferred tubes are recommended for clients at risk of aspiration from by some clients. Except for gastro- stomy tubes, the tubes should be soft and small bore to decrease Enteral Nutrition: Tube Feedings trauma. First, tube feeding is usually safer, amounts calculated to provide adequate water, protein, 444 SECTION 5 NUTRIENTS, FLUIDS, AND ELECTROLYTES CLIENT TEACHING GUIDELINES Drugs That Aid Weight Loss General Considerations plements when taking a prescription appetite suppres- ✔ In addition to feeling better, health benefits of weight loss sant. The combination can cause serious adverse effects may include reduced blood pressure, reduced blood fats, from excessive heart and brain stimulation. The recommended rate of weight loss is approx- does not cause heart or brain stimulation. Medications to aid weight loss are Self-Administration usually recommended only for people whose health is en- ✔ Take appetite suppressants in the morning to decrease dangered (ie, those who are overweight and have other appetite during the day and avoid interference with sleep risk factors for heart disease and those who are obese). If ✔ Have blood pressure and heart rate checked at regular unclear about any aspect of the information, consult a intervals (the drug increases them). Because these ✔ With orlistat: drugs stimulate the heart and the brain, adverse effects ✔ Take one capsule with each main meal or up to 1 hour may include increased blood pressure, fast heart beat, after a meal, up to 3 capsules daily. If you miss a meal irregular heart beat, heart attack, stroke, dizziness, ner- or eat a non-fat meal, you may omit a dose of orlistat. In addition, prolonged use of prescription drugs (A,D,E, and K) daily, at least 2 hours before or after may lead to psychological dependence. Orlistat prevents absorption of fat- ✔ Avoid over-the-counter decongestants, allergy, asthma, soluble vitamins from food or multivitamin prepara- and cold remedies and weight loss herbal or dietary sup- tions if taken at the same time. Although tube feeding for- rationale is to decrease the diarrhea and dehydration that mulas vary in the volume needed for adequate intake of nu- may ensue when hypertonic solutions are given and trients, any of the complete formulas can be used effectively. Some authorities ques- Other guidelines include the following: tion the value of this regimen and prefer starting with • Once the kind and amount of formula are chosen, the small amounts of full-strength formulas. For feedings that enter Osmolite are isotonic and should be given full strength.

Modern drugs have been developed from the herbs muscle relaxer 93 mefenamic 500 mg for sale, such as treatments for asthma and hay fever from Chi- nese ephedra; hepatitis remedies from schizandra fruits and licorice roots; and a number of anticancer agents from trees and shrubs muscle spasms 2 weeks generic mefenamic 250 mg line. More than 300 herbs that are commonly used today have a history of use that goes back at least 2 muscle relaxant vs anti-inflammatory order mefenamic 250mg amex,000 years. Over that time, a vast amount of experience has been gained that has gone toward perfecting their clinical applications. According to Chinese clinical studies, these herbs, and others that have been added to the list of useful items over the centuries, can greatly increase the effectiveness of modern drug treatments, reduce their side effects, and sometimes replace them completely. In China, the two most common methods of applying herb therapies are to make a decoction (a strong tea that must be simmered for an hour or more) and to make large honey-bound pills (boluses). Both of these forms meet with consider- able resistance in Western countries. The teas are deemed too time-consuming, smelly, and awful-tasting to justify their use, and the honey pills are sticky, difficult to chew, and bad tasting. Thus, modern forms that are more acceptable have been developed for most applications. The two popular forms to replace the standard Chinese preparations are ex- tract powders (or granules) and smooth, easy-to-swallow tablets or capsules. The extracts are made by producing a large batch of tea and then removing the water and producing a powder or tiny pellets; the resulting material is swallowed down with some water or mixed with hot water to make a tea. Tablets and capsules con- tain either powdered herbs or dried extracts or a combination of the two. Despite the convenience, one must take a substantial quantity of these prepared forms (com- pared to the amount of drugs one takes). The herb materials used in all these preparations are gathered from wild sup- plies or cultivated, usually in China (some come from India, the Mid-East, or else- where). There are an estimated 6,000 species in use, including nearly 1,000 materials derived from animal sources and over 100 minerals, all of them categorized under the general heading herbs. These materials are then combined in a formulation; the ingre- dients and amounts of each item depend on the nature of the condition to be treated. In some cases, a practitioner of Chinese medicine will design a specific formu- lation for an individual patient, which might be changed frequently over a course of treatment. In other cases, one or more formulas already prepared for ingestion without modification are selected for use. The outcome is monitored, and the de- termination of whether to continue the current formula, change to another, or discontinue use is made on the basis of actual versus desired outcomes and the obvious or subtle effects of using the herbs. As a general rule, acute ailments (those that arise suddenly and are to be treated right away) are treated for a period of one to 30 days. If an outbreak of influenza or eruption of herpes virus is caught early enough, a one- or two-day treatment will prevent further development of the disease. In the case of acute active hepatitis causing jaundice, a treatment of 15 to 30 days may be necessary. For chronic dis- eases (those that have persisted for several months or years), the treatment time is often dependent on the dosage used and the ability of the individual to undertake all necessary steps to overcome the disease (perhaps changing diet, lowering stress, and increasing exercise). If the daily dosage is lowered (because of inability to take the higher doses), the treatment time increases—perhaps to six to 12 months. Ex- amples of chronic ailments are autoimmune disorders and degenerative diseases associated with aging. In some cases, herbs are taken daily, for an indefinite pe- riod, just as some drugs are taken daily. This is typically the situation when there are genetic disorders or permanent damage that cannot be entirely reversed, prob- lems of aging, and ailments that have been left for too long without effective treatment. The main reason that more Westerners are turning to Chinese herbs rather than local herbs is because of the vast scope of experience in using the Chinese materials. New books are written by practitioners who have had several de- cades of personal experience or by compilers who scan the vast diverse modern literature and arrange the results of clinical trials into neat categories. American practitioners are usually trained at any one of about 45 colleges in the United States, with a three- or four-year series of courses that include basic Oriental medical theory, acupuncture, and herb prescribing. Certification is of- fered at the national level and licensing or registration is offered now by most states.

Because the drugs decrease plasma volume muscle relaxant use purchase mefenamic once a day, de- postnatally spasms right side abdomen buy mefenamic 500mg free shipping, impaired function of the tricuspid valve in the heart spasms near sternum buy cheap mefenamic line, creased blood flow to the uterus and placenta may occur with pulmonary hypertension, degenerative changes in the myocardium, resultant impairment of fetal nutrition and growth. Other adverse impaired platelet function with resultant bleeding, intracranial effects may include fetal or neonatal jaundice, thrombocytopenia, bleeding, renal impairment or failure, oligohydramnios, gastro- hyperbilirubinemia, hemolytic jaundice, fluid and electrolyte im- intestinal (GI) bleeding or perforation, and increased risk of necrotizing enterocolitis, a life-threatening disorder. These drugs are delivery, maternal effects include delayed onset of labor and deliv- not indicated for treatment of dependent edema caused by uterine ery and increased risk of excessive bleeding. They also are inhibitors (eg, celecoxib) have not been studied in pregnant women; not effective in prevention or treatment of pregnancy-induced diclofenac is contraindicated in pregnant women. Thyroid Hormone Loop diuretics (eg, furosemide) are not considered teratogenic, Levothyroxine does not readily cross the placenta and it seems but animal studies indicated fetal toxicity and death. However, it may cause tachycardia in azides, loop diuretics may decrease plasma volume and blood flow the fetus. When given as replacement therapy in hypothyroid to the placenta and fetus. Marijuana impairs formation of DNA and RNA, the Thus far, the main emphasis on drug use during pregnancy basic genetic material of body cells. It also may decrease the has related to actual or potential adverse effects on the fetus. Heroin ingestion in- Despite the general principle that drug use should be avoided creases the risks of pregnancy-induced hypertension, third when possible, pregnant women may require drug therapy trimester bleeding, complications of labor and delivery, and for various illnesses, increased nutritional needs, pregnancy- postpartum morbidity. FETAL THERAPEUTICS Although the major concern about drugs ingested during Herbal and Dietary Supplements pregnancy is adverse effects on the fetus, a few drugs are given to the mother for their therapeutic effects on the fetus. Pregnancy increases nutritional needs and vitamin and min- These include digoxin for fetal tachycardia or heart failure, eral supplements are commonly used. Folic acid supplemen- levothyroxine for hypothyroidism, penicillin for exposure to tation is especially important, to prevent neural tube birth maternal syphilis, and prenatal corticosteroids to promote defects (eg, spina bifida). Such defects occur early in preg- surfactant production to improve lung function and decrease nancy, often before the woman realizes she is pregnant. In addition, pregnancy increases folic Antacids may be used if necessary. Because little systemic acid requirements by 5- to 10-fold and deficiencies are com- absorption occurs, the drugs are unlikely to harm the fetus if mon. A supplement is usually needed to supply adequate used in recommended doses. For deficiency states, 1 mg or more daily may be cralfate may also be used. Herbal supplements are not recommended during preg- Gestational Diabetes nancy. Ginger has been used to relieve nausea and vomit- ing during pregnancy, with a few studies supporting its use. Overall, it has not been proven effective, but is probably This is called gestational diabetes. Most women without risk factors, or Pregnancy-Associated Symptoms whose initial test was normal, should be tested between 24 and and Their Management 28 weeks of gestation. For women with gestational diabetes, initial management Anemias includes nutrition and exercise interventions, calorie restric- tion for obese women, and daily self-monitoring of blood glu- Three types of anemia are common during pregnancy. If these interventions are ineffective, recombinant physiologic anemia, which results from expanded blood vol- human insulin is needed to keep blood sugar levels as nearly ume. A second is iron-deficiency anemia, which is often re- normal as possible. Oral antidiabetic drugs are generally con- lated to long-term nutritional deficiencies. Iron supplements traindicated, although acarbose, metformin, and miglitol seem are usually given for prophylaxis (eg, ferrous sulfate 300 mg to cause minimal fetal risk. Iron prepara- These women may revert to a nondiabetic state when tions should be given with food to decrease gastric irritation. A third type is megaloblas- ment of overt diabetes within 5 to 10 years. Nausea and Vomiting Constipation Nausea and vomiting often occur, especially during early preg- Constipation often occurs during pregnancy, probably from nancy. Dietary management (eg, eating a few crackers when decreased peristalsis.

Good writing is not just a succession of facts put down in a plausible order (see leaf shuffling) spasms heart effective mefenamic 250mg, but an interesting or important message spasms jaw muscles generic 250mg mefenamic amex, supported by evidence (see truth) muscle relaxant agents purchase line mefenamic. Clichés the word comes from the French term for a printing block, and means a phrase that is reproduced so often that it is at best unoriginal, at worst tiresome. First, avoid choosing clichés that will cause your target reader (though not your false feedback loop) to ridicule you. Second, if you see a familiar phrase, ask yourself whether something more original would be a better choice. This is not normally considered the best way to develop and motivate people. Coaching is an alternative approach, based on the assumption that people do best at a task if they are allowed to get on with it themselves. In the light of this, get them to commit to the what and the when (see writing goals). Encourage them to take time to ruminate, to set their own brief – and provide support at this early stage. Encourage research on the market as well as the topic being written about (see evidence-based writing). Once the writing process has started, provide support and encouragement. Meet regularly to ensure that the deadlines are being met and, if not, work with the writer to find ways of getting the work moving again. When (and if) the time comes for you to look at the manu- script, ask why you are being asked to read it – for silly mistakes, for instance, for major factual omissions or for potential political problems? Follow the example of successful sports coaches – and celebrate whenever you achieve your goals. Create a culture where winning – as defined by the writer in advance – is celebrated. BOOKLIST: coaching • the coaching pocketbook, by Ian Fleming and Allan JD Taylor, Alresford: Management Pocketbooks, 1998. Entertaining and versatile, part of an excellent series that also includes books on time management and personal development. Ostensibly for those who are setting 21 THE A–Z OF MEDICAL WRITING out to write a thesis, this is perhaps even more useful for super- visors. An interesting book from two journalists in Florida with important lessons for those working with writers. Co-authors As a general rule, the greater the number of co- authors, the greater the problems. The manuscript over which you have been sweating for months is torn apart by others, who believe that they are failing if they are not pumping out as many criticisms as they can think of. The poor author is then left, manuscript and confi- dence in tatters, with a pile of alternative suggestions, many of them conflicting. You will be pleased to know that there are some techniques that can ease the pain. Agree who the co-authors will be, what they will do, and in which order they will appear on the manuscript (see authorship). Lay down dead- lines, agree on the target journal and, more important still, get everyone to agree what the message will be (see brief setting). If all co-authors have agreed on the deadlines, you have a lever which may help to move the laggards. Send co- authors regular updates of progress; this will enable everyone to identify those who are slowing the process down. Far more important is the support and advice received as you are preparing the various drafts, and this is really the time you need sensible input from your colleagues. Keep them in touch with what you are doing, and encourage them to play the role of coach rather than critic.