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Screening methods are generally qualitative buy generic coumadin 2 mg hypertension signs and symptoms, relatively simple and inexpensive 1mg coumadin fast delivery blood pressure chart pdf, and designed to maximize sensitivity (possibly with some sacrifice of specificity). Screening methods, give the emphasis on maximizing sensitivity, may produce significant numbers of false-positive results. A “negative” screen can rule out only the finite number of compounds tested for at concentrations above the threshold of detection for the particular method used. Because of the inherent limitations of screening tests, definitive results must be based on a second method, a confirmatory procedure. It is important to note that inclusion of chemicals in a screening panel is generally governed by methodological as well as clinical considerations. Positive screens: The notation “toxin detected” is entered next to the particular chemicals found. Negative screens: The notation “toxin tested for not detected” or similar comment is made. Negative toxicology screen results 42 Toxicology in the face of strong clinical suspicions to the contrary may occur due to a number of reasons. If laboratory personnel are notified of the suspected agents, they can generally either modify the existing screen or suggest alternative strategies. The toxicology screen is performed on a specimen collected at a time outside the detection period for a particular toxin. Most of the common drugs of abuse are detectable in urine for 48-72 hours after ingestion, e. The toxins may be present in concentrations below the limits of detectability for the method used. In general, when faced with an unresponsive victim and an incomplete clinical history, minimum testing should include quantification of ethanol, acetaminophen, salicylate, and barbiturates. Confirmatory methods Confirmatory methods are designed to have near-perfect specificity and tend to be technically much more complex and demanding. Confirmatory methods are of relatively little importance in the context of emergency toxicology. Their principal use is in legal situations, where it must be established beyond a reasonable doubt that a particular drug was present. In these cases, integrity of specimen handling (chain of custody) becomes 43 Toxicology as important as the analytic procedure itself in order to rule out the possibility of specimen tampering or substitution. Spot tests Spot tests are rapid, easily performed, non-instrumental qualitative procedures. They are the most rudimentary toxicology tests, & generally performed on urine specimens. In the test procedure, the sample (that is suspected for having a particular toxic chemical) will react with a chemical or chemicals set as a solution, or coated on a strip & the result of the reaction expressed by a color formation detected visually or colorometrically. Spot tests are available for a number of compounds, including salicylate, acetaminophen, carbonmonoxide, halogenated hydrocarbons, and heavy metals. The tests are rapid and convenient; however sensitivity and specificity are generally poor and accurate quantification is virtually impossible. Because of improvements in other technologies, spot tests are now largely replaced by rapid immuno- assays that may perform at the point- of-care or in the central laboratories. Ultraviolet & visible spectrophotometry Many toxins have characteristic absorption spectra, but they must be extracted from body fluids in order to measure these spectra. The major problem encountered with this technique is interference, and some form of sample purification, such as solvent extraction or microdiffusion, is usually employed. Immunoassays Immunoassays are diagnostic techniques used for the detection of antigen and antibody. Depending on the immunoassay techniques that are employed for the specific test, either antigen or antibody may be detected from the samples based on their reaction with their specific antibody or antigen respectively. Those not involving radioactivity or separation steps (homogeneous immunoassays) can be automated on routine clinical chemistry instruments, making them convenient for laboratories of all sizes.

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When a client has a change in health status or reports symptoms such as chest pain or fainting 3 purchase coumadin 1 mg fast delivery blood pressure weight loss. Age • Children’s temperature continue to be more labile than those of adults until puberty • Elderly people purchase coumadin 1mg fast delivery blood pressure 8060, particularly those > 75 are at risk of hypothermia • Normal body temperature of the newborn if taken orally is 37 0 C. Diurnal variations (circadian rhythms) • Body temperature varies through out the day • The point of highest body temperature is usually reached between 8:00 p. Exercise • Hard or strenuous exercise can increase body temperature to as high as 38. Hormones • In women progesterone secretion at the time of ovulation o raises body temperature by about 0. Stress • Stimulation of skin can increases the production of epinephrine and nor epinephrine – which increases metabolic activity and heat production. Environment • Extremes in temperature can affect a person’s temperature regulatory systems. A client who has fever is referred to as febrile; the one who has not is a febrile. Basic Nursing Art 60 0 0 0 Hypothermia: – body temperature between 34 c – 35 c, < 34 c is death Common Types of Fevers 1. Intermittent fever: the body temperature alternates at regular intervals between periods of fever and periods of normal or subnormal temperature. Remittent fever: a wide range of temperature fluctuation (more than 0 2 c) occurs over the 24 hr period, all of which are above normal 3. Relapsing fever: short febrile periods of a few days are interspersed with periods of 1 or 2 days of normal temperature. Constant fever: the body temperature fluctuates minimally but always remains above normal Measuring Body Temperature There are Two Kinds of Body Temperature 1. Core Temperature • Is the Temperature of the deep tissues of the body, such as the cranium, thorax, abdominal cavity, and pelvic cavity • Remains relatively constant • Is the Temperature that we measure with thermometer 2. Surface Temperature: • The temperature of the skin, the subcutaneous tissue and fat Sites of Measure Temperature Most common are: • Oral • Rectal • Axillary • Tympanic membrane Thermometer: is an instrument used to measure body temperature Basic Nursing Art 61 Types 1. Rectal Temperature: Readings are considered to be more accurate, most reliable Contraindication • Rectal or perineal surgery; • Fecal impaction – the depth of the thermometer insertion may be insufficient; • Rectal infection; • Neonates –can cause rectal perforation and ulceration; 0 0 • Is > 0. Oral • Most accessible and convenient • The thermometer tip is placed beside the frenulum below the tongue • Is 0. Pulse It is a wave of blood created by contraction of the left ventricle of the heart. Stress: increases the sympathetic nerve stimulation – increases the rate and force of heart beat 8. Position changes: when a patient assumes a sitting or standing position blood usually pools in dependent vessels of the venous system. Temporal: is superior (above) and lateral to (away from the midline of) the eye 2. Carotid: at the side of the neck below tube of the ear (where the carotid artery runs between the trachea and the sternoclidiomastoid muscle) 3. Apical: at the apex of the heart: routinely used for infant and children < 3 yrs th th th 4. In adults – Left midclavicular line under the 4 , 5 , 6 intercostals space Basic Nursing Art 64 5. Brachial: at the inner aspect of the biceps muscle of the arm or medially in the antecubital space (elbow crease) 7. Radial: on the thumb side of the inner aspect of the wrist – readily available and routinely used 8. Pedal (Dorslais Pedis): palpated by feeling the dorsum (upper surface) of the foot on an imaginary line drawn from the middle of nd the ankle to the surface between the big and 2 toes Method Pulse: is commonly assessed by palpation (feeling) or auscultation (hearing) The middle 3 fingertips are used with moderate pressure for palpation of all pulses except apical; the most distal parts are more sensitive, Assess the Pulse for • Rate • Rhythm • Volume • Elasticity of the arterial wall Pulse Rate • Normal 60-100 b/min (80/min) • Tachycardia – excessively fast heart rate (>100/min) • Bradycardia < 60/min Pulse Rhythm • The pattern and interval between the beats, random, irregular beats – dysrythymia Basic Nursing Art 65 Pulse Volume: the force of blood with each beat • A normal pulse can be felt with moderate pressure of the fingers and can be obliterated with greater pressure. Hyperventilation: very deep, rapid respiration Hypoventilation: very shallow respiration Two Types of Breathing 1. Costal (thoracic) • Involves the external muscles and other accessory muscles (sternoclodio mastoid) • Observed by the movement of the chest up ward and down ward 2.

The exact value measured for the resting membrane potential varies between cells buy 1 mg coumadin blood pressure medication how long to take effect, but -70 mV is most commonly used as this value cheap 1mg coumadin mastercard heart attack man. This voltage would actually be much lower except for the + + contributions of some important proteins in the membrane. Leakage channels allow Na to slowly move into the cell or K + + to slowly move out, and the Na /K pump restores them. The Action Potential Resting membrane potential describes the steady state of the cell, which is a dynamic process that is balanced by ion leakage and ion pumping. Because the concentration of Na is higher outside the cell than inside the cell by a factor of 10, ions will rush into the cell that are driven largely by the concentration gradient. Because sodium is a positively charged ion, it will change the relative voltage immediately inside the cell relative to immediately outside. The resting potential is the state of the membrane at a voltage of -70 mV, so the sodium cation entering the cell will cause it to become less negative. The electrical gradient also plays a role, as negative proteins below the membrane attract the sodium ion. These channels are 528 Chapter 12 | The Nervous System and Nervous Tissue + + specific for the potassium ion. As K starts to leave the cell, taking a positive charge with it, the membrane potential begins to move back toward its resting voltage. This is called repolarization, meaning that the membrane voltage moves back toward the -70 mV value of the resting membrane potential. Repolarization returns the membrane potential to the -70 mV value that indicates the resting potential, but it actually overshoots that value. Potassium ions reach equilibrium when the membrane voltage is below -70 mV, so a period of + + hyperpolarization occurs while the K channels are open. What has been described here is the action potential, which is presented as a graph of voltage over time in Figure 12. The change in the membrane voltage from -70 mV at rest to +30 mV at the end of depolarization is a 100-mV change. The change seen in the action potential is one or two orders of magnitude less than the charge in these batteries. What happens across the membrane of an electrically active cell is a dynamic process that is hard to visualize with static images or through text descriptions. The membrane potential will stay at the resting voltage until something This OpenStax book is available for free at http://cnx. A ligand-gated Na channel will open when a neurotransmitter binds + to it and a mechanically gated Na channel will open when a physical stimulus affects a sensory receptor (like pressure applied to the skin compresses a touch receptor). Whether it is a neurotransmitter binding to its receptor protein or a sensory stimulus activating a sensory receptor cell, some stimulus gets the process started. The channels that start depolarizing the membrane because of a stimulus help the cell to depolarize from -70 mV to -55 + mV. Any depolarization that does not change the membrane potential to -55 mV or higher will not reach threshold and thus will not result in an action potential. Also, any stimulus that depolarizes the membrane to -55 mV or beyond will cause a large number of channels to open and an action potential will be initiated. Because of the threshold, the action potential can be likened to a digital event—it either happens or it does not. If depolarization reaches -55 mV, then the action potential + continues and runs all the way to +30 mV, at which K causes repolarization, including the hyperpolarizing overshoot. Also, those changes are the same for every action potential, which means that once the threshold is reached, the exact same thing happens. A stronger stimulus, which might depolarize the membrane well past threshold, will not make a “bigger” action potential. All action potentials peak at the same voltage (+30 mV), so one action potential is not bigger than another.

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