Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Informations

Showing posts with label Medical and Surgical Nursing. Show all posts
Showing posts with label Medical and Surgical Nursing. Show all posts

Monday, June 30, 2008

Woman and Heart Disease

Woman and Heart Disease
Modifiable risk factors for heart disease endanger both men and women, however, they may contribute to a poorer prognosis for women. Educate women about the following risk factors over which they have some control:

* Diabetes
* Hypertension
* Smoking
* Dyslipidemia
* Obesity
* Sedentary life style
* Stress

Thursday, June 26, 2008

Pericarditis

PERICARDITIS


Pericarditis is an inflammation of the pericardium.


1. Acute pericarditis: may be dry or may cause excessive fluid accumulation in the pericardial space.

2 Chronic pericarditis: fibrous thivkening of the visceral and parietal pericardium; thickening inhibits cardiac filling during systole.


Assessment

  1. Risk factors/iology

    1. Acute.

      1. Infection.

      2. Myocardial Injury.

      3. Hypersensitivity (collagen diseases, systematic lupus erythematosus, drug reactions).

      4. Renal failure.

  2. Clinical Manifestations.

    1. Acute.

      1. Precordial pain.

      2. Pericardial friction rub caused by myocardium rubbing against inflamed pericardium.

      3. Pain increases with respiration; sitting may relieve pain.

    2. Chronic: symptoms are characteristic of gradually occurring CHF; chest pain is not a prominent symptom.

  3. Diagnostics (acute and chronic).

    1. ECG changes.

    2. increased WBCs.

    3. History of precipitating causes.

    4. CT scan.

Complications.

  1. Pericardial effusion resulting in cardiac tamponade.


PA and lateral close-ups show thick pericardial calcification around
apex of heart from patient with history of tuberculous pericarditis

Treatment

  1. Acute episode.

    1. Treat underlying problem.

    2. Bed rest.

    3. Antiinflammatory medications.

    4. If pleural effusion and tamponade occur, then pericardiocentesis (aspiration of fluid from the pericardial sac) is performed.

Nursing Intervention

  • GOAL: To maintain homeostasis and promote comfort.

  1. Assess characteristics of pain; administer appropriate analgesics.

  2. Upright position, with client leaning forward, may relieve the pain.

  3. Decrease anxiety, because client often associates problem with an MI; assist client to distinguish the difference.

  4. Observe for symptoms of cardiac tamponade.
    -Paradoxical blood pressure: precipitous decrease in systolic blood pressure on inspiration.

    -CVP increased; presence of jugular venous distention.

-Heart sounds are muffled or distant.
-Narrowing pulse pressure.
  1. In a client with chronic pericarditis, evaluate for symptoms of CHF and initiate nursing intervention.





Wednesday, June 25, 2008

Pulmonary Edema

PULMONARY EDEMA




  • Pulmonary Edema is caused by an abnormal accumulation of fluid in the lung, in both the interstitial and alveolar spaces.




  1. Origin is most often cardiac: Pulmonary congestion occurs when the pulmonary vascular bed receives more blood from the right side of the heart (venous return) than the left side of the heart (cardiac output) can accommodate.

  2. Pulmonary edema results from severe impairment in the ability of the heart to maintain cardiac output, thereby causing an engorgement of the pulmonary vascular bed.




Assessment


  1. Risk factors/etiology.

    1. Hypertention

    2. Aortic valva problems, CHF.

    3. Cardiac myopathy.

    4. Overhydration.


  1. Clinical manifestations: hypoxia

    1. Problem may occur at night or in clients for whom bed rest has been prescribed. The supine position increases venous return and promotes reabsorption of edema from the legs, thus precipitating an increase in cardiac workload and an increase in circulating volume.

    2. Sudden onset of dyspnea.

    3. Severe anxiety, restlessness, irritability.

    4. Cool, moist skin.

    5. Tachycardia (S3, S4 gallop)’tachypnes.

    6. Jugular vein distention

    7. Severe coughing

    8. Noisy, wet respirations that do not clear with coughing.

    9. Frothy, blood-tinge sputum.


*GERIATRIC PRIOT|RITY: Pulmonary edema can occur very rapidly and become a medical emergency.


  1. Diagnostics.

    1. Clinical manifestations.

    2. Predisposing condition.

    3. BNP (B-type natriuretic peptide) levels measured to assess for CHF (<100 pg/ml rules out CHF).




Treatment


Condition demands immediate attention; medications are administered intravenously.

  1. O2 high in concentration.

  2. Sedation (morphine) to allow controlled ventilation: decreases preload/vasoconstriction, as well as decreasing anxiety and pain.

  3. Diuretics to reduce the myocardial workload.

  4. Dopamine to facilitate myocardial contractility.

  5. Medications to increase cardiac contractility and cardiac output

  6. Vasodilators to decrease afterload.





Nursing Intervention


*GOAL: To assess and decrease hypoxia


*GOAL: To improve ventilation.


  1. Place in high-Fowler’s position with the legs dependent.

  2. Administer high levels of O2.

  3. Evaluate level of hypoxia and dyspnea; may need endotracheal tube intubation and mechanical ventilation.

  4. I.V. sedatives/narcotics.

    1. To decrease anxiety and dyspnea and to decrease pressure in pulmonary capillary bed.

    2. Closely observe for respiratory depression.


*ALERT: Pulmonary edema is one of the few circumstances in which a client with respiratory distress may be given a narcotic. The fear of not being able to breath is so strong that the client cannot cooperate. When a sedative/narcotic is administered, the nurse must be ready to support ventilation if respirations become severely depressed.


  1. Administer bronchodilators and evaluate clieant’esponse and common side effects.


*GOAL: To reduce circulating volume and cardiac workload.

  1. Diuretics.

  2. Medications to decrease afterload and increase cardiac output.

  3. Carefully monitor all I.V. fluids and evaluate overall hydration status.

  4. Do not elevate the client’s legs because this will rapidly increase the venous return and the circulating volume.


*GOAL: To provide psychological support and decrease anxiety.


A. Approach client in a calm manner.

B. Explain procedures.

C. Administer sedatives.

D. Remain with the client in acute respiratory distress.


*GOAL: To prevent recurrence of problem.


  1. Recognize early stages.

  2. Maintain client in semi-Fowler’ position.

  3. Decrease levels of activity.

  4. Use extreme caution in administration of fluids and transfusions.







Tuesday, June 24, 2008

Multiple Myeloma

MULTIPLE MYELOMA

Myeloma PET Scan Multiple Myeloma

* A malignancy of plasma cells, specifically the B lymphocytes. Infiltration occurs in the bones and soft tissues.

Assessment
A. Clinical Manifestations.

1. Back pain, bone pain.

2. Pathological fractures.

3. Hypercalcemia.

4. Renal failure.


B. Diagnostics.

1. Serum and/or protein electrophoresis.

2. Bone marrow biopsy.

3. X-ray film showing typical punched-out appearance of the bones caused by demineralization.

Treatment


A. Chemotherapy.

B. Palliative radiation therapy.

PET-CT-Fusion corona multiple myeloma


Nursing Intervention

GOAL: To maintain physical equilibrium.

A. Careful ambulation to decrease hypercalcemia and improve pulmonary status.

B. Adequate hydration to prevent calcium from precipitating in the kidneys; careful monitoring of hydration status.

C. Comfort measures and analgesics for pain.

D. Safety measures to prevent pathological fractures.

1. Do not lift anything weighing more than 10 pounds.

2. Use proper body mechanics.

E. Braces may be necessary to support the spine.


GOAL: To assist client to understand implications of the disease and measures to maintain health.






Thursday, May 22, 2008

Cardiovascular System Anatomy



Slideshow Transcript

Slide 1: Anatomy of Cardiovasvular System

Slide 2: The Cardiovascular System

Slide 3: • Your heart and circulatory system make up your cardiovascular system. • Your heart works as a pump that pushes blood to the organs, tissues, and cells of your body. • Blood delivers oxygen and nutrients to every cell and removes the carbon dioxide and waste products made by those cells.

Slide 4: • Blood is carried from your heart to the rest of your body through a complex network of arteries, arterioles, and capillaries. • Blood is returned to your heart through venules and veins.

Slide 5: • If all the vessels of this network in your body were laid end-to-end, they would extend for about 60,000 miles (more than 96,500 kilometers), which is far enough to circle the earth more than twice!

Slide 6: • The one-way circulatory system carries blood to all parts of your body. • This process of blood flow within your body is called circulation. • Arteries carry oxygen-rich blood away from your heart, and veins carry oxygen-poor blood back to your heart.

Slide 7: • In pulmonary circulation, though, the roles are switched. • It is the pulmonary artery that brings oxygen-poor blood into your lungs and the pulmonary vein that brings oxygen-rich blood back to your heart.

Slide 8: • In the diagram, the vessels that carry oxygen-rich blood are colored red, and the vessels that carry oxygen-poor blood are colored blue.

Slide 9: • Twenty major arteries make a path through your tissues, where they branch into smaller vessels called arterioles. • Arterioles further branch into capillaries, the true deliverers of oxygen and nutrients to your cells. Most capillaries are thinner than a hair. In fact, many are so tiny, only one blood cell can move through them at a time.

Slide 10: • Once the capillaries deliver oxygen and nutrients and pick up carbon dioxide and other waste, they move the blood back through wider vessels called venules. • Venules eventually join to form veins, which deliver the blood back to your heart to pick up oxygen.

Slide 11: Blood

Slide 12: • The circulatory system is the route by which the cells in your body get the oxygen and nutrients they need, but blood is the actual carrier of the oxygen and nutrients. • Blood is made mostly of plasma, which is a yellowish liquid that is 90% water.

Slide 13: • But in addition to the water, plasma contains salts, sugar (glucose), and other substances. And, most important, plasma contains proteins that carry important nutrients to the body’s cells and strengthen the body’s immune system so it can fight off infection.

Slide 14: • The average man has between 10 and 12 pints of blood in his body. • The average woman has between 8 and 9 pints. To give you an idea of how much blood that is, 8 pints is equal to 1 gallon (think of a gallon of milk).

Slide 15: What is blood? • Blood is actually a tissue. • It is thick because it is made up of a variety of cells, each having a different job. In fact, blood is actually about 80% water and 20% solid.

Slide 16: • We know that blood is made mostly of plasma. But there are 3 main types of blood cells that circulate with the plasma:

Slide 17: • Platelets, which help the blood to clot. Clotting stops the blood from flowing out of the body when a vein or artery is broken. Platelets are also called thrombocytes.

Slide 18: • Red blood cells, which carry oxygen. Of the 3 types of blood cells, red blood cells are the most plentiful. In fact, a healthy adult has about 35 trillion of them. The body creates these cells at a rate of about 2.4 million a second, and they each have a life span of about 120 days. Red blood cells are also called erythrocytes.

Slide 20: • White blood cells, which ward off infection. These cells, which come in many shapes and sizes, are vital to the immune system. When the body is fighting off infection, it makes them in ever-increasing numbers. Still, compared to the number of red blood cells in the body, the number of white blood cells is low. Most healthy adults have about 700 times as many red blood cells as white ones. White blood cells are also called leukocytes.

Slide 22: • Blood also contains hormones, fats, carbohydrates, proteins, and gases.

Slide 23: What does blood do? Blood carries oxygen from the lungs and nutrients from the digestive tract to the body’s cells. It also carries away carbon dioxide and all of the waste products that the body does not need. (The kidneys filter and clean the blood.)

Slide 24: Blood also • Helps keep your body at the right temperature • Carries hormones to the body’s cells • Sends antibodies to fight infection • Contains clotting factors to help the blood to clot and the body’s tissues to heal

Slide 25: Blood types • There are 4 different blood types: A, B, AB, and O. Genes that you inherit from your parents (1 from your mother and 1 from your father) determine your blood type.

Slide 26: • Blood is always being made by the cells inside your bones, so your body can usually replace any blood lost through small cuts or wounds. But when a lot of blood is lost through large wounds, it has to be replaced through a blood transfusion (blood donated by other people).

Slide 27: • In blood transfusions, the donor and recipient blood types must be compatible. People with type O blood are called universal donors, because they can donate blood to anyone, but they can only receive a transfusion from other people with type O blood.

Slide 28: Blood tests and cardiovascular conditions • Certain blood tests can be performed to see if there is a problem with your heart, lungs, or blood vessels.

Slide 29: • Cardiac enzyme tests, which measure the cardiac enzyme levels in the blood. Certain enzymes will be present if the heart muscle (myocardium) has been damaged by a heart attack, because damaged heart cells release these enzymes into the blood. The most common cardiac enzyme that is released is creatine kinase.

Slide 30: • Troponin tests, which measure the amount of troponin (a type of protein) in the blood. Troponin affects how the heart muscle contracts. If there are high levels of troponin in the blood (troponin T or troponin I), there is most likely damage to the heart muscle. The amount of troponin released into the blood correlates with the degree of damage to the heart muscle.

Slide 32: • Arterial blood gas studies, which measure how well the blood is being oxygenated in the lungs.

Slide 33: • Lipoprotein (cholesterol) profile, which measures how much fat or lipid is in the blood.

Slide 34: • Blood cultures, which can be used to determine if there are microorganisms (like the bacteria that causes endocarditis) in the body’s system. After the blood is drawn, it is placed on a culture, which helps the bacteria grow. The bacteria is then analyzed to determine what type it is and what medicines can be used to kill it.

Slide 36: • Blood clotting tests, which measure the blood’s ability to clot. Clotting stops the blood from flowing out of the body when a vein or artery is broken.

Slide 37: Heart Anatomy

Slide 38: • The heart weighs between 7 and 15 ounces (200 to 425 grams) and is a little larger than the size of your fist. • By the end of a long life, a person's heart may have beat (expanded and contracted) more than 3.5 billion times. • In fact, each day, the average heart beats 100,000 times, pumping about 2,000 gallons (7,571 liters) of blood.

Slide 40: • Your heart is located between your lungs in the middle of your chest, behind and slightly to the left of your breastbone (sternum). • A double-layered membrane called the pericardium surrounds your heart like a sac.

Slide 41: • The outer layer of the pericardium surrounds the roots of your heart's major blood vessels and is attached by ligaments to your spinal column, diaphragm, and other parts of your body.

Slide 42: • The inner layer of the pericardium is attached to the heart muscle. • A coating of fluid separates the two layers of membrane, letting the heart move as it beats, yet still be attached to your body.

Slide 43: • Your heart has 4 chambers. • The upper chambers are called the left and right atria, and the lower chambers are called the left and right ventricles. • A wall of muscle called the septum separates the left and right atria and the left and right ventricles.

Slide 44: • The left ventricle is the largest and strongest chamber in your heart. • The left ventricle's chamber walls are only about a half-inch thick, but they have enough force to push blood through the aortic valve and into your body.

Slide 45: The Heart Valves

Slide 46: Four valves regulate blood flow through your heart: • The tricuspid valve regulates blood flow between the right atrium and right ventricle.

Slide 48: • The pulmonary valve controls blood flow from the right ventricle into the pulmonary arteries, which carry blood to your lungs to pick up oxygen.

Slide 50: • The mitral valve lets oxygen-rich blood from your lungs pass from the left atrium into the left ventricle.

Slide 52: • The aortic valve opens the way for oxygen-rich blood to pass from the left ventricle into the aorta, your body's largest artery, where it is delivered to the rest of the body.

Slide 54: The Conduction System

Slide 56: • Electrical impulses from your heart muscle (the myocardium) cause your heart to beat (contract). • This electrical signal begins in the sinoatrial (SA) node, located at the top of the right atrium. • The SA node is sometimes called the heart's "natural pacemaker."

Slide 57: • When an electrical impulse is released from this natural pacemaker, it causes the atria to contract. • The signal then passes through the atrioventricular (AV) node. • The AV node checks the signal and sends it through the muscle fibers of the ventricles, causing them to contract.

Slide 58: • The SA node sends electrical impulses at a certain rate, but your heart rate may still change depending on physical demands, stress, or hormonal factors.

Slide 59: The Coronary Arteries

Slide 61: Coronary Circulation • The heart muscle, like every other organ or tissue in your body, needs oxygen-rich blood to survive. • Blood is supplied to the heart by its own vascular system, called coronary circulation.

Slide 62: • The aorta (the main blood supplier to the body) branches off into two main coronary blood vessels (also called arteries). • These coronary arteries branch off into smaller arteries, which supply oxygen-rich blood to the entire heart muscle.

Slide 63: • The right coronary artery supplies blood mainly to the right side of the heart. • The right side of the heart is smaller because it pumps blood only to the lungs.

Slide 64: • The left coronary artery, which branches into the left anterior descending artery and the circumflex artery, supplies blood to the left side of the heart. • The left side of the heart is larger and more muscular because it pumps blood to the rest of the body.

Slide 65: The Heart Valves

Slide 66: • Four valves regulate blood flow through your heart: • The tricuspid valve regulates blood flow between the right atrium and right ventricle.

Slide 68: • The pulmonary valve controls blood flow from the right ventricle into the pulmonary arteries, which carry blood to your lungs to pick up oxygen.

Slide 70: • The mitral valve lets oxygen-rich blood from your lungs pass from the left atrium into the left ventricle.

Slide 72: • The aortic valve opens the way for oxygen-rich blood to pass from the left ventricle into the aorta, your body's largest artery, where it is delivered to the rest of the body.

Slide 74: The Heartbeat

Slide 75: • A heartbeat is a two-part pumping action that takes about a second. • As blood collects in the upper chambers (the right and left atria), the heart's natural pacemaker (the SA node) sends out an electrical signal that causes the atria to contract.

Slide 76: • This contraction pushes blood through the tricuspid and mitral valves into the resting lower chambers (the right and left ventricles). • This part of the two-part pumping phase (the longer of the two) is called diastole.

Slide 77: • The second part of the pumping phase begins when the ventricles are full of blood. • The electrical signals from the SA node travel along a pathway of cells to the ventricles, causing them to contract. • This is called systole.

Slide 78: • As the tricuspid and mitral valves shut tight to prevent a back flow of blood, the pulmonary and aortic valves are pushed open. • While blood is pushed from the right ventricle into the lungs to pick up oxygen, oxygen-rich blood flows from the left ventricle to the heart and other parts of the body.

Slide 79: • After blood moves into the pulmonary artery and the aorta, the ventricles relax, and the pulmonary and aortic valves close. • The lower pressure in the ventricles causes the tricuspid and mitral valves to open, and the cycle begins again.

Slide 80: • This series of contractions is repeated over and over again, increasing during times of exertion and decreasing while you are at rest. • The heart normally beats about 60 to 80 times a minute when you are at rest, but this can vary.

Slide 81: • As you get older, your resting heart rate rises. • Also, it is usually lower in people who are physically fit.

Slide 82: • Your heart does not work alone, though. Your brain tracks the conditions around you—climate, stress, and level of physical activity—and adjusts your cardiovascular system to meet those needs.

Slide 83: • The human heart is a muscle designed to remain strong and reliable for a hundred years or longer. • By reducing your risk factors for cardiovascular disease, you may help your heart stay healthy longer.

Slide 84: Vasculature of the Arm

Slide 85: • The one-way circulatory system carries blood to all parts of your body. • This process of blood flow within your body is called circulation. • Arteries carry oxygen-rich blood away from your heart, and veins carry oxygen-poor blood back to your heart.

Slide 86: • In pulmonary circulation, though, the roles are switched. • It is the pulmonary artery that brings oxygen-poor blood into your lungs and the pulmonary vein that brings oxygen-rich blood back to your heart.

Slide 87: • In the diagram, the vessels that carry oxygen-rich blood are colored red, and the vessels that carry oxygen-poor blood are colored blue.

Slide 88: Vasculature of the Head

Slide 89: • The one-way circulatory system carries blood to all parts of your body. • This process of blood flow within your body is called circulation. • Arteries carry oxygen-rich blood away from your heart, and veins carry oxygen-poor blood back to your heart.

Slide 90: • In pulmonary circulation, though, the roles are switched. • It is the pulmonary artery that brings oxygen-poor blood into your lungs and the pulmonary vein that brings oxygen-rich blood back to your heart.

Slide 91: Arteries of the Head and Upper Torso

Slide 92: Veins of the Head and Upper Torso

Slide 93: • In the diagrams, the vessels that carry oxygen-rich blood are colored red, and the vessels that carry oxygen-poor blood are colored blue.

Slide 94: Vasculature of the Leg

Slide 95: • The one-way circulatory system carries blood to all parts of your body. • This process of blood flow within your body is called circulation. • Arteries carry oxygen-rich blood away from your heart, and veins carry oxygen-poor blood back to your heart.

Slide 96: • In pulmonary circulation, though, the roles are switched. • It is the pulmonary artery that brings oxygen-poor blood into your lungs and the pulmonary vein that brings oxygen-rich blood back to your heart.

Slide 97: • In the diagram, the vessels that carry oxygen- rich blood are colored red, and the vessels that carry oxygen- poor blood are colored blue.

Slide 98: Vasculature of the Torso

Slide 99: • The one-way circulatory system carries blood to all parts of your body. • This process of blood flow within your body is called circulation. • Arteries carry oxygen-rich blood away from your heart, and veins carry oxygen-poor blood back to your heart.

Slide 100: • In pulmonary circulation, though, the roles are switched. • It is the pulmonary artery that brings oxygen-poor blood into your lungs and the pulmonary vein that brings oxygen-rich blood back to your heart.

Slide 101: • In the diagram, the vessels that carry oxygen- rich blood are colored red, and the vessels that carry oxygen- poor blood are colored blue.

Slide 102: “Nurses Informations” http://nursesinformations.blogspot.com

Friday, May 9, 2008

Cardiovascular Pathology (part 1)

Sunday, April 6, 2008

Direct inguinal hernia repair

Description: Laparoscopic repair of Bilateral direct inguinal hernia by TAPP

Note:
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Saturday, March 15, 2008

Pulmonary Tuberculosis

Friday, March 14, 2008

Cutaneous Antrax & Its Mimics

Thursday, March 13, 2008

Pathology of Pneumonia

Thursday, February 7, 2008

Tourette’s syndrome (TS)

Tourette’s syndrome (TS), a neurologic disorder is characterized by persistent tics—involuntary movements and vocalizations.


TS affects 1:10 children/1,000 (estimated)
3 boys:1 girl are affected

Onset of symptoms: 7-year-old
Peak of symptoms: 8 to 12-year-old
Decline of symptoms:
steadily at 20-year-old


Distinguishing Characteristics:
1. Repetitive motor
2. Vocal tics - differ in severity & duration
*grunting
*barking
*sniffing
*throat clearing

(other common kinds of tics: eye blinking, facial grimacing, shoulder shrugging, and head or shoulder jerking)


Extreme forms:
1. Tics that result in self-harm (punching oneself in the face)
2. Vocal tics
*coprolalia (uttering swear words)
*echolalia (repeating others’ words or phrases)


Coexisting Neurobehavioral Conditions:
1. Attention-deficit hyperactivity disorder
2. Obsessive-compulsive behaviors
*This may exacerbate the symptoms of TS and impair a child’s ability to learn. If successfully treated, these may diminish tic severity.
*TS doesn’t impair a person's intelligence.


A diagnosis:
1. based on patient history
2. based on clinical assessment
*no tests are diagnostic for TS

Formal criteria for a diagnosis of TS:
* multiple motor and at least one vocal tic
* a waxing and waning course with decreasing severity over time
* tic symptoms persisting for at least 1 year
* symptom onset before age 21
* no precipitating illnesses (such as encephalitis or stroke) or precipitating drugs (such as stimulants, antiepileptic drugs, levodopa, or haloperidol)
* observation of tics by a medical professional.


Patients with TS:

*Aren’t significantly disabled by their symptoms
*Don’t require medication
-may be indicated if the symptoms affect the persons functioning
-They only reduce the severity and do not eliminate symptoms
-must be monitored closely for adverse reactions


Management of mild symptoms:

1. Education
2. Counseling
3. Behavioral techniques

*MOST SUCCESSFUL BEHAVIORAL INTERVENTION: Habit reversal (focuses on techniques to replace the tic with an alternate behavior)

Management for severely disabled patients:
*experimental surgical interventions (deep brain stimulation)


Tier One Drugs (for mild to moderate symptoms):
1.Clonidine
2 Clonazepam
3 Guanfacine

Main Adverse Reactions:

1. Sedation
2. Irritability.


Tier Two Drugs (for severe symptoms):
1. Haloperidol
2. Pimozide
3. Risperidone
4. Fluphenazine

Main Adverse Reactions:
1. Sedation
2. Weight gain
3. Extrapyramidal symptoms
* tardive dyskinesia (involuntary movements, usually of the mouth, lips, and tongue)
* tremors
* rigidity
* akathisia (physical restlessness)
* acute dystonia (muscle contractions)


*Refer patients and their families to support groups and Web sites because symptoms can make patients feel socially isolated and self-conscious. TS can strain family relationships knowing that other families are having the same experiences.

Chronic Kidney Failure

• The end result of conditions that greatly reduce kidney function by destroying nephrons and producing a marked decrease in the glomerular filtration rate (GFR) are represented by chronic kidney failure.

• As renal function moves from renal insufficiency (GFR 50% to 20% normal), to kidney failure (20% to 5% normal), to end-stage kidney disease (<5% normal), signs of kidney failure begin to appear. Dialysis or kidney transplantation is necessary for survival when the GFR decreases to less than 5% of normal.

• The kidneys' inability to perform their normal functions of regulating fluid and electrolyte balance, controlling blood pressure through fluid volume and the renin-angiotensin system, eliminating nitrogenous and other waste products, governing the red blood cell count through erythropoietin synthesis, and directing parathyroid and skeletal function through phosphate elimination and activation of vitamin D are the manifestations of chronic kidney failure represent

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