By Q. Marcus. Lenoir-Rhyne College. 2018.

The conducting zone of the respiratory system includes the organs and structures not directly involved in gas exchange buy generic bactroban 5 gm line acne remedies. Conducting Zone The major functions of the conducting zone are to provide a route for incoming and outgoing air buy 5gm bactroban acne-, remove debris and pathogens from the incoming air, and warm and humidify the incoming air. The epithelium of the nasal passages, for example, is essential to sensing odors, and the bronchial epithelium that lines the lungs can metabolize some airborne carcinogens. The Nose and its Adjacent Structures The major entrance and exit for the respiratory system is through the nose. When discussing the nose, it is helpful to divide it into two major sections: the external nose, and the nasal cavity or internal nose. The external nose consists of the surface and skeletal structures that result in the outward appearance of the nose and contribute to its numerous functions (Figure 22. An ala is a cartilaginous structure that forms the lateral side of each naris (plural = nares), or nostril opening. While the root and bridge of the nose consist of bone, the protruding portion of the nose is composed of cartilage. The nares open into the nasal cavity, which is separated into left and right sections by the nasal septum (Figure 22. The nasal septum is formed anteriorly by a portion of the septal cartilage (the flexible portion you can touch with your fingers) and posteriorly by the perpendicular plate of the ethmoid bone (a cranial bone located just posterior to the nasal bones) and the thin vomer bones (whose name refers to its plough shape). Each lateral wall of the nasal cavity has three bony projections, called the superior, middle, and inferior nasal conchae. The inferior conchae are separate bones, whereas the superior and middle conchae are portions of the ethmoid bone. Conchae serve to increase the surface area of the nasal cavity and to disrupt the flow of air as it enters the nose, causing air to bounce along the epithelium, where it is cleaned and warmed. The conchae and meatuses also conserve water and prevent dehydration of the nasal epithelium by trapping water 1036 Chapter 22 | The Respiratory System during exhalation. Each paranasal sinus is named for its associated bone: frontal sinus, maxillary sinus, sphenoidal sinus, and ethmoidal sinus. The nares and anterior portion of the nasal cavities are lined with mucous membranes, containing sebaceous glands and hair follicles that serve to prevent the passage of large debris, such as dirt, through the nasal cavity. The conchae, meatuses, and paranasal sinuses are lined by respiratory epithelium composed of pseudostratified ciliated columnar epithelium (Figure 22. The epithelium contains goblet cells, one of the specialized, columnar epithelial cells that produce mucus to trap debris. The cilia of the respiratory epithelium help remove the mucus and debris from the nasal cavity with a constant beating motion, sweeping materials towards the throat to be swallowed. Interestingly, cold air slows the movement of the cilia, resulting in accumulation of mucus that may in turn lead to a runny nose during cold weather. Serous and mucus-producing cells also secrete the lysozyme enzyme and proteins called defensins, which have antibacterial properties. Immune cells that patrol the connective tissue deep to the respiratory epithelium provide additional protection. Pharynx The pharynx is a tube formed by skeletal muscle and lined by mucous membrane that is continuous with that of the nasal cavities (see Figure 22. The pharynx is divided into three major regions: the nasopharynx, the oropharynx, and the laryngopharynx (Figure 22. A pharyngeal tonsil, also called an adenoid, is an aggregate of lymphoid reticular tissue similar to a lymph node that lies at the superior portion of the nasopharynx. The function of the pharyngeal tonsil is not well understood, but it contains a rich supply of lymphocytes and is covered with ciliated epithelium that traps and destroys invading pathogens that enter during inhalation. The pharyngeal tonsils are large in children, but interestingly, tend to regress with age and may even disappear. Both the uvula and soft palate move like a pendulum during swallowing, swinging upward to close off the nasopharynx to prevent ingested materials from entering the nasal cavity. In addition, auditory (Eustachian) tubes that connect to each middle ear cavity open into the nasopharynx. As the nasopharynx becomes the oropharynx, the epithelium changes from pseudostratified ciliated columnar epithelium to stratified squamous epithelium. A palatine tonsil is one of a pair of structures located laterally in the oropharynx in the area of the fauces. Similar to the pharyngeal tonsil, the palatine and lingual tonsils are composed of lymphoid tissue, and trap and destroy pathogens entering the body through the oral or nasal cavities.

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Study questions • Describe infection prevention in health care setups • List chain of infection • Identify between medical asepsis and surgical asepsis • Discuss the purpose purchase 5 gm bactroban acne on temples, use and components of standard precautions purchase bactroban 5gm acne cyst removal. After completion of a procedure, observe the patient reaction to the procedure, take care of all used equipment and return to their proper place. Patient Care Unit: is the space where the patient is accommodated in hospital or patient home whereto receive care. Consists of a hospital bed, bed side stand, over bed table, chair, overhead light, suction and oxygen, electrical outlets, sphygmomanometer, a nurse’s call light, waste container and bed side table and others as needed and available. Hospital Bed • Gatch bed: a manual bed which requires the use of hand racks or foot pedals to manipulate the bed into 50 Basic Clinical Nursing Skills desired positions i. Side rails • It should be attached to both sides of the bed _ Full rails – run the length of the bed – Half rails _ run only half the length of the bed and commonly attached to the pediatrics bed. Bed Side Table/Cabinet • Is a small cabinet that generally consists of a drawer and a cupboard area with shelves • Used to store the utensils needed for clients care. Includes the washbasin (bath basin, emesis (kidney) basin, bed pan and urinal • Has a towel rack on either sides or along the back • Is best for storing personal items that are desired near by or that will be used frequently E. Over Bed Table • The height is adjustable 51 Basic Clinical Nursing Skills • Can be positioned and consists of a rectangular, flat surface supported by a side bar attached to a wide base on wheels • Along side or over the bed or over a chair • Used for holding the tray during meals, or care items when completing personal hygiene F. The Chair • Most basic care units have at least one chair located near the bedside • For the use of the client, a visitor, or a care provider G. Overhead Light (examination light) • Is usually placed at the head of the bed, attached to either the wall or the ceiling • A movable lamp may also be used • Useful for the client for reading or doing close work • Important for the nurse during assessment H. Suction and Oxygen Outlets • Suction is a vacuum created in a tube that is used to pull (evacuate) fluids from the body E. Care of Patient Unit • Nursing staffs are not responsible for actual cleaning of dust and other dirty materials from hospital. General Instructions for Care of Hospital Equipment • Use articles only for the purpose for which they are intended. Care of Linen and Removal of Stains • Clean linen should be folded properly and be kept neatly in the linen cupboard. Care of Pick Up Forceps and Jars Pickup forceps: is an instrument that allows one to pick up sterile equipment. Pick up forceps should be kept inside the jar in which 2/3 of the jar should be filled with antiseptic solution • Wash pick up forceps and jars and sterilize daily • Fill jar with disinfectant solution daily such as detol or preferably carbolic solution 56 Basic Clinical Nursing Skills • Care should be taken not to contaminate tip of the forceps • Always hold tip downward • If tip of forceps is contaminated accidentally, it should be sterilized before placing it back in the jar to avoid contamination. Rubber Bags Example: hot water bottles, ice bags should be drained and dried They should be inflated with air and closed to prevent the sides from sticking together 6. Rubber Tubing • Should be washed with warm, soapy water • The inside should be flushed and rinsed well Study questions: 1. Admission Admission is a process of receiving a new patient to an individual unit (ward) of the hospital. Make introduction and orient the patient • Greet the patient • Introduce self to the patient and the family • Explain what will occur during the admission process (admission routines) such as admission bath, put on hospital gowns etc. Observation and physical examination such as: • Vital signs; temperature pulse, respiration and blood pressure. Documentation • Record all parts of the admission process • Other recording include ⇐ Notification to dietary departments ⇐ Starting kardex card and medication records ⇐ If there is specific form to the facility, complete it. Transfer of the patient to another unit Transfer of the patient to another unit is done for several reasons. Procedure ™ Explain the transfer to the client and the family ™ Assemble all the client’s personal belongings, charts, x-films and lab reports. Give the time, the unit to which the transfer occurs, types of transportation (wheelchair, stretcher), and the cleint’s physical and psychological condition ™ Make sure that the receiving unit is ready. Plan for continuing care of the patient • Referral as necessary • Give information for a person involved in the patient care. Teaching the patient about • What to expect about disease outcome • Medications (Treatments) • Activity • Diet 62 Basic Clinical Nursing Skills • Need for continued health supervision, and others as needed 4. Do final assessment of physical and emotional status of the patient and the ability to continue own care.

Percussion of the frontal and maxillary sinus area may be indicated cheap 5gm bactroban with visa skin care zits, especially in animals with orbital disease buy bactroban 5gm acne under jawline. A stethoscope is helpful to critically assess the sounds generated during percussion and certainly comparison of both sides will identify subtle fluid accumulations. Retropulsion  Retropulsion or pushing the globe deeper into the orbit through the closed eyelids is a technique that is used to determine if there is an abnormal amount of orbital contents. Resistance to retropulsion, especially as compared to the contralateral orbit would signify increased orbital mass and perhaps a localization of a focal swelling could be identified with this method combined with the direction of any apparent deviation of the globe. This technique would not of course be used in an eye that is in danger of rupture. The maximal amount of valuable information gained from the findings of these procedures results when the examiner is familiar with the normal bony and soft tissue anatomy. Palpation  Palpation used in a stimulatory manner (Palpebral Reflex) to evaluate sensory and motor nerve function is important to evaluate the fifth, sixth and seventh cranial nerves. Touching the periocular area should normally produce a blink reflex, verifying that the fifth and seventh cranial nerves are intact as well as the orbicularis oculi muscle. Corneal Reflex  Touching the cornea with the wisped end of a cotton tipped applicator (Corneal Reflex) will evaluate the ophthalmic branch of the fifth nerve and a normal reflex will elicit a head jerk, blink and retraction of the globe with secondary prolapse of the third eyelid. Pupillary symmetry  Pupillary symmetry can be evaluated by viewing the animal head on from about 6 feet through a direct ophthalmoscope set a 0 diopters and stimulating a tapetal reflex. At the same time, the fellow pupil should also constrict, resulting in the consensual pupillary light reflex. Observation of this reflex may require a second person due to the lateral placement of the globes. The equine pupil responds slower than the cat or dog and as with all animals, its presence does not confirm sight. Finnoff Transilluminator Excitement or opacity of the ocular media from blood, pus or cataract will not override the reflex from a bright focal light source. Inexpensive Lights Intermediate Examination Process  Now a more through evaluation of the external eye can be done and systemic analgesic/sedatives could be given at this point if deemed necessary, which will not affect the subsequent portions of the examination. Use of an neck twitch or lip twitch is also often necessary during the moment of more uncomfortable examination procedures. Such as, at the time the periocular nerve block injections are made, eversion of the eyelids, especially the third eyelid and perhaps when the nasolacrimal system is flushed. Close Inspection For the majority of the examination minimal restraint is usually optimal and holding the horse by the halter seems to work well. Close evaluation of the eyelid margins, conjunctiva, cul de sacs and cornea for abnormalities can effectively be done with a bright light source and magnification. A head loupe such as an "Opti-Visor" is very helpful in addition to an adequate light source. The otoscope will provide a 3 x – 5x magnification and a powerful light source all in one. Opacities in the Ocular Media  With the direct ophthalmoscope set at 0 diopters and viewing the eye from a distance of about one to two feet, an evaluation of the of the ocular media for opacities. Opacities in the Ocular Media  The best situation is when the pupil is dilated artificially with tropicamide (1%) – do not use atropine for diagnostic purposes. This will allow the examiner to briefly evaluate the lens and vitreal space in this indirect manner for synechia, cataracts, vitreal floaters and retinal detachments. Opacities in the Ocular Media  Later, when it is more appropriate to use a mydriatic, this indirect examination with the direct ophthalmoscope can be repeated when the pupil is large. Opacities that are anterior to the center of the lens will move in the same direction of the globe and ones posterior to the center of the lens will move in the opposite direction. Retinal detachments, if large will be seen easier with this method than looking directly. Ocular Opacity Focal Beam Examination  Using a focal beam and or a slit beam directed into the eye at an angle evaluate the anterior chamber. Evaluation of the chamber contents and depth are essential as well as the character of the pupillary margin with regard to adhesions of the iris to the lens and pigment deposits on the anterior surface of the lens and the physical condition of the corpora nigra. Slit Light Examination Localization of an opacity  Slit Light Examination Localization of an opacity  Slit Light Examination Flare  The aqueous is normally optically clear.

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In an attempt to and inattention to important improve outcomes purchase 5 gm bactroban acne y estres, gynaecologists aspects such as tissue handling buy generic bactroban 5 gm on-line skin care laser clinic birmingham, involved in reconstructive pelvic correct choice of suture material foor surgery have looked to and strict asepsis will have an the general surgeons, who have important impact on the outcome employed various graft materials of the prolapse repair. A wide variety of crucial in ensuring the appropriate synthetic and biological grafts are procedure is performed and currently available. The synthetic support in all three vaginal grafts have shown some promise 154 in the prevention of recurrent and assess the properties of both prolapse but unfortunately have synthetic and biological prostheses a tendency to erode, extrude or employed in reconstructive pelvic become infected. The biological foor surgery and evaluate surgical grafts have been developed to outcomes and peri-operative avoid these complications. The newest development has been Anterior Compartment the introduction of xenograft (See table 1) materials, derived from animal Ahlfelt in 1909 stated that the only sources, into prolapse surgery. There are colporrhaphy, which involved however reservations regarding plication of the urethral muscle. A number of other procedures advocated for the repair of the The introduction of new prostheses cystocele have subsequently into practice has regrettably been evolved and these include: marketing rather than evidence vaginal para-vaginal repair, driven. It is vital that practitioners colposuspension and abdominal involved in reconstructive pelvic paravaginal repair. The success foor surgery are aware of the rates of anterior colporrhaphy in effcacy, limitations and potential the management of cystoceles morbidity of these products. Much higher failure rates following anterior, recurrence rates have, however apical and posterior compartment been reported. In addition, we will classify control trials, Weber et al and 155 Table 1: Failure rates of anterior compartment prolapse repair Procedure Follow-up Failure (variably defned) Midline fascial placation 1 – 20 yrs 3-58 % Site-specifc fascial repair 6 mths – 2 yrs 10-32 % Vaginal-paravaginal repair 6 mths – 6 yrs 30-67 % Abdominal paravaginal repair 6 mths – 6 yrs 20 % Concomitant sling support 17 mths – 4 yrs 2-57 % Sand et al reported the anterior related to failure of the initial colporraphy to be successful in procedure to identify and repair all only 42% and 57% respectively. Adequate support Success rates of the vaginal of the vaginal apex is essential paravaginal repair for cystoceles in ensuring the longevity of an in various case series range from anterior compartment procedure. In addition, this procedure has signifcant morbidity including Posterior Compartment ureteric ligation, retropubic (See table 2) haemorrhage and abscess Reports of recurrence after formation. Colposuspension has rectocele repair range from 7% a failure rate of up to 33% and to 67%, depending on the type of abdominal paravaginal repair fails operation. The vaginal In addition to the traditional risk procedures include: site –specifc factors, recurrence of anterior repair, fascial plication and levator compartment prolapse may be plication repair. The transanal repair, the the vaginal, abdominal and colorectal surgeon’s route of laparoscopic approaches are choice, has reported failure rates employed for apical prolapse. Objective failure rates vary from 24% to 47% in various studies on sacrocolpopexy, bilateral Apical Prolapse iliococcygeus fxation and sacrospinous fxation. The vaginal apex, be it uterus or post –hysterectomy vaginal cuff, is the keystone of pelvic organ support. Appropriate attention 157 Classifcation And Non-carcinogenic Properties Of Graft Affordable Materials Accessible Easy to handle Prostheses may be derived from Flexible synthetic materials, biological tissues or mixed synthetic and biological grafts. The biological grafts include autologous grafts, Synthetic Grafts which are derived from the individual’s own tissues, allografts Synthetic grafts are durable, easy from human donor tissue and to handle and readily available. They do not require harvesting as Recently, a mixed synthetic with the autografts and they do and biological graft has been not carry the infection risks of the produced. Over the past few years, there Important aspects that should be has been extensive research and considered when selecting a graft development in an attempt to include the inherent strength, identify the properties of an surgical handling, its reaction ideal synthetic prosthesis. The properties of the been manufactured, each with ideal graft for pelvic reconstructive its own properties and in-vivo surgery are listed in table 3. Mesh prostheses have been used to reinforce abdominal Table 3: Properties of the ideal hernia repair by general surgeons graft for a few decades now. When placing mesh through a vaginal Biocompatible incision, additional factors need Inert to be considered in prosthesis Hypoallergenic selection. The risk of infection Hypoinfammatory is four times higher if placed vaginally rather than abdominally. Resistant to mechanical stress The sexual function of the vagina Sterile also needs to be retained and 158 the mesh should therefore be with varying success rates. Erosion The absorbable mesh used is is the greatest risk of synthetic almost exclusively Polyglactin mesh and infection of the graft 910 (Vicryl).

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It helps establish the resting membrane potential in neurons and muscle fibers after membrane depolarization and action potentials cheap bactroban 5 gm without prescription acne when pregnant. Potassium is excreted purchase bactroban 5gm otc acne with mirena, both actively and passively, through the renal tubules, especially the distal convoluted tubule and collecting ducts. Potassium participates in the exchange with sodium in the renal tubules under the influence of aldosterone, which also relies on basolateral sodium-potassium pumps. Similar to the situation with hyponatremia, hypokalemia can occur because of either an absolute reduction of potassium in the body or a relative reduction of potassium in the blood due to the redistribution of potassium. Some insulin-dependent diabetic patients experience a relative reduction of potassium in the blood from the redistribution of potassium. Hyperkalemia, an elevated potassium blood level, also can impair the function of skeletal muscles, the nervous system, and the heart. This can result in a partial depolarization (excitation) of the plasma membrane of skeletal muscle fibers, neurons, and cardiac cells of the heart, and can also lead to an inability of cells to repolarize. For the heart, this means that it won’t relax after a contraction, and will effectively “seize” and stop pumping blood, which is fatal within minutes. Because of such effects on the nervous system, a person with hyperkalemia may also exhibit mental confusion, numbness, and weakened respiratory muscles. The paths of secretion and reabsorption of chloride ions in the renal system follow the paths of sodium ions. Hypochloremia, or lower-than-normal blood chloride levels, can occur because of defective renal tubular absorption. Hyperchloremia, or higher-than-normal blood chloride levels, can occur due to dehydration, excessive intake of dietary salt (NaCl) or swallowing of sea water, aspirin intoxication, congestive heart failure, and the hereditary, chronic lung disease, cystic fibrosis. In people who have cystic fibrosis, chloride levels in sweat are two to five times those of normal levels, and analysis of sweat is often used in the diagnosis of the disease. Carbon dioxide is converted into bicarbonate in the cytoplasm of red blood cells through the action of an enzyme called carbonic anhydrase. Calcium About two pounds of calcium in your body are bound up in bone, which provides hardness to the bone and serves as a mineral reserve for calcium and its salts for the rest of the tissues. A little more than one-half of blood calcium is bound to proteins, leaving the rest in its ionized form. In addition, calcium helps to stabilize cell membranes and is essential for the release of neurotransmitters from neurons and of hormones from endocrine glands. A deficiency of vitamin D leads to a decrease in absorbed calcium and, eventually, a depletion of calcium stores from the skeletal system, potentially leading to rickets in children and osteomalacia in adults, contributing to osteoporosis. Hypocalcemia, or abnormally low calcium blood levels, is seen in hypoparathyroidism, which may follow the removal of the thyroid gland, because the four nodules of the parathyroid gland are embedded in it. Hypophosphatemia, or abnormally low phosphate blood levels, occurs with heavy use of antacids, during alcohol withdrawal, and during malnourishment. In the face of phosphate depletion, the kidneys usually conserve phosphate, but during starvation, this conservation is impaired greatly. Hyperphosphatemia, or abnormally increased levels of phosphates in the blood, occurs if there is decreased renal function or in cases of acute lymphocytic leukemia. Regulation of Sodium and Potassium Sodium is reabsorbed from the renal filtrate, and potassium is excreted into the filtrate in the renal collecting tubule. Aldosterone Recall that aldosterone increases the excretion of potassium and the reabsorption of sodium in the distal tubule. Aldosterone is released if blood levels of potassium increase, if blood levels of sodium severely decrease, or if blood pressure decreases. Its net effect is to conserve and increase water levels in the plasma by reducing the excretion of sodium, and thus water, from the kidneys. This action increases the glomerular filtration rate, resulting in more material filtered out of the glomerular capillaries and into Bowman’s capsule. In the distal convoluted tubules and collecting ducts of the kidneys, aldosterone stimulates the synthesis and activation of the sodium-potassium pump (Figure 26. Aldosterone’s effect on potassium is the reverse of that of sodium; under its influence, excess potassium is pumped into the renal filtrate for excretion from the body.

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