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Use of a vaccine (for actually contracting the disease) usually renders one temporary or permanent resistance to the infectious disease cheap 25mg sildigra visa. Vaccines and toxoids promote the type of antibody production one would see if they had experienced the natural infection purchase sildigra 50 mg visa. This active immunization involves the direct administration of antigens to the host to cause them to produce the desired antibodies and cell mediated immunity sildigra 25mg generic. These agents may consist of live attenuated agents or killed (inactivated) agents sildigra 100mg overnight delivery, or agents that alter the hosts genetic structure discount 50mg sildigra. Immunoglobulins and anti venins only after passive short vaccines and vitamins term immunity are usually administered for a specific exposure. Aggressive pediatric immunization programs have helped reduce preventable diseases and death to children worldwide. A careful immunization history should be documented for every client, regardless of age. When in doubt, or if unknown if had infection or immunization, appropriate titers may be drawn. The following lists show some of the more common diseases, the general recommended schedule to confer immunization, and the length immunity conferred. Every year in the United States, pneumococcal bacteria cause tens of thousands of cases of potentially life threatening invasive infection, including meningitis and bacteremia. For about two decades now, we’ve been able to immunize adults and children over age 2 against pneumococcal disease. We are uniquely positioned to help ensure that this vaccine is used appropriately, and to serve as a source of health information for parents and the communitity. To help you do these things, we’ll briefly review the impact of invasive and noninvasive pneumococcal disease and highlight Prevnar’s effectiveness and cost. Then we’ll focus on nursing considerations, including how and when administering the vaccine, adverse effects, and what to teach parents of children who receive it. Infants and toddlers face a high risk of infection Both noninvasive pneumococcal infections (including pneumonia and otitis media) and invasive infections (including bacteremia and meningitis) are caused by Streptococcus pneumoniae, a gram-positive bacterium that’s a major source of illness and death worldwide. The organism may account for 30 - 50% of all cases of pneumonia in the United States each year. It’s also responsible for about 40,000 deaths, 50,000 cases of bacteremia, and 3,000 cases of meningitis each year. About one third of these cases of bacteremia and about one quarter of these cases of meningitis occur in children younger than 5. Of particular note is the fact that children ages 2 and younger have the highest incidence of invasive pneumococcal infection of any age group. Streptococcal pneumoniae is also responsible for many cases of otitis media (ear infections) and sinusitis. Although these conditions are generally less serious than the ones mentioned previously, they nevertheless create a heavy burden in terms of treatment costs and days lost from school and work. For example, the bacteria causes approximately 7 million cases of otitis media each year, resulting in more than 15 million office visits. Assessing the value of the vaccine Research modeled on the success of the Heamophilus influenzae (Hib) vaccine led to the development of an effective pneumococcal vaccine for young children. This step was necessary because the immature immune system of infants and toddlers cannot produce an effective immune response to the pneumococcal vaccine. However, this protein complex does produce a strong primary immune response in infants and a strong booster response on repeated vaccination. It resulted in a larger and more complex molecule, which limited the number of serotypes that could be included in a single vaccine. For that reason, Prevnar targets only seven serotypes of Streptococcus pneumoniae but these seven are responsible for 86% of all bacteremia, 83% of all meningitis, and 65% of all otitis media in children under 6 years of age in the United States. Prevnar’s efficacy and safety were evaluated in a randomized, prospective, double blind trial and researchers were able to demonstrate that the vaccine was 97% effective in preventing meningitis and bacteremia caused by the serotypes the vaccine targets. By the researchers estimates, the routine vaccination with Prevnar of the roughly 3. Children who are 7 - 11 months old and have not received the vaccines should be given a total of three doses. Unvaccinated children who are 12 - 23 months old should get a total of two doses, and those who are 2 years of age or older need only one dose.

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This concept is defined by the Monro-Kellie doctrine cheap 120 mg sildigra otc, which states that the total intracranial volume is fixed generic 100mg sildigra. Since the intracranial volume is fixed generic 50 mg sildigra, unless there is some com- pensatory action discount 100mg sildigra otc, such as a decrease in the volume of one of the other intracranial components 100 mg sildigra free shipping, the intracranial pressure will rise. This is related intimately to intracranial compliance, which is defined as the change in pressure due to changes in volume. The brain has very limited compliance and cannot tolerate significant increases in volume that can result from diffuse cerebral edema or significant mass lesions, such as a hematoma. Autoregulation also is impaired in the injured brain, and, as a result, there is pressure passive perfusion within and around injured regions of the brain. The intracranial compartment is divided into three compartments by two major dural structures, the falx cerebri and the tentorium cerebelli. As the brain slides over these dural edges, it compresses other regions of the brain (e. There are five types of herniation: transtentorial herniation, subfalcine herniation, central herniation, cerebellar herniation,andtonsillar herniation. Transtentorial herniation occurs when the medial aspect of the tempo- ral lobe (uncus) migrates across the free edge of the tentorium. This compresses the third cranial nerve, interrupting parasympathetic input to the eye and resulting in a dilated pupil. This unilateral dilated pupil is the classic sign of transtentorial herniation and usually (80%) occurs ipsilateral to the side of the transtentorial herniation. While there is significant overlap in the treatment of these two types of injury, there are some important differences that are discussed later in this chapter. Closed head injury treatment is divided further into the treatment of mild and moderate/severe head injuries. Herniation syndrome Mechanism Transtentorial herniation Medial temporal lobe is displaced across the tentorial edge Subfalcine herniation Medial frontal lobe is displaced under the falx Central (downward) herniation Cerebral hemisphere(s) is displaced down through the tentorial incisura Cerebellar (upward) herniation Cerebellum is displaced up through the tentorial incisura Tonsillar herniation Cerebellar tonsils are displaced through the foramen magnum 32. Brain Trauma Foundation, American Associa- tion of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. Shepard Closed Head Injury Mild Head Injury Treatment The majority of head injuries are mild head injuries. Most people pre- senting with mild head injuries do not have any progression of their head injury; however, up to 3% of mild head injuries progress to more serious injuries. Patients with mild to moderate headaches, dizziness, and nausea are considered to have a low-risk injury. Most of these patients require only observation after they have been assessed carefully, and many do not require radiographic evaluation. These patients may be discharged if there is a reliable individual to monitor them at home. A concussion is defined as physiologic injury to the brain without any evidence of structural alteration, as in the case presented. Loss of consciousness frequently occurs in concussions, but it is not part of the definition of concussion. Concussions may be graded on a scale of I to V based on criteria such as length of confusion, type of amnesia following the event, and length of loss of consciousness (Table 32. The initial resus- citation of a head-injured patient is of critical importance to prevent hypoxia and hypotension. Subdural/epidural hematoma resulting in midline shift >5mm Intracerebral hematoma >30cc Temporal or cerebellar hematoma with diameter >3cm Open skull fracture Skull fracture with displacement >1cm mortality rate of those patients who were normotensive on presenta- tion4. The combination of hypoxia and hypotension resulted in a mor- tality rate two-and-one-half times greater than if both of these factors were absent. If there is a surgical lesion present, then arrangements are made for immediate transport to the operating room. Although there are no strict guidelines for defining surgical lesions in head injury, most neurosurgeons consider any of the following to rep- resent indications for surgery in the head-injured patient: extraaxial hematoma with midline shift greater than 5mm, intraaxial hematoma with volume >30cc, an open skull fracture, or a depressed skull frac- ture with more than 1cm of inward displacement (Table 32. Also, any temporal or cerebellar hematoma that is greater than 3cm in diam- eter usually is evacuated prophylactically because these regions of the brain do not tolerate additional mass as well as other regions of the brain. After appropriate fluid resuscitation has been completed, intravenous fluids are administered to maintain the patient in a state of euvolemia or mild hypervolemia.

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Which of the following tests should be used to β-lactam antibiotics by standardized disk diffusion differentiate Staphylococcus aureus from and broth microdilution susceptibility methods Staphylococcus intermedius? Plasmid altered Microbiology/Select methods/Reagents/Media/Bacteria/ Microbiology/Apply knowledge of fundamental Identification/2 biological characteristics/Bacteria/1 Answers to Questions 10–14 11 discount 25mg sildigra fast delivery. Staphylococcus saprophyticus is best differentiated from Staphylococcus epidermidis by resistance to: 10 generic sildigra 50 mg free shipping. The resistant population Microbiology/Correlate clinical and laboratory data/ grows more slowly than the susceptible one and Bacteria/Staphylococcus/2 can be overlooked cheap sildigra 100 mg with amex. Using the standardized agar = β (acid production) Kirby–Bauer sensitivity procedure sildigra 25 mg without prescription, a 6–12 mm zone of growth inhibition is considered resistant buy cheap sildigra 50 mg line. Staphylococcus hominis tube method calls for an incubation of 4 hours at 35°C–37°C and 18–24 hours at room temperature. Microbiology/Evaluate laboratory data to make Both must be negative to interpret the result as identifications/Bacteria/3 coagulase negative. Staphylococcus aureus recovered from a wound positive and, therefore, identified as S. D Vancomycin, along with rifampin, is used for strains pattern by the standardized Kirby–Bauer method of S. Their heteroresistance results Cephalothin = R Cefoxitin = R in a film of growth consisting of very small Vancomycin = S Methicillin = R colonies formed within the defined inhibition Which is the drug of choice for treating this zone surrounding the antibiotic disk. Which of the following tests will rapidly ulcer from a 31-year-old diabetic patient showed differentiate micrococci from staphylococci? The catalase differentiates the identifications/Bacteria/3 Micrococcaceae family (positive) from the Streptococcaceae family (negative). Urine cultured from the catheter of an 18-year-old female patient produced more than 100,000 col/mL 16. Colonies were catalase positive, possibilities because they are both catalase positive, coagulase negative by the latex agglutination slide coagulase negative, urease positive, and ferment method as well as the tube coagulase test. Novobiocin susceptibility is the test of choice single test for identification is: for differentiating these two species. The tube (cellulitis) was negative for the slide coagulase test test should be performed because the slide test was (clumping factor) and negative for novobiocin negative. A Staphylococci are susceptible to furazolidone, identification is (are): giving zones of inhibition that are 15 mm or greater. Furazolidone (Furoxone) susceptibility is a test greater is considered susceptible. The Staphylococcus used to differentiate: species are resistant and grow up to the disk, while A. Microbiology/Select methods/Reagents/Media/Bacteria/ Filter paper disks that are saturated with oxidase Identification/2 reagent (tetramethyl-p-phenylenediamine in 19. Microbiology/Select methods/Reagents/Media/Bacteria/ Identification/2 420 Chapter 7 | Microbiology 21. Streptococcus species exhibit which of the following Answers to Questions 21–25 properties? Facultative anaerobe, oxidase negative, catalase grow aerobically as well, and are oxidase and catalase negative negative. Facultative anaerobe, β-hemolytic, catalase blood agar, it is best to stab the agar to create positive anaerobiosis because streptolysin O is oxygen labile. A Group A β-hemolytic streptococci are the cause of Microbiology/Apply knowledge of fundamental scarlet fever, and some strains produce toxins biological characteristics/Streptococci/1 (pyrogenic exotoxins A, B, and C) that cause a scarlatiniform rash. A The bacitracin disk test is used in conjunction Microbiology/Apply knowledge of fundamental with other confirmatory tests for the β-hemolytic biological characteristics/Bacteria/1 streptococci. A fourfold rise in titer of which antibody is the and G are also β-hemolytic and give a positive test best indicator of a recent infection with group A for bacitracin (a zone of inhibition of any size). Anti-B α-hemolytic, is susceptible to small concentrations Microbiology/Select methods/Reagents/Media/Bacteria/ of bacitracin, as are other α-hemolytic streptococci. Susceptible or resistant Susceptible Group B Resistant Resistant Microbiology/Correlate clinical and laboratory data/ Non-A, Susceptible Susceptible Bacteria/Streptococci/2 non-B or Resistant 27. Identification/2 Group D streptococci (enterococci and nonenterococci) are positive, causing blackening 29. Te bile solubility test causes the lysis of: of half or more of the slant within 48 hours.

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This chapter will summarise the symptoms of schizophrenia according to the medical model sildigra 50 mg amex. This is followed by a discussion of the social constructionist position as an alternative perspective for understanding mental illness and schizophrenia in particular cheap 25mg sildigra amex. An understanding of what schizophrenia is and the epidemiology of schizophrenia has been included in an attempt to contextualise the sample of interviewees discount sildigra 50 mg without prescription, by describing the accepted view of what people with schizophrenia in the general population experience in terms of illness symptoms as well as the associated outcomes sildigra 100 mg low price. Critically discount 120mg sildigra free shipping, some of the unsettling statistics regarding the significant impact that schizophrenia has on the lives of consumers and the community reinforce the benefits of research aimed at improving the outcomes for people with schizophrenia. A clinical diagnosis of schizophrenia requires the presence of delusions and/or hallucinations, formal thought disorder and unusual behaviour lasting for at least one month, with significant social and occupational deterioration experienced prior or subsequent to psychotic symptoms (Picchioni & Murray, 2007; Sharif, Bradford, Stroup & Lieberman, 2007). People with a diagnosis of schizophrenia typically experience symptoms which are consistently described by the dominant medical model of clusters of positive, negative and cognitive symptoms. However, some individuals may predominantly experience symptoms from positive or negative clusters, respectively (Cutting, 2003). Positive symptoms are so called because they are considered an addition to a person’s repertoire (Birchwood & Jackson, 2001). Positive symptoms include things such as delusions, unusual thoughts and suspiciousness, paranoia, hallucinations and distorted perceptions typically considered to be manifestations of psychosis (McEvoy, Scheifler & Frances, 1999). Negative symptoms are those that are evident by the blunting of motivation and emotion; for example, social withdrawal, lack of energy, loss of sense of pleasure, inability to make decisions, limited speech and poor self care (Smith, Weston & Lieberman, 2009). Negative symptoms persist even in the absence of positive symptoms during periods of remission; however, they may be secondary to other factors, such as depression (McGorry, 1992). Cognitive symptoms common to people with schizophrenia include problems with attention, learning new information, memory, verbal fluency, problem solving, recognising social cues, confused thinking, disorganised speech and disorganised behaviour (Freedman, 2005; McEvoy et al. It is estimated that approximately 75% of people with schizophrenia have clinically meaningful deficits in at least two cognitive domains and 90% have deficits in one (Sharif et al. An alternative medical model of schizophrenia that is also often deployed by researchers is comprised of clusters of positive, negative and disorganised symptoms (Beck, Rector, Stolar & Grant, 2009; Cutting, 2003; Sharif et al. Such models typically group cognitive impairments (such 3 as impairments in attention, learning, memory and perception) in the negative symptom cluster. Disorganisation symptoms include disordered thought processes, bizarre behaviour and disturbances of emotions or inappropriate affect (Cutting, 2003; Sharif et al. Specifically, the paranoid type describes individuals who experience delusions (persecutory or grandiose) or hallucinations but thought disorder, disorganised behaviour and negative symptoms are absent. Individuals are diagnosed as the disorganised type when they present with both thought disorder and flattened affect. The catatonic type defines those who exhibit agitated, purposeless movement or are immobile. The undifferentiated type is diagnosed in cases when psychotic symptoms are present but do not meet criteria for the paranoid, disorganised or catatonic types. The residual type is diagnosed when individuals experience mild positive symptoms only. The above descriptions of schizophrenia are based on the current, dominant construction of schizophrenia as a mental illness or pathology, in line with psychiatry’s medical model. Schneider (2010) highlights the fact that schizophrenia has not always regarded as an illness in line with the current dominant medical model of health, as the ever-changing historical accounts of schizophrenia or “madness” indicate. There is also a significant social constructionist literature which suggests that “schizophrenia” is but a disease metaphor which has gained acceptance as a bio-psychiatric entity despite a lack of evidence (Wise, 2004). By a lack of evidence, researchers allude to an absence of medical tests to confirm a diagnosis, no clear causes identified and there being no consistent set of symptoms present in all cases (Schneider, 2010). Advocates of this 4 position dispute the use of diagnostic labels to describe people’s experiences and regard terminology such as “schizophrenia” and “mental illness” as mechanistic social constructions of deviant behaviour which are morally based and serve stigmatising functions (Schneider, 2010; Wise, 2004). The medical management of what is, ultimately, considered to be unwanted conduct according to some moral standard is, thus, also frequently contested by proponents of a social constructionist position (Wise, 2004). Whilst I acknowledge the social constructionist position and am sympathetic towards it, I use the terms ‘schizophrenia’ and ‘mental illness’ throughout this thesis. The term ‘schizophrenia’ has been used to describe people who have been given a diagnosis of the illness from a mental health professional based on meeting the present criteria of the current medical model of schizophrenia.

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