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There are 2 primary types of movement depending on whether the muscle changes length during contraction tamoxifen 20mg fast delivery womens health houston. Isotonic contraction: In this type, muscle tension remains constant as the muscle changes length. Isometric contraction: In this type, the muscle is prevented from shortening, so tension developed at constant muscle length. Isotonic contractions are used for body movements and for moving external objects. The submaximal isometric contractions are important for maintaining posture and for supporting the object in a fixed position. During a given movement, a muscle may shift between Isotonic and isometric contractions. Isotonic contraction 90 Steps of Excitation-contraction coupling and relaxation • Ach released from a motor neuron terminal initiates an action potential in the muscle cell that is conducted over the entire surface of the muscle cell membrane. The active transport of Ca++ ions back in to the sarcoplasmic reticulum, is energy dependent. Smooth muscle The majority of these muscles are present in the walls of hollow organs, blood vessels and tubular structures in the body. Their contraction exerts pressure on the contents and regulates the forward movement of contents of these structures. Smooth muscles are spindle-shaped, have 1 nucleus and are much smaller in size (2-10 μm in diameter 92 and 50-100 μm in length). Three types of filaments present in smooth muscles are • Thin actin filaments, which have tropomyosin but lack troponin • Thick myosin filaments, longer than those found in skeletal muscles. Smooth muscles do not form myofibril and are not arranged in sarcomere pattern of skeletal muscle. Smooth muscle myosin interacts with actin only when the myosin is ++ phosphorylated. During excitation, cytosolic Ca increases, that acts as an intracellular messenger, initiating a series of biochemical events that result in phosphorylation of myosin. In Smooth muscles Ca++ binds with calmodulin and intracellular protein similar to troponin in structure. This calcium- calmodulin complex binds to and activates another protein, myosin kinase, which in turn phosphorylats myosin. Phosphorylated myosin then binds with actin thin filament starting cross bridge cycle. Single- unit smooth muscle (visceral smooth muscles) • Found in the walls of hollow organs/viscera - digestive, reproductive, urinary tract and small blood vessels. Slow wave potential Slow contractile response of smooth muscle A smooth muscle contractile response is slower than of muscle twitch. A single smooth muscle contraction may last as long as 3 sec (3000 msec) compared to the maximum of 100 msec for a single contraction response skeletal muscle. Describe the generation of action potential, its phases, ionic basis and mode of propagation 4. Describe the transmission of neural signals at the neuromuscular junction of skeletal muscle. It transports substances from place to place, buffers pH changes, carries excess heat to the body surface for loss, plays a very crucial role in the body’s defense against microbes and minimizes blood loss by evoking homeostatic responses when a blood vessel is injured. Cells need a constant supply of oxygen to execute energy-producing chemical reactions that produce carbon dioxide that must be eliminated continuously. Blood is about 8% of total body weight and has an average volume of 5 liters in women and 5. A very tiny portion of the cardiac output passes through each capillary, bringing oxygen, nutrients, and hormones to each cell and removing carbon dioxide and metabolic end products (waste products). Blood composition Blood consists of erythrocytes, leukocytes, and platelets suspended in liquid called plasma. The white cells and platelet after centrifugation are packed in a thin, cream colored layer because they are colorless, the “buffy coat”, on top of the packed red cell column. The hematocrit averages 42% for women, 45% for men, with average volume occupied by plasma being 58% for women and 55% for men. They are biconcave disks, manufactured in the red bone marrow, losing their nuclei before entering the peripheral circulation. Red cells having nuclei seen on the peripheral smear suggest an underlying disease state.
Principles of toxin eliminations - If the poison has been inhaled cheap 20 mg tamoxifen mastercard womens health network, the victim should first be removed from the contaminated environment. However, repeated oral administration of activated charcoal appears to be effective in enhancing elimination of certain poisons. The results of either a qualitative or a quantitative toxicological analysis may be required before some treatments are commenced because they are not without risk to the victim. In general, specific therapy is only started when the nature and/or the amount of the poison(s) involved are known. Antidotes or protective agents are only available for a limited number of poisons. In summery there are four main methods of enhancing elimination of the poison from the systemic circulation: 1. Some antidotes &protective agents used to treat acute poisoning Antidote Indication • Acetylcysteine Paracetamol 24 Toxicology • Atropine Organophosphate • Deferoxamine Iron • Methylene blue Nitrates • Physiostigmine Atropine • Naloxone Opioids • Pyridoxine Isoniazid Exercise 1. Discuss about collection, transportation, storage, characteristics, physical examination &analytical tests of laboratory specimens. Describe about apparatus, reference compounds & reagents used in clinical toxicology laboratory 6. Introduction Clinical toxicology involves the detection and treatment of poisonings caused by a wide variety of substances, including household and industrial products, animal poisons and venoms, environmental agents, pharmaceuticals, and illegal drugs. The toxicology laboratory must provide appropriate testing in three general areas: Identification of agents responsible for acute or chronic poisoning; Detection of drugs of abuse; and therapeutic drug monitoring. Increasingly sophisticated analytic methods are available to accomplish these tasks, but it is imperative that they be used judiciously. The numbers of compounds for which true emergency laboratory results are needed to guide therapy are still relatively few. For most potentially lethal intoxications the victim must be treated empirically before the laboratory results are known. A wide held misconception is that the laboratory can routinely detect 27 Toxicology any of the thousands of potential drugs or toxins that may be present in a sample. Because the financial and personnel resources required for such complete “screens” would be prohibitive, clinical laboratories must employ selective procedures suitable for the victim population in question. Therefore in most cases in clinical or hospital-based settings, tests are done for only a finite number of compounds, generally the more common drugs of abuse. Ideally, a diagnosis of poisoning would be made clinically, with the laboratory playing a confirmatory role. This short chapter is meant to discuss the basic structures which are said to be vital in clinical toxicology laboratory. The role of clinical toxicology laboratory Most poisoned victims can be treated successfully without any contribution from the laboratory other than routine clinical biochemistry and hematology. This is particularly true for those cases where there is no doubt about the poison involved and when the results of a quantitative analysis would not affect therapy. However, toxicological analyses can play a useful role If the diagnosis is in doubt, The administration of antidotes or protective agents is contemplated, or The use of active elimination therapy is being considered. Basic information necessary for toxicology laboratory 28 Toxicology Close communication between clinical and laboratory personnel is essential. Although a standard screen may not include the suspected agent, if alerted beforehand the laboratory may be able to modify procedures as needed in order to search for the suspected agents. Suspected dose Analytic sensitivities vary among laboratories, and some facilities may not be able to detect therapeutic concentrations of certain drugs in their routine screens. Knowledge of the approximate dose ingested is important because in certain cases the use of analytic methods designed for therapeutic monitoring, not screening may be necessary. Time of ingestion and sampling Knowledge of both ingestion and sampling time is necessary to determine the degree of drug absorption; with serial determinations, knowledge of sampling times is critical, as a single quantitative level may be misleading and must be correlated with the time of ingestion. Serial levels, timed appropriately with respect to the pharmacokinetics of the agent, document that the concentration has peaked, which helps guide further therapy.
The Renaissance Image of Nursing: The Nurse as Servant The Renaissance saw the decline of monastic orders and the rise in individualism and materialism order 20mg tamoxifen free shipping menstrual goddess. There was a radical change from the image of the selfless nurse that had developed in the early Christian period and the Middle Ages. The hospitals of this time were plagued by pestilence and filled with 4 Basic Clinical Nursing Skills death; those who worked in them were seen as corrupt and unsavory. The Emergence of Modern Nursing To some extent, the three early images of the nurse were held th simultaneously for hundreds of years. Although born to wealth and a family well placed in Victorian English Society, Florence Nightingale had a firm belief in Christian ideals that made h1er disdainful of a life of luxury. As an intelligent and well- educated woman, she recognized that optimum care of the sick required education. She persevered against family and social opposition and initiated personal study and research into sanitation and health. She studied with Pastor Fleidner of 33, was to reorganize the care for the sick at a hospital established for “Gentlewomen in Distressed Circumstances. Britain was then engaged in a major war in the Crimea; reports were coming back that more men died of wounds in the hospitals than on the battlefield. When she arrived at the front, Nightingale found that conditions in the military hospitals were abominable. The absence of sewers and laundry facilities, the lack of supplies, the poor food, and the disorganized medical services 5 Basic Clinical Nursing Skills contributed to a death rate of more than 50% among the wounded. The school was organized around three components: 1) a trained matron with undisputed authority over all members of the staff, 2) a planned course of theoretical and practical training, and 3) a home attached to the hospital in which carefully selected students were placed in the care of “sisters” responsible for their moral and spiritual training. Her school prepared nurses for hospital care (where they were called “ward sisters”) and for supervisory and teaching positions. Nightingale also set up a program for preparing “district” nurses, the public health/visiting nurses of England. She wrote that these district nurses needed additional education because they would be working more independently than the hospital staff members. Nightingale’s strong statements about the role of nurses and their need for lifelong education are still quoted widely today. Perhaps 6 Basic Clinical Nursing Skills she, more than anyone else, can be credited with establishing nursing as a profession. Before the development of modern nursing, women of nomadic tribes performed nursing duties, such as helping the very young, the old, and the sick, care-dwelling mothers practiced the nursing of their time. As human needs expanded, nursing development broadened; its interest and functions through the social climates created by religious ideologies, economic development, industrial revolutions, wars, crusades, and education. The dynamic change in economic and political situations also influenced every corner of human development including nursing. She also contributed to the definition of nursing “to put the patient in best possible way for nature to act. Around 1866 missionaries came to Eritrea, (one of the former provinces of Ethiopia) and started to provide medical care for very few members of the society. In 1949 the Ethiopian Red Cross, School of Nursing was established at Hailesellasie I hospital in Addis Ababa. In 1954 HailesellasieI Public Health College was established in Gondar to train health officer, community health nurses and sanitarians to address the health problem of most of the rural population. In line with this, the Centralized school of Nursing formerly under Ministry of health and recently under Addis Ababa University Medical Faculty and Nekemit School of nursing are among the senior nurse’s training institutions. An additional higher health professional training institution was also established in Jimma(1983) to train health professionals using educational philosophy of community based and team approach. Additional public health professional training institutions were opened in Alamaya University and Dilla College of Teacher Education and Health Sciences (1996). Following further expansion of higher learning, Mekele University has started medical education and the former diploma offering university have upgraded to degree program in which nursing education is a part.
Fill the graduated tube to the '20' mark of the red graduation or to the 3g/dl mark of the yellow graduation with 0 tamoxifen 20mg free shipping womens health 8 healthy eating instagram. Blow the blood from the pipette into the graduated pipette into the graduated tube of the acid solution. If the color of the diluted sample is darker than that of the reference, continue to dilute by adding 0. Depending on the type of hemoglobinometer, this gives the hemoglobin concentration either in g/dl or as a percentage of 'normal'. Hemoglobin color scale Many color comparison methods have been developed in the past but these have become obsolete because 165 Hematology they were not sufficiently accurate or the colors were not durable. A new low-cost hemoglobin color scale has been developed for diagnosing anemia which is reliable to within 10 g/l (l g/dl). The color of a drop of blood collected onto a specific type of absorbent paper is compared to that on the chart. Validation studies in blood transfusion centers have shown the scale to be more reliable and easier to use than the copper sulphate method in donor selection checks. Copper Sulphate Densitometery This is a qualitative method based on the capacity of a standard solution of copper sulphate to cause the suspension or sinking of a drop of a sample of blood as a measure of specific gravity of the latter and corresponding to its hemoglobin concentration. The method is routinely utilized in some blood banking laboratories in the screening of blood donors for the presence of anemia. Normal hemoglobin reference range: Children at birth 135-195 g/l children 2 y – 5 y 110-140 g/l Children 6 y – 12 y 115-155 g/l Adult men 130-180 g/l Adult women 120-150 g/l Pregnant women 110-138 g/l 167 Hematology Review Questions 1. What are the two most commonly applied color comparison methods for measurement of hemoglobin in a sample of blood? How do you check the linearity of the spectrophotometric method of hemoglobin quantitation in the laboratory? It is of greater reliability and usefulness than the red cell count 169 Hematology that is performed manually. Microhematocrit method Materials required • Capillary tubes These need to be plain or heparinized capillaries, measuring 75mm in length with an internal diameter of 1mm and wall thickness of 0. The plain ones are used for 171 Hematology anticoagulated venous blood while the heparinized ones (inside coated with 2 I. Test method 1 Allow the blood to enter the tube by capillarity (if anticoagulated venous blood, adequate mixing is 173 Hematology mandatory) leaving at least 15mm unfilled (or fill 3/4th of the capillary tube). Since it is difficult to measure the volume of plasma trapped between the packed red cells (‘trapped plasma’), it is not customary in routine practice to correct for this trapped plasma. It is increased in hypochromic anemia, macrocytic anemia, sickle cell anemia, spherocytosis and thalassemia. Advantages of the Microhematocrit Method • It enables higher centrifugation speeds with consequent shorter centrifugation times and superior packing. A note should be made on the patient’s report if an abnormal plasma or buffy coat is seen as this is often an important clue for the clinician. When it contains an increased amount of bilirubin (as occurs in hemolytic anemia) it will appear abnormally yellow. When white cell numbers are significantly increased, this will be reflected in an increase in the volume of buffy coat layer. The method uses a Wintrobe tube which can also be used to determine the erythrocyte sedimentation test. One side is graduated from 0 to 10cm (0-100mm) from the bottom to the top, while the other side is graduated from 10 to 0cm (100-0mm) from bottom to top. The hematocrit is read from the scale on the right hand side of the tube taking the top of the black band of reduced erythrocytes immediately beneath the reddish gray leucocyte layer. District laboratories should check the reference ranges with their nearest Hematology 178 Hematology Reference Laboratory. These formulas were worked out and first applied to the classification of anemias by Maxwell Wintrobe in 1934. Abnormal 182 Hematology hemoglobins, such as in sickle cell anemia, can change the shape of red blood cells as well as cause them to hemolyze. Cells of normal size are called normocytic, smaller cells are microcytic, and larger cells are macrocytic.
