By R. Hatlod. University of Evansville. 2018.

Patients may have a history of cumulative trauma to the wrist in carpenters order lithium 300 mg without a prescription medicine yoga, rowers order lithium 150 mg overnight delivery stroke treatment 60 minutes, typists, computer users, or those who regularly use vibrating tools or machinery Cascara – It is the main ingredient in a laxative which is supposed to be fairly good 399 Cataplexy – a sudden brief loss of muscle control brought on by strong emotion or emotional response, such as a hearty laugh, excitement, surprise, or anger. Cataracts – opacity or cloudy looking of the lens of the eye or its capsule or both Catatonic – a phase of schizophrenia in which the patient is unresponsive, the tendency is to remain and assume in a fixed position, refusal to move or talk are characteristics Catecholamines – one of many biologically active amines, including Metanephrines, Dopamines, Epinephrine and Norepinephrine, derived from Amino and Tyrosine. It is composed primarily of secretions of the choroids plexi in the lateral ventricles and in the third and fourth ventricles in the brain. Openings in the roof of the fourth ventricle allow the fluid to flow into the subarachnoid spaces around the brain and the spinal cord. The flow of fluid is from the blood in the choroids plexi, through the ventricles, the central canal, the subarachnoid spaces, and back into the blood. Samples of the fluid may be removed by lumbar puncture Cerebrovascular – pertaining to the blood vessels of the brain especially to pathological changes Ceroids – morbid condition of membranes resembling wax-like scales 400 Cervical erosion – a wearing away of the cervix in the uterus of females Chemoreceptor trigger zone – a sense organ or sensory nerve ending that is stimulated by and reacts to certain chemical stimuli and that is located outside the central nervous system. The excess pigmentation often occurs in pregnant women, in women using oral contraceptives, or in patients with underlying liver disease. Sun exposure tends to worsen the condition Cholelithiasis - formation or presence of stones in the bladder or kidneys or bile- stones in the gallbladder or common duct Cholestatic – arrest of the flow of bile. This may be due to intrahepatic causes, obstruction of the bile duct by gallstones, or any process that blocks the bile duct Cholesterol – a sterol widely distributed in animal tissues. Found in egg yolks, various oils, fats, myelin in the brain, spinal cord and axons, liver, kidneys, and adrenal glands. It is synthesized in the liver and is a normal constituent of most gallstones and of atherosclerotic plaques found in arteries. Spores from the fungus circulate in the air, when the dirt is disturbed during construction, dust storms, or earthquakes. About 80% of those persons living in the southwest and western states have positive skin test, which identify those infected. Usually these infections are asymptomatic and require no treatment Cogwheel rigidity – an abnormal rigor in muscle tissue, characterized by jerky movements when the muscle is passively stretched. Synthetic derivatives of this agent are used medicinally to relax skeletal muscles during anesthesia and critical care Cyanosis – slightly bluish, grayish, slate like or dark purple discoloration of the skin due to presence of abnormal amounts of reduced hemoglobin in the blood Cycloplegia – paralysis of the ciliary muscle (eye). This can be an anticholenergic side effect of antipsychotic or antidepressant medications Cyst – a closed sac or pouch with a definite wall, which contains fluid, semi fluid or solid material, usually an abnormal structure resulting from developmental anomalies, obstruction of ducts, or parasitic infection, usually not cancerous Cystic Fibrosis – a potentially fatal autosomal recessive disease that manifests itself in multiple body systems including the lungs, the pancreas, the urogenital system, the skeleton, and the skin; it causes chronic obstructive pulmonary obstructive disease, frequent lung infections, deficient elaboration of pancreatic enzymes, osteoporosis, and an abnormal high electrolyte concentration in sweat. The street name for this is “speed” Diabetes Mellitus – a chronic metabolic disease marked by hyperglycemia (high sugar level). Diabetes results either from failure of the pancreas to produce insulin (type I Diabetes) or from insulin resistance, with inadequate insulin secretion to sustain normal metabolism (type 2 Diabetes). It is the greatest single cause of absence from school and work among menstrual-age women Dysmetria – an inability to fix the range of a movement, rapid and brisk movements made with more force than necessary, seen in cerebellar affections Dysostosis – defective bone formation Dyspepsia - Imperfect digestion, not a disease in itself, but symptomatic of other diseases or disorders, indigestion Dysphagia - inability or difficulty in swallowing, impairment of speech resulting from a brain tumor Dysphonic – difficulty in speaking, hoarseness Dysphoric – exaggerated feeling of depression and unrest without apparent cause Dyspnea – air hunger resulting in labored or difficult breathing usually accompanied by pain, insufficient oxygenation of the blood resulting from disturbances in the lungs, low oxygen pressure in the air, circulatory disturbances, hemoglobin deficiencies, acidosis, excessive sodium bicarbonate content of the blood, excessive muscular activity, lesions of the respiratory center, emotional excitation, asthma Dysrhythmia – irregular possibly painful heart rhythm due to a variety of reasons Dystonia – not having the ability to possess muscular tone or unable to have a state of normal tension or partial contraction of muscle fibers while at rest Dysuria – painful or difficult urination, symptomatic of numerous conditions, usually frequent urination, may be indicative of cystitis, neuralgia of the bladder, urethritis, ulcerated prostate in the male or prolapsed uterus in the female, pelvic peritonitis and abscess, pain and burning may also be caused by concentrated acid urine 406 E Ecchymosis – when blood leaks into the skin or mucous membrane, due to injury, clotting mechanism problems, etc. The patient loses consciousness and undergoes tonic contractions for approximately 10 seconds, followed by a somewhat longer period of clonic seizures accompanied by apnea; on awakening the patient has no memory of the shock. Acids, bases, and salts are common electrolytes Electrolyte imbalance – a condition of a solution needed for conduction of electricity for an electric current that is not balanced within the “normal” ranges causing a wide variety of other health problems, usually think of sodium, potassium, calcium, magnesium, etc Electron microscopy – a specific test used in the diagnoses of Batten Disease Embolism – obstruction of a blood vessel by foreign substance or a blood clot, diagnosing depends on the factors predisposing arteriosclerosis favors a thrombosis while atrial fibrillation, bacterial endocarditis, or thrombophlebitis points to embolism, nearly always embolism is due to blood clots Emulsion – a mixture of two liquids not mutually soluble. If they are thoroughly shaken, one divides into globules in what is called the discontinuing or dispersed phase; the other is then the continuous phase. Milk is an emulsion in which butterfat is the discontinuous phase Endometriosis – tissues located in various sites throughout the pelvis or in the abdominal wall, found more commonly in the ovary than elsewhere 407 Endotracheal – within or through the trachea Emesis – vomiting Emetic - medicines that produce vomiting Empiric – a practitioner whose skill or art is based on what has been learned through experience Emphysema – distention of tissues by air or gas in between the cells of the lung, a condition in which the alveoli of the lungs become distended or ruptured, usually the result of interference with expiration, or loss of elasticity of the lung Encephalin – a pentapeptide produced in the brain.

The techniques of pancreatic surgery are advanced enough that mortality rates should be under 3% at specialized centers buy generic lithium 150mg line symptoms 6 days after iui. If the tumor is technically resectable cheap lithium 300 mg amex keratin smoothing treatment, the surgeon must be pre- pared to perform definitive resection without a tissue diagnosis. Five- year survival may be as high as 20% with truly localized disease resected with a negative margin and combined with adjuvant therapy. The differential diagnosis is between a true cystic neoplasm and a pancreatic pseudocyst. Persistent pain and the development of an abdominal mass follow- ing a bout of acute pancreatitis should raise suspicion about a pseudo- cyst. About one third to one half of acute pseudocysts resolve spontaneously within about 6 weeks. Chronic pseudocysts with symptoms of pain, obstruction, and infection usually require treatment. Various treatment options exist, including external percutaneous drainage, internal endoscopic drainage (cystogastros- tomy), and internal surgical drainage (cystogastrostomy or cystoje- junostomy). Percutaneous drainage works well for some patients, but, when the technique fails, the patient often has a complicated course. Surgical drainage allows for biopsy of the pseudocyst wall to exclude cystic malignancy. These malignant tumors have much higher cure rates with surgical resection compared to noncystic tumors. Further testing included a bone marrow aspirate revealing an increased number of megakary- ocytes. Primary Secondary Hereditary spherocytosis Cirrhosis Hemoglobinopathies (sickle cell) Splenic vein thrombosis Hemolytic anemia Myeloid metaplasia Idiopathic thrombocytopenic purpura Chronic myelogenous leukemia Thrombotic thrombocytopenic purpura present in serum. He was vaccinated against encapsulated organisms, and a laparoscopic splenectomy was per- formed, revealing a mildly enlarged spleen. Hypersplenism and Splenomegaly The patient in Case 3 had signs of hypersplenism (increased function of the spleen). Although it was not appreciated on physical examina- tion, he had mild splenomegaly. Hypersplenism and splenomegaly are separate findings related to function and size of the spleen. Due to the spleen’s location under the left rib cage, mild enlargement often can be missed on physical examination. One of the normal functions of the spleen is to clear abnormal and aged cellular elements from the blood. If an increased number of abnormal cells are presented to the spleen with increased destruction, the patient has primary hyper- splenism. Alternatively, a patient may develop splenic enlargement due to intrinsic splenic disease that leads to secondary hyper- splenism (Table 22. In the case presented, the patient’s spleen is inherently normal, but it has enlarged as a consequence of increased clearance of abnormal platelets. A variety of bacterial, parasitic, and viral infections can lead to increased proliferation of immune system cells (e. Malaria Granulomatous disease Rheumatoid disease Hematologic disorders Cirrhosis Lymphoma Splenic abscess Storage disease Leukemia Splenic cysts Viral infection 420 T. Kearney Metabolic abnormalities, such as Gaucher’s disease, can lead to accu- mulation of unmetabolized products in the spleen. In primary hypersplenism, the spleen inherently is normal, but it enlarges in size and increases function in response to an increased work load.

Te premise that all workers are unmotivated social generic lithium 300 mg with mastercard treatment xanthelasma, esteem buy lithium 300mg without prescription symptoms 4dpiui, and self-actualization. A According to Frederick Herzberg, achievement, happy opportunity for advancement, recognition, D. Te professional development of the employee challenging work, responsibility, and a chance for advancement and personal growth are motivators Education and management/Apply knowledge of and should be included as part of a job design. Te laboratory is undergoing a renovation listed, the four core processes for all managers are D. Employees jointly agree to institutional goals planning, organizing, directing, and controlling. Education and management/Apply knowledge of Planning includes formulating of goals and management theory/2 objectives, organizing the tasks, and establishing schedules. Te four essential functions of a manager are: communication, relationships, job descriptions, and A. Directing, leading, forecasting, implementing steps and stages of the plan, including coordination C. Innovating, designing, coordinating, problem resource utilization and outcomes, managing costs, solving and modifying the process to improve quality. Which of the following questions is allowable are related to legitimate occupational qualifications. Overtime pay cost of a test in order to obtain the desired profit Education and management/Laboratory economics/1 margin. Tests sent to reference laboratories or done in-house have the added cost that is referred to as 18. Which of the following accounts for the largest the surcharge/cost-plus method of determining test portion of the direct cost of a laboratory test? Using the surcharge/cost-plus method for determining test charges, determine the charge for an ova and parasite examination on fecal specimens, given the following information: Collection, handling, clerical, and so forth = $2. In deciding whether to adopt a new test on the Answers to Questions 20–24 laboratory’s automated chemistry analyzer, which parameters are needed to determine the number of 20. D The formula for calculating the break-even point tests that must be performed to break even? Number of other tests performed per month The total fixed costs are the expenses that are not D. The average between test volume and revenue or costs for reimbursement represents the expected revenue batch-run tests? Revenue is approximately equal for both as instrumentation, labor, and management do not high- and low-volume tests change with the size of the batch. In most laboratories, about 80% of the revenue is generated by the laboratory tests that 22. Te specific laboratory procedures are procedures, which are grouped according to billed according to which system of coding? A hospital has a contract with a major medical (known) revenue based upon a negotiated per-capita insurer that reimburses the laboratory at a rate fee for the members of the group. Tis type of the laboratory must manage its resources to provide reimbursement is called: covered laboratory tests to the group at a cost that A. A preferred provider discount prospective payment system is used by Medicare and C.

Nursing Considerations: Antiarrhythmics (Flecanide -Tambocor - heart) discount 300 mg lithium visa medicine 50 years ago, (Propafenone - Rythmol – heart) buy cheap lithium 150mg on-line medications safe while breastfeeding, Phenothiazines) may increase levels of these drugs. Use cautiously and with increased monitoring, especially when starting or increasing dosages. Do not induce emesis; gastric lavage or activated charcoal may be performed soon 121 after ingestion or if patient is still symptomatic. Because drug undergoes extensive distribution, forced diuresis, dialysis, hemoperfusion, and exchange transfusion are not helpful. For moderately depressed outpatients, usual maximum dose is 225 mg daily; in certain severely depressed patients, dose may be as high as 375 mg daily. Use cautiously and with increased monitoring at the start of therapy and with dose increase. Symptoms may include agitation, insomnia, anxiety, aggressiveness, or panic attacks. Use together cautiously, especially at the start of therapy or at dosage increases. If patient does not improve, increase dose by 10 mg daily at intervals of at least 1 week to a maximum of 50 mg daily. Available in suspension – 10 mg/5 ml; Tablets – 10 mg, 20 mg, 30 mg, and 40 mg; Tablets controlled release – 12. Withdrawal or discontinuation syndrome may occur if drug is stopped abruptly, symptoms include headache, myalgia, lethargy, and general flulike symptoms. Available forms: capsules (delayed release) 90 mg; capsules (pulvules) 10 mg, 20 mg, and 40 mg; oral solution 20 mg/5 ml; tablets 10 mg and 20 mg. Advise use of cough suppressant that does not contain Dextromethorphan Robitussin - antitussive) while taking Prozac (antidepressant). Monitor patient closely, especially at the start of treatment and when dosage increases. John’s Wort (herb) may increase sedative and hypnotic effects; may cause Serotonin Syndrome. Avoid using Thioridazine (Mellaril – an antipsychotic, Canada only) with Prozac (antidepressant) or within 5 weeks after stopping Prozac (antidepressant). Do not confuse Prozac (antidepressant) with Proscar (same as Propecia - for hair loss), Prilosec – antacid), or Prosom (insomnia). Tell patient to avoid taking drug in the afternoon whenever possible because doing so commonly causes nervousness and insomnia. Warn patient to avoid driving and other hazardous activities that require alertness and 134 good psychomotor coordination until effects of drug are known. Available forms: tablets (extended release) 150 mg and 300 mg; tablets (immediate release) 75 mg and 100 mg; tablets (sustained released) 100 mg, 150 mg, and 200 mg. Nursing Considerations: Amantadine (Symmetrel – antiparkinsonian), Levodopa (antiparkinsonian) may increase risk of adverse reactions. If used together, give small first doses of Wellbutrin (antidepressant) and increase dosage gradually. Carefully monitor patient for worsening depression or suicidal thoughts, especially at the beginning of therapy, and during dosage changes. This may be likely to occur with Wellbutrin (antidepressant) than with other Antidepressants. Available in capsules of 25 mg, 50 mg, and 100 mg; oral concentrate 20 mg/ml; tablets 25 mg, 50 mg, and 100 mg. Use cautiously, with close monitoring, especially at the start of treatment and during dosage adjustments.