Pediatric

Harlequin Sign

harlequin

Harlequin Sign

Harlequin Sign – recurrent episodes of asymmetrical skin color, last 1-20 minutes

Harlequin color change is a cutaneous condition seen in newborn babies characterized by momentary red color changes of half the child, sharply demarcated at the body’s midline.

 

[1] Reference:

New State Board Examination 3rd Edition – Appleton and Lange’s Review of Nursing

Wikipedia

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Food, Physiological Need, Physiological Needs

Diet on My Big Love

Step 1: GOAL SETTING

Weight: 300 lbs

lbs to kg

300 lbs ÷ 2.2 kg = 136.36 kg

Height: 1.8 meters

Meters to Inches

1.8 m × 39.37 inches = 70.86 inches

Meters to feet

1.8 m × 3.28 ft = 5 ft 9 in

Body Mass Index

Weight in kg ÷ (height in meters)2 

=136.36 kg ÷ (1.8 m)2

=136.36 kg ÷ 3.24

=42.08

  • BMI of below 24 risk for malnourish
  • BMI of 25 – 29 overweight
  • BMI of 30 – 39 obese
  • BMI of above 40 is considered extreme obesity

Goal: 180 lbs

Step 2: START TODAY

Diet Meal

Low Sugar and Low Cholesterol Diet

Heavy Breakfast

  • Chicken
  • Lean meat
  • Salmon

Lunch

Light Dinner

  • 1 cup Cereal/oats

Step 3: NO SHORT CUTS

Step 4: MOTIVATE YOURSELF

Step 5: BE HAPPY

Music, Uncategorized

The Science of Being Inlove

Did you know that the feeling of being in love does not come from the heart? It is transmitted from the base of the brain which is called the Pituitary gland that releases a hormone known as Endorphins that goes to the blood and gives us the feeling of giddiness. – Kim Atienza (Trivia/Weather Anchor, Actor, TV Host and former politician.

Movies, Pharmacology

Medications with Better Living Through Chemistry


Amoxicillin 

  • Antibiotic/Antimicrobial/Antibacterial
  • treats infections

Amoxicillin (plus Clarithromycin and protonpump inhibitor such as Omeprazol ([Prilosc]) 

  • given with pneumonia patients who has existing cardio pulmonary disease
  • high dose of amoxicillin/Clavulanate ([Augmentin, Clavulin]) plus a macrolide or doxycycline
  • a bacterial antibiotic that assists with eradicating H-Pylori bacteria in the gastric mucosa
  •  may cause diarrhea
  •  do not use in patients allergic to penicillin

Amoxicillin / Amoxil

  • first line of antibiotic for acute sinusitis

Clavulanate/Augmentin 

  • second line of antibiotic for acute sinusitis

Amoxicilliry/Clavinate (Augmentin) 

  • antimicrobial agents

Antideppressants

Sertraline/Zoloft

T-1/2 = 24 hours

Dosage: 50-200 mg/dc

Use: Depression, Panic Disorder, OCD, PTSD, Social Anxiety Disorder, PMDD

Side Effects: Drowsiness, dizziness, headache,fatigue,insomia,nausea,diarrhea, dry mouth, sexual dysfunctioning, sweating, tremor, myalgia, anxiety, altered taste, hot flashes, etc. 

Caution:Hepatic/ Renal Impairment/Pregnancy/Lactation/ Children

Serious Fatal Reaction with MAOI’s: concurrent primozide; do not use with St. John’s wort or SAMe; drug-drug interactions with drugs that inhibit the P-450 system. 

MAOI Diet (Tyramine) Restrictions

Foods must avoid completely

  • Aged red wines (cabernet sauvignon/merlot/Chianti)
  • Aged (smoked, aged, pickled, fermented, marinated, and processed) meats (pepperoni/bologna/salami, pickled herring, liver, frankfurters, bacon, ham)
  • Aged/mature cheeses (blue/cheddar/provolone/Brie/Romano/Parmesan/Swiss)
  • Overripe fruits and vegetables (overripe bananas/ sauerkraut/all overripe fruit)
  • Beans (fava/Italian/Chinese pea pod/fermented bean curd/soya sauce/miso soup)
  • Condiments (bouillon cubes/meat tenderizers/canned soups/gravy/sauces/soy sauce)
  • Soups (prepared/canned/frozen)
  • Beverages (beer/ales/vermouth/whiskey/liqueurs/canned soups/gravy/sauces/soy sauce)

Foods use with caution moderation

  • Avocados (not overripe)
  • Raspberries (small amounts)
  • Chocolate (small amounts)
  • Caffeine (2-8 oz. Servings per day or less)
  • Dairy products (limit to buttermilk, yogurt, and sour cream [small amounts]; cream cheese, cottage cheese, milk ok if fresh)

Medications: Must Avoid

  • stimulants and decongestants
  • OTC medications (check with PCP/pharmacist) 
  • Opioids (e.g. meperidine)

Biguanides

Metformin (Glucophage)

  • oral antidiabetic agents
  • produces it’s antidiabetic effects by facilitating insulin’s action on peripheral receptor sites
  • it can be used only in the process of insulin
  • have no effect on pancreatic beta cells
  • used with a sulfonyl urea 
  • may enhance the glucose -lowering effect more than either medications used alone.

Complication: Lactic Acidosis (Monitor closely when therapy is initiated/dosage change

Drug Interactions: 

  • Anticoagulants
  • Corticosteroids
  • Diuretics
  • Oral Contraceptives 

Contraindications

  • renal impairment serum creatinine level more than 1.4
  • risk for renal dysfunction (e.g. Acute Myocardial  Infarction

Renal function studies performed periodically to ensure that function is not impaired. 

Withold for two days prior to diagnostic testing that requires contrast agent. Increase risk for lactic acidosis. An extended release form and a combination form (Glucovance) combines Metformin with a Sulfonylurea such as glyburide. The combination provides two mechanism of action and improved potential compliance. Hypoglycemia is at risk.

Anticonvulsants

Carbamazepine (CBZ) / Tegretol

T1/2 = initial: 18-55 h;

long-term 

dosing: 12-17 h 

Dosage: 400-1200 mg/d (mania)

Use: Bipolar: Acute Mania; mixed; seizures, trigeminal pain

Common Side Effects: Ataxia, drowsiness, blurred vision, APLASTIC ANEMIA, AGRANULOCYTOSIS, THROMBOCYTOPENIA, STEVENS-JOHNSON SYNDROME (SJS) 

CAUTION : Therapeutic Range (4-12ug/mL) Weekly CBC, platelet and reticulocyte counts, LFTs; impaired renal/liver/cardiac functions. Sx of SJS: cough, FUO, mucosal lesions, rash; stop CBZ.

Chantix/ Varenicline

– treats nicotine addiction

Side Effects: Constipation give enema as prescribe 


Antiviral Drug

Valtrex (Valacyclovir)

Treatment: herpes virus, genital herpes, cold sores, shingles

Side effects: nausea, vomiting, diarrhea and headache

Opiods:

Oxycodone

orally- provides a consistent serum level than IM

Dosage: 20 to 30 mg 

T1/2: 2-3 hours

Duration 2-4 hours

Side effects:

  • Respiratory deppression – increase risk with age and with other depressants
  • sedation- opioid doses are increase; increase the time of dose and reduce dose temporarily as prescribe
  • Nausea and vomiting – appears after a few hours of ingestion; change position slowly; hydrate and give antiemetic drugs as prescribe
  • Constipation – mild laxative; fluid; fiber; 
  • Check for liver toxicity

 Antianxiety (Anxiolytic drugs)

Benzodiazepines

Alprazolam/ Xanax

Use: Anxiety, panic disorde

Dosage: 0.75-4 mg/d; not to exceed 10 mg/d

Common Side effects: Dizziness, drowsiness, lethargy, headahe, blurred vision, constipation, diarrhea. Possible physical/psychological dependence,tolerance, paradoxical excitation

Caution:  Hepatic dysfunction

Contraindications: pregnancy/lactation; narrow-angle glaucoma; concurrent ketoconazole or itraconazole; decrease dose elderly/debilitated

Attention Deficit Hyperdisorder (ADHD) 

Amphetamine/ Adderall 

Dosage: 5-40 mg/ 10-30 mg

Use: focus

Cardiovascular Drugs

Angiotensin Converting Enzyme Inhibitors

Benazepril (Lotensin)/Captopril (Capoten)

  • Inhibits conversion of angiotensin I to angiotensin Ii
  • Lowers total peripheral resistance
  • Fewer cardiovascular side effects
  • Can be used with thiazide diuretics and digitalis
  • Hypotension can be reversed by fluid replacement
  • Contraindicated with renal impairment/pregnancy
  • Gerontologic considerations: requires reduce dosage and the addition of loop diuretics when there is a renal dysfunction


Angiotensin II Receptor Blockers

Losartan (Cozaar)/Eprosartan (Teveten)

  • Block the effects of angiotensin II at the receptor
  • Treats hypertension
  • Reduce peripheral resistance
  • Minimal side effects
  • Contraindicated: pregnancy, renovascular disease
  • Monitor for hypokalemia


Antilipidemics

Lipitor (Atorvastatin)

Dose: Given once daily, usually in the evening

  • Statins inhibit an enzyme involved in cholesterol synthesis, especially in the liver.
  • Increase serum high density lipid (HDL)
  • Decrease low density lipid (LDL)  and very low density lipid (VLDL) and plasma + triglyceride levels
  • Nursing implications: contraindicated to pregnancy
  • May cause multiple gi symptoms
  • Increased liver function test
  • Increased digoxin and oal contraceptive levels
  • May cause rhabdomyolysis
  • Discontinue at first sign of pain


    Movies, Respiratory System

    Devil Wears Prada Prevents Colds

                                       In a busy world like Andrea Sachs prevention of diseases such as the colds, rhinitis and influenza  is a must. 

    • Common colds are obtained by direct contact with contaminated secretions, or inhaling particles from a person who sneezes or coughs or the particles that remained in the air. To protect self from transmission of organism one must wash hands frequently or use alcogel/antibacterial wipes for disinfection.
    • The virus or bacteria may be retained in fabrics so use disposable tissue.
    •             Try to avoid walking in the crowd during peak season of flu.

    • If walking in the crowd is unavoidable, obtain an influenza vaccine from your health care provider.

    • Boost your immune system by eating nutritious food and take Vitamin C like Fern C. 


    Vitamin C strengthens immunity by forming an antibody protection. It rapidly heals the wound through collagen formation and promotes capillary formation and tissue synthesis. 

    Fern C is non – acidic and the only Quali C Vitamin C made from Europe. Fern C may be taken 1-2 capsule a day with or without meals. Take 3-4 capsule or dissolve it in water for colds.


    • Exercise increases ventilation and stimulates breathing by activating the proprioreceptors in the muscles and joints.

    • Have enough quality  sleep. During sleep the body allows repair via protein synthesis. Sleep restores vital energy and balance in the nervous system.


    • The odor and taste of a viscuous sputum from cough and colds reduces the appetite of a person. Oral hygiene and drinking citric juices cleanses the sputum taste thereby increasing the palatability of the food.

    • A poncho will keep you warm in the winter while a humidifier keeps the mucous membrane from drying and  irritated.

    • Smoking impairs the bronchial damage by interfering with ciliary action and increases bronchial secretions. If unprevented it will continue the inflammation and hyperplasia of the mucous membrane. This will also reduce the surfactant production that causes pleural friction rub.
    • If the cold is associated with allergic rhinitis identify the allergen and avoid exposure to irritants like dust, chemical, tobacco  smoke or animals. Non allergic rhinitis are due to temparature change, humidity, infection, food, odors and etc.
    • For soothing the sore throat gargle with salt water.
    • Drink plenty of water or hot liquids to reduce the viscous secretion. 
    • Cough and colds may lead to infection and is encourage to seek the doctor if symptoms persist for more than 7- 10 days or if the following signs exist:
    • Swollen lymph nodes
    • Fever for more than 2 days
    • Difficulty of breathing or wheezing
    • Severe pain or tenderness around the eyes or persistent pain in sunus area. 
    • Extreme red throat or white patches on the back of the throat
    • Discolored drainage or foul-smelling drainage nasal discharge
    • Severe headache

    The Devil Wears Prada Way of Reducing Stress

    Beautify

    Recite a positive mantra
    Seek Wisdom
    Makeover

    Beauty

    Materials Girls talks Natural Skin Care


    Ava and Tanzie Marchetta are the faces of Marchetta All Natural Cosmetics and as they save their company from shattering they averted their distress with natural skin care.

    • Enjoy a smoke free lifestyle

                                          Not only does smoking cause lung and heart diseases but it also gives skin a dull appearance. Smoking decreases the flow of oxygenated blood to the capillaries on the epidermis of the skin. Thereby loosing the elasticity of the collagen fiber increasing the age by a notch.

    “Exposing your skin into the harsh chemicals an d the sun is a nightmare for the skin. If you start with an all natural ingredients this cure the skin’s most difficult problems.”
    • Go for skin protection

                                           The rays of the sun has an ultraviolet radiation known as the UVA and the UVB that causes the breakdown of collagen and elastin causing skin damage. To protect yourself from the sun get SPF products with Titanium Dioxide, Zinc Oxide othe Avobenzone / Parsol 1789. Use SPF 15 as part of your daily regimen before going out or better yet use a foundation with SPF15 like L’oreal Paris True Match with Titanium Dioxide.

    • Cleansing

                                    For Ava it is important to cleanse after load of carbohydrate intake with hot water, kayenne pepper, maple syrup and lemon. Eat a lot antioxidants like fruits annd vgetables to get rid of the free radicals circulating the brain and drink a lot of water.

    • Puffy eyes cure

                              Tanzie recommends Preparation H for puffy eyes. It has hydrocoritisone that reduces the inflammation. Keeping a supine position with head elevated will prevent the puffiness from occuring or use freezed spoon over the eyes after waking up. Less salt fo fluid retention.

    • Mascara

                           For events use waterproof mascara with fiber free ingredients.

    • Indulge with Homemade Spa

                                                       Tinzie combines a tea tree oil, avocado and rosemarie for a facial mask.


    • Exfoliate

    “The key to soft skin is exfoliation. Anything abrasive like scrub will get rid of of the dead cells. Use natural hypoallergenic ingredients and stay away from formaldehyde.”

    • Skin care over make up 

                                            Always remove make up, cleanse face and moisturize before sleeping.