Hospital patients compromised

The health of the small intestine can also be compromised by poor nutrition or starvation, which can regularly occur in hospital. Patients are normally starved overnight, prior to operation, and starvation may continue well after completion of the surgery because of the nature of the operation or because of the anorexia that can result from surgery or anaesthesia. This will deny adequate nutrition to epithelial cells in the intestine, which can resnlt in slow recovery after surgery and, in addition, may compromise the immune system. Provision of food by the enteral ronte, as soon as possible after injury, surgery, sepsis or bums, is therefore highly desirable (Chapter 18). 

Fungal infections are rarely transmitted directly from person to person. Fungi are derived from the commensal flora of the patient or from animal and innate sources in the environment, and are inoculated by (micro)trauma, ingestion or inhalation of spores. The incidence of invasive fungal infections among hospitalized patients has increased primarily due to the introduction of medical interventions that compromise the natural defenses of the patients. 

Neutropenia is a condition characterized by a decrease in blood neutrophil count below 1.5 X 109 cells per litre a normal blood count is (2.0-7.5) X 109 cells per litre. Its clinical symptoms include the occurrence of frequent and usually serious infections, often requiring hospitalization. Neutropenia may be caused by a number of factors (Table 10.6), at least some of which are responsive to CSF treatment. Particularly noteworthy is neutropenia triggered by administration of chemotherapeutic drugs to cancer patients. Chemotherapeutic agents (e.g. cyclophosphamide, doxorubicin and methotrexate), when administered at therapeutically effective doses, often induce the destruction of stem cells and/or compromise stem cell differentiation. 

Pneumonia - Do not use oral azithromycin in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following nosocomially acquired infections known or suspected bacteremia conditions requiring hospitalization cystic fibrosis significant underlying health problems that may compromise patients ability to respond to their illness (including immunodeficiency or functional asplenia) elderly or debilitated patients. 

Describe budgetary issues confronting a hospitals pharmacy department. Identify strategies undertaken by the departments director and staff pharmacists to reduce operating costs without compromising patient care. 

Initial clinical work focused on a product that would be used to convert patients who were hospitalized for recent-onset AF as an alternative to a cardioversion procedure. Cardiome partnered with Fujisawa (now Astellas Pharmaceuticals) for the clinical development of a vernakalant (1), which produces robust AF conversion rates and none of the ventricular conduction abnormalities associated with less selective agents.35 By the close of 2009, vernakalant had been in 5 large trials and several smaller trials, including a total of over 1200 AF patients. Four Phase III studies—Atrial Arrhythmia Conversion Trials (ACT 1, 2, 3, and 4) —examined patients with recent onset AF (< 45 days) and the measured the rate of conversion to NSR in various periods after drug administration.36 38 The conversion rate was 45-63% in these studies, which tended to exclude patients with more compromised heart function or a history of heart failure. While there has been no specific study looking at QT prolongation, monitoring in both patients and in healthy volunteers showed only modest increases in the QT interval with no directly associated incidents of TDP across all trials. 

The incidence of hypotension with the use of midazolam for pre-hospital rapid-sequence intubation of the trachea has been assessed in a retrospective chart review of two aeromedical crews (19). The rapid-sequence protocols were identical, except for the dose of midazolam. Both crews used 0.1 mg/kg, but one crew had a maximum dose of 5 mg imposed. This meant that patients over 50 kg received lower doses of midazolam they also had a higher incidence of hypotension. This relation was also present in patients with traumatic brain injury, implying that cerebral perfusion could be compromised at a critical time in those without dosage restriction. 

Approximately 50% of hemiparetic patients in hospital develop a deep vein thrombosis in their paralyzed leg, although this is not usually detectable clinically. However, a swollen and painful leg compromises rehabilitation. A resultant pulmonary embolism causes... 

Respiratory syncytial virus is the most common cause of acute bronchiolitis, an infection that mostly affects infants during their first year of life. In the well infant, bronchiolitis is usually a self-limiting viral illness, whereas in the child with underlying respiratory or cardiac disease or both, the child may develop severe respiratory compromise (failure) necessitating in-hospital treatment, such as rehydration, oxygen, and in select patients, bronchodilators, ribavirin aerosol, or both. 

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