Patients hospitalized

Beriberi, Thiamine Deficiency. The recognition of vitamins and their importance to the health of human beings came about when Eijkman, a Dutch pathologist, was sent to Java in an attempt to cure an epidemic of beriberi that had appeared in one of the hospitals. Eijkman kept a flock of chickens on the hospital grounds to assist in discovering the disease agent he assumed was involved in the etiology of beriberi. These chickens were fed the scraps from the plates of the hospital patients—primarily poHshed rice, the common food in that part of the world (11). 

Pleasant odors of flowers, fmit, or food can reheve the depression of hospital patients, whether they are aware of the scents or not. 

When an antimalarial drug is given to a hospitalized patient for treatment of malaria, the preadministration assessment includes vital signs and a summary of the nature and duration of the symptoms. Laboratory tests may be ordered for the diagnosis of malaria Additional laboratory tests, such as a complete blood count, may be ordered to determine the patient s general health status. 

The expected outcomes for the patient may include an optimal response to therapy, management of common adverse reactions, an absence of diarrhea, maintenance of an adequate intake of fluids, maintenance of adequate nutrition, an understanding of the therapeutic regimen (hospitalized patients), and an understanding of and compliance with the prescribed therapeutic regimen (outpatients). 

Pilocarpine Ocular System. If the pilocarpine ocular system is prescribed for the hospitalized patient, die nurse checks die cheek and eye area several times a day because die system can become displaced from die eye. 

A patient receiving an antianxiety drug may be treated in the hospital or in an outpatient setting. Before starting therapy for the hospitalized patient, the nurse obtains a complete medical history, including mental status and anxiety level. In the case of mild anxiety, patients may (but sometimes may not) give a reliable history of their illness. 

In addition, if possible, die nurse obtains a history of any past drug or alcohol abuse. Individuals with a history of previous abuse are more likely to abuse odier drug s, such as the antianxiety drug s. Some patients, such as diose with mild anxiety or depression, do not necessarily require inpatient care. These patients are usually seen at periodic intervals in die primary health care provider s office or in a psychiatric outpatient setting. The preadministration assessments of the outpatient are the same as diose for the hospitalized patient. 

The preadministration assessments of the outpatient are basically die same as diose for the hospitalized patient. The nurse obtains a complete medical history and a history of die symptoms of the depression from die patient, a family member, or die patient s hospital records. During die initial interview, die nurse observes die patient for symptoms of depression and die potential for suicide The initial physical assessment also should include the patient s vital signs and weight. 

Physical assessments include obtaining blood pressure measurements on both arms with the patient in a sitting position, pulse, respiratory rate, and weight. The hospitalized patient may ultimately be discharged from the psychiatric setting. Some patients, such as those with mild schizophrenia, do not require inpatient care. The nurse usually sees these patients at periodic intervals in the psychiatric outpatient setting. 

The patient is monitored carefully vital signs are taken frequentiy, and die patient is placed on a cardiac monitor while the drug is being titrated to a therapeutic dose The dosage may be increased more rapidly in hospitalized patients under close supervision. 

In many individuals, hyperlipidemia has no symptoms and the disorder is not discovered until laboratory tests reveal elevated cholesterol and triglyceride levels, elevated LDL levels, and decreased HDL levels. Often, these drags are initially prescribed on an outpatient basis, but initial administration may occur in the hospitalized patient. Seram cholesterol levels (ie, a lipid profile) and liver functions tests are obtained before the drugs are administered. 

When caring for a hospitalized patient with a UTI, die nurse monitors die vital signs every 4 hours or as ordered by the primary healtii care provider. Any significant rise in temperature is reported to die primary healtii care provider because methods of reducing the fever or repeat culture and sensitivity tests may be necessary. 

ASSESSMENT OF THE HOSPITALIZED PATIENT The hospitalized patient receiving a female hormone requires careful monitoring. The nurse takes the vital signs daily or more often, depending on the patient s physical condition and the reason for drug use. The nurse observes the patient for adverse drug reactions, especially those related to the liver (the development of jaundice) or the cardiovascular system (thromboembolism). The nurse weighs the patient weekly or as ordered by the primary health care provider. The nurse... 

MANAGING SODIUM AND WATER RETENTION. Sodium and water retention may occur during female hormone therapy, hi addition to reporting any swelling of die hands, ankles, or feet to the primary health care provider, die nurse weighs the hospitalized patient daily, keeps an accurate record of die intake and output, encourages ambulation (if not on bed rest), and helps the patient to eat a diet low in sodium (if prescribed by the primary health care provider). 

The most important type of mixed solution is a buffer, a solution in which the pH resists change when small amounts of strong acids or bases are added. Buffers are used to calibrate pH meters, to culture bacteria, and to control the pH of solutions in which chemical reactions are taking place. They are also administered intravenously to hospital patients. Human blood plasma is buffered to pH = 7.4 the ocean is buffered to about pH = 8.4 by a complex buffering process that depends on the presence of hydrogen carbonates and silicates. A buffer consists of an aqueous solution of a weak acid and its conjugate base supplied as a salt, or a weak base and its conjugate acid supplied as a salt. Examples are a solution of acetic acid and sodium acetate and a solution of ammonia and ammonium chloride. 

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients a meta-analysis of prospective studies. JAMA. 1998 Apr 15 279(15) 1200-5. 

Clozapine eligibility among State hospital patients. Schizophr Bull22y 15—25. 

Rosenheck R, Cramer J, Xu W, et al (1997). A comparison of clozapine and haloperidol in hospitalized patients with refractory schizophrenia. N Engl J Med b b7> 809-15. 

Neufeld, 0. Smith, J. R. and Goldman, S. L. Arterial Oxygen Tension in Relation to Age in Hospital Patients. 

The normal range should be established with samples obtained from an adequate sample of healthy persons of specified age and sex. The effect of physiological variables such as activity, eating, menstruation and pregnancy should be known. The confidence limits should be determined with the appropriate statistical tools. Normal ranges determined with hospital patients should be rejected (20 21). 

Many enzyme activities have been proposed for diagnosis, in serum, urine, cerebrospinal fluid and other body fluids, and the proposed methods have been reviewed elsewhere (17). Here we will confine ourselves to the tried and most commonly used enzyme activities which yield useful information in ambulatory or hospital patients. 

Tartrate is a most widely used inhibitor of prostatic acid phenylphosphatase activity. With this inhibitor Bonner and associates detected five cases of unsuspected carcinoma of the prostate in 221 hospital patients and clarified the diagnoses in another four patients (98). Nonetheless, the diagnostic specificity of an elevated 1-tartrate inhibited activity is not absolute, as Fishman et. al found it elevated in 48 of 1,190 males without cancer. Whitmore and associates also observed this activity to be elevated in 3 of 20 patients with uncomplicated nodular hyperplasia (102). Hill compared the total versus the "prostatic" serum activities in 20 patients with localized untreated carcinoma of the prostate and observed... 

Table 6.3 Urinary tract infection—distribution of pathogenic bacteria in the community and hospitalized patients...

Acquired resistance to the glycopeptides is transposon-mediated and has so far been largely confined to the enterococci. This has been a problem clinically because many of these strains have been resistant to all other antibiotics and were thus effectively untreatable. Fortunately, the enterococci are not particularly pathogenic and infections have been confined largely to seriously ill, long-term hospital patients. Two types of acquired glycopeptide resistance have been described (Woodford et al. 1995). The VanA phenotype is resistant to vancomycin and teicoplanin, whereas VanB is resistant... 

In hospitals today a wide variety of complex equipment is used in the course of patient treatment. Humidifiers, incubators, ventilators, resuscitators and other apparatus require proper maintenance and decontamination after use. Chemical disinfectants used for this purpose have in the past through misuse become contaminated with opportunist pathogens, such as Ps. aeruginosa, and ironically have contributed to, rather than reduced, the spread of cross-infection in hospital patients. Disinfectants should only be used for their intended purpose and directions for use must be followed at all times. 

A patient s resistance is cmcial in determining the outcome of a medicament-borne infection. Hospital patients are more exposed and susceptible to infection than those treated in the general community. Neonates, the elderly, diabetics and patients traumatized by surgeiy or accident m have impaired defence mechanisms. People suffering fiom leukaemia and those treated with immunosuppressants are most vulnerable to infection there is a strong case for providing all medicines in a sterile form for these patients. 

Report of the Public Healdi Laboratory Service Working Party (1971) Microbial contamination of medicines administered to hospital patients. Pharm J, 207, 96-99. 

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