Patients needs

Whole blood is seldom used ia modem blood transfusion. Blood is separated into its components. Transfusion therapy optimizes the use of the blood components, using each for a specific need. Red cell concentrates are used for patients needing oxygen transport, platelets are used for hemostasis, and plasma is used as a volume expander or a source of proteins needed for clotting of the blood. 

Aerosolized steroids clearly play an important role in the present-day management of asthma (87). They are reasonably safe and work best when taken prophylacticaHy. Patient compliance, however, remains a significant problem. In part this problem is typical of any aerosolized agent. But in the case of steroids, the problem is exacerbated because a patient needs to take the steroids (especially prednisone) are the antiasthmatic agents of last resort and are widely used to treat status asthmaticus. An agent that could mimic the actions of steroids but which would work faster and/or without side effects might be the ideal antiasthmatic agent. 

Does the patient need special equipment, such as needles and syringes If so, where and how can the equipment be stored for safety and convenience Does the patient have an appropriate disposal container Will the refuse be safe from children and pets ... 

If the patient needs several drugs, can the patient or caregiver identify which drugs are used and when Do they know how to use them and why ... 

CONSTIPATION The nurse checks the bowel elimination pattern daily because constipation can occur with repeated doses of a narcotic. The nurse keeps a daily record of bowel movements and informs the primary health care provider if constipation appears to be a problem. Most patients should begin taking a stool softener or laxative with the initial dose of a narcotic analgesic. Many patients need to continue taking a laxative as long as the narcotic analgesic is taken. If the patient is constipated despite the use of a stool softener, the primary health care provider may prescribe an enema or another means of relieving constipation. 

Before administering a barbiturate or miscellaneous sedative and hypnotic, the nurse takes and records the patient s blood pressure, pulse, and respiratory rate In addition to the vital signs, the nurse assesses the following patient needs. 

Record weight twice a week and notify the primary health care provider if there is any sudden weight gain or loss. (Note the primary health care provider may also want the patient to monitor pulse rate If this is recommended, the patient needs instruction in the proper technique and a recommendation to record the pulse rate and bring die record to the primary healdi care provider s office or clinic.)... 

Patients seen for flashbacks are treated with oral diazepam (15—30 mg/day for adults) if symptoms of anxiety are severe (Rumack 1987). Neuroleptics, especially haloperidol, have been implicated in a transient increase in visual flashbacks and are not recommended (Moskowitz 1971 Strassman 1984). Risperidone and selective serotonin reuptake inhibitors may also worsen symptoms of hallucinogen persisting perception disorder (Halpern and Pope 2003). The patient needs assurance of the self-limiting nature of the phenomenon and its decreasing frequency of reoccurrence with time. The patient should be reminded that any future use of hallucinogens or marijuana may precipitate similar symptoms (Strassman 1984). 

In spite of the fact that the final result is always significant, a complete elimination of all the scars is usually impossible. Patients need to be aware that use of multiple complimentary techniques and time-consuming treatments is needed to produce optimal results. 

The stepwise approach is intended to assist, not replace, the clinical decision making required to meet individual patient needs. 

The controlled-release (CR) formulation is more slowly absorbed and longer acting than immediate-release tablets. Patients need to increase the total daily dose by 30%, as it is not as bioavailable as the immediate-release levodopa/carbidopa. The CR formulation has a delayed onset (45 to 60 minutes) compared to the standard formulation (15 to 30 minutes). Thus, patients may also need to take immediate-release tablets or even a liquid formulation when they want a quicker onset of effect, such as with the first morning dose.1,8,25... 

Opioids maybe administered in a variety of routes including oral (tablet and liquid), sublingual, rectal, transdermal, transmucosal, intravenous, subcutaneous, and intraspinal. While the oral and transdermal routes are most common, the method of administration is based on patient needs (severity of pain) and characteristics (swallowing difficulty and preference). Oral opioids have an onset of effect of 45 minutes, so intravenous or subcutaneous administration maybe preferred if more rapid relief is desired. Intramuscular injections are not recommended because of pain at the injection site and wide fluctuations in drug absorption and peak plasma concentrations achieved. More invasive routes of administration such as PCA and intraspinal (epidural and intrathecal) are primarily used postoperatively, but may also be used in refractory chronic pain situations. PCA delivers a self-administered dose via an infusion pump with a preprogrammed dose, minimum dosing interval, and maximum hourly dose. Morphine, fentanyl, and hydromorphone are commonly administered via PCA pumps by the intravenous route, but less frequently by the subcutaneous or epidural route. 

O To meet present attention-deficit hyperactivity disorder diagnostic criteria, patients need to display either hyperactivity, impulsivity, and/or inattentiveness before 7 years of age. 

Does the patient need continued prophylaxis therapy ° When do you stop prophylaxis ... 

There is no cure for AMD and the efficacy of most treatments is low. Newer drug developments show promise but no treatment can reverse damage that has already occurred.23 Early diagnosis is critical. High-risk patients need periodic eye examinations because some patients do not notice any changes, even when neovascularization has occurred.20... 

Additionally, the patient needs to be counseled on the necessity of prophylactic antibiotics prior to any dental or surgical procedure in order to prevent recurrent infections. This is critical in patients with risk factors that predispose them to developing IE, such as prosthetic heart valves, other valvular defects, or previous IE. 

For patients receiving corticosteroids, monitor for adverse effects and drug interactions. Does the patient need Gl prophylaxis for long-term treatment Slowly taper once symptoms improve and/or radiation is completed. 

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