Patients vulnerability

Debating the Issue The intensive chemotherapy required to treat sickle cell disease drastically weakens the immune system, leaving the patient vulnerable to overwhelming infection. Five to eight percent of the children who undergo this treatment do not survive. Should doctors be allowed to use this procedure to treat sickle cell disease ... 

Inhibition of liver MAO leaves the patient vulnerable to the so-called wine-and-cheese syndrome, with adverse cardiovascular effects caused by absorption of such vasoactive amines as tyramine into the general circulation [for review, see Blackwell et al. (23)], The syndrome can include severe headache and hypertension and may lead to cerebral hemorrhage and death. Although this is a real risk, it seems likely that fears of MAOfood interactions may have been grossly exaggerated. Pare (24) reviewed the evidence in 1985 and noted that despite the widespread use of MAO inhibitors in the previous decade there had only been 17 reports of food interactions with phenelzine (19) and none of these proved fatal. With tranylcypromine (23) seven deaths had been reported, but in only two of these could a definite relationship with diet be established. 

Fluperlapine shows potent central antiserotonin activity [622]. The pharmacological profile is similar to that of clozapine with additional antidepressant properties [623]. It has a good antipsychotic effect and alleviated the apathetic and depressive syndromes in a trial with schizophrenic patients [624,625]. The drug is beneficial in the treatment of patients vulnerable to neurological side-effects [626]. 

Narcotic analgesics can produce serious or potentially fatal respiratory depression if given too frequently or in an excessive dose. Respiratory depression may occur in patients receiving a normal dose if the patient is vulnerable (ie, in weakened state or debilitated state). Elderly, cachectic, or debilitated patients may have a reduced initial dose until die response of the drug is known. If the respiratory rate is 10/min or below, the nurse must monitor die patient at frequent intervals and notify the primary health care provider immediately. 

The nurse immediately reports to the primary health care provider any significant change in the patient s vital signs. Narcotic analgesics can cause hypotension. Particularly vulnerable are postoperative patients and individuals whose ability to maintain blood pressure has been compromised. 

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. 

Psychoses, when they occur, appear to be due to drug effect interacting with a vulnerable personality organization (Luisada 1978). Our experience has been that some adolescents with borderline personality disorders, as well as adolescents at risk of schizophrenic decompensation, may have this vulnerability. Although we do not have hard data to support the hypothesis that patients with PCP psychoses that are most resistant to treatment have the poorest long-term prognosis (Erard et al. 1980), our observations have been that persistence of symptoms of psychosis after the first 2 to 3 weeks of treatment often correlates with extended periods of impai rment. 

Light therapy is an alternative treatment for depression associated with seasonal (e.g., winter) exacerbations. Possible side effects include eye strain, headache, insomnia, and hypo-mania.16,17 Also, potentially vulnerable patients, such as those with photosensitivity or a history of skin cancer, should be evaluated carefully prior to therapy.16... 

The superior vena cava (SVC) is the primary drainage vein for blood return from the head, neck, and upper extremities. It is a relatively thin-walled vein that is particularly vulnerable to obstruction from adjacent tumor invasion or thrombosis. The obstruction leads to elevated venous pressure, although collateral veins partially compensate. This is one reason for the relatively slow onset of the classic symptoms of SVCS. In fact, 75% of patients have signs and symptoms for more than 1 week before seeking medical attention.15... 

A second problem with relapse-prevention trials is related to research suggesting that the use of antidepressants might make people more vulnerable to relapse. Patients who are being treated... 

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