Supine position

Fhtients with hypertension must have their blood pressure and pulse taken on both arms in sitting, standing, and supine positions before therapy is begun. If the patient has a cardiac arrhythmia, the initial assessment includes taking the pulse rate, determining the pulse rhythm, and noting the patient s general appearance. 

During initial therapy, headache and postural hypotension may occur, and the nurse must notify the primary health care provider because a dose change may be necessary. The nurse assists patients having episodes of postural hypotension with all ambulatory activities. The nurse instructs those with episodes of postural hypotension to take the drug in a sitting or supine position and to remain in that position until symptoms disappear. Hypotension maybe accompanied by paradoxical... 

A. remain in a supine position until the effects subside... 

When diazoxide or nitroprusside isused fora hypertensve emergency, the nurse placesthe patient in a supine position immediately before, as well as after, administration of the drug. The rate of infusion (nitroprussde) or rate of direct IV administration (diazoxide) and the patient s blood pressure are monitored closely during and after administration of the drug because severe hypotension can occur. The blood pressure and pulse rate may need to be monitored every 15 minutes until the blood pressure is reduced to safe levels The systolic pressure should not drop below 60 mm Hg. 

Recommends a supine position with knees flexed and legs spread. 

Place patient in a supine position. Elevate lower extremities if... 

Intubation and mechanical ventilation increase the risk of HAP/VAP 6- to 21 -fold.2,22 VAP also may be related to colonization of the ventilator circuit23 Risk of aspiration is increased in these patients owing to the supine positioning of the patient, the presence of the endotracheal tube preventing closure of the... 

Aggravated by movement, supine positioning, coughing, sneezing, neck flexion, straight-leg raise, Valsalva maneuver, and palpation of spine... 

More bile aspirated post-prandially and in supine position. 

Patients are generally treated in the supine position. If conventional simulationis used, a barium swallow should be done at the time of simulation to outline the target volume. Optimal immobilization such as an alpha cradle to improve daily set up reproducibility... 

Effects are dependent on dosage amount, route of administration. Ambulatory patients and those not in severe pain may experience dizziness, nausea, vomiting, hypotension more frequently than those in supine position or having severe pain Frequent... 

In summary, DMHP and some of its acetate Isomers produced various degrees of physical incapacitation due largely to the moderate to marked and prolonged orthostatic hypotension. Blood pressure was normal In the supine position. Mental effects of DMHP were much less severe than those of THC or cannabis at doses that produced similar degrees of orthostatic hypotension. Individual differences in intensity of response were considerable some subjects showed little or no response at doses that produced Intense symptoms in other subjects. 

The cross-over study was carried out in two parts. In the first part the subjects were fasted overnight and at 8 a.m. took one capsule with 100 ml of tap water, Food was subsequently withheld for 3 h, after which a standard lunch was served. Blood was sampled (10 ml) just before and 2, 4, 8, 12, 24 and 32 h after dosage. Immediately following each blood sample (except at 0 and 32 h) an X-ray photograph was taken to determine the position of the pellets in the gastrointestinal tract. The X-ray photographs were taken in the supine position and the sites of the alimentary canal numbered as in Table 1. 

Reduction in arterial blood pressure by clonidine is accompanied by decreased renal vascular resistance and maintenance of renal blood flow. As with methyldopa, clonidine reduces blood pressure in the supine position and only rarely causes postural hypotension. Pressor effects of clonidine are not observed after ingestion of therapeutic doses of clonidine, but severe hypertension can complicate a massive overdose. 

The most important stimulus to the release of ANP from the heart is atrial stretch via mechanosensitive ion channels. ANP release is also increased by volume expansion, changing from the standing to the supine position, and exercise. ANP release can also be increased by sympathetic stimulation via aiA-adrenoceptors, endothelins via the -receptor subtype (see below), glucocorticoids, and vasopressin. Plasma ANP concentration increases in various pathologic states, including heart failure, primary aldosteronism, chronic renal failure, and inappropriate ADH secretion syndrome. 

Caution [C, ] CrCl <30 Contra Component sensitivity, asthma, severe COPD, sinus bradycardia Disp Soln SE Irritation, bitter taste, superficial keratitis, ocular allergic Rxn EMS Drug is absorbed systemically OD May cause electrolyte disturbances (K), acidosis and bradycardia monitor ECG Doxazosin (Cardura, Cardura XL) [Antihypertensive/Alpha Blocker] Uses HTN symptomatic BPH Action < [-Adrenergic blocker relaxes bladder neck smooth muscle Dose HTN Initial 1 mg/d PO may be T to 16 mg/d PO BPH Initial 1 mg/d PO, may T to 8 mg/d XR 2-8mg qAM Caution [B, ] Use w/ PDE5 inhibitor (eg, sildenafil) can cause 1 BP Contra Component sensitivity Disp Tabs SE Dizziness, HA, drowsiness, sexual dysfxn, doses >4 mg T postural BP risk Interactions T Effects W/ nitrates, antihypertensives, EtOH i effects W/ NSAEDs, butcher s broom -t effects OF clonidine EMS Concurrent EtOH use can T drowsiness syncope may occur w/in 90 min of initial dose OD May cause profound hypotension place pt in supine position, give IV fluids, use pressors if needed... 

Inoue S, Kawaraguchi Y, Kitaguchi K, Furaya H. Inclusion of epinephrine to hyperbaric tetracaine and the supine position enhance the cephalad spread of spinal anaesthesia compared with hyperbaric tetracaine alone in the lithotomy position. Acta Anaesthesiol Stand. 2004 48 342-346. 

Alpha blockers reduce arterial pressure by dilating both resistance and capacitance vessels. As expected, blood pressure is reduced more in the upright than in the supine position. Retention of salt and water occurs when these drugs are administered without a diuretic. The drugs are more effective when used in combination with other agents, such as a 13-blocker and a diuretic, than when used alone. 

Tadalafil has also been extensively evaluated in patients with cardiovascular disease and has a similar safety and efficacy profile to sildenafil (45). Studies have shown no adverse effects on cardiac contraction, ventricular repolarization, or ischemic threshold. A similar hypotensive effect has been recorded with a dose of doxazosin 8 mg so caution is needed. As hypotension does not occur in the supine position and as tadalafil has a long half-life it is suggested that tadalafil is taken in the morning and doxazosin in the evening. There is no interaction of tadalafil with the selective a-adrenoceptor antagonist tamsulosin, which can, therefore, be prescribed as an alternative to doxazosin for symptomatic benign prostate hypertrophy (46). 

On June 13,1998, this patient participated in 100-m, 400-m, and 1500-m time-trial races at 1400 hours. Left loin pain occurred at 1600 hours. He considered that he had caught a cold, and took a commercially available drug for colds and an analgesic agent. Initially, pain was marked in the sitting position, and became less marked in the supine position. However, it gradually became worse even in the supine position, and he attended the Emergency Outpatient Unit of our hospital at 0500 hours on June 14. His serum creatinine, total bilirubin, and CPK levels were increased to 2.1 mg/dl, 2.8 mg/dl (the reason for an increase in total bilirubin was unclear), and 329 U/L, respectively, and the patient was referred to our department. On June 14, CT 24, 48, and 96 h after the administration of contrast medium showed patchy lesions (Fig. 38)... 

Albino rabbits of either sex weighing 2 to 3 kg are fastened securely in a supine position and the hair carefully clipped from the abdominal area with a fine-bladed clipper. The bare abdominal surface is marked... 

Rats are anaesthetized and fixed in supine position on a temperature-controlled heating plate to maintain body temperature. The left carotid artery and the right jugular vein are catheterized with short polyethylene catheters. The catheters are filled with isotonic saline solution and clamped. The two ends of the catheters are... 

Anaesthetized rats are fixed in supine position on a temperature-controlled (37 °C) heating-table. Following catheterization of a carotid artery (for measurement of blood pressure) and a jugular vein, the test compound is administered. After a defined latency period, the tail of the rat is transected with a razor-blade mounted on a self-constructed device at a distance of 4 mm from the tip of the tail. Immediately after transection, the tail is immersed into a bath filled with isotonic saline solution (37 °C). 

Facial and neck injuries may predispose the victim to airway and ventilatory difficulty. Airway compromise may result if the patient with facial fractures remains in a supine position due to lack of bony support. Progressive airway obstruction may also result from hemorrhage from penetrating neck wounds. Bleeding into the trachea, bronchus, and lungs will all compromise the victim s airway and ventilatory status. An artificial airway should be placed to maintain airway patency until intubation is required (American College of Sur-... 

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