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Rapid fluid loss leads to inadequate tissue perfusion and ear infection 9 month old purchase genuine suprax line, if not reversed virus yardville nj order 200 mg suprax with amex, ultimately, to organ failure. A significant loss of greater than 30% of circulating volume results in a decrease in venous return, which in turn diminishes cardiac output, decreases perfusion to vital organs, and causes the symptoms associated with shock. When there is insufficient oxygen available to the cells, metabolism shifts from aerobic to anaerobic pathways. In this process, lactic acid accumulates in the tissues, and the patient develops metabolic acidosis. In addition, the tissues do not receive adequate glucose, and they cannot accomplish the removal of carbon dioxide. This disruption in normal tissue metabolism results initially in cellular destruction and, if left uncorrected, multiple organ failure and death. Significant hypovolemic shock (40% loss of circulating volume) lasting several hours or more is associated with a fatal outcome. The American College of Surgeons separates hypovolemic/hemorrhagic shock into four classifications: Stage I occurs when up to 15% of the circulating volume, or approximately 750 mL of blood, is lost. These patients often exhibit few symptoms except perhaps anxiety and a H 622 Hypovolemic/Hemorrhagic Shock slight increase in heart rate because compensatory mechanisms support bodily functions. These patients have subtle signs of shock, but vital signs usually remain normal except for tachycardia and mild tachypnea. The patient may be slightly confused or irritable, and his or her skin may feel cool. This patient looks acutely ill, with significant tachycardia, thready pulses, hypotension, tachypnea, cold and clammy skin, lethargy, oliguria, and metabolic acidosis. The patient has severe tachycardia, weak or absent pulses, significant hypotension, hypothermia, acidosis, severe tachypnea, coma, cyanosis, and anuria. This patient has lost more than 40% of circulating volume, or least 2,000 mL of blood, and is at risk for exsanguination. Complications of hypovolemic shock include adult respiratory distress syndrome, sepsis, acute renal failure, disseminated intravascular coagulation, cerebrovascular accident, multiple organ dysfunction syndrome, and death. As circulation fails, hypovolemic and/or hemorrhagic shock causes the endothelium to be altered due to oxygen deprivation, leading to endothelial cell death. Lactic acidosis occurs from hypoxemia as the rate of oxygen diffusion to organ cells decreases and muscle cells move to anaerobic metabolism. Hemorrhage caused by active blood loss that results from trauma is a frequent source of hypovolemia. Active bleeding or rupture of internal organs, such as the bowel or the fallopian tube when caused by an ectopic pregnancy, can quickly result in hypovolemia even without obvious bleeding. Profound decreases in circulating fluid volume can be caused by the plasma shifts seen in burns and ascites. Other sources of hypovolemia include decreases in fluid intake (dehydration) and increases in fluid output (vomiting, diarrhea, excessive nasogastric drainage, draining wounds, and diaphoresis). Excessive diuresis from diuretic overuse, diabetic ketoacidosis, and diabetes insipidus can also cause hypovolemia. Pregnancy-related disorders that can lead to hypovolemic shock include ruptured ectopic pregnancy, placenta previa, and abruption of the placenta. In comparison, although trauma can occur at any age, in young adults the major cause of hypovolemic shock is hemorrhage from multiple trauma. In regions at war or with civil or political strife, traumatic injuries also lead to hemorrhagic shock. If the patient is actively bleeding or is severely compromised, the history, assessment, and early management merge together into the primary survey. Generally, patients who are experiencing hypovolemia because of trauma have either obvious bleeding or a history of injury to a vascularized area. Elicit information from the patient, emergency medical personnel, or the family as to how much blood was lost or how long the bleeding has continued. In the case of traumatic blood loss, it is important to remember that the most obvious injury site may not be the cause of the evolving hypovolemic shock. Explore the possibility of a mechanism of injury, such as a burn or crush injury, leading to plasma fluid shifts extravascularly. Likewise, a history of either recent alterations in fluid volume intake or excessive loss- as in vomiting, diarrhea, excessive diaphoresis, or diuresis- is a potential indicator. In addition, obtain a subjective history of thirst, lethargy, and decreased urinary output. Early signs include restlessness, anxiety, agitation, confusion, weakness, lightheadedness, and tachycardia. The patient may appear either stable and alert or critically ill depending on the phase of hypovolemic shock. Mental status changes may be indicators of diminished cerebral perfusion and are among the early signs of hypovolemic shock. Other early indicators include a decreased urinary output of less than 30 mL/hour, delayed capillary blanching, and signs of sympathetic nervous system stimulation (tachycardia, piloerection [gooseflesh]). Monitor vital signs, including heart and respiratory rate, blood pressure, and temperature. Changes in blood pressure (particularly hypotension) are a late rather than an early sign; pulse pressure, however, does initially widen and then narrow in the first two stages of shock. If bowel sounds are hypoactive, bleeding may be causing blood to shunt to other more vital organs. If the thighs have deformities or are enlarged, those may be signs of femoral fracture and bleeding into the thigh. Of particular concern are the parents of young trauma patients who have to deal with a sudden, life-threatening event that may lead to the death of a child.

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The patient and family should discuss quality-oflife issues antibiotic 2 pills first day buy suprax 200 mg amex, including the psychological stresses of living with an unruptured aneurysm antibiotics for sinus infection in babies buy suprax in india. Make sure that the family understands when to schedule follow-up visits and how to support the patient to live a healthy lifestyle. People with concussions may or may not experience loss of consciousness but usually exhibit confusion, delayed responses to questions, a blank facial expression, emotional lability, and headache. Most concussion patients recover fully within 48 hours, but subtle residual impairment may Cerebral Concussion 255 occur. There is a growing awareness that athletes may not notice mild symptoms or may underreport concussions so that they can continue to play the sport. Athletes with a history of one or more concussions have a greater risk for being diagnosed with another concussion than those without such a history. The first 10 days after a concussion presents the greatest risk for another concussion. Some patients develop postconcussion syndrome (postinjury sequelae after a mild head injury). Symptoms may be experienced for several weeks and, in unusual circumstances, may last up to 1 year. Other complications of cerebral concussion include seizures or persistent vomiting. In rare instances, a concussion may lead to intracranial hemorrhage (subdural, parenchymal, or epidural) or death. Sudden and rapid acceleration of the head from a position of rest makes the head move in several directions. The lag between skull movement and brain movement causes stretching of veins connecting the subdural space (the space beneath the dura mater of the brain) to the surface of the brain, resulting in minor disruptions of the brain structures. Common causes of concussion are a fall, a motor vehicle crash, a sports-related injury, and a punch to the head. In high school athletes, the rate of concussions per 1,000 exposures for boys is 0. In children from birth to 4 years of age, assault is the most common cause of concussion. In young adults 15 to 19 years of age, traffic injuries are the leading cause of concussion, followed by sports injuries. Older adults have higher rates of concussion-producing falls than do other age groups. Falls from heights of less than 5 meters are the leading cause of injury overall, and automobile crashes are the next most frequent cause. If the patient cannot report a history, speak to the life squad, a witness, or a significant other to obtain a history. Determine if the patient became unconscious immediately and for how long- a few seconds, minutes, or an hour- at the time of the trauma. Find out if the patient experienced momentary loss of reflexes, arrest of respirations, and possible retrograde or anterograde amnesia. Elicit a history of headache, drowsiness, confusion, dizziness, irritability, giddiness, visual disturbances ("seeing stars"), and gait disturbances. Other symptoms include memory loss, momentary confusion, residual memory impairment, and retrograde amnesia. A postconcussive syndrome that may occur weeks and even months after injury may lead to headache, fatigue, inattention, dizziness, vertigo, ataxia, concentration problems, memory deficits, depression, and anxiety. The most common symptoms of a concussion include confusion, emotional lability, pain, dizziness, memory loss, and visual disturbances. Several signs to look for include ipsilateral miosis (Horner syndrome), in which one pupil is smaller than the other with a drooping eyelid; bilateral miosis, in which both pupils are pinpoint in size; ipsilateral mydriasis (Hutchinson pupil), in which one of the pupils is much larger than the other and is unreactive to light; bilateral midposition, in which both pupils are 4 to 5 mm and remain dilated and nonreactive to light; and bilateral mydriasis, in which both pupils are larger than 6 mm and are nonreactive to light. Observe the patient to ensure that no other focal lesion, such as a subdural hematoma, has been overlooked. Expect parents of children who are injured to be anxious, fearful, and sometimes guilt-ridden. Generally, a family member is instructed to evaluate the patient routinely and to bring the patient back to the hospital if any further neurological symptoms appear. Parents are often told to wake a child every hour for 24 hours to make sure that the patient does not have worsening neurological signs and symptoms. Treatment generally consists of bedrest with the head of the bed elevated at least 30 degrees if possible, observation, and pain relief. Neurological consultation after 2 to 4 weeks should occur before the athlete resumes a sport. Patients should be evaluated for a postconcussive syndrome with symptoms such as recurrent headaches, dizziness, memory impairment, ataxia, sensitivity to light and noise, concentration and attention problems, and depression or anxiety. Pharmacologic Highlights General Comments: Narcotic analgesics and sedatives are contraindicated because they may mask neurological changes that indicate a worsening condition. Make sure that before the patient goes home from the emergency department, the significant others are aware of all medications and possible complications that can occur after a minor head injury. Discuss with the patient and family the best ways to maintain cognitive and physical rest. Encourage the patient to avoid activities that require higher-level processes such as reaction time, multitasking, and memory. Patients do not have to remain in bed in a darkened room, but encourage brain rest by having patients stay at home, avoid physical activity, and avoid driving. Children and teenagers 258 Cerebral Concussion should avoid homework until given approval by the healthcare team to resume schoolwork. Most experts recommend avoiding television and electronics such as computers and tablets for several days to rest the brain. Teach the patient and significant others to recognize signs and symptoms of complications, including increased drowsiness, headache, irritability, or visual disturbances that indicate the need for reevaluation at the hospital.

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The patient with an acute gallbladder attack appears acutely ill infection you get in hospital generic 100 mg suprax overnight delivery, is in a great deal of discomfort antibiotics risks cheap 100 mg suprax free shipping, and sometimes is jaundiced. A low-grade fever is often present, especially if the disease is chronic and the walls of the gallbladder have become infected. Right upper quadrant pain is intense in acute attacks and requires no physical examination. A positive Murphy sign, which is positive palpation of a distended gallbladder during inhalation, may confirm a diagnosis. Elderly people may present with vague symptoms such as localized tenderness and without pain and fever. The patient with an acute attack of cholelithiasis may be in extreme pain and very upset. The experience may be complicated by guilt if the patient has been advised by the physician in the past to cut down on fatty foods and lose weight. Supporting tests include phosphatase, aspartate amino transferase, lactate dehydrogenase, alkaline phosphatase, serum amylase, and serum bilirubin levels; oral cholecystogram; and computed tomography. Antibiotics may be given to manage infection along with bowel rest, intravenous hydration, correction of electrolyte imbalances, and pain management with follow-up care. Criteria for outpatient treatment include that the patient is febrile, with no evidence of obstruction on laboratory assessment and sonogram, no underlying medical problems, adequate pain control, and proximity to an acute care facility if needed from home. However, given the effectiveness of laparoscopic cholecystectomy, the only patients who will receive medical dissolution are generally those who are nonobese patients with very small cholesterol gallstones and a functioning gallbladder. The one seen most commonly today is a laparoscopic cholecystectomy, which is performed early (within 48 hours of acute onset of symptoms) in the course of the disease when there is minimum inflammation at the base of the gallbladder. It is considered the standard of care for the surgical management of cholecystectomy. The procedure is performed with the abdomen distended by an injection of carbon dioxide, which lifts the abdominal wall away from the viscera and prevents injury to the peritoneum and other organs. A laparoscopic cholecystectomy is done either as an outpatient procedure or with less than 24 hours of hospitalization. After the surgery, the patient may complain of pain from the presence of residual carbon dioxide in the abdomen. The traditional open cholecystectomy is performed on patients with large stones as well as with other abnormalities that need to be explored at the time of surgery. This procedure is particularly appropriate up to 72 hours after onset of acute cholecystitis. Early cholecystectomy has the advantage of resolving the acute condition early in its course. Delayed cholecystectomy can be performed after the patient recovers from initial symptoms and acute inflammation has subsided, generally 2 to 3 months after the acute event. Extracorporeal shock wave lithotripsy, similar to the type used to dissolve renal calculi, is now also used for small stones. For those patients who are not good surgical candidates, both methods have the advantage of being noninvasive. However, they have the disadvantage of leaving in place a gallbladder that is diseased, with the same propensity to form stones as before treatment. The anticholinergics relax the smooth muscle, preventing biliary contraction and pain. If inflammation of the gallbladder has led to gallstones and obstruction of bile flow, replacement of the fat-soluble vitamins is important to supplement the diet. Bile salts may be prescribed to aid digestion and vitamin absorption as well as to increase the ratio of bile salts to cholesterol, aiding in the dissolution of some stones. Independent During an acute attack, remain with the patient to provide comfort, to monitor the result of interventions, and to allay anxiety. Although most patients return from surgery or a procedure breathing on their own, if stridor or airway obstruction occurs, create airway patency with an oral or nasal airway and notify the surgeon immediately. The high incision makes deep breathing painful, leading to shallow respirations and impaired gas exchange. Splinting the incision while encouraging the patient to cough and breathe deeply helps both pain and gas exchange. Cholecystitis and Cholelithiasis 277 Patients not undergoing surgery or a procedure need a thorough education. Teach the patient to avoid high-fat foods; dairy products; and, if the patient is bothered by flatulence, gas-forming foods. Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology. They examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute gallbladder disease. The patients in the emergency group had the surgery during the time of the emergency admission. Those in the delayed group were admitted as an emergency and then readmitted for surgery at a later date. The authors concluded that using the emergency procedures was more efficient and effective in terms of quality of life. After a laparoscopic cholecystectomy, provide discharge instructions to a family member or another responsible adult as well as to the patient because the patient goes home within 24 hours after surgery. Explain the possibility of abdominal and shoulder pain caused by the instillation of carbon dioxide so that if the pain occurs, the patient will not experience unnecessary anxiety about a heart attack. Teach the patient to avoid submerging the abdomen in the bathtub for the first 48 hours, to take the prescribed antibiotics to provide further assurance against infection, and to watch the incisions for signs of infection. Following a 3- to 5-day hospital stay for an open cholecystectomy, instruct the patient on the care of the abdomen wound, including changing the dressing and protection of any drains.

Syndromes

  • Pulmonary aspergillosis is an invasive type that is a serious infection with pneumonia that can spread to other parts of the body. This infection almost always occurs in people with a weakened immune system due to cancer, AIDS, leukemia, an organ transplant, chemotherapy, or other conditions or medications that lower the number or function of normal white blood cells or weaken the immune system.
  • Irregular or slow heartbeat
  • Control gum bleeding by applying pressure directly on the gums with a gauze pad soaked in ice water.
  • Bleeding inside your belly
  • Acute mountain sickness
  • Skin
  • High blood pressure
  • Improved sleep

During the stent procedure antibiotics for uti keflex discount 100 mg suprax otc, the cardiologist places a small antibiotic injection for cats buy discount suprax, hollow metal (mesh) tube, or stent, in the artery to keep it open following a balloon angioplasty. Recent research is questioning the use of stents on the basis of long-term outcome data. A patent blood vessel from another part of the body is grafted to the affected coronary artery distal to the lesion. Unfortunately, unless reduction of risks and modification of the lifestyle accompany this procedure, the grafted vessels will also eventually occlude. Vessels commonly used for grafting are the greater or lesser saphenous veins, basilic veins, and right and left internal mammary arteries. Managing the patient after heart surgery involves complex collaborative strategies among the nurse, surgeon, and respiratory therapist. Usually, a patient leaves the operating room with a systemic arterial and pulmonary artery catheter in place. Early complications from heart surgery include hypotension or hypertension (lowered or raised blood pressure), hemorrhage, dysrhythmias, decreased cardiac output, fluid and electrolyte imbalance, pericardial bleeding, fever or hypothermia, poor gas exchange, gastric distention, and changes in level of consciousness. If the patient has a large amount of drainage from mediastinal tubes, the nurse may initiate autotransfusion. In the immediate postoperative period, patients will need airway management with an endotracheal tube and breathing support with mechanical ventilation. Some patients will also require temporary cardiac pacing through epicardial pacing wires that are inserted during the surgery. Patients will often need fluid therapy with blood, colloids, or crystalloids to replace lost fluids or bleeding. Pharmacologic Highlights Medication or Drug Class Aspirin Dosage 325 mg every other day Description Has an antiplatelet action Nitrates such as isosorbide and nitroglycerin, beta-adrenergic blockers such as atenolol and propranolol, and calcium channel blockers such as diltiazem, nifedipine, and verapamil Bile-sequestering agents (cholestyramine), folic acid derivatives (gemfibrozil), and cholesterol synthesis inhibitors (lovastatin) Rationale Reduces incidence of myocardial infarction by preventing clots Increase coronary artery blood flow through vasodilation Nitrates and other antianginal agents Varies by drug Antilipemic agents Varies by drug Lower excessively high serum lipid levels Coronary Heart Disease (Arteriosclerosis) 305 Pharmacologic Highlights (continued) Other Drugs: If the patient is having angina, nitrates, beta-blockers, statins, calciumchannel blockers, and ranolazine will be considered. Antihypertensives are also used because hypertension increases stress on damaged blood vessels. Angiotensinconverting enzyme inhibitors such as ramipril (altace) and quinapril (accupril) are used to lower blood pressure. Clopidogrel (plavix) inhibits platelet aggregation; amlodipine (norvasc) relaxes the coronary smooth muscle and produces coronary vasodilation. When the episode is over, ask the patient to grade the severity of the pain (1 is low pain and 10 is severe pain), and document it in detail. Information about resumption of sexual activity acceptable for the medical condition is helpful. Although many patients will be admitted on the day of surgery, preoperative teaching about the intensive care unit environment, the procedure, postoperative coughing and breathing exercises, and postoperative expectations of care is essential. The surgery is a family crisis that may lead to a long recovery, patient dysfunction, and even death. Percutaneous coronary intervention in stable angina (orbita): A double-blind, randomised controlled trial. Review the risk factor and lifestyle modifications that are acceptable to the patient and her or his family members. Be certain that the patient and appropriate family members understand all medications, including the correct dosage, route, action, and adverse effects. Care of Incision Often the incision heals with no home healthcare, but the patient needs to know the signs of infection. Instruct patients on when they can resume exercise and the intensity of the exercise. While it is difficult to know how many people in the United States have cor pulmonale, experts estimate that 15 million people have the condition. It causes increases in pulmonary vascular resistance, and as the right side of the heart works harder, the right ventricle hypertrophies. An increase in pulmonary vascular resistance is the result of anatomic reduction of the pulmonary vascular bed, pulmonary vasoconstriction, or abnormalities of ventilatory mechanics. Alveolar wall damage results in anatomic reduction of the pulmonary vascular bed as the number of pulmonary capillaries are reduced and the vasculature stiffens from pulmonary fibrosis. Constriction of the pulmonary vessels and hypertrophy of vessel tissue are caused by alveolar hypoxia and hypercapnia. Abnormalities of the ventilatory mechanics bring about compression of pulmonary capillaries. Complications of cor pulmonale include biventricular heart failure, hepatomegaly, pleural effusion, and thromboembolism related to polycythemia. In the Cor Pulmonale 307 United States, approximately 25,000 sudden deaths occur per year from heart failure associated with pulmonary emboli. Respiratory insufficiency- such as chest wall disorders, upper airway obstruction, obesity hypoventilation syndrome, and chronic mountain sickness caused by living at high altitudes- can also lead to the chronic forms of the disease. A contributing factor is chronic hypoxia, which stimulates erythropoiesis, thus increasing blood viscosity. In children, cor pulmonale is likely to be a complication of cystic fibrosis, hemosiderosis, upper airway obstruction, scleroderma, extensive bronchiectasis, neurological diseases that affect the respiratory muscles, or abnormalities of the respiratory control center. Determine if the patient has experienced orthopnea, cough, fatigue, epigastric distress, anorexia, or weight gain or has a history of previously diagnosed lung disorders. Determine the amount and type of dyspnea and if it is related only to exertion or is continuous.

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You may need to consult other sources natural antibiotics for acne infection buy generic suprax from india, such as family or friends antimicrobial needleless connectors discount 200 mg suprax free shipping, to obtain accurate information when the patient is acutely intoxicated upon admission. The intoxicated individual needs to have a careful respiratory, cardiovascular, and neurological evaluation. In life-threatening situations, conduct a brief survey to identify serious problems and begin stabilization. Monitor the patient carefully for apnea and respiratory depression throughout the period of intoxication. Note that early intoxication may be associated with tachycardia and hypertension, whereas later intoxication may be associated with hypotension. The brief mental status examination includes general appearance and behavior, levels of consciousness and orientation, emotional status, attention level, language and speech, and memory. Depression of the gag reflex from alcohol leads to the risk for aspiration of stomach contents. Individuals admitted to the hospital during episodes of acute alcohol intoxication need both a thorough investigation of the physiological responses and a careful assessment of their lifestyle, attitudes, and stressors. Acute Alcohol Intoxication 41 Diagnostic Highlights Test Blood alcohol concentration Normal Result Negative (10 mg/dL or 0. Elevated or low blood glucose levels without a family history of diabetes mellitus indicate chronic alcohol use. Ensure that the patient maintains a normal body temperature; 42 Acute Alcohol Intoxication initiate body warming procedures for hypothermia. During periods of acute intoxication, use care in administering medications that potentiate the effects of alcohol, such as sedatives and analgesics. The result is the number of hours the patient needs to metabolize the alcohol fully. Formal withdrawal assessment instruments are available to help guide the use of benzodiazepines. If the patient is a dependent drinker, an alcohol referral to social service, psychiatric consultation service, or a clinical nurse specialist is important. Brief interventions (short counseling sessions that focus on helping people cut back on drinking) are appropriate for people who drink in ways that are harmful or abusive, and such interventions can be delivered by clinicians who are trained in the technique. Reorient the patient frequently to people and the environment as the level of intoxication changes. Alcoholic withdrawal can occur as early as 48 hours after the blood alcohol level has returned to normal or, more unusually, as long as 2 weeks later. Avoid using restraints unless the patient is at risk for injuring herself or himself or others. As the patient recovers, perform a complete nutritional assessment with a dietary consultation if appropriate. Women and men admitted for alcohol intoxication at an emergency department: Alcohol use disorders, substance use and health and social status 7 years later. Acute Kidney Injury 43 · the investigators recommend that because of the nature and extent of alcohol use, substance use, and mental health problems in this population, the initial emergency department visit should be used to promote health behaviors and deliver secondary prevention measures. Focus teaching on the problems associated with intoxication and strategies to avoid further intoxication. The other 30% of patients never develop oliguria and have what is considered nonoliguric renal failure. During the initial phase (often called the oliguric phase), when trauma or insult affects the kidney tissue, the patient becomes oliguric. During the diuretic phase, patients may produce as much as 5 L of urine in 24 hours but lack the ability for urinary concentration and regulation of waste products. The final stage, the recovery phase, is characterized by a return to a normal urinary output (about 1,500­ 1,800 mL/24 hr), with a gradual improvement in metabolic waste removal. Some patients take up to a year to recover full renal function after the initial insult. The patient is also at risk for secondary infections, congestive heart failure, and pericarditis. Disorders that can lead to prerenal failure include cardiovascular disorders (dysrhythmias, cardiogenic shock, heart failure, myocardial infarction), disorders that cause hypovolemia (burns, trauma, dehydration, hemorrhage), maldistribution of blood (septic shock, anaphylactic shock), renal artery obstruction, and severe vasoconstriction. Nephrotoxic injuries occur when the renal tubules are exposed to a high concentration of a toxic chemical. Ischemic injuries occur when the mean arterial blood pressure is less than 60 mm Hg for 40 to 60 minutes. Situations that can lead to ischemic injuries include cardiopulmonary arrest, hypovolemic or hemorrhagic shock, cardiogenic shock, or severe hypotension. Oliguria in the older patient, therefore, may be diagnosed with urine production of as much as 600 mL/day. Elderly patients may have a decreased blood flow, decreased kidney mass, decreased filtering surface, and decreased glomerular filtration rate. Older men have the added risk of preexisting renal damage because of the presence of benign prostatic hypertrophy. Question the patient about recent illnesses, infections, or injuries, and take a careful medication history with attention to maximum daily doses and self-medication patterns. Some patients have a recent history of weight gain, edema, headache, confusion, and sleepiness. The patient appears seriously ill and often drowsy, irritable, confused, and combative because of the accumulation of metabolic wastes. In the oliguric phase, the patient may show signs of fluid overload such as hypertension, rapid heart rate, peripheral edema, and crackles when you listen to the lungs.

References

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  • Xiao W, Yan F, Ji H, et al: A randomized study of a new landmark-guided vs traditional para-carotid approach in internal jugular venous cannulation in infants, Paediatr Anaesth 19:481-486, 2009.
  • Pais Jr, VM, Strandhoy JW, Assimos DG. Pathophysiology of Urinary Tract Obstruction. In: Wein AJ, Kavoussi LR, Novick AC, et al. Campbell-Walsh urology. 9th ed. Philadelphia: Saunders Elsevier. 2007.
  • White TJ, Arakelian A, Rho JP: Counting the costs of drug-related adverse events. Pharmacoeconomics 1999;15:445-458.
  • Perk J, de Backer G, Gohlke H, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur. Heart J. 2012;33:1635-1701.
  • Tai E, Buchanan B, Eliman D, et al. Understanding and addressing the lack of clinical trial enrollment among adolescents with cancer. Pediatrics 2014;133(Suppl 3):S98-S103.