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By Q. Cyrus. Midwestern Baptist College.

Other factors to take into account are displacement volumes for antibiotic injections discount 100 mg tenormin with amex. How much water for injections do you need to add to ensure a strength of 600mg per 5mL? Moles and millimoles 42 Approximately how many millimoles of sodium are there in a 10mL ampoule of sodium chloride 30% injection? Calculation of drip rates 44 What is the rate required to give 500 mL of sodium chloride 0 cheap 100mg tenormin with mastercard. Answers xvii Conversion of dosages to mL/hour Sometimes it may be necessary to convert a dose (mg/min) to an infusion rate (mL/hour) generic tenormin 50mg on line. Conversion of mL/hour back to a dose 48 You have dopexamine 50mg in 50mL and the rate at which the pump is running is 21 mL/hour order tenormin 50 mg on line. There have been numerous articles highlighting the poor performance of various healthcare professionals. The vast majority of calculations are likely to be relatively straightforward and you will probably not need to perform any complex calculation very often. It is difficult to explain why people find maths difficult, but the best way to overcome this is to try to make maths easy to understand by going back to first principles. Maths is just another language that tells us how we measure and estimate, and these are the two key words. It is vital, however, that any person performing dose calculations using any method, formula or calculator can understand and explain how the final dose is actually arrived at through the calculation. Working from first principles and using basic arithmetical skills allows you to have a ‘sense of number’ and in doing so reduces the risk of making mistakes. However, this is not to say that calculators should not be used – calculators can increase accuracy and can be helpful for complex calculations. The main problem with using a calculator or a formula is the belief that it is infallible and that the answer it gives is right and can be taken to be true without a second thought. This infallibility is, to some extent, true, but it certainly does not apply to the user; the adage ‘rubbish in equals rubbish out’ certainly applies. An article that appeared in the Nursing Standard in May 2008 also highlighted the fact that using formulae relies solely on arithmetic and gives answers that are devoid of meaning and context. The article mentions that skill is required to: extract the correct numbers from the clinical situation; place them correctly in the formula; perform the arithmetic; and translate the answer back to the clinical context to find the meaning of the number and thence the action to be taken. How can you be certain that the answer you get is correct if you have no ‘sense of number’? You have no means of knowing whether the numbers have been entered correctly – you may have entered them the wrong way round. For example, if when calculating 60 per cent of 2 you enter: 100 60 × instead of 60 100 You would get an answer of 3. Another advantage of working from first principles is that you can put your answer back into the correct clinical context. You may have entered the numbers correctly into your formula and calculator and arrived at the correct answer of 1. For example: 1 You have: 200mg in 10mL From this, you can easily work out the following equivalents: 100mg in 5mL (by halving) 50mg in 2. If your answer means that you would need six ampoules of an injection for your calculated dose, then common sense should dictate that this is not normal practice (see later: ‘Checking your answer – does it seem reasonable? Using it will enable you to work from first principles and have a ‘sense of number’. The rule works by proportion: what you do to one side of an equation, do the same to the other side. In whatever the type of calculation you are doing, it is always best to make what you’ve got equal to one and then multiply by what you want – hence the name.

Staphylococcus aureususually presents as multiple abscesses purchase tenormin 100mg otc, especially in children cheap tenormin 50mg without prescription. Headaches that are new in onset and clearly different from any the patient has experienced previously are commonly a symptom of serious illness and therefore demand prompt evaluation generic 50 mg tenormin otc. The precipitating factors buy tenormin 100mg cheap, associated symptoms and clinical findings on examination, together with the results of appropriate investigations, can provide a guide to the cause of the headache. If these episodes are recurrent over several months or years without an identifiable cause, they are commonly described as epilepsy. The term status epilepticus is used for repeated seizures which occur without the patient regaining consciousness between attacks. Patients may sometimes describe the warning signals (termed a prodrome or aura) which they experienced before the event. Drug treatment should certainly be considered after two seizures and the type of drug depends on the type of seizure. Give at 5 mg/minute until seizures stop or a total of 20 mg has been given or significant respiratory depression occurs. It is also frequently used to describe the light-headedness that is felt in panic and anxiety attacks, during palpitations and fainting episode (syncope) or in chronic ill health. Like dizziness, “blackouts” is a vague, descriptive term implying either altered consciousness, visual disturbance or a sensation of falling. Episodes of transient disturbance of consciousness and falls are common clinical problems. It is usually possible to distinguish between a fit (a seizure), an episode of fainting and other types of attack from the history given by the patient and the account of an eye witness. They should be watched carefully for a few minutes after rising and not be permitted to drive or operate machinery immediately. The cause of unconsciousness is often not immediately evident, and a systematic approach to its diagnosis and management is therefore important. It is characterised by inattention, poor concentration and hyperactivity or impulsivity that interferes with functioning at home and school and in relationships. The child must have these symptoms for at least 6 months and they must be more prominent than others of their age for a doctor to consider the diagnosis. In patients with this form of disorder, there may be a history of physical, sexual, psychological abuse. The symptoms may be precipitated by stress and the signs are often variable and may include resistance to eye opening upon examination. Assessing a complaint of sleep disorders requires a thorough history and clinical examination and specific sleep- wake history. Insomnia may suggest an underlying medical, psychological, psychiatric (especially depression) or environmental problem. There may be perceptual changes like hallucinations and delusions that overwhelm the patient. Disorientation and alteration in consciousness are often prominent when the cause is organic. It has a tendency to recur, though some may become bipolar, when episodes of mania may also be observed. Most Ghanaian patients present mainly with bodily symptoms, sleep disturbances as well as morbid dreams and “worrying excessively”. They hardly mention a depressed mood unless they are asked specifically, and even then many deny or trivialise it as a consequence of acknowledged symptoms like headache or insomnia. One should not dismiss or take for granted statements made by patients such as “I want to die”, “life is not worth living”, “I am fed up with life”. All cases of attempted suicide should be referred to a psychiatrist after initial management of the presenting complication e. Recurrent depression or unipolar depression is treated differently (with antidepressants) from bipolar depression, which responds more to mood stabilizers. Increase by 25mg every 3-5 days up to 150 mg orally at night by end of second week. Increase by 25 mg every 3-5 days up to 150 mg orally at night by end of second week. After an episode of depression, continue antidepressants for at least 6 months, as there is a high risk of relapse in this period If night sedation is required, Diazepam 5-10 mg or Lorazepam 1-2 mg orally may be given, in general, for not more than 2 weeks at a stretch to avoid dependence • Stop antidepressants immediately if manic swing occurs.

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