Wednesday, February 29, 2012
Bedside Assessment of Enteral Tube Placement: Aligning Practice with Evidence
Just read this article about how to make sure feeding tubes are in place. Reminds me of a (completely unrelated) book I want to read called Lies My Teacher Told Me.
Saturday, February 25, 2012
panhypopituitarism
The pituitary gland is regulated by the hypothalamus, the small region of the brain below the thalamus and the major link between the nervous and endocrine systems. The hypothalamus secretes releasing hormones that stimulate the anterior pituitary, and inhibiting hormones that suppress the pituitary. (Painful, stressful, and emotional experiences all cause changes in hypothalmic activity.)
The anterior pituitary synthesizes human growth hormone (hGH), thyroid stimulating hormone TSH, the gonadotropins- leutenizing hormone and follicle-stimulating hormone (LH & FSH), Prolactin (PRL), adrenocorticotropic hormone (ACTH), and melanocyte-stimulating hormone (MSH). Human grown hormone promotes cells in many other tissues to secrete insulinlike growth factors (IGFs). IGFs help bones and muscles grow during childhood/adolescence, and help maintain bone and muscle mass during adulthood, as well as promoting healing and tissue repair; they enhance lipolysis in adipose tissues; they stimulate liver cells to release glucose into the blood. HGH is key to maintaining normoglycemia. TSH stimulates T3 and T4 production in the thyroid. In females, FSH stimulates the ovaries, initiating development of follicles each month, and stimulating secretion of estrogens. In males, FSH stimulates the testes to produce sperm. In females, LH triggers ovulation and stimulates formation of the corpus luteum and causes it to secrete progesterone. In males, LH stimulates the interstitial cells of the testes to secrete testosterone. PRL works with other hormones to cause lactation in females. ACTH acts on the adrenal cortex to produce and secrete cortisol (or hydrocortisone) and other glucocorticoids. Glucocorticoids stimulate formation of glucose and glycogen in the liver, increase lipolysis in adipose tissue, and also have anti-inflammatory and immunodepressant effects. MSH's exact role is unknown in humans, but it does play some role in brain activity.
The posterior pituitary doesn't synthesize hormones, but it stores and releases hormones from the hypothalamus: oxytocin (OT) and antidiuretic hormone (ADH), aka vasopresin. OT affects uterine and breast tissue in pregnant females; its affects on males and nonpregnant females are unclear. ADH causes water resorption in the kidneys, decreases water lost through sweating, and causes artery constriction.
Whenever the pituitary is underproducing one or more hormones, it is called hypopituitarism. If many or all of the hormones aren't being produced, it is called panhypopituitarism. Diagnosis is made by measuring pituitary hormones as well as hormones secreted by glands that the pituitary regulates.
Treatment involves replacing the hormones regulated by the pituitary.
source=http://www.emoryhealthcare.org/pituitary/treatments/medical-pituitary-treatments.html
The anterior pituitary synthesizes human growth hormone (hGH), thyroid stimulating hormone TSH, the gonadotropins- leutenizing hormone and follicle-stimulating hormone (LH & FSH), Prolactin (PRL), adrenocorticotropic hormone (ACTH), and melanocyte-stimulating hormone (MSH). Human grown hormone promotes cells in many other tissues to secrete insulinlike growth factors (IGFs). IGFs help bones and muscles grow during childhood/adolescence, and help maintain bone and muscle mass during adulthood, as well as promoting healing and tissue repair; they enhance lipolysis in adipose tissues; they stimulate liver cells to release glucose into the blood. HGH is key to maintaining normoglycemia. TSH stimulates T3 and T4 production in the thyroid. In females, FSH stimulates the ovaries, initiating development of follicles each month, and stimulating secretion of estrogens. In males, FSH stimulates the testes to produce sperm. In females, LH triggers ovulation and stimulates formation of the corpus luteum and causes it to secrete progesterone. In males, LH stimulates the interstitial cells of the testes to secrete testosterone. PRL works with other hormones to cause lactation in females. ACTH acts on the adrenal cortex to produce and secrete cortisol (or hydrocortisone) and other glucocorticoids. Glucocorticoids stimulate formation of glucose and glycogen in the liver, increase lipolysis in adipose tissue, and also have anti-inflammatory and immunodepressant effects. MSH's exact role is unknown in humans, but it does play some role in brain activity.
The posterior pituitary doesn't synthesize hormones, but it stores and releases hormones from the hypothalamus: oxytocin (OT) and antidiuretic hormone (ADH), aka vasopresin. OT affects uterine and breast tissue in pregnant females; its affects on males and nonpregnant females are unclear. ADH causes water resorption in the kidneys, decreases water lost through sweating, and causes artery constriction.
Whenever the pituitary is underproducing one or more hormones, it is called hypopituitarism. If many or all of the hormones aren't being produced, it is called panhypopituitarism. Diagnosis is made by measuring pituitary hormones as well as hormones secreted by glands that the pituitary regulates.
Treatment involves replacing the hormones regulated by the pituitary.
source=http://www.emoryhealthcare.org/pituitary/treatments/medical-pituitary-treatments.html
Thursday, February 9, 2012
Caffeine Content in Food & Drugs
Good reminders found here, such as:
Coffee has 100-200mg caffeine per cup.
A Starbucks Grande Iced Chai has 100mg caffeine per cup.
Brewed tea has 50-100mg caffeine per cup.
12oz of Dr Pepper has 42mg of caffeine.
8.3oz of Red Bull has 80mg of caffeine.
2 extra strength Excedrin have 130mg of caffeine.
Also very pertinent:
Ghirardelli 72% Twilight Delight chocolate has 22mg of caffeine per square (according to this.)
Dark chocolate generally has 20mg per ounce.
Milk chocolate generally has 6mg per ounce (according to this.)
Coffee has 100-200mg caffeine per cup.
A Starbucks Grande Iced Chai has 100mg caffeine per cup.
Brewed tea has 50-100mg caffeine per cup.
12oz of Dr Pepper has 42mg of caffeine.
8.3oz of Red Bull has 80mg of caffeine.
2 extra strength Excedrin have 130mg of caffeine.
Also very pertinent:
Ghirardelli 72% Twilight Delight chocolate has 22mg of caffeine per square (according to this.)
Dark chocolate generally has 20mg per ounce.
Milk chocolate generally has 6mg per ounce (according to this.)
Wednesday, February 8, 2012
"Unsafe Injection Practices" CE
--viral, bacterial, even parasite infections can result from unsafe injection practices!
--when using multi-dose vials, when the needle becomes contaminated, so does the syringe! (needle and syringes are one unit)
--even if you can't see blood, it can be contaminated by bloodborn pathogens
--systems should be in place that use one vial, one needle, one syringe, so that there is a double layer of protection because no one practices in a vacuum. Even if one employee has great aseptic technique and uses a new needle and new syringe for a shared vial, if someone else doesn't, the vial can be contaminated.
It is kind of sad to me that the first 2 examples of what NOT TO DO (re-use of syringes, diversion of medications) were from Colorado :(
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