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By G. Mannig. Defiance College.

The medulla consists of 10­18 conical or pyramidal shaped structures discount escitalopram 20 mg visa anxiety jewelry, known as the renal pyramids The base of a renal pyramid faces towards the cortex cheap 5mg escitalopram with amex anxiety symptoms images. Microscopic examination of mammalian kidneys reveals that each kidney consists of about million nephron, which are the functional unit of the kidney. The nephron consists of the glomerulus, the renal tubules, the collecting tubules and the associated blood vessels. The renal artery divides into innumerable branches and the ultimate divisions of the artery form a tuft of capillaries called glomerulus. The blood pressure inside the glomerulus drives out the fluid through it is opposed by the osmotic pressure. The filtrate in the capsule consists of all the constituents of blood, except the plasma proteins and the formed elements of blood. A large number of substances are reabsorbed (reabsorption) by the tubules, a few substance added (secreation) to the filtrate and the final urine is formed. For example, water, glucose, some salts and a small fraction of urea are reabsorbed from the primary urine into the blood. Usually about 200 liters of filtrate is formed per day of which one and a half liters is sent out as urine. About 80% of this re­absorption takes place in the proximal tubules and the rest is absorbed in the distal tubules, and sent back to the blood stream. Re­absorption is carried out with the help of anti ­ diuretic hormone which is secreted in the posterior pituitary gland. Thus each nephron is able to ‘clean’ or filter a very large volume of blood without causing the body to lose much of water or other essential materials. It is devoid of glu­ cose, amino acids, certain salts (phosphates and sodium) and has a very high urea concentration. When the bladder is empty, the muscular wall becomes thick and the entire organ feels firm The organ may increase from the length of 2 or 3 inches to 5 inches or more inches. It is controlled by the action of circular muscles, continu­ ous with those in the walls of the bladder and in the urethra. Normally urine is composed of Water 96% Urea 2% Salts 2% The salts consists mainly of sodium chlorides, phosphates and sulphates. Examples of exocrine glands are the sweat, lacrymal and mammary glands which pass their secre­ tion along the ducts to the external surface of the body and the glands of the mouth, stomach, and intestine which pass their secretions along ducts into the alimentary tract. A hormone is a chemical substance produced by the endocrine glands and their overall function is to regulate the activities of various body organs and their functions. The main endocrine glands in the body are 1) Thyroid 2) Parathyroid 3) Islets of Langerhans 4) Adrenal gland 5) Pituitary gland 6) Sex glands. Thyroid Gland: The largest of the endocrine glands is the thyroid which is located in the neck region. Parathyroid Gland These are two tiny oval pair (6mm x 2mm) of glands situated at upper end and lower poles of lateral lobes of thyroid gland. Islets of Langerhans in the pancreas: The pancreas is both an exocrine gland secreting digestive juice through a duct into the duodenum and an endocrine gland secreting hormone into the blood stream. Functions of Glucagon: 1) Increases the blood glucose level 2) Break down the liver glycogen into glucose 3) Stimulates the break down of lipid in adipose tissue Functions of Insulin: 1) Converts glucose into glycogen and accelerates the transport of glucose from the blood into the cells. The inner area is called medulla which is brown in color while the outer area is called cortex which is lighter in color Adrenal Cortex: It is composed of three layers. They are 1) Zona glomerulosa (outer layer) 2) Zona Faciculate (middle layer) 3) Zona reticularis ( inner layer) The adrenal cortex secretes three hormones. Minerlocorticoids: Acts on sodium and potassium and help in the conversation of sodium in the body 53 3. Functions of Medullary hormones 1) Dilation of the pupils and improves the visual acuity 2) Increases both rate and amplitude of contraction of heart and raises the cardiac out put.

Once the pipette accurately filled to the mark buy generic escitalopram 20mg online anxiety zoning out, the rubber suction (or mouth piece) is carefully removed cheap 5 mg escitalopram mastercard anxiety monster, with the pipette held horizontally and only one finger sealing the tip. Both ends of the pipette may then be sealed with special small rubber sealing caps or with the middle finger on the tip and the thumb on the other end. The cover glass is placed on the chamber and a slight pressure applied to the ends of the cover glass until a 96 Hematology “rain bow” or Newton’s diffraction rings are revealed on either side. Once the diluted blood in the pipette has been thoroughly mixed, a few drops are expelled to discard the cell-free diluting fluid in the long stem of the pipette. With the index finger forming a controlled seal over the end of the pipette, which is held at an angle of 450 , the tip of the pipette is brought up to the edge of the cover glass and by gentle release of index finger pressure, fluid is allowed to run out slowly until the counting platform is covered. If blood is diluted with the tube technique (in which 20µl of blood is taken with a sahli pipette and mixed with 0. The chamber is placed in position on the microscope stage and is allowed to stand for 2 or 3 minutes so that the cells will settle. Pipettes (thomma and sahli) should be washed well with a sequence of water and acetone (filled with 97 Hematology each fluid three or four times) and air drawn after the acetone until the inside of the pipette is thoroughly dry. Pipettes should be periodically cleaned with potassium dichromate cleaning solution or hydrogen peroxide. Hemocytometers should be washed in distilled water immediately after use and dried with gauze or tissue paper. Performance of the Count The counting chamber is surveyed with the low power objective to ascertain whether the cells are evenly distributed. Calculation If N is the number of leucocytes in four large squares, then the number of cells per mm3 is given by: No. The corrected leucocyte count Nucleated red cells will be counted and can not be distinguished from leucocytes in the total leucocyte count. If their number is high as seen on the stained smear, a correction should be made according to the following formula: 99 Hematology Corrected leucocyte count = Uncorrected count × 100 No. Using a capillary, Pasteur pipette, or plastic bulb pipette held at an angle of about 450C, fill one of the grids of the chamber with the sample, taking care not to overfill the area. Count as described in thomma white cell count method * When a count is higher than 50 x 109/l, repeat the count using 0. Total leucocyte counts are commonly increased in infections and when considered along with the differential leucocyte count can be indicators as to whether the infecting agent is bacterial or viral. Red Cell Count Although red cell counts are of diagnostic value in only a minority of patients suffering from blood diseases, the advent of electronic cell counters has enormously increased the practicability of such counts. Their value, too, has been increased now that they can be done with a degree of accuracy and reproducibility comparable to that for hemoglobin estimation. Although clearly an 104 Hematology obsolete method (because the combined error of dilution and enumeration is high), visual counting will still has to be undertaken for some years to come in the smaller laboratories. Principle A sample of blood is diluted with a diluent that maintains (preserves) the disc-like shape of the red cells and prevents agglutination and the cells are counted in a Neubauer or Burker counting chamber. Diluting Fluid 1% formal citrate Dilution Thomma Red Cell Pipette Take a well mixed blood or blood from a freely flowing capillary puncture to the “0. Tube Dilution Take 20µl blood with sahli pipette and mix it with 4ml diluent in a small tube to give a final dilution of 1:201 105 Hematology Counting and Calculation After the suspension is charged into the chamber and the cells allowed to settle, cells should be counted using the 40× objective and 10× eyepiece in 5 small squares of the central 1mm2 area of the improved Neubauer counting chamber (4 corner and 1 central squares each with an area of 0. It is important to count as many cells as possible for the accuracy of the count is increased thereby; 500 cells should be considered as the absolute minimum. Platelet counts are also performed when patients are being treated with cytotoxic drugs or other drugs which may cause thrombocytopenia. Method using formal-citrate red cell diluent Diluent should be prepared using thoroughly clean glassware and fresh distilled water.

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Guidelines 1) Work systematically 2) Plan the work 3) Collect equipment in the order that they are to be used purchase escitalopram 10mg with mastercard anxiety 4th herefords. The mucous membrane is an epithelial tissue that lines and protects organs escitalopram 10mg with mastercard anxiety symptoms checklist pdf, secretes mucous to keep pas­ sageways of digestive system moist and lubricated, and absorbs nutrition. Purposes of Mouth Care 1) Oral Hygiene helps maintain the healthy state of the mouth, teeth, gums and lips. Proper Mouth Care 1) Good oral hygiene involves cleanliness, comfort and the moisturizing the mouth structures. Common Oral problems: The two major types of Oral problems are dental caries (cavities) and periodontal disease (Pyorrhoea) Dental caries is the most common oral problem of younger people. Decalcification is a result of an accumulation of mucin, carbohydrates and lactic acid bacilli in the saliva normally found in the mouth, which forms a coating on the teeth called plaque. Causes: (1) Riboflavin deficiency (2) Mouth breathing (3) Excess salivation Stomatitis is an inflammative condition of the mouth Causes: (1) Vitamin deficiency (2) Infection by bacteria, viruses or fungi (3) Use of Chemotherapeutic drugs Glossitis is an inflammation of the tongue resulting from an infectious disease or injury such as burn or bite. Causes: (1) Pipe smoking (2) Tobacco Chewing Equipments A tray containing 1) Cotton swab or clean pieces in a bowl 2) Forceps (artery and dissecting forceps) 3) Gallicups 2 nos. If the patient is unable to do so, the nurse has to remove the dentures by grasping it with gauze pieces, place them in a tumbler or cup containing water. But when an individual is confined to bed, the weight of his body has to be borne by his back or sides. The skin of the soles of our feet is very tough and thick and it does not break easily in spite of the entire weight of the body being supported by it. The nature has designed the sole of the skin for weight bearing whereas the skin over the back of the body is not. When there is pressure on the skin of the back because of the weight of the body, the skin breaks and an ulcer develops. Definition of Decubitus Ulcer: A decubitus ulcer is a pressure sore resulting from prolonged confinement in bed. These various pictures are illustrating different body positions and the pressure areas Elbows Scapulae Back of head Heels Sacrum (Olecranon Process) (Occipital bone) (Calcaneus) Malleolus Knee Ear Llium (medial (medial Shoulder Side of head and and lateral Greater (acromial (parietal and lateral) condyles) trochanter process) temporal bones) C. Prone Position Toes Knees Genitalia Breasts Shoulder Cheek and ear (phalanges) (patellas) (men) (women) (acromial (zygomatic process) bone) 7 D. Heels (calcaneus) Vertebrae (spinal processes) 30 ° Pelvis Sacrum (ischial tuberosity) Causes of Decubitus Ulcer: Local causes: (a) Pressure: When any body prominence presses upon the bed, the tissues lying between them get reduced blood supply. If this condition prolongs, the superficial tissues necroses, skin breaks down and formation of an ulcer takes place. The following condition causes prolonged pressure: 1) Leaving a patient in one position for a long time. These patients are unable to appreciate the weight of pressure and change their position 2) Paralysed patients (Paraplegic and quadriplegic patients). Diabetes Prevention of decubitus ulcers: A) Prevent Pressure: 1) Establish a turning schedule for bedridden patients; turn hourly. B ) Prevent Friction: 1) When changing position of your patient lift him and do not drag him on to bed. D ) Prevent Predisposing causes: 1) Improve patient’s health by means of good food, ventilation, sunlight and exercises. E ) Observe early signs and symptoms of decubitus ulcers: 1) Redness 2) Dark discoloration 3) Bruising 4) Tenderness of the area 5) Burning sensation 9 F ) Give good care to pressure points: Careful cleaning and massage should be carried out 3 or 4 times a day for all bed­ridden patients.

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Therefore buy escitalopram 5 mg mastercard anxiety nos, a large drop in oxygen levels is required to stimulate the chemoreceptors of the aortic arch and carotid arteries cheap escitalopram 10 mg without prescription anxiety klonopin. The hypothalamus and other brain regions associated with the limbic system also play roles in influencing the regulation of breathing by interacting with the respiratory centers. The hypothalamus and other regions associated with the limbic system are involved in regulating respiration in response to emotions, pain, and temperature. These episodes may last for several seconds or several minutes, and may differ in the frequency with which they are experienced. Sleep apnea leads to poor sleep, which is reflected in the symptoms of fatigue, evening napping, irritability, memory problems, and morning headaches. In addition, many individuals with sleep apnea experience a dry throat in the morning after waking from sleep, which may be due to excessive snoring. Obstructive sleep apnea is caused by an obstruction of the airway during sleep, which can occur at different points in the airway, depending on the underlying cause of the obstruction. For example, the tongue and throat muscles of some individuals with obstructive sleep apnea may relax excessively, causing the muscles to push into the airway. Another example is obesity, which is a known risk factor for sleep apnea, as excess adipose tissue in the neck region can push the soft tissues towards the lumen of the airway, causing the trachea to narrow. In central sleep apnea, the respiratory centers of the brain do not respond properly to rising carbon dioxide levels and therefore do not stimulate the contraction of the diaphragm and intercostal muscles regularly. However, some medical conditions, such as stroke and congestive heart failure, may cause damage to the pons or medulla oblongata. In addition, some pharmacologic agents, such as morphine, can affect the respiratory centers, causing a decrease in the respiratory rate. A diagnosis of sleep apnea is usually done during a sleep study, where the patient is monitored in a sleep laboratory for several nights. The patient’s blood oxygen levels, heart rate, respiratory rate, and blood pressure are monitored, as are brain activity and the volume of air that is inhaled and exhaled. This pressurized air can help to gently force the airway to remain open, allowing more normal ventilation to occur. Other treatments include lifestyle changes to decrease weight, eliminate alcohol and other sleep apnea–promoting drugs, and changes in sleep position. In addition to these treatments, patients with central sleep apnea may need supplemental oxygen during sleep. At the respiratory membrane, where the alveolar and capillary walls meet, gases move across the membranes, with oxygen entering the bloodstream and carbon dioxide exiting. It is through this mechanism that blood is oxygenated and carbon dioxide, the waste product of cellular respiration, is removed from the body. Gas Exchange In order to understand the mechanisms of gas exchange in the lung, it is important to understand the underlying principles of gases and their behavior. For example, the atmosphere consists of oxygen, nitrogen, carbon dioxide, and other gaseous molecules, and this gaseous mixture exerts a certain pressure referred to as atmospheric pressure (Table 22. For example, in the atmosphere, oxygen exerts a partial pressure, and nitrogen exerts another partial pressure, independent of the partial pressure of oxygen (Figure 22. Dalton’s law describes the behavior of nonreactive gases in a gaseous mixture and states that a specific gas type in a mixture exerts its own pressure; thus, the total pressure exerted by a mixture of gases is the sum of the partial pressures of the gases in the mixture. Partial Pressures of Atmospheric Gases Partial pressure Gas Percent of total composition (mm Hg) Nitrogen (N )2 78. A gas will move from an area where its partial pressure is higher to an area where its partial pressure is lower. In addition, the greater the partial pressure difference between the two areas, the more rapid is the movement of gases. Solubility of Gases in Liquids Henry’s law describes the behavior of gases when they come into contact with a liquid, such as blood.


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