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By Y. Daryl. Western Carolina University. 2017.

If Nursing Process neonatal respiratory depression occurs buy ketoconazole cream 15gm amex, it can be reversed by naloxone (Narcan). Assessment Duramorph is a long-acting form of morphine that pro- Assess each female client of reproductive age for possible vides analgesia up to 24 hours after injection into the epidural pregnancy. If the client is known to be pregnant, assess sta- catheter at the completion of a cesarean section. Possible • Use of prescription, over-the-counter, herbal, nonthera- side effects include maternal urinary retention, but no signifi- peutic, and illegal drugs cant effects on the fetus. They are injected by physicians for regional anesthe- Also determine whether any tissue has been expelled from sia in the pelvic area. When stopping labor is possible or desired, a to- into the epidural space of the spinal cord. With regional anesthesia, the mother • When spontaneous labor occurs in normal, full-term preg- is usually conscious and comfortable, and the neonate is nancy, assess frequency and quality of uterine contrac- rarely depressed. Fentanyl may be combined with a small tions, amount of cervical dilatation, fetal heart rate and amount of an anesthetic drug for both analgesia and anes- quality, and maternal blood pressure. No significant effects on the fetus occurred in clin- • Assess antepartum women for intention to breastfeed. Nursing Diagnoses • Risk for Injury: Damage to fetus or neonate from mater- NEONATAL THERAPEUTICS nal ingestion of drugs • Noncompliance related to ingestion of nonessential drugs In the neonate, any drug must be used cautiously. Drugs are during pregnancy usually given less often because they are metabolized and ex- • Risk for Injury related to possible damage to mother or creted slowly. Immature liver and kidney function prolongs infant during the birth process drug action and increases risks of toxicity. Also, drug therapy • Deficient Knowledge: Drug effects during pregnancy and should be initiated with low doses, especially with drugs that lactation are highly bound to plasma proteins.

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I have not made a diagnosis of myasthenia gravis in a single patient discount 15 gm ketoconazole cream with mastercard, although I have looked for the disease diligently. Even though several people with the disease have been in my practice, I have never made the original diagnosis. It took many years for me to see that myasthenia gravis is a rare disease and that there would be only a few diseases as clearly defined or as dramatically treatable, at least in my life- time. I wanted to make a diagnosis and give the drug or chemical that would precisely correct the biochemical lesion or kill the invading organism. I wanted to do all of that and treat patients and give a normal life back to those who were af- flicted. I pic- tured the practice of medicine as finding some missing chemical or element, then supplying the missing substance and curing the pa- tient. I thought all diseases and their remedies would be as straight- forward as what I had just witnessed with Dr. I believed medical science would find similar cures for every single disease and that I would live long enough to make all kinds of diagnoses, give a pill or an injection, and cure people completely. During medical school and my postgraduate training, I com- pletely accepted and embraced the biomolecular model of humans and diseases and the virtual separation of mind and body. I thought that the sole job of the physician was to find out what was wrong in the body and fix it. However misguided I might have been, I saw the physician as purely a combination detective and biochemical mechanic of the body. I would live and learn with those narrow notions for several more years to come. I would be a long time in learning that separating the mind from the body imposed clinical restrictions. Te patient stories that follow confronted and forever changed my views about disease and the nature of human beings. As far as I could see, the land stretched into the distance to a faint line of horizon that barely sep- arated sky from ground.

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