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Clinical Director, University of Virginia School of Medicine
Dose levels of 2 grams daily are recommended if a sustained-release preparation is available acne wash purchase 10mg inotrin amex. It is good practice to start on 100 mg niacin tid and gradually increase the dose to 500 mg tid or qid acne diet order inotrin with american express. A statin- niacin regimen is regarded as safe and effective in managing dyslipidemias in most patients at risk for cardiovascular events who respond poorly to either agent used alone skin care 4d motion cleanser purchase generic inotrin on line. Although current guidelines do not recommend use of niacin in patients with diabetes because of concerns about adverse effects on glycemic control, niacin may be useful in type 2 diabetics. Chapter 101 / Vitamin B3 (Niacin) 695 Vitamin B3 can be used to enhance perfusion. Even though flushing pro- vides only a temporary therapeutic benefit, vitamin B3 may be used to relieve chilblains and muscle cramps caused by impaired perfusion in peripheral vascular disease. Perfusion is even more effectively improved with a combined approach using α-tocopherol-nicotinate 200 mg tid. In addition to its hypolipidemic and flushing effects, niacin significantly decreases fibrinogen. In view of both its lipid and anticoagulant effects, 100 to 150 mg of niacin given orally three to five times per day deserves serious consideration in the treatment of peripheral vascular disease. A 500-mg dose of vitamin B3 taken an hour before bedtime is recommended for insomnia. Niacinamide has also been reported to increase joint mobility and func- tion and decrease joint stiffness, deformity, swelling, and pain. However, nau- sea, vomiting, and hepatotoxicity have been reported at doses of 3 grams/day. High doses may also cause diarrhea, dizziness, blurred vision, arrhythmia, arthralgia, and myalgia. The spectrum of toxicity from least to most toxic is niacinamide, niacin, and sustained-release niacin preparations. Nausea and hepatotoxicity are especially marked with slow-release forms of niacin. The vasodilatory effect of niacin (at dosages of 100 to 200 mg), when not used to increase perfusion, is regarded as a side effect. Flushing presents with a burning tingling sensation, pruritus, and reddening of the face, arms, and chest. Flushing appears to be more closely related to a continuous rise in plasma niacin than to the absolute dose. Niacin-induced flushing usually occurs within 15 to 30 minutes and may be reduced by tak- ing niacin with meals, avoiding hot drinks, and taking 300 mg of aspirin 30 minutes before the niacin dose. In doses of 100 to 500 mg tid, other adverse effects of niacin are hyperglycemia, hyperuricemia, and raised liver 696 Part Three / Dietary Supplements enzymes. Other interactions include alcohol, aspirin, nitroglycerine, warfarin, and cholesterol-lowering medica- tions. Niacin competes with uric acid for excretion and may precipitate gout in susceptible persons. Patients with gout, peptic ulceration, or liver disease should avoid niacin supplementation.
Diseases
If torsion is suspected acne complex order inotrin on line amex, based primarily upon sudden onset skin care tips for men buy inotrin 40mg line, excruciating pain acne home treatments purchase inotrin 30mg visa, age under 20, and elevation of the testicle, immediate consultation should be obtained because immediate surgery may be needed. Examination of a patient with epididymitis shows tenderness of the epididymis and possible swelling. In men with sexually transmitted epididymitis, there will usually be symptoms or signs of urethritis, but this may not be prominent (particularly in men with chlamydia). If possible, a microscopic examination of the urethral secretions or urine should be performed to look for white blood cells and microorganisms. Management of epididymitis includes bed rest with elevation of the testicle, ice and analgesics. Genital Ulcer Erosions of the skin (ulcers) may be caused by Herpes simplex virus (genital herpes), Treponema pallidum (syphilis) and Haemophilus ducreyi (chancroid). Erosions may be caused by trauma (during sex or in zippers) or less commonly by reactions to medications (particularly tetracyclines). The most common disease is genital herpes, whose incubation period is five to10 days. Initially, small, painful, grouped blisters occur which, over several days, break open into shallow ulcerations. Over ensuing days, the ulcers crust and heal; the entire process takes about 21 days for initial attacks. The primary stage of syphilis is characterized by one to four painless smooth ulcers which appear about 21 days following infection. As the ulcers are healing, or several weeks afterward, the secondary stage of syphilis occurs and is characterized by a skin rash consisting of small flat patches, often most noticeable on the palms and soles; patients may have a low-grade fever. Without treatment, the rash will resolve after about two to six weeks, but may return. Without treatment at this stage, patients may develop tertiary syphilis in one to 30 years, characterized by neurologic (stroke, dementia) or cardiac (heart valve disease) abnormalities. H-3 Chancroid is characterized by one to four very painful ulcers which often appear quite ragged. In either case, treatment is not urgent and evaluation and therapy can be delayed. The infectious agent is a Bedsonia organism closely related to that of psittacosis. Subclinical or inapparent infections, and an asymptomatic carrier state, have been described in females. After an incubation period averaging one to four weeks, a small painless genital lesion occurs in about one fourth of patients. The lesion is an inconspicuous bump, blister, or shallow ulcer that heals within a few days and typically goes unnoticed by 0 0 the patient. Shortly after the onset of these symptoms, the patient becomes aware of a painful swelling in one or both groin areas. Early in the course of regional node involvement, one can feel one or more enlarged discrete movable tender nodes. Because there are nodes in different stages of evolution, the mass becomes large and lobulated with alternating areas of softening and hardness. The overlying skin becomes swollen, sometimes bluish-red in color, and fixed to the underlying mass. When pus forms and breakdown occurs, multiple fistulous tracts may open to the skin surface. Other symptoms less commonly found include lower abdominal pain and diarrhea due to involvement of nodes in the pelvis and around the rectum.
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Role of hospital/community setting • Management and treatment of the patient as detailed above • Prevention of cross-infection to others; see Appendix 1 Health education and health promotion As for diphtheria Now carry out Learning Activity 6 skin care 90036 generic 30mg inotrin with mastercard. S (1990) Control of Communicable World Health Organization (1999) Diseases in Man skin care center purchase generic inotrin online. At home the child should ideally sleep in a separate bedroom or bed from susceptible siblings skin care education inotrin 20mg lowest price. Soiled tissues should be disposed of straight into a disposal bag where possible, avoiding the risk of contaminating surfaces or needing to handle secretions. Surfaces should be cleaned with a damp cloth and detergent daily to avoid the build up of contamination. Disinfection of surfaces and equipment should be undertaken with a 1 in 10 solution of bleach (hypochlorite). Protective clothing • Where available masks and eye protection should be worn by health care staff where splashing or spraying of secretions into the eyes or mucous membranes of the nose or mouth may occur, e. Module 5 Page 153 General nursing care Appendix 2 Assess respiratory status as per Appendix 3. Physical and psychological rest • Bed rest in a semi-prone position to increase the vital capacity of the lungs and facilitate breathing. Ensure a quiet calm environment, explain procedures as appropriate for the patients age. Management of fever • Ensure adequate fluid intake to prevent dehydration and reduce the symptoms of toxicity. Intravenous or nasogastric fluids may be necessary to prevent electrolyte imbalance and to avoid aspiration of oral fluids during acute respiratory distress. Children 10–15 mg/kg per dose every 4–6 hours or as a general guide: 3 months–1 year: 60–120 mg per dose / 1–5 years : 120–250 mg per dose / 6–12 years : 250– 500 mg per dose. Reduce the ambient room air temperature and improve air circulation by using a fan. If the patient is peripherally shutdown with cold extremities, apply cotton socks/mittens. Nutrition and hydration • A light nourishing diet should be given, nasogastric tube feeding may be necessary. Mothers of breast feeding babies should have the baby rest intermittently during feeding to avoid the aspiration of milk. In infants under one year feel the anterior fontanelle, if it is sunken or depressed this may indicate poor hydration. Page 154 Module 5 General nursing care Appendix 2 (continued) Respiratory care • Keep the nostrils clear of mucous so the child can breathe while sucking and eating; infants are obligatory nose breathers. It can also be administered via nasal prongs or a mask in older patients at approximately 0. Where available the patients oxygen saturations are monitored via a pulse oximiter. At home the room air can be moistened by placing a moist cloth or uncovered pot of water on/near the heater. There may be dryness of the lips due to dehydration or excoriation of the skin around the nose from secretions, apply white soft paraffin. The parents/relatives should seek advice immediately if the patient’s condition deteriorates, i. The patient must be reassessed; the antibiotics may need to be changed and the patient may need admitting to hospital. Module 5 Page 155 Assessing respiratory status in a child Appendix 3 Ask Observe How old is the child? Has the child been sleeping longer Try and count the respiratory rate when the child is calm.
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