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This is because certain dietary proteins can interfere with the stomach’s absorption of levodopa and the body’s ability to get it to the brain cells buy 7.5 mg olanzapine with amex. It is important to consult with a dietitian for proper advice on planning your meals purchase 10 mg olanzapine mastercard. Lifestyle Suggestions P • Exercise can help improve mobility discount olanzapine 20 mg without prescription, range of motion cheap 20 mg olanzapine fast delivery, and muscle tone and strength 5 mg olanzapine with amex. Weight-bearing activities (walking, dancing) can help strengthen the bones, which helps in the prevention of osteoporosis. Wear proper footwear and consult with a physical therapist or personal trainer to get advice on exercises that can improve balance, coordination, and strength. This is a specialty supplement that is available through natural health care practitioners. People with Parkinson’s tend to have low Q10 levels and several studies have shown that supple- ments can slow the progression of the disease. The 1,200 mg dose of coenzyme Q10 significantly slowed the progression of the disease (Archives of Neurology, 2002: 59; 1541–1550). Preliminary studies with methio- nine and L-carnitine have shown benefits for reducing symptoms. L-tyrosine should not be taken with L-dopa as it may interfere with the transport of L-dopa to the brain. Many studies have shown that it can improve memory and cognitive function in the elderly. Dosage: 120–240 mg daily, standardized to 6 percent terpene lactones and 24 percent flavone glycosides. P Vitamin B6: May improve Parkinson’s symptoms and enhance the effectiveness of Sinemet. Do not take if you are taking levodopa alone as this can increase the conversion of levodopa to dopamine outside the brain. Vitamins C and E: Antioxidants that protect against free radical damage in the brain, includ- ing key dopamine-producing brain cells. Boost intake of fibre (whole grains, fruits, and vegetables) along with healthy fats and yogurt. Minimize or avoid saturated fat, alcohol, processed and fast foods, and artificial sweeteners. In the absence of ovu- lation, the menstrual cycle is irregular or absent, and cysts containing the immature P eggs form on the ovaries. Genetic factors may also be at play since this occurs more com- monly in those with a family history. Meta- bolic syndrome is a cluster of symptoms (abdominal obesity, high cholesterol and triglycerides, and insulin resistance) that greatly increases the risk of heart disease and diabetes. There are several medications that doctors prescribe to address the symp- toms of infertility, hirsutism, and acne. For those not trying to become pregnant, low-dose oral contraceptives are used to regulate the menstrual cycle, decrease androgen production, improve acne, reduce hair growth, and reduce the risk of endometrial cancer. Oral or topical progesterone for 10–14 days each month is sometimes used to regulate the cycle. Spironolactone is a drug used to decrease androgens and reduce hair growth and acne. Other, non-drug methods of hair removal include electrolysis, laser, sugaring, and waxing. Drugs such as Glucophage (metformin) are used to improve insulin resistance and reduce androgen levels. For women trying to conceive, fertility drugs such as clo- miphene and gonadotropin shots are used to stimulate ovulation, which may result in multiple births. These foods are high in fibre and low in the glycemic index, which helps to improve blood sugar and insulin levels. Lifestyle Suggestions • Exercise regularly, which will help with weight loss, which in turn can reduce both insulin and androgen levels, and may restore ovulation. Wash your face morning and night using skin care prod- ucts containing tea tree oil (10–15 percent) to help reduce acne and oily skin. Top Recommended Supplements Indole-3-carbinol: A compound found naturally in cruciferous vegetables. Complementary Supplements Calcium D-glucarate: Helps the liver detoxify and eliminate excess hormones, particularly estrogen. Chasteberry: Balances the estrogen to progesterone ratio and may help normalize ovula- tion. One study found that it significantly increased efficacy of the fertility drug clomiphene. To- day, however, it is recognized there are a number of factors involved in causing the notorious symptoms, including hormonal and biochemical imbalances, diet, and en- vironment. They vary greatly among women in both severity and the number of symptoms experienced. Symptoms include severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability, and tension.

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Preliminary research found that supplementing with 500 mg twice a day for six months significantly increased preg- nancy rate in a group of women with infertility and mild endometriosis olanzapine 20 mg online. Essential fatty acids: Fish oils and primrose or borage oil should be taken daily by women to promote the healthy functioning of the uterus and help regulate hormone production generic 2.5mg olanzapine free shipping. Vitamin B12: Deficiency can lead to reduced sperm counts and lowered sperm mobility buy 2.5 mg olanzapine amex. Vitamin B12 supplementation has been tried for improving fertility in men with abnormal sperm production purchase 20 mg olanzapine with mastercard. Eat a healthful diet with organic whole grains olanzapine 5mg discount, vegetables, fruits, nuts, seeds, wild fish, and free-range poultry. Men should take antioxidants, L-carnitine, and a multivitamin/mineral complex containing adequate zinc and folate. Women should take a multivitamin/mineral complex and consider extra vitamin C and chasteberry. Approximately 30 percent of adults suffer occasionally from insomnia and 10 percent experience chronic insomnia. Sleep is vital for physical and mental health, yet it often gets sacrificed when we are busy. While it is thought that sleep is relaxing and passive, actually quite a lot happens in the body during sleep. During the deepest stages of sleep our bodies’ ma- jor organs and regulatory systems are busy working on repair and regeneration and secreting certain hormones. This may result from temporary situations, such as jet lag, stress at work, a brief illness, or a change in environment. When the precipitating factor disappears, the condition goes away, usually without medical treatment. Insomnia is classified as long term or chronic when it lasts more than three weeks. Possible causes include stress; depression; use of alcohol, caffeine, or nico- tine; snoring or sleep apnea; and other medical conditions as noted below. The exact amount of sleep needed varies among individuals, but is between seven and nine hours. Getting less than six hours is associated with health problems, I such as memory loss, poor concentration, depression, headache, irritability, increased response to stress, high blood pressure, depressed immune function, low libido, and weight gain. The most commonly used class is the benzodiazepines, including Ativan (lorazepam), Restoril (temazepam), and Valium (diazepam). These drugs are recommended only for short-term use (a few weeks), as they cause a number of side effects, including loss of short-term memory. When used over the long term, they become less effective, can result in dependency, and actually worsen sleep quality. Abruptly stopping use of these drugs can cause withdrawal symptoms therefore they I should be weaned off slowly (reduce dosage and take every other night) under doctor supervision. In most cases insomnia is temporary and can be improved with good sleep hygiene habits. Dietary Recommendations Foods to include: • A small snack before bed of food that contains tryptophan (an amino acid) stimulates the release of serotonin, a brain chemical that facilitates sleep. Foods to avoid: • Caffeine (coffee, tea, pop, and chocolate) can affect sleep quality, and should be avoided eight hours before bed. Leaving only five or six hours may make you feel stressed and affect your ability to fall asleep. Top Recommended Supplements Melatonin: A hormone that is naturally secreted by the brain in response to darkness and regulates sleep/wake cycles. Supplements reduce the time needed to fall asleep, reduce nighttime wakening, and improve sleep quality. It is particularly helpful for those who work shifts or travel to different time zones (jet lag). Valerian: An herb that is widely used for insomnia; it improves many aspects of sleep and is non-addictive. Some formulas combine valerian with hops, passion flower, and other herbs that promote relaxation. Complementary Supplements Calcium and magnesium: Important minerals for muscle and nervous system relaxation. Note: Supplements that promote sleep should be used only occasionally, as it is important to address the underlying factors causing insomnia. It is also one of the most common reasons for a doctor’s appointment, especially among women.

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Non-narcotic analgesics are used to treat headaches cheap olanzapine 7.5 mg free shipping, menstrual pain (dysmenor- rheal) discount 5mg olanzapine with visa, pain from inflammation discount 10mg olanzapine overnight delivery, minor abrasions generic olanzapine 7.5 mg amex, muscular aches and pain order 5mg olanzapine amex, and mild-to-moderate arthritis. Narcotic analgesics are also used to suppress coughing by acting on the respiratory and cough cen- ters in the medulla of the brain stem. All relieve pain and all, except meperidine (Demerol), have an antitussive (cough suppression) and antidiar- rheal effect. Although the exact mechanism of action is unknown, these agents have both agonist and antagonist effects on the opioid receptors. Commonly used narcotic agonist-antagonists are Pentazocine (Talwin), Butorphanol tartrate (Stadol), duprenorphine (Buprenex), and nalbuphine hydrochloride (Nubain). They have a higher affinity to the opiate receptor site than the narcotic analgesic and block the narcotic analgesic from binding to the opiate receptor site. Naloxone (Narcan) is a narcotic antagonist and can be used to determine if an unconscious patient has used an opioid narcotic drug. If the patient wakes up after Narcan is administered intravenously, the patient is likely to have ingested or injected an opioid narcotic. Summary Pain is sensed when a nerve ending is stimulated sending an impulse along the neural pathway to the brain that interprets the impulse as pain. Pain is assessed in a patient by asking the patient to describe the intensity of the pain on a pain scale—the higher the value, the more severe the pain. Besides intensity, pain is assessed according to onset, duration, frequency, what started the pain (precipi- tating cause), and what relieves the pain. There are six classifications of pain: acute pain, chronic pain, visceral pain, somatic pain, neuropathic pain, and psychogenic pain. Nonpharmacological pain treatment includes massage, imagery, music, dis- traction, humor, acupuncture, chiropractic interventions, hypnosis, herbal thera- pies, therapeutic touch, and transcutaneous electronerve stimulation. Narcotic analgesics are opioid narcotics that can induce respiratory depres- sion. The effects of a narcotic analgesic can be reversed by administering a nar- cotic antagonist. Many patients and healthcare providers are concerned that a patient will become addicted to narcotic analgesics or develop a tolerance for these drugs. In the next chapter, we’ll take a look at medications that are used to control the immune system. Physical sensation of pain (a) occurs when nerve endings are stimulated causing it to send an impulse along the nerve pathways to the brain. The presence of severe discomfort or an uncomfortable sensation that has a sudden onset and subsides with treatment is (a) neuropathic pain. The color scale uses colors ranging from blue to red where blue is free- dom from pain and red is the most severe pain. Pain occurring from skeletal muscles, fascia, ligaments, vessels, and joints is called (a) neuropathic pain. The immune system also treats its own abnormal cells, such as cancer cells, as foreign and attacks it with the same energy as it attacks microorganisms. The patient encounters more episodes of infection that can ultimately lead to death. A Brief Look at Immunity The immune system is the body’s way of combating the invasion of micro- scopic organisms such as bacteria, viruses, molds, spores, pollens, protozoa, 315 Copyright © 2006 by The McGraw-Hill Companies, Inc. The immune system pre- vents an invasion from attacking internal organs and, if that fails, the immune system neutralizes, destroys, and eliminates any non-self proteins and cells, including microorganisms. Non-self proteins and cells also include self cells (the body’s own cells) that have become infected or debilitated. One example is malignant transforma- tion that changes healthy cells into cancer cells. The ability of the immune system to differentiate between the body’s own cells and non-self cells is called self-tolerance. The immune system is able to recognize self-cells by using unique proteins that are on the surface of all self-cells. When bacteria invade your body, your immune system detects the bacteria’s surface protein as not being a self-cell. Mature immune system cells are released from the bone marrow into the bloodstream where they circu- late throughout the body looking for invaders. The body must be exposed to sufficient amounts of an antigen before the immune system produces an antibody to combat the antigen. Patients can be given vaccinations that stimulate the immune system to generate antibodies before the microorganism actually invades the body. In this way, the antibodies already exist and can attack at the first sign of the microorganism. Cell- mediated immunity also causes the body to release cytokines, which regulate the activities of antibody-mediated immunity and inflammation. Cell-mediated immunity is critically important in preventing development of cancer and metastasis after exposure to carcinogens. Infected patients are particularly vulnerable to opportunistic infections and cancers.

Symptoms of opioid withdrawal occur after cessation of (or reduction in) heavy and prolonged opioid use olanzapine 2.5 mg. Symptoms of withdrawal can also occur after administration of an opioid antagonist after a period of opioid use discount olanzapine 2.5 mg with mastercard. Symptoms of opioid withdrawal can occur within minutes to several days following use (or antagonist) generic olanzapine 7.5mg line, and include dysphoric mood purchase olanzapine 5 mg, nausea or vomiting discount olanzapine 2.5mg amex, muscle aches, lacrima- tion or rhinorrhea, pupillary dilation, piloerection, sweating, abdominal cramping, diarrhea, yawning, fever, and insomnia. Use can be on a chronic daily basis but more often is taken episodically in binges that can last several days. Dependence can occur following recreational use of the substance “on the street” or after prescribed use of the substance for relief of anxiety or insomnia. Once dependence develops, there is evidence of strong substance-seeking behaviors (obtaining prescriptions from several physicians or resorting to illegal sources to maintain adequate supplies of the substance). Abrupt cessation of these substances can result in life- threatening withdrawal symptoms. Symptoms of intoxication develop during or shortly after intake of sedatives, hypnotics, or anxiolytics. Symptoms of intoxication include inappropriate sexual or aggressive behavior, mood lability, impaired judgment, and impaired social or occupational functioning. Withdrawal symptoms occur after cessation of (or reduc- tion in) heavy and prolonged use of sedatives, hypnotics, or anxiolytics. Symptoms of withdrawal occur within several hours to a few days after abrupt cessation or reduction in use of the drug. A summary of symptoms associated with the syndromes of intoxication and withdrawal is presented in Table 4-2. Common Nursing Diagnoses and Interventions for Clients with Substance-Related Disorders (Interventions are applicable to various health-care settings, such as inpatient and partial hospitalization, community outpatient clinic, home health, and private practice. Related/Risk Factors (“related to”) [Substance intoxication] [Substance withdrawal] [Disorientation] [Seizures] [Hallucinations] [Psychomotor agitation] [Unstable vital signs] [Delirium] [Flashbacks] [Panic level of anxiety] Goals/Objectives Short-term Goal Client’s condition will stabilize within 72 hours. Assess client’s level of disorientation to determine specific requirements for safety. Knowledge of client’s level of func- tioning is necessary to formulate appropriate plan of care. Knowledge regarding substance ingestion is important for accurate as- sessment of client condition. Observe client behaviors frequently; assign staff on one- to-one basis if condition is warranted; accompany and assist client when ambulating; use wheelchair for trans- porting long distances. Pad headboard and side rails of bed with thick towels to protect client in case of seizure. Use mechanical restraints as necessary to protect client if excessive hyperactivity accompanies the disorientation. Ensure that smoking materials and other potentially harmful objects are stored away from client’s access. Disori- entation may endanger client safety if he or she unknow- ingly wanders away from safe environment. Monitor client’s vital signs every 15 minutes initially and less frequently as acute symptoms subside. Vital signs provide the most reliable information about client condition and need for medication during acute detoxification period. Com- mon medical intervention for detoxification from the follow- ing substances includes: a. Benzodiazepines are the most widely used group of drugs for substitution therapy in alcohol with- drawal. Commonly used agents include chlordiazepoxide (Librium), oxazepam (Serax), diazepam (Valium), and alprazolam (Xanax). In clients with liver disease, accumulation of the longer-acting agents, such as chlordiazepoxide (Librium), may be problematic, and the Substance-Related Disorders ● 91 use of shorter-acting benzodiazepines, such as oxazepam (Serax), is more appropriate. Some physicians may order anticonvulsant medication to be used prophylactically; however, this is not a universal intervention. Multivitamin therapy, in combination with daily thiamine (either orally or by injection), is common protocol. Narcotic antagonists, such as naloxone (Narcan), naltrexone (ReVia), or nalmefene (Revex), are administered intravenously for narcotic overdose. Substitution therapy may be instituted to decrease withdrawal symptoms using propoxyphene (Darvon), methadone (Dolophine), or buprenorphine (Subutex). Substitution therapy may be instituted to decrease withdrawal symptoms using a long-acting barbiturate, such as phenobarbital (Luminal). When stabilization has been achieved, the dose is gradu- ally decreased by 30 mg/day until withdrawal is complete. Treatment of stimulant intoxication usually begins with minor tranquilizers such as chlordiazepoxide (Librium) and progresses to major tranquilizers such as haloperidol (Haldol). Antipsychotics should be adminis- tered with caution because of their propensity to lower seizure threshold. Withdrawal treatment is usually aimed at reducing drug craving and managing severe depression.