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BH
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Date Posted: 15:34:52 08/28/02 Wed
Subject: bioscience in your practice
Author: b
Date Posted: 19:58:11 02/22/01 Thu
This forum is a place to discuss your experiences with bioscience in your practice.
Subject: Case Study
Author: R
Date Posted: 16:50:14 04/02/01 Mon
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We had an interesting case come in the other week, the history goes as follows:
A women aged 63 years came in ventialted and sedated, she was previously well. @/52 ago she knocked her R) leg on the rotary hoe, then pre-admission had a 3/7 hx of hypertension and her GP started heron the antihypertensive of Indapamide. The next day she blacked out and 'fainted' but came right.
The following day the neighbours noticed that things weren't as they usually are so they called the ambulance ( knowing that *H had blackout the day before), the police were called to break into the house. *H was found next to her bed with a GCS of 6.
CT Scan of the head was NAD.
There was a working diagnosis of tetanus fro the R) leg wound , which was debrided.
Admission labs were Na 110, K 2.7, Urea 2.4, Creatinine 46, Mg 0.65, Corr Calcium 2.15, Phospahte 1.01, Glucose 7.5
A lumbar puncture was done, CSF was clear, pressure was low and WCC was 1.0.
*H was being managed on fluid restriction, having IVF of D5W + 20% NaCl with regular K additives.
At 1400hrs the following day *H's GCS was 13-15 and her labs were as follows Na 121, K 4.0, Urea 2.5, Creatinine 41, Mg 0.90, Corr Calcium 2.15, Phosphate 0.66
By this stage we had veered away fromt eh diagnosis of tetanus and were thinking it was more a side effect from the Indapamide, which can have occasional side effect of hypokalaemia and rare effect of a diuretic.
I think *H decreased GCS was related to her low K and dehydration due to her large diuresis, which in effect lowered her Na ( she had been thirty prior to her initial blackout).
What do you think?
*H is a fictional name.
Subject: Re: Case Study
Author: b (tutor)
Date Posted: 18:11:38 04/02/01 Mon
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Looks like helen has wonky electrolyte levels. she also has a low sodium which would match with a diuresis presumably caused by the antihypertensive?
with such a low sodium a fluid shift would occur which would be related to a compromised GCS.
I know why but can anyone else explain it? this case is a very good example for when we do body fluids.
Subject: Re: Case Study
Author:b (tutor)
Date Posted: 20:03:39 05/06/01 Sun
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Remember H?
why would 20% NaCl cause a diuresis?
you may wish to look at the following information again. This relates to osmolarity that you did in cells.
Admission labs were Na 110, K 2.7, Urea 2.4,
>Creatinine 46, Mg 0.65, Corr Calcium 2.15, Phospahte
>1.01, Glucose 7.5
>*H was being managed on fluid restriction, having
>IVF of D5W + 20% NaCl with regular K additives.
She developed dehydration due to her large diuresis,
Subject: Re: Case Study H & body fluids/electrolytes
Author: B
Date Posted: 13:46:43 07/26/01 Thu
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Remember R's case study H?
Please read again and look at my responses as well. It is worth taking a look at as very pertinent to body fluids.
R's case study
>We had an interesting case come in the other week, the
>history goes as follows:
>A women aged 63 years came in ventialted and sedated,
>she was previously well. @/52 ago she knocked her R)
>leg on the rotary hoe, then pre-admission had a 3/7 hx
>of hypertension and her GP started heron the
>antihypertensive of Indapamide. The next day she
>blacked out and 'fainted' but came right. The
>following day the neighbours noticed that things
>weren't as they usually are so they called the
>ambulance ( knowing that *H had blackout the day
>before), the police were called to break into the
>house. *H was found next to her bed with a GCS of
>6.
>CT Scan of the head was NAD.
>There was a working diagnosis of tetanus fro the R)
>leg wound , which was debrided.
>Admission labs were Na 110, K 2.7, Urea 2.4,
>Creatinine 46, Mg 0.65, Corr Calcium 2.15, Phospahte
>1.01, Glucose 7.5
>A lumbar puncture was done, CSF was clear, pressure
>was low and WCC was 1.0.
>*H was being managed on fluid restriction, having
>IVF of D5W + 20% NaCl with regular K additives.
>At 1400hrs the following day *H's GCS was 13-15
>and her labs were as follows Na 121, K 4.0, Urea 2.5,
>Creatinine 41, Mg 0.90, Corr Calcium 2.15, Phosphate
>0.66
>By this stage we had veered away fromt eh diagnosis of
>tetanus and were thinking it was more a side effect
>from the Indapamide, which can have occasional side
>effect of hypokalaemia and rare effect of a diuretic.
>I think *H decreased GCS was related to her low K
>and dehydration due to her large diuresis, which in
>effect lowered her Na ( she had been thirty prior to
>her initial blackout).
>What do you think?
>*H is a fictional name.
Subject: bioscience in your practice
Author: b
Date Posted: 19:58:11 02/22/01 Thu
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I decided to start a discussion forum to explore how the bioscience you are learning is applicable to the areas you practice in as nurses or midwives.
who will be the first.
Subject: bioscience in practice
Author:A
Date Posted: 14:17:27 03/05/01 Mon
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hi, I find that in the gerontology area all this is important esp. the likes of fluid balance, input/output levels,eg. whether someone be dehydrated from lack of fluid intake or GI upsets.
Homeostasis is very evident in the elderly perticularly as the mechanisms are sometimes starting to fail a little and require, sometimes, constant help to maintain balance (or at least regular input). eg Temperature control, good circulation, ridding the body of waste etc.
Subject: Re: bioscience in practice
Author:B (tutor)
Date Posted: 17:48:46 03/05/01 Mon
-----------------------------------------------------------I agree A
homeostatic mechanisms in the elderly are not as 'sharp' for example the thirst mechanism - a very important feedback mechanism for fluid balance, deteriorates and may no longer be present. No wonder the elderly person may not be interested in the fluids they are 'forced' to drink.
Subject: Digestion
Author: J
Date Posted: 17:12:30 07/12/01 Thu
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In mental health areas , bioscience quirks present in fewer cases than in general health work.
My query may be blindingly obvious to others but has kept my colleagues and I talking for a while.
Feeding via a naso gastric tube to provide total nutrition to a pt with longstanding history of binge/vomit and restrictive food intake. Our dilemma has been the length of time post feed before stomach has emptied ie - vomitting no longer possible?
Argument was based on :
1 Liquid feed so mechanical digestion not required as much so would food move on to small intestine quicker?
2 Stomach not familiar with processing food so might act slower?
3 Does the rate of the feed affect the rate of stomach emptying?
4 Overall time frames for management plans to support pt.
Subject: Re: Digestion- N/G feeding
Author:B (tutor)
Date Posted: 14:02:52 07/26/01 Thu
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A very interesting scenario J
sorry I've taken so long to respond.
I couldn't put a time on 'the length of time post feed before stomach has emptied ie - vomitting no longer possible?'
BUT
your reasoning is good.
'Liquid feed so mechanical digestion not required as much so would food move on to small intestine quicker?' TRUE
BUT remember even the smell of food can stimulate churning as can the presence of non foods such as coffee & alcohol.
Question - what is stimulated to instigate churning?
Once food is soft enough it will be able to spurt out via pyloric sphincter into duodenum so Liquid food would have an advantage re removal from stomach.
Question - which hormone is directly involved in stomach emptying?
>2 Stomach not familiar with processing food so might
>act slower? NOT SURE ABOUT THIS - more like related to gastric damage that may exist.
Usual stimulant pathways should still operate unless nerves supplying stomach are damaged. If gastric glands damaged then secretions of acid and hormones may be compromised.
>3 Does the rate of the feed affect the rate of stomach
>emptying? I WOULD SAY SO
Because you are giving liquid it will almost pass straight through the sphincters so the faster it goes in the faster it enters duodenum
If too fast could induce gas and fullness in small intestine.
DOES ANYONE ELSE HAVE ANY COMMENTS?
Subject: Re: Digestion- N/G feeding
Author: J
Date Posted: 22:03:34 08/17/01 Fri
------------------------------------------------------------Stomach churning is from autonomic nerve stimulation?Sensory pick up of sight and smell and sound of food can trigger the churning?.
( In my new job it seems for me to totally related to how quiet the house is I am visiting. To hear my patients over my rumbling tum I am having to start eating morning teas as well as the strangely regular breakfast. Still to deal with the exercise side....)
2 Enterogastrones - a collection fo hormones including CCK, VIP, secretin ,intestinal gastrin, and GIP work together to govern secretion of oeachother and the over muscle action of the stomach and its exit.
>'Liquid feed so mechanical digestion not required as
>much so would food move on to small intestine
>quicker?' TRUE
>
>BUT remember even the smell of food can stimulate
>churning as can the presence of non foods such as
>coffee & alcohol.
>
>Question - what is stimulated to instigate churning?
>
>Once food is soft enough it will be able to spurt out
>via pyloric sphincter into duodenum so Liquid food
>would have an advantage re removal from stomach.
>
>Question - which hormone is directly involved in
>stomach emptying?
>
>
>>2 Stomach not familiar with processing food so might
>>act slower? NOT SURE ABOUT THIS - more like related
>to gastric damage that may exist.
>
>Usual stimulant pathways should still operate unless
>nerves supplying stomach are damaged. If gastric
>glands damaged then secretions of acid and hormones
>may be compromised.
>
>>3 Does the rate of the feed affect the rate of stomach
>>emptying? I WOULD SAY SO
>
>Because you are giving liquid it will almost pass
>straight through the sphincters so the faster it goes
>in the faster it enters duodenum
>If too fast could induce gas and fullness in small
>intestine.
Subject: nervous system & electrolytes
Author:B (tutor)
Date Posted: 14:10:05 07/26/01 Thu
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This is a fictional scenario based on truth. New people (E & J) can think about this too but may wish to come back to it later.
Ms M has been experiencing diarrhoea for several days possibly related to some dubious smelling fish she ate. She has been drinking plenty of water to prevent dehydration but this morning could hardly get out of bed. She was feeling very weak and her legs barely held her upright.
Question 1 - how may the diarrhoea have altered Ms M's electrolyte balance?
Question 2 - If an electrolyte imbalance has occurred how might this affect muscle function?
Hint: - think nerve impulses & what is needed for normal action potentials.
Subject: Re: nervous system & electrolytes
Author: J
Date Posted: 21:30:46 08/17/01 Fri
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>A gastric infection from contaminated food is frequently identified by the passing of loose frequent stools. This is in part due to the lining of the system being damaged or irritated by the infection presence and food moving through with a minimal of fluid reabsorption.
The excess fluid excreted needs to be replaced to avoid dehydration and consequent electrolyte imbalances.
2. Voluntary muscle control is governed by nerve impulses travelling from brain to indiviual muscles. To effect movement, the impulse relies on a Na+ and K+ balance to hold a stable state till the nerve impulse comes in a wave like action, of local depolarisation and repolarisation. Dehydration from excess fluid loss can result in a lack of Na+ thus altering the balance and interferring with Mrs S's ablity to stand steadily
>
Subject: lets get discussing
Author: b (tutor)
Date Posted: 03:33:43 06/14/01 Thu
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at this time of year lots of students are feeling the cold.
why is more food intake recommended particularly of the stodgy variety?
Subject: Re: lets get discussing
Author:j2
Date Posted: 01:32:27 06/20/01 Wed
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when cold our metabolic rate increases, to create heat production. this rise in metabolic rate requires increase intake of fuel, (food). stodgy foods - potatoes,pasta and puddings are carbonhydrates offer a readily source of energy, particulary the puddings which have a high sugar level. The glucose is a readily converted to ATP.
>at this time of year lots of students are feeling the
>cold.
>
Subject: Re:cold and stodgy food
Author:B (tutor)
Date Posted: 13:49:37 07/26/01 Thu
------------------------------------------------------------In reply to J2
the metabolic does indeed increase in the cold & stodgy foods do supply much needed glucose in form of carbohydrate
Question - does anyone know which hormones increase the metabolic rate?
>when cold our metabolic rate increases, to create heat
>production. this rise in metabolic rate requires
>increase intake of fuel, (food). stodgy foods -
>potatoes,pasta and puddings are carbonhydrates offer a
>readily source of energy, particulary the puddings
>which have a high sugar level. The glucose is a
>readily converted to ATP.
>>at this time of year lots of students are feeling the
>>cold.
>>
>>why is more food intake recommended particularly of
>>the stodgy variety?
Subject: stress response
Author: b (tutor)
Date Posted: 15:37:36 08/22/01 Wed
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Do you know why the heart races during the stress response?
we need to think about the Sympathetic nervous system (SNS) stimulation of heart rate & the adrenal glands.
SNS neurotransmitter - what is it and what does it bind to to increase heart rate?
the same neurotransmitter binds to receptors on bronchioles - What is the effect?
How does this improve the flight response?
same neurotransmitter stimulates adrenals---->
Glucocorticoids are released from the adrenals during the stress response to ensure sufficient glucose is available for flight.
Which other hormones are released from the adrenals & how do they complement the nervous system response??
post your thoughts & if you don't know we can nut it out until we do.
Subject: Re: stress response
Author: D
Date Posted: 15:30:13 08/25/01 Sat
------------------------------------------------------------Ok, I'll have a go at answering this B.
Norepinephrine binds with beta receptors in the heart to strengthen contractions. Dilates the bronchioles for more air intake, stimulates the adrenals to release more epinephrine to sustain and prolong the effects.
Subject: Re: stress response
Author: b
Date Posted: 15:25:48 09/02/01 Sun
------------------------------------------------------------quite correct D
a bit more detail is required.
Norepinephrine binds with beta-1 receptors on heart muscle
to strengthen contractions. Also binds with same receptors on sinoatrial node to increase heart rate.
Dilation of the bronchioles occurs due to Norepinephrine binding with beta-2 receptors
stimulates the adrenals to release more epinephrine and norepinephrine.
Any ideas about the glucocorticoids???
Subject: Glycolysis, etc!
Author: D
Date Posted: 20:00:10 04/17/01 Tue
------------------------------------------------------------If, like me, you are having problems understanding glycolysis, Kreb's cycle etc, try this web site, it has neat animations.
www.science.smith.edu/departments/Biology/Bio111/glycolysis.html
Subject: DNA website
Author: D
Date Posted: 22:24:11 04/05/01 Thu
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Here's another DNA website that might be useful.
www.accessexcellence.com/AB/GG/dna_molecule.html
It also has a lot of links to other sites.
Subject: Re: DNA website
Author: R
Date Posted: 18:05:13 04/06/01 Fri
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>Here's another DNA website that might be useful.
>www.accessexcellence.com/AB/GG/dna_molecule.html
>It also has a lot of links to other sites.
Good find D.
Subject: DNA website
Author: A
Date Posted: 01:11:41 03/08/01 Thu
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Finding a good website on DNA has been a task and a half - but this one seems to be good.
http://vector.cshl.org/dnaftb/
Called DNA From The Beginning
It is a bit wordy but has lots of info and this is delivered in a variety of ways - if you have time to sort through it all you will get something out of it.
Subject: Re: DNA website
Author: b
Date Posted: 20:54:24 03/19/01 Mon
------------------------------------------------------------good one A
will have a look soon
Subject: Altered Homeostasis
Author: D
Date Posted: 22:36:40 03/08/01 Thu
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Whoops!! I hit enter too soon.
Anyway, an example, probably not a good one, because there is no outcome to report.
A woman into ED with PV bleed, slight at the start, but became much heavier, she was 10/40. BP was stable for around an hour, then dropped quickly, tachy, pale, sweaty, and c/o nausea and dizziness. PV bleed increased. Despite positioning, IVF STAT, BP continued to drop, and bleed increased. Result was an emergency I&D to remove retained products. Is this what you are looking for Bronwyn?
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Subject: Re: Altered Homeostasis
Author: b (tutor)
Date Posted: 20:53:07 03/19/01 Mon
------------------------------------------------------------Yes this is good D. the signs you saw were related to her haemorrhage and drop in blood volume which caused the BP to drop.
Now we need to think about the homeostatic mechanisms related to maintaining BP.. was the tachycardia a compensatory mechanism? why the faintness & pallor, sweatiness.
which part of the nervous system is activated?
You may need to go to your cardiovascular chapter in the textbook to get more detail about control of BP....
Did they put up IV fluids?
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Subject: homeostasis
Author: b
Date Posted: 17:58:09 03/05/01 Mon
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you have all stated the relevance of bioscience in nursing & midwifery.
Now we need some specific examples of altered homeostasis - case studies that we can discuss.
they don't need to be text book perfect but 'spring boards' for getting discussion going.
shall I start.
Case study - fiction
Maurice has poorly controlled insulin dependent diabetes mellitus.
His blood glucose levels fluctuate between 8 - 12 mmol/L on a good day & are often a lot higher.
Consequently, he often feels thirsty and passes a lot of urine. Think about how his fluid balance is altered, what sort of negative feedback may occur AND what is hapenning at cellular level to the glucose.
you do not need to look up diabetes mellitus unless you really want to. the important concepts are related to altered homeostasis - glucose & water balance.
Have a think & lets discuss your responses.
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Subject: relevence
Author: m
Date Posted: 00:17:29 03/04/01 Sun
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In midwifery I am continually faced with questions from clients or myself ie endorphins /adrenaline/pain in labour, body fluid changes dehyration hormonal feedbacks why there is glycosuria for some women and not others, is that red sore breast, infection or blocked duct? etc etc etc
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[> Subject: Re: relevence
Author:b (tutor)
Date Posted: 17:46:09 03/05/01 Mon
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Good examples M. Can you describe a specific example or two where homeostasis has been disrupted - discuss the feedback mechanisms. You don't need to state everything just give the history & get the discussion going.
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Subject: Relevance
Author:D
Date Posted: 16:59:51 03/01/01 Thu
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I am usually sent to Emergency Care, and agree with T, this paper is very relevant to being able to assess much faster what is happening to body systems in an acute setting. I need some revision in this area.
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Subject: Re: Relevance
Author:B (tutor)
Date Posted: 17:41:11 03/05/01 Mon
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Good to see that you both - D & T - see the relevance of bioscience in your clinical specialities. Have you some specific examples debbie of altered homeostasis eg temperature, fluids.
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Subject: application to work
Author:T
Date Posted: 22:44:12 02/27/01 Tue
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Hi there. Working in an acute Surgical ward and on Ambulance and occassionally ICU/CCU all the areas that are covered in this course are very applicable to my areas of work. Knowing when someone is dehydrated or overloaded or their U's & E's are all mucked up or vomiting because they are pregant or post op unwell, septic, wound breakdowns etc. All this is relevant.
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Subject: Re: application to work
Author: B (tutor)
Date Posted: 17:38:57 03/05/01 Mon
------------------------------------------------------------can you give us some specific examples T. for example type of trauma & clinical signs & symptoms, U & Es obs etc.
what does happen to U's & Es if dehydrated???
Hi there. Working in an acute Surgical ward and on
>Ambulance and occassionally ICU/CCU all the areas that
>are covered in this course are very applicable to my
>areas of work. Knowing when someone is dehydrated or
>overloaded or their U's & E's are all mucked up or
>vomiting because they are pregant or post op unwell,
>septic, wound breakdowns etc. All this is relevant.
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