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Glucophage SR

By T. Ernesto. Fresno Pacific University.

The most effective way to moderate the amount of fat and added sugars in the daily diet is to cut down on "extras" - foods in the sixth food group (fats cheap glucophage sr 500mg with visa, oils order 500mg glucophage sr overnight delivery, and sweets) glucophage sr 500 mg line. Bread cheap 500 mg glucophage sr amex, Cereal, Rice, and Pasta Group - 6 to 11 servings To get fiber, choose several servings a day of foods made from whole grains. Choose foods made with little fat or sugars, such as bread, English muffins, rice, and pasta. When preparing pasta, stuffing, and sauce from packaged mixes, omit or use only half the butter or margarine suggested; if milk or cream is called for, use skim or low fat milk. Vegetable Group - 3 to 5 servings Different types of vegetables provide different nutrients. Punches and most fruit "drinks" contain only a little juice and lots of added sugars. Milk, Yogurt, and Cheese Group - 2 to 3 servings Choose skim milk and nonfat yogurt. Choose "part skim" or low fat cheeses when available and lower fat milk desserts, like ice milk or low fat frozen yogurt. Meat, Poultry, Fish, Dry Beans, Eggs, & Nuts Group - 2 to 3 servings Choose lean meat (lowest in fat); poultry without skin; fish, dry beans and peas. Prepare meats in low fat ways: trim away all the visible fat; remove skin from poultry; broil, roast, or boil these foods instead of frying them. Fats, Oils, and Sweets - Use sparingly Go easy on fats and sugars added to foods in cooking or at the table; butter, margarine, gravy, salad dressing, sugar, and jelly. Food provides the energy needed daily; and, this energy is in the form of calories. There are three calorie sources that the body needs every day: carbohydrate, fat, and protein. They each play a different role in the body and people need different amounts of each. The calories not used will be converted into body fat whether from carbohydrate, fat, or protein. By improving the food choices made daily, improvements in health are possible by understanding calories and the forms they take. Fat: Foods: Butter, margarine, salad dressing, fatty meats, oils, pastries, cookies, crackers, whole milk, hot dogs, french fries, chocolate, nuts, and ice cream. In the body: Fat provides energy and is easily converted to body fat if one eats too much. Notice that if one eats the same amounts (by weight) of carbohydrate, protein and fat, the fat will provide over twice as many calories. A low fat diet means essentially being able to eat more food and be more satisfied with fewer calories. Foods provide a range of nutrients in addition to fats, carbohydrates and proteins. Fiber, the building block of fruits, vegetables and whole grains, aides digestion and other functions. Vitamins are substances needed in minute (but essential) quantities to facilitate all the body processes. For example, vitamin A, found in yellow and orange vegetables, is needed for vision, but too much can be toxic. Minerals, such as iron, zinc, and copper, are also needed in minute amounts – but are poisonous in large quantities. Too little vitamin C can cause scurvy, an illness that historically killed thousands of mariners when fresh fruits and vegetables were not available at sea. Learning this, sailors carried limes on long voyages; thus the term “limeys” for sailors evolved. The sum of these processes in which the energy and nutrients from food are made available to and utilized by the body is referred to as metabolism. Some of these include: Clear Liquid: Clear fluids and foods that are liquid at body temperature, such as broth, gelatin, popsicles and juices. Full Liquid: Foods that are liquid or liquefy at body temperature such as strained meat and vegetables, cream soups, ice cream, custards, and hot cereals. Soft Diet: Foods that are mildly flavored, non-gas forming and easily chewed, such as tender meat, cooked carrots, canned fruit, and pudding. Avoid hard foods, fried foods, most raw fruits and vegetables, and very coarse breads and cereals. When there is injury in the mouth or oral cavity area or when the patient is nauseous and vomiting, give a clear liquid diet. When there is acute abdominal pain present, and until a diagnosis is established, it is always best to provide only clear liquids or give the patient nothing by mouth. Other special diets include bland diet (without spices or difficult to digest foods), low-sodium diet, and diabetic diet (carbohydrates are carefully measured). Research has shown that as stresses accumulate, an individual becomes increasingly susceptible to physical illness, mental and emotional problems, and accidental injuries. When threatened or stressed our bodies mount a chemical response, and this response affects our emotions and outlook. The rise in anxiety and hormone levels that accompanies stress is essential and protective. But, when extreme, the physical effects of stress can stop protecting us and begin to damage us. Identify the Sources of Chronic Stress Various versions of stress questionnaires are available that help you identify the most serious sources of stress in your life. Questions related to stress during the past six months: Has your spouse/life partner died? Lie or sit comfortably, close your eyes, visualize a “happy” scenario, and breathe in slowly, hold your breath for a few seconds, and exhale slowly through your nose. Continue this technique for five minutes or more at a time, as often as you need it. Break down tasks and problems into individual, easily accomplished steps, so that things do not seem overwhelming. Stress sometimes arises from frequent changes in routine; this may be a particular problem shipboard. Medications are available to relieve anxiety, and antidepressants can help with low moods. Remember, the drugs may temporarily relieve your symptoms, but the underlying cause of stress and anxiety still needs to be identified and addressed directly. People who become addicted to alcohol often begin to drink to relieve stress and anxiety.

By improving the food choices made daily discount 500 mg glucophage sr free shipping, improvements in health are possible by understanding calories and the forms they take buy glucophage sr 500mg without prescription. Fat: Foods: Butter glucophage sr 500mg visa, margarine discount glucophage sr 500 mg with mastercard, salad dressing, fatty meats, oils, pastries, cookies, crackers, whole milk, hot dogs, french fries, chocolate, nuts, and ice cream. In the body: Fat provides energy and is easily converted to body fat if one eats too much. Notice that if one eats the same amounts (by weight) of carbohydrate, protein and fat, the fat will provide over twice as many calories. A low fat diet means essentially being able to eat more food and be more satisfied with fewer calories. Foods provide a range of nutrients in addition to fats, carbohydrates and proteins. Fiber, the building block of fruits, vegetables and whole grains, aides digestion and other functions. Vitamins are substances needed in minute (but essential) quantities to facilitate all the body processes. For example, vitamin A, found in yellow and orange vegetables, is needed for vision, but too much can be toxic. Minerals, such as iron, zinc, and copper, are also needed in minute amounts – but are poisonous in large quantities. Too little vitamin C can cause scurvy, an illness that historically killed thousands of mariners when fresh fruits and vegetables were not available at sea. Learning this, sailors carried limes on long voyages; thus the term “limeys” for sailors evolved. The sum of these processes in which the energy and nutrients from food are made available to and utilized by the body is referred to as metabolism. Some of these include: Clear Liquid: Clear fluids and foods that are liquid at body temperature, such as broth, gelatin, popsicles and juices. Full Liquid: Foods that are liquid or liquefy at body temperature such as strained meat and vegetables, cream soups, ice cream, custards, and hot cereals. Soft Diet: Foods that are mildly flavored, non-gas forming and easily chewed, such as tender meat, cooked carrots, canned fruit, and pudding. Avoid hard foods, fried foods, most raw fruits and vegetables, and very coarse breads and cereals. When there is injury in the mouth or oral cavity area or when the patient is nauseous and vomiting, give a clear liquid diet. When there is acute abdominal pain present, and until a diagnosis is established, it is always best to provide only clear liquids or give the patient nothing by mouth. Other special diets include bland diet (without spices or difficult to digest foods), low-sodium diet, and diabetic diet (carbohydrates are carefully measured). Research has shown that as stresses accumulate, an individual becomes increasingly susceptible to physical illness, mental and emotional problems, and accidental injuries. When threatened or stressed our bodies mount a chemical response, and this response affects our emotions and outlook. The rise in anxiety and hormone levels that accompanies stress is essential and protective. But, when extreme, the physical effects of stress can stop protecting us and begin to damage us. Identify the Sources of Chronic Stress Various versions of stress questionnaires are available that help you identify the most serious sources of stress in your life. Questions related to stress during the past six months: Has your spouse/life partner died? Lie or sit comfortably, close your eyes, visualize a “happy” scenario, and breathe in slowly, hold your breath for a few seconds, and exhale slowly through your nose. Continue this technique for five minutes or more at a time, as often as you need it. Break down tasks and problems into individual, easily accomplished steps, so that things do not seem overwhelming. Stress sometimes arises from frequent changes in routine; this may be a particular problem shipboard. Medications are available to relieve anxiety, and antidepressants can help with low moods. Remember, the drugs may temporarily relieve your symptoms, but the underlying cause of stress and anxiety still needs to be identified and addressed directly. People who become addicted to alcohol often begin to drink to relieve stress and anxiety. Resources on where to find help, and answers to frequently asked questions about alcohol use, are given at: http://www. Make certain personal protective devices (“life jackets” and other safety equipment) are available. Hypothermia is a common cause of death at sea, especially if one is tossed to sea during an emergency. Always have appropriate cold weather gear easily accessible, and in adequate supply for the entire crew. The shipboard setting poses some particular risks and is often a more demanding physical environment than being on land. Any kind of impairment of your mental and physical functioning can put one at higher risk overall on shipboard. Over-the-counter medications that make one drowsy or sleepy such as antihistamines for allergies, 6-17 sleeping pills, and cough medications can adversely affect judgment and physical functioning. Always maintain an ongoing awareness of physical and mental capabilities and take that into account when you plan work and non-work activities each day. The primary responsibility to yourself and those around you is not to take risks when under the influence of alcohol or other drugs or medications. These last points are particularly important on board ship where sun exposure can occur for many hours of the day and in relatively unprotected situations. When on liberty, always wear seat belts: everyone in the moving vehicle, driver and passengers, front seat and back, should always wear seat belts. Personal Hygiene Personal hygiene protects the health of each individual and the entire crew. The health of a seaman depends, in part, on his own efforts to maintain habits of cleanliness and neatness. To prevent disease spread by fecal contamination, hands must always be washed immediately after urinating or defecating. A little petroleum jelly, cold cream, or hand lotion rubbed into the skin after washing may help to prevent chapping and resulting skin infections. Personal cleanliness includes good care of the skin, hair, nails, mouth and teeth, and proper maintenance of clothing, towel, and other personal gear. A daily bath or shower, particularly in hot weather or after working in hot compartments, is conducive to good health and lessens the possibility for infection. Care of the mouth and teeth including toothbrushing after meals and daily use of dental floss, are essential to prevent gum disease, infection, and tooth decay. Before brushing natural teeth, any partial dentures should be removed and carefully cleaned with a brush and mild soap or special denture cleanser.

Her low albumin suggests that she has had longer term malabsorption; it is likely to take several weeks or longer to cor- rect safe 500 mg glucophage sr. The abdominal Gastrointestinal case studies 17 X-ray is to exclude toxic dilation of the colon or bowel perforation buy glucophage sr 500 mg, which would require urgent surgical attention order glucophage sr 500mg with amex. I It is unlikely that she will be able to absorb any drugs by the oral route 500 mg glucophage sr amex, so treatment will need to be given parenterally. I Mesalazine has only been shown to be of benefit in mild to moderate flares of ulcerative colitis and so it can be stopped. I Her prednisolone should be replaced with full dose corticosteroid – most commonly intravenous hydrocortisone 100 mg four times daily to control the inflammation. I She will also need deep vein thrombosis prophylaxis as she is at an increased risk of a thromboembolic event, and intravenous fluids, with potassium, to replace what she is losing with the diarrhoea. Surgery is undertaken in patients not responding to medical treatments (or for the reasons mentioned previously). Surgery may also be used when patients have poorly controlled frequently relapsing disease. In ulcerative colitis surgery (a colectomy) offers the hope of a cure, by removing the diseased portion of the gastrointestinal tract. This contrasts with Crohn’s disease, where surgery is undertaken for symptomatic relief. However, as Crohn’s disease can affect the whole of the gastrointestinal tract it is not curative, and the disease often recurs in a different area following surgery. Several studies have been conducted, including some small randomised studies, to assess the use of ciclosporin in Crohn’s disease. The evidence suggests that intravenous ciclosporin can induce disease remission in severe flares of ulcera- tive colitis that are unresponsive to corticosteroids. Oral ciclosporin has only been shown to be useful as a bridging treatment between intravenous ciclosporin and more long-term maintenance strategies. I Reason for using ciclosporin: Ciclosporin is used to suppress the immune system and therefore the disease activity, and has a rapid onset of action. Discuss its other uses and explain that this is an unlicensed but not uncommon treatment for patients in her situation (relapsing unresponsive disease). Although it may avoid the need for surgery in some patients it doesn’t always work and surgery may still be needed. I How the ciclosporin will be given: Initially the ciclosporin will be given through a drip. If it is successful in controlling the disease she will be given oral treatment, which you can come back to discuss. It would be prudent to discuss the most significant effects and offer to return when she has had the opportunity to read through a patient information leaflet. I Increases in blood pressure are quite common, and these may be treated with blood pressure tablets, or by stopping the medicine. I Other common adverse effects include tingling, most often in the hands and feet, cramps and muscle pains. Problems tend to be more common with high doses, and blood levels of the drug will be monitored to ensure that they are within an acceptable range. The usual dose is 2–4 mg/kg/day (British Society of Gastroenterology guidelines recommend the lower dose). It is given as an infusion over 2–6 hours diluted in glucose 5% or sodium chloride 0. I Prednisolone 40–60 mg daily, with a reducing course over several weeks (regimens vary, but reductions should not be more than 10 mg and will need to be smaller and slower towards the tail end of treatment. As Mrs D was previously taking prednisolone 10 mg daily, dosage reductions from this point down will need to be very gradual. Local policy and dosing regimens vary and not all patients will necessarily receive this drug or dose. I Ciclosporin levels – although a therapeutic range has not been defined it is usual to aim for levels of between 100 and 200 ng/mL. The British Society of Gastroenterology recommends that measurements are taken at baseline, after one and two weeks, and then monthly. Mrs D should be given the following advice: I As ciclosporin is a powerful immunosuppressant you will be more susceptible to infection. You will be given an antibiotic three times a week to prevent some serious infections. I If you are to have vaccines it is important you say that you are on ciclosporin as some should not be given to patients taking ciclosporin as they can result in infections. I Let doctors, dentists, nurses and pharmacists know that you are taking this medicine. Note that ibuprofen is a general sale list medicine and so can be freely purchased. This can interact with ciclosporin and so should generally be avoided without further medical advice. I Monitoring: Regular blood tests will be needed to guard against adverse effects. Ciclosporin levels need to be taken before your first dose of the day (trough level). Therefore on some days (usually once a month) you will be asked not to take your ciclosporin until the blood has been taken. The ciclosporin will be continued for 3–6 months to allow the azathio- prine time to start working – a full effect may take three months. She is likely to continue aminosalicylates, and patients often remain on corticosteroids. Potentially, although controlled evidence for their use is sparse and more study is needed. Patients with pouchitis (which may occur following some surgical procedures for ulcerative colitis) may have significant clinical improvement fol- lowing the use of metronidazole. Ciprofloxacin is also useful for pouchitis, and concurrent use with metronidazole appears to be superior to either antibacterial alone. Ciprofloxacin alone may also be of potential use for disease control in ulcerative colitis, but data in the absence of other standard treatments are lack- ing. Discuss the general mechanisms of Cthese cellular needs by removing the substances from the external environment regulating digestive function. Identify the roles of enzymes and process is another important step in maintaining homeostasis. This chapter briefly gastrointestinal hormones in the discusses the basic digestive processes: motility, secretion, digestion, and absorption. It also reviews the anatomy of the digestive tract and discusses techniques used in the 4. Identify the difference between Motility is the process whereby muscular contractions mix and move the contents of abnormal and normal gastrointesti- nal assessment findings. The smooth muscle of the digestive tract maintains a con- stant low level of contraction known as tone. Tone maintains a steady pressure on the digestive tract contents and prevents permanent stretching.

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