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By X. Jensgar. Voorhees College. 2018.

In this chapter 20 mg aciphex with amex, only those aspects re- tobramycin may be given because they are usually less sus- lated specifically to these drugs are included discount 20 mg aciphex amex. Assessment The choice of fluoroquinolone is also determined by local With aminoglycosides generic 20 mg aciphex mastercard, assess for the presence of factors susceptibility patterns and specific organisms because indi- that predispose to nephrotoxicity or ototoxicity: vidual drugs differ somewhat in their antimicrobial spectra buy aciphex 20mg with amex. The multiple-dose reg- that increase risks of adverse drug effects (eg, impaired imen has been used traditionally and guidelines are well de- renal function, inadequate fluid intake, frequent or pro- fined. The single-dose regimen is being used increasingly, and longed exposure to sunlight in usual activities of daily living): guidelines are still evolving as studies and clinical experience accumulate. These two regimens are described in the follow- • Assess laboratory tests (eg, complete blood counts and ing sections. An initial loading dose, based on client weight and the • Receive aminoglycoside dosages that are individualized desired peak serum concentration, is given to achieve by age, weight, renal function, and serum drug levels therapeutic serum concentrations rapidly. If the client • Have serum aminoglycoside levels monitored when is obese, lean or ideal body weight should be used be- indicated cause aminoglycosides are not significantly distributed • Have renal function tests performed regularly during in body fat. In clients with normal renal function, the aminoglycoside and fluoroquinolone therapy recommended loading dose for gentamicin, tobramycin, • Be well hydrated during aminoglycoside and fluoro- quinolone therapy and netilmicin is 1. Maintenance doses are based on serum drug concentra- Interventions tions. Peak serum concentrations should be assessed 30 • With aminoglycosides, weigh clients accurately (dosage to 60 minutes after drug administration (5 to 8 mcg/mL is based on weight), monitor laboratory reports of BUN, for gentamicin and tobramycin, 20 to 30 mcg/mL for serum creatinine, serum drug levels, and urinalysis for amikacin, 4 to 12 mcg/mL for netilmicin). Keeping the client well hydrated reduces gentamicin and tobramycin, peak levels above 10 to risks of nephrotoxicity with aminoglycosides and crystal- 12 mcg/mL and trough levels above 2 mcg/mL for pro- luria with fluoroquinolones. With impaired renal function, dosage of aminoglyco- • Interview and observe for improvement in the infection sides must be reduced. References should be consulted for specific 532 SECTION 6 DRUGS USED TO TREAT INFECTIONS CLIENT TEACHING GUIDELINES Oral Fluoroquinolones General Considerations food. Ciprofloxacin (Cipro), gatifloxacin (Tequin), lome- ✔ Avoid exposure to sunlight during and for several days floxacin (Maxaquin), moxifloxacin (Avelox), and sparfloxacin after taking one of these drugs. These drugs may or zinc at the same time, within 4 hours before, or within cause dizziness or lightheadedness. Self-Administration ✔ Take norfloxacin (Noroxin) and enoxacin (Penetrex) 1 hour before or 2 hours after meals. Do not take ofloxacin with recommendations on adjusting aminoglycoside doses client to eliminate the drug to very low serum concentrations for renal impairment. In urinary tract infections, smaller doses can be used postantibiotic effect is active while there is minimal drug than in systemic infections because the aminoglycosides accumulation in body tissues. The use of once-daily (or extended interval) aminoglyco- side dosing is increasing. This dosing method uses high Dosage of Fluoroquinolones doses (eg, gentamicin, 7 mg/kg) to produce high initial drug concentrations, but a repeat dose is not administered until the Recommended dosages of fluoroquinolones should not be serum concentration is quite low. Most clients can be success- exceeded in any clients, and dosages should be reduced in the fully managed with one daily dose using this approach. Guidelines for Reducing Toxicity This practice evolved from increased knowledge about the concentration-dependent bactericidal effects and postantibiotic of Aminoglycosides effects of aminoglycosides. Concentration-dependent bacteri- cidal effects mean that the drugs kill more microorganisms In addition to the preceding recommendations, guidelines to with a large dose and high peak serum concentrations. Post- decrease the incidence and severity of adverse effects include antibiotic effects mean that aminoglycosides continue killing the following: microorganisms even with low serum concentrations. Identify clients at high risk for adverse effects (eg, characteristics allow administration of high doses to achieve neonates, older adults, clients with renal impairment, high peak serum concentrations and optimal killing of micro- clients with disease processes or drug therapies that organisms. The longer interval until the next dose allows the impair blood circulation and renal function). Keep clients well hydrated to decrease drug concentra- tion in serum and body tissues. The drugs reach higher Nursing Notes: Apply Your Knowledge How Can You Avoid This Medication Error?

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I told my clients that they had to stick with me for at least six weeks before they would see major results buy aciphex 20 mg otc. The Extreme Makeover challenge of training and transforming four women in a short period of time opened up a new universe to me 10 mg aciphex amex. I realized that many people generic aciphex 20mg with mastercard, given the right exercise and nutrition plan discount aciphex 10 mg overnight delivery, can achieve stunning results in as little as two weeks. Even more important, if they stick with the right maintenance plan, something the Extreme Makeover show does not develop, they can maintain these results for life. The basic philosophy of the show not only included diet and exercise (which I would be in charge of), but also extensive plastic sur- gery, including nose jobs, brow lifts, liposuction, and face-lifts. That said, I agreed to participate, and the process helped me to develop the program that eventually grew into this book. I felt that I could show these women and millions of viewers that one could have a makeover, and a pretty comprehensive one at that, by adhering to the sound eating and exercise principles of my program. Not only was I going to transform their bodies, but I was going to empower them by teaching them how to maintain their results throughout their lives. I was asked to help women completely make over their bodies in just 14 to 21 days. Generally, I suggest a much longer program for body transformation, one that lasts about six weeks. Yet, because the Extreme Makeover show wanted extreme results in an extremely short period of time, I modified the 1 IIII Copyright © 2005 David Kirsch. TLFeBOOK traditional nutrition and fitness program that I generally prescribe to my clients. Although all the women had cosmetic surgery, they all agree that it was the workout and the nutrition regimens that still resonate in their everyday lives. They all still follow my training program, albeit maybe not as rigorously, and adhere at least to a certain degree to my nutrition plan. What if I could convince others to embrace the notion that ultimate makeovers were attainable and could be realized with sweat and determination—but no plastic surgery? EXTREME VERSUS ULTIMATE RESULTS My objective here is not to bash the Extreme Makeover show. I think the human element in the show is compelling and makes for good television. If you are still going to reach for the burger and fries, then all the liposuction in the world will not keep you skinny. For this program, your nutrition plan is just as important—if not more 2 THE ULTIMATE NEW YORK BODY PLAN TLFeBOOK important—than your exercise plan. The biggest distinction between my Ultimate Body Plan and the Extreme Makeover program is that I not only train you, but I also feed you and teach you how to incorporate nutrition prin- ciples into your everyday life. With empowerment, you will have the courage, willpower, and fortitude to stay the course. THE ULTIMATE MAKEOVER After working on the Extreme Makeover show, I began introducing this faster, more extreme program to clients. I had many clients who were very fit and who ate well, but who wanted to take their bodies to the next level. They wanted to look great for bikini season or sculpt their best body for a wedding or upcoming reunion. I would have talked you out of your desire for fast results and into embarking on a longer, six-week program designed to last a lifetime. Even for the Extreme Makeover show, I was at first skeptical of how much could be accomplished in so short a period of time. I feel blessed for the opportunity to have worked with these amazing women. Even after all these years of personal training, I, too, learned a valuable lesson. As long as you accept that change—any change—will include physical, mental, and spiritual transformation, then you can do it.

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