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A This case represents an acute hemolytic reaction where the patient had previous sensitization to E and c antigens purchase lisinopril 17.5 mg with mastercard blood pressure medication in pregnancy. This brings to light the importance of running a panel whenever the patient has a positive antibody screen regardless of previous results lisinopril 17.5mg with amex prehypertension dizziness. Vital signs unit of red cells hours previously with no problems buy lisinopril 17.5 mg with visa high blood pressure medication and zyrtec, were taken at 4:30 p. A transfusion reaction was called and the blood Therefore, any serological abnormalities could not unit, tubing, and paperwork sent to the blood be identified. Tere were no clinical manifestations specimen postmortem if a reaction is called, so that noted on the paperwork and no post-transfusion the transfusion reaction investigation can be specimen was sent to the blood bank. Volume overload Blood bank/Correlate clinical and laboratory data/ Transfusion reactions/3 4. Small bowel resection was indicated, but the platelet concentrates may be made from this unit? Results vary depending upon the age of the removing leukocytes from red blood cells? B Platelets preparation from whole blood must be problem(s) is (are) present in this situation? Te only problem is with the returned unit; the 30-minute limit has expired and the unit cannot be used B. Te returned unit may be held for this patient for 48 hours but cannot be used for another patient D. Transport so that temperature is maintained at of collection and transfused within 6 hours 20°C–24°C D. Which of the following is true regarding apheresis the outdate of the unit and washed and transfused or platelets? What method can be employed to detect bacteria longer be used as a screening test for platelets. Cryoprecipitate may be used to treat all of the Answers to Questions 11–18 following, except: A. D A unit having a noticeable clot should not be issued for transfusion to a patient. The clot may be an Blood bank/Select best course of action/Hemotherapy/ indication of contamination or bacterial growth. Centrifuge/sterile connecting device platelets may be given to a transplant in which the D. Cell washer/heat sealer donor is A and the recipient is O; once the stem cells Blood bank/Apply knowledge of standard operating engraft, platelets/plasma must be compatible with procedures/Blood components/Platelets/2 type A cells. If only type O single-donor platelets are available, the product can be spun down using a 15. What component(s) is (are) indicated for patients centrifuge and plasma can be removed. C Patients with anti-IgA antibodies should not receive components containing plasma. Washed or Blood bank/Select course of action/Hemotherapy/2 deglycerolized red cells can be issued. Ultraviolet radiation induces apoptosis of Blood bank/Select course of action/Hemotherapy/ lymphocytes Irradiation/2 Blood bank/Apply knowledge of standard operating procedures/Blood components/Stem cells/1 20. Platelet concentrates Blood bank/Apply knowledge of standard operating Blood bank/Apply knowledge of standard operating procedures/Blood components/1 procedures/Blood bank/Expiration date/1 21. Which of the following is true regarding Answers to Questions 19–26 granulocyte concentrates? C A red cell unit that has been leukocyte reduced must retain 85% of original red cells. Blood bank/Apply knowledge of standard operating procedures/Blood components/2 21. C Granulocyte concentrates contain a large amount of red cells and must be crossmatched with the 22. A Pooled cryoprecipitate is a closed system; however, it has an outdate of 4 hours once thawed. Blood bank/Apply knowledge of standard operating Platelet concentrates expire in 5 days. All of the following are advantages of using single- Answers to Questions 27–30 donor platelets as opposed to random donor platelets, except: 27. Less antigen exposure for patients prepared by apheresis, which may require 1–3 hours C. No pooling is required random donor platelets in equivalent amounts may require only a few minutes. Blood bank/Apply principles of special procedures/ Blood components/Platelets/1 28. A When individual Cryo units are pooled in an open system, the expiration time is 4 hours; if Cryo is 28. What is the expiration of cryoprecipitate once pooled using a sterile connecting device, the pooled? What is the number of white blood cells permitted Platelets may be needed to control bleeding, and in a unit of leukoreduced red cells? Te patient’s hemoglobin is 8 g/dL owing to chemotherapy with a drug known to cause bone marrow depression and immunodeficiency. Platelet count of 75 × 109/L in a donor who is a vaccine last week frequent platelet donor B. A 54-year-old man who tested positive for Blood bank/Apply knowledge of standard operating hepatitis C last year, but has no active symptoms procedures/Donor requirements/1 of disease Blood bank/Apply knowledge of standard operating Answers to Questions 1–5 procedures/Donor requirements/2 1. She is currently on Persons who lived in an area endemic for malaria warfarin and vitamin B12. No, her hemoglobin is too low However, because she is currently on warfarin, only red cells can be prepared from her donation.

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Put the paper strip in the culture medium after autoclaving and observe for germinating bacteria to check for growth discount lisinopril 17.5mg with mastercard blood pressure chart. It prevents active multiplication of bacteria by decreasing the metabolic activity of bacteria cheap lisinopril 17.5mg without a prescription prehypertension blood pressure treatment. Radiation : Ioning and ultra violet radiation Ioning radiation includes χ ray order lisinopril 17.5 mg overnight delivery arteria musculophrenica, γ ray and β ray. Ultra violet radiation has less quantum energy with low penetrating power than ionic radiation. Spore forming bacteria are more resistant to ionic and ultra violet radiation than vegetative bacteria because of: 1. Anti-Microbial agents and Sensitivity Testing Anti- Microbial drugs Anti-microbial drugs include. Chemical anti-microbials Antibiotics: Definition: Antimicrobial substances produced by living micro- organisms. Chemical anti-microbials Definition: synthetically produced anti-micorbial compounds. Anti-microbial drugs show specific toxicity to microbial cells due to differences in cell envelope, protein and enzymes to host cells. Those damaging cell membrane leading to loss of cell contents and then cell death. Those inhibiting protein synthesis and then arresting bacterial growth - aminoglycosides - tetracycline - erythromycin - chloramphenicol - clindamycin 4. Those inhibiting nucleotide synthesis - sulfonamide - trimethoprim 105 Resistance of bacteria to anti-microbial drugs Production of enzymes that destroy or inactivate anti-microbials Eg. Developing an altered metabolic pathway that bypasses the reaction inhibited by the drugs Eg. Developing an altered enzyme that can still perform its metabolic function but is much less affected by the drug Eg. Wide spread sensitization resulting in hypersensitivity and anaphylactic reaction, and drug rashes. Changing normal microbial flora leading to “super infection” due to over growth of drug-resistant micro-organism. A filter paper disk containing measured quantities of drug is placed on a solid medium that has been seeded with the test organisms. Following over right incubation, the diameter of the clear zone of inhibition surrounding the deposit of drug is taken as a measure of the inhibitory power of the drug against the particular test organism. Bacterial strains sensitive to the drug are inhibited at a distance from the disk whereas resistant strains grow up to the edge of the disk. Dilution Sensitivity Tests - Agar dilution tests - Broth dilution tests Graded amounts of antimcorbial agents are incorporated into liquid or solid bacteriology media. Nowadays the above tests are either time consuming or cumbersome, so the advent of microdilution both solution tests has simplified the method and permit a quantitative result to be reported, indicating the amount of a given drug necessary to inhibit or kill the test micro-organism. Components of medium - media composition components enhance or inhibit bacterial growth. Size of inoculum: the larger the bacterial inoculum, the lower the apparent sensitivity of the organisms. Length of incubation: short exposure of moisture to the drug inhibits their growth but does not kill them; longer exposure of moisture to a drug gives a chance for resistant motants to emerge. Metabolic activity of moistures - actively and rapidly growing micro-organisms are more susceptible to drug action than those in the resting phase. Techniques of routinely used antimicrobial sensitivity testing (disc diffusion tests) Required: - sensitivity testing media - Anti-microbial discs - Control strains - Turbidity standard 109 Sensitivity testing media: The commonly used media is Mueller- Hinton agar. For pathogens requiring enriched media like Neisseria gonorrhea, Heamophilus influenzae and Streptococcus pneumoniae, it is necessary to add blood to (heat it if needed) sensitivity testing agar. Turbidity (Opacity) standard: This is a barium chloride standard against which the turbidity of the test inocula can be compared. The turbidity of the standard is equivalent to the turbidity of subcultured broth test micro-organism. Method - Emulsify several colonies of similar appearance of the test organism in a small volume of sterile nutrient both. Type of specimen The correct type of specimen to be collected will depend on the pathogens to be isolated. For example: a cervical not a vaginal swab is required for the most successful isolation of N. Time of collection ™ Specimens such as urine and sputum are best collected soon after a patient wakes when organisms have had the opportunity to multiply over several hours. Collection techniques ♦ The laboratory should issue written instruction to all those responsible for collecting specimens including staff of wards, out patient clinics and health centres. The swabs used to collect the specimens must be sterile and the absorbent cotton wool from which the swabs are made must be free from antibacterial substances. Container must be clean but need not be sterile for the collection of feaces and sputum. Labelling of specimens and sending of a request form Each specimen must be accompanied by a request form which gives: - The patient’s name, age (whether an infant, child or adult), number, and ward or health center. Preservatives and transport media for microbiological specimen ™ In general, specimens for microbiological investigations should be delivered to the laboratory as soon as possible. Amies transport medium widely used and effective in ensuring the survival of pathogens like the more delicate organisms such as Neisseria gonorrhoeae. Cary - Blair medium in used as transport medium for faeces that may contain Salmonella, shigella, campylobacter or vibro species. Transport of microbiological specimens collected in a hospital • Specimen should reach to the laboratory as soon as possible or a suitable preservative or transport medium must be used. When dispatching microbilogical speciemens: 117 1) Keep a register of all specimens dispatched. Type of specimen Investigation required Date of dispatch Method of sending the specimen (eg. Seal round the container cap with adhesive tape to prevent loosening and leakage during transit. Therefore, it becomes contaminated in the small number of commensal organisms from the upper respiratory tract and mouth Gram positive Gram negative Staphyloccus aureus Neisseria Staphyloccus epidermidis Branhamella catarrhac’s Streptococcus Viridans Haemophilus influenzae Streptococcus pnemoniae Fusobacteria Enterocci Coliforms Diphtheroids Yeast-lke fungi 119 In a hospital with a microbiology Laboratory. Give the patient a clean (need not be sterile), dry, wide- necked, leak- proof container and request him or her to cough deeply to produce a sputum specimen Note: The specimen must be sputum, not saliva.

In Bill’s case 17.5mg lisinopril with mastercard heart attack young squage, he may have optimistically assumed that his illness had dissipated after a brief course of medication purchase lisinopril 17.5 mg amex pulse pressure 31, perhaps partly due to his doctor’s instructions and buy discount lisinopril 17.5 mg hypertension kidshealth, thus, discontinued his medication. While discussing her resistance to medication however, Cassie expresses frustration that she was the only one in her family diagnosed with a mental illness, indicating a reluctance to accept her fate perhaps on the grounds of the seeming injustice of her situation and the isolation that might entail from taking medication which would signify acceptance of the diagnosis and being different from the rest of the family as a result. Regardless of the motivations (if any) for denial, the above extracts provide examples of consumers refusing, or not wanting, to take their medication because of a lack of awareness of symptoms being caused by mental illness. Peer workers are mental health consumers who are often employed by mental health community centres to provide support services to other people with mental illnesses. Travis tended to generalize his statements about schizophrenia, perhaps due to his role which would enable him to share experiences with other consumers. He talks about the difficulties accepting that one has a mental illness upon diagnosis amongst first episode consumers, using his experiences as an example. Especially um, most people that develop a mental illness, they won’t um, want to accept it straight away. And um, they’ll always just say, I had plans for my life and whether it’s-, you’re older or younger you know, it’s not a nice feeling. You may, you may enjoy it when you’re manic a little bit but the downer way outweighs that. But um, I have to say to you, the first step is, is, is you know, there’s a few different steps in the acceptance, one is like, ok, so I’ve got an illness but the other is to move forward and start making things happen for your life. My friends were out partying, doing everything that teenagers should be doing, you know 91 and I was sitting at home, hearing voices, hyper-ventilating and sleeping about two hours a night so um- Travis illustrates the difficulty of accepting that one has a mental illness by contrasting his late teenage years with those of typical, mentally- healthy peers; “My friends were out partying, doing everything that teenagers should be doing, you know and I was sitting at home, hearing voices, hyper-ventilating and sleeping about two hours a night”. Travis’ contrast between him and his friends when younger also functions to highlight how mental illness can be isolating and, thus, acceptance of one’s diagnosis and that one is different from their peers could be undesirable, similar to Cassie in the earlier extract. Therefore, as with Cassie, denial of having a mental illness could serve a protective function for first-episode consumers as they avoid dealing with the realities of having a mental illness. Travis indicates that only once acceptance takes place can positive actions ensue. It is implied that adherence is one of these positive actions that can follow once awareness that one has a mental illness is gained. As was the case with Bill and Cassie in earlier extracts, taking medication represented admitting to being different for Travis and was, thus, avoided in the early stages of his illness. In addition to highlighting how denial of having a mental illness can lead to non-adherence, as previous extracts have done, the following extract also indicates that once insight that one has an illness is gained, adherence to treatment may follow. Ryan, 26/09/2008 92 R: It’s a positive sign if they uh, if they uh, say own up to what they’re experiencing. Sometimes it’s just like I was the first time, just um, deny that they have a problem and then it’s kinda like, they just detain you in hospital for longer until I do realise, work out that it is a problem, then treat it with the medication. Based on his personal experiences, Ryan states that it is a “positive sign” if consumers are able to acknowledge their mental illness but points out that, unfortunately, denial is common amongst first episode consumers, consistent with his experience. Ryan indicates that denial often leads to longer periods of detainment in hospital, which can lead the consumer to then “realise” or “work out” that their mental illness is problematic and requires treatment with medication. He does not indicate the mechanism by which this realization is gained but rather frames it as merely proceeding hospitalisation. Thus, it is unclear as to whether Ryan is suggesting that he, like other consumers, gained insight from being able to self-reflect, for example, in hospital, or whether he noticed how medication improved his symptoms. Alternatively, Ryan could be interpreted as indicating that prolonged incarceration of consumers leads them to conclude that they must be sick or that the only means of being discharged from hospital is for them to be medication adherent. The following extract highlights how medication non-adherence and relapse can represent a vicious cycle, especially for consumers whose insight into having an illness depletes as their symptoms exacerbate. This extract provides support for lack of insight as a diagnostic criterion for schizophrenia, which may become more pronounced during symptom flare- ups. If you don’t think you’re sick I guess you’re not going to take your medication either. I’ve got people on the inside [peers] who know if they’re getting ill so they seek help quick. L: So it kind of reaches a point maybe, like when you get sick, you find you just can’t tell what’s real and what’s not. In the above extract, whilst Matthew states that he has retrospective insight that he has a mental illness, he indicates that during episodes, he lacks insight (“Now I’ve got insight but when I’m unwell, I haven’t”). That is, as Matthew’s symptoms worsen, so too does his awareness of his symptoms (“I’m sick and I don’t know I’m sick”). It could be assumed that some consumers, like Matthew, for example, may become encompassed by their symptoms such as delusions and hallucinations which may compromise their abilities to identify such experiences as illness symptoms, which could thereby lead to non-adherence. This extract is different from previous extracts, which primarily related to first or early episode experiences of consumers who were in denial about having a mental illness as Matthew states that he loses insight when his symptoms become worse and concurs 94 with the interviewer that he then stops taking his medication. Matthew indicates that whilst early intervention is possible for peers who are aware that they have schizophrenia and can recognize when their symptoms are returning, he has to wait for other people to detect signs that he is relapsing. Specifically his “mum” and his “mental health” team have been able to identify warning signs of symptom fluctuations in the past. Matthew could be interpreted to imply that insight in relation to warning signs or triggers for symptom relapse can assist with adherence or at least enhance outcomes for consumers in terms of illness stability, by highlighting that his peers who have insight seek help as needed, thus, potentially avoiding negative consequences (“I’ve got people on the inside who know if they’re getting ill so they seek help quick. That is, rather than attributing their auditory hallucinations, for example, to mental illness, they attribute them to external sources, such that a consumer may believe that they are actually talking to God, as is the example used by Katherine. Whilst Katherine talks in general terms about spiritual experiences, Margaret describes how she used to believe the voices she was hearing were real. Katherine, 05/02/2009 L: So could you think of any strategies, or anything that you think could be useful to encourage some of these people then to stay adherent? K: Um, it’s really difficult because a lot of them don’t have insight, like a lot of schizophrenics, like you said, think it’s a gift. K: Because they don’t see the, like, they might think, yes they do talk to God and why should I take this medication? Margaret, 04/02/2009 M: I mean I believed in ‘em implicitly til about two to three years back when I thought, you know, this is not a gift. And it was once I started accepting that that I got better and took my medication. In the first extract, Katherine constructs a consumer’s interpretation of their hallucinations as spiritual experiences and not as illness symptoms as a barrier to adherence (“like a lot of schizophrenics, like you said, think it’s a gift. According to Katherine, this type of insight, which again involves a denial of having a mental illness, leads consumers to perceive medication as unnecessary or as interfering with their “gift” and, thus, non- adherence seems a logical choice following this reasoning (“why should I take this medication?

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