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For infants (birth to and vegetables may be associated with factors other than vita- 12 months) buy proscar 5mg low cost, the only UL is for vitamin D (25 mcg) cheap proscar 5mg amex. For min C (eg, interactions between vitamin C and other compo- other children, ULs vary according to age, as follows. D 50 mg 50 mg 50 mg 50 mg E 200 mg 300 mg 600 mg 800 mg C 400 mg 650 mg 1200 mg 1800 mg Use in Preventing Cardiovascular Disease Folate 300 mcg 400 mcg 600 mcg 800 mcg Niacin 10 mg 15 mg 20 mg 30 mg Folic acid and vitamin C are believed to have cardioprotective Pyridoxine 30 mg 40 mg 60 mg 80 mg effects. Folic acid is important in the metabolism of homo- cysteine, a toxic amino acid and a major risk factor for heart disease. Homocysteine is normally produced during metabo- Use in Older Adults lism of methionine, another amino acid. Several B vitamins, including folic acid, are required for the metabolism of ho- Vitamin requirements are the same as for younger adults. How- mocysteine to a nontoxic substance, and an increased blood ever, deficiencies are common in older adults, especially of vi- level of homocysteine occurs with folic acid deficiency. With vitamin B12, for example, it is estimated that arteries and leads to plaque formation, arteriosclerosis, and older adults absorb only 10% to 30% of the amount found in thrombosis. Other factors may also contribute to deficiencies, includ- effects by lowering blood levels of homocysteine. Although ing limited income, anorexia, lack of teeth or ill-fitting den- the FDA requirement that folic acid be added to cereal grain tures, drugs that decrease absorption of dietary nutrients, and foods may be helpful, the folic acid intake that helps prevent disease processes that interfere with the ability to obtain, pre- cardiovascular disease is thought to be higher. Vitamin C is thought to help prevent cardiovascular disease Every older adult should be assessed regarding vitamin in- by its antioxidant effects. The atherogenic effects of blood take (from foods and supplements) and use of drugs that in- lipids, especially low-density lipoprotein (LDL) cholesterol teract with dietary nutrients. Vitamin C may help to prevent oxidation of LDL healthy and able to eat a varied, well-balanced diet. Overall, however, the effects of vitamin C on pre- tion, requirements may be increased during illnesses, espe- vention of coronary artery disease (CAD) are unclear. Overdoses, especially of studies indicate an increased risk for CAD only with a severe the fat-soluble vitamins A and D, may cause toxicity and vitamin C deficiency and that vitamin C has little effect on should be avoided. Tolerable ULs for older adults have ischemic heart disease and stroke after adjustment for other been established for some vitamins (D, 50 mg; E, 1000 mg; risk factors. More research is needed before vitamin C supple- C, 2000 mg; folate, 1000 mcg; niacin, 35 mg; pyridoxine, ments are recommended for cardioprotective effects. For a number of years, vitamin E was thought to have an- Use in Preventing Cancer tioxidant, cardioprotective effects similar to those of vitamin C. Vitamin A, its precursor beta carotene, and vitamin C are the main vitamins associated with prevention of cancer. Vitamin Use in Renal Impairment A and beta carotene may reduce cancers of the lung, breast, oral mucosa, esophagus, and bladder.

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Edema More likely in clients who are elderly or who have heart or kidney disease d order proscar 5 mg. Hypercalcemia More likely in women with advanced breast cancer (continued) 432 SECTION 4 DRUGS AFFECTING THE ENDOCRINE SYSTEM NURSING ACTIONS RATIONALE/EXPLANATION e order proscar 5 mg mastercard. Difficulty voiding due to prostate enlargement More likely in middle-aged or elderly men f. Drugs that decrease effects of androgens (1) Barbiturates Increase enzyme induction and rate of metabolism (2) Calcitonin Decreases calcium retention and thus antagonizes calcium-retaining effects of androgens SELECTED REFERENCES Review and Application Exercises Drug facts and comparisons. What are the adverse effects of using large doses of ana- bolic steroids in body-building efforts? If your 14-year-old brother said some friends were telling him to take drugs to increase muscle development and ath- letic ability, how would you reply? Minimize complications of enteral and parenteral tions of fluid imbalances, undernutrition, and nutrition. Collaborate with nutritionists and physicians in develop and maintain a safe and realistic designing and implementing nutritional support weight loss program. Critical Thinking Scenario Jamie, 2 months of age, had a gastrostomy tube placed after surgical repair of his esophagus. He is being sent home with his parents to receive tube feedings for a period of 6 to 8 weeks. Compare and contrast how tube feedings are the same and different for an infant and adult. Thus, nutritional care should be indi- health, to prevent illness, and to promote recovery from illness vidualized. The first four nutrients are discussed in this chapter; tionists advise about dietary matters, it is often the nurse who vitamins and minerals are discussed in the following chapters. Water, carbohydrates, proteins, and fats are necessary for Consequently, this chapter discusses the use of products to im- life. Water is required for cellular metabolism and excretion of prove nutritional status in clients with deficiency states and spe- metabolic waste products; 2000 to 3000 mL are needed daily. Proteins are basic anatomic and physiologic components of all body cells and tissues; the recommended amount for adults is 50 to 60 g daily. Carbohydrates and fats serve pri- NUTRITIONAL DEFICIENCY STATES marily as sources of energy for cellular metabolism. Energy is measured in kilocalories (kcal) per gram of food oxidized Nutritional deficiencies result from inadequate amounts of in the body. Carbohydrates and proteins supply 4 kcal/g; fats water, carbohydrates, proteins, or fats. Causes and symptoms 434 CHAPTER 30 NUTRITIONAL SUPPORT PRODUCTS AND DRUGS FOR OBESITY 435 of water imbalances are listed in Table 30–1; those of protein- Carbohydrate, Protein, calorie imbalances are listed in Table 30–2. TABLE 30–2 and Fat Imbalances Nurses encounter many clients who are unable to ingest ad- equate fluid and food because of illness.

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Berger neurons changes dynamically according to the environmental conditions 5 mg proscar with mastercard. In the two cases we have considered in this chapter buy proscar 5 mg without prescription, it is clear that developing a model of the coordination of movement by the cerebellum, or the learning and memory functions of the hippocampus, will allow cognitive operations to be related to the spatiotempo- ral distribution of activity in the cerebellum or hippocampus and the specific molec- ular mechanisms of synaptic plasticity. First, the size of the neuromimetic network would be immense, since it has to correspond strictly to the number of elements of the real network. Second, and more fundamentally, the specific functions provided by the global, nonlocal inte- gration of structures would not be obtained. We have seen the example of the hippo- campus, for which a statistical interpretation was needed. However, it is clear that the implementation of the algorithm will have to be of an analogical, non-numerical nature because of the necessarily adaptive nature of the learning and memory system. Appendix A: Structural Propagators In the most general case, the biological system is assumed to have: n levels of structural organization denoted as r; s; c... Phenomena are observed at the highest level, which means: r The functional interaction c traverses levels successively from the highest to the lowest. At each level, the interaction cannot go directly from one point to another without traversing the lower levels because each level represents a discontinuity; thus, at each level, except the lowest, the field equation is nonlocal. At the lowest level (molecular level), the field equation is local (reaction-di¤usion type). We have called Pi½c Š the structural propagator (S-propagator) since the propagation of the functional interaction occurs in the structural organization for the space of units u, including the structural discon- s tinuities at level s with the field variable c. Now, using the continuous notation for r0, the propagation of the field from r0 to r occurs, at the lower level, along d ðr0Þ i from r0 in u to the border of the structural discontinuity denoted as s0, then along i dðsÞ inside s, and finally from s to r along dðrÞ inside the unit u. This propagation corresponds to the mathematical operation per unit time: s 0 Pi½c Š¼PCPi 1 PCðrÞPðr A:4Þ which is the product of the translevel propagator P in u , i. Pðr0Þ, the in-level i i s propagator C for field variable c at the level s, which represents the transport through the structural discontinuity, and the translevel propagator P in u, i. It is sometimes convenient (however confusing) to note in the same way the operator and the field variable. If there is no discontinuity, then Cðs; s0; rÞ¼dðs À s0Þ where d is the Dirac function. Thus, the passage from r0 to r through s0 gives 0 0 0 0 ½Pðr; s ÞPðr ; s ފ 1 ½PðrÞPðr ފ: This relationship includes the density of units and their connectivity (a continu- ous expression using a density connectivity function prs, i. The pathways in the above diagram represent the action of the operators. It gives the global representation of the operation of the processes at each level of the hierarchy. The r S-propagator is a nonlocal field operator that transports the field variable c from point r0 in the space of units at time t0 to point r at time t. Mathematical Modeling of Neuromimetic Circuits 153 To sum up, it is crucial to note that the S-propagator represents the operation of the processes inside the units of the space of units.

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