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Emerging roles for the advanced cr nurse

Access The Future of Nursing: Leading Change, Advancing Health. Identify the two recommendations for nursing education you believe will be most effective or radical in creating change within the industry. Provide rationale based on your experience in practice. Do you agree or disagree with how the Institute of Medicine (IOM) describes the advanced practice registered nurse role evolving? Why or why not?

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Mechanism of action: In low PH values, pantoprazole is transformed into cationic sulfenamide, which is its active form [184, 190] , this drug accumulates in the highly acidic environment of the parietal-cell canalicular lumen and it is activated. The active form, tetracyclic cationic sulfonamide, reacts with thiol groups of cysteines 813 and 822 of transmembranal H+ / K+ ATPase[183, 186]. This conversion must take place beside the gastric parietal cells, so pantoprazole must be absorped intact by GIT [184]. The pantoprazole is an acid labile drug, which undergoes degradation in the stomach [191-194]. Therefore, the drug should be targeted to the intestine; to bypass the stomach. The gastro resistant drug delivery system is designed for the acid labile drugs due to the necessity to pass intact through the stomach for reaching the duodenum for absorption. The dosage form is prepared to bypass the stomach by formulating a solution for intravenous administration (lyophilized powder for reconstitution) or as gastric‐resistant tablets (oral delayed‐release dosage form) [195]. In the case of oral administration, the enteric coating prevents the drug from degradation in the gastric juice (at pH 1–2, for a few minutes [195-197]. Therefore the enteric coating, on the acid labile drug, is essential, thus they are less affected by pH. Thus the concept of gastro resistant drugs was generated. The wavelength of maximum absorbance for pantoprazole sodium sesquihydrate (λmax) was found to be 283.5 nm in 0.1N Hcl (pH 1.2) and 288.5 nm in phosphate buffer (pH 6.8). Calibration curves for pantoprazole sodium sesquihydrate in each of 0.1N Hcl (pH 1.2) and phosphate buffer (pH 6.8) were assessed from absorbance values, at λmax of a series of pantoprazole sodium sesquihydrate solutions containing different concentration of pantoprazole as shown in figure (1) and figure (2). The proposed nanoprecipitation (solvent displacement or interfacial precipitat
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