Chron’s Disease

November 7, 2009 in Nurses' Notes by isl30fvi3w

Chron’s Disease- Inflammatory disease involving any portion of the intestinal tract.

SIGNS and SYMPTOMS:
1. Nausea
2. Severe abdominal pain

PATHOGNOMONIC SIGN:
1. Fecal fat test determines fat content.
2. D-xylase tolerance test

TREATMENT:
1. Clear fluid diet to bland low-residue and low fat diet.
2. Antidiarrheals

NURSING MANAGEMENT:
1. Observe for signs of fluid and electrolyte imbalance.
2. Teach client to avoid laxatives and salicylates.

Congestive Heart Failure

November 7, 2009 in Nurses' Notes by isl30fvi3w

Congestive Heart Failure- Heart fails to pump causing congestion when blood is not adequately circulated.

SIGNS and SYMPTOMS:
1. Right-sided symptoms of  congestion in periphery with edema and distended neck veins.
2. Left-sided symptoms of congestion in the lungs,pulmonary edema,cyanosis,dyspnea and orthopnea.
3. Corpulmonae symptoms of both right-sided and left-sided failure.

DIAGNOSTIC TEST:
1. ECG
2. ABGs
3. Chest radiographs

TREATMENT:
1. Digitalis
2. Diuretics
3. Oxygen therapy
4. Restricted Sodium Intake

NURSING MANAGEMENT:
1. Monitor apical pulse for 1 full minute before digitalis administration.
2. Record Intake and Output.
3. Restrict fluid as ordered
4. weigh daily
5. Assess exercise tolerance

Congenital Clubfoot or Talipes Equinovarus

November 7, 2009 in Nurses' Notes by isl30fvi3w

Congenital Clubfoot or Talipes Equinovarus- Foot is fixed in plantar flexion and medial deviation.

SIGNS and SYMPTOMS:
1. Deformity is readily apparent at birth.
2. Deformity may be rigid or flexible.
3. Contractures
4. Shortening of tendons

DIAGNOSTIC TEST:
x-ray

TREATMENT:
1. Surgery
2. Rehabilitation
3. Casting
4. Braces
5. Corrective shoes

NURSING MANAGEMENT:
1. Observe toes for signs of circulatory impairment.
2. Cast care post-operative care.

Coxa-Plana (Legg-Calve Perthes Disease)

November 7, 2009 in Nurses' Notes by isl30fvi3w

Coxa-Plana (Legg-Calve Perthes Disease)- Ischemic oseptic necrosis of the femoral head, epiphysis, acetabulum.

SIGNS and SYMPTOMS:
1. Persistent pain on affected hip
2. Limitation of motion on affected hip, limp

TREATMENT:
1. Surgical correction
2. Non-weight bearing devices such as abduction brace, leg casts, leather harness sling

NURSING MANAGEMENT:
1. Educate parents and child in correct use of appliances
2. Assist the child and family in selecting activities according to the child’s age, interest and physical limitations.

Cholelithiasis (Cholecystitis)

November 7, 2009 in Nurses' Notes by isl30fvi3w

Cholelithiasis (Cholecystitis)- Inflammation of the gall bladder.

SIGNS and SYMPTOMS:
1. Pain Right Upper Quadrant of abdomen
2. Vomiting
3. Jaundice
4. Indigestion after eating of fatty foods.

DIAGNOSTIC TEST:
1. Serum bilirubin and alkaline phosphatase are elevated.
2. Ultrasonography (determines presence of gallstones)
3. Endoscopic retrograde cholangiopancreatography

TREATMENT:
Surgery- cholecystectomy

NURSING MANAGEMENT:
1. Teach dietary modification
2. Vitamin A and E supplementation
3. Provide pre-operative and post-operative care.

Abdominal Birth or Cesarian Section

November 7, 2009 in Nurses' Notes by isl30fvi3w

Cesarian Section- Birth via transabdominal incision: transverse incision or lower uterine vertical incision.

PREDISPOSING FACTORS:
1. Cephalopelvic disproportion
2. Dystocia
3. Placenta Previa and Abruptio Placenta
4. Postmaturity
5. Growths within birth canal
6. Multiple births
7. Diabetes
8. Pregnancy Induced Hypertension (PIH)
9. Rh Incompatibility
10. Fetal distress
11. Active Herpes
12. Malpresentations

NURSING MANAGEMENT:
1. Monitor for lochia discharges- may be less than vaginal birth.
2. Uterine Involution
3. Post operative care
4. Pain relief

Osteoarthritis

November 7, 2009 in Nurses' Notes by isl30fvi3w

Osteoarthritis- Non-systemic progressive degenerative joint disease.

SIGNS and SYMPTOMS:
1. Assymetric pain on joints that increases with weight bearing and relived by rest.
2. Crepitus when joint is moved.

PATHOGNOMONIC SIGNS:
1. Heberden’s nodes
2. Bouchard’s nodes
*Both occurs symmetrically on fingers.

DIAGNOSTIC TEST:
1. CBC
2. Radiographs

TREATMENT:
1. Acetaminophen
2. NSAIDs
3. Surgery

NURSING MANAGEMENT:
1. Provide range of motion exercises. (ROM)
2. Relieve discomfort
3. Increase fluid intake

WHO Pandemic Phases

November 7, 2009 in Nurses' Notes by isl30fvi3w

In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans. The grouping and description of pandemic phases have been revised to make them easier to understand, more precise, and based upon observable phenomena. Phases 1-3correlate with preparedness, including capacity development and response planning activities, while Phases 4-6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities.
In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.
In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.
In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.
Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.
Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.
During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.
Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature.
In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.

Past Influenza Pandemics

November 7, 2009 in Nursing News by isl30fvi3w

About influenza pandemic
“An influenza pandemic is a rare but recurrent event.” -WHO
“A pandemic occurs when a new influenza virus emerges and starts spreading as easily as normal influenza – by coughing and sneezing. Because the virus is new, the human immune system will have no pre-existing immunity. This makes it likely that people who contract pandemic influenza will experience more serious disease than that caused by normal influenza.” – WHO

Past influenza pandemics
first well-documented case was traced back to 1580
28 cases of influenza pandemic were recorded from 1580-1900
since 1900-present, there have been at least 3 pandemics: Spanish Flu, Asian Flu, and Hong Kong Flu

  • Spanish influenza

occurred in 1918-1919, just as World War I was winding down
killed an estimated 40-50 million people worldwide (WHO estimates)
swept through North America, Europe, Asia, Africa, Brazil, and the South Pacific
considered one of the deadliest disease events in human history
caused by influenza type A virus (H1N1)
higher mortality rate among the younger population; people between 20-45 years old accounted for 60% of the fatalities

  • Asian influenza

occurred in 1957-1958
estimated 2 million deaths
first identified in China
caused by type A virus (H2N2)
outbreak occurred between late summer and fall
those mainly infected were above 55 years old

  • Hong Kong influenza

occurred in 1968
estimated 1 million deaths
arose in Southeast Asia (first detected in Hong Kong), then spread to the US and Europe
caused by type A virus (H3N2)
GMANews.tv

Influenza

November 7, 2009 in Nurses' Notes by isl30fvi3w

Flu, or influenza, is a highly contagious acute respiratory illness. Flu season generally occurs annually all over the world, during the cold season.
Flu is caused by the Influenza virus that invades and multiplies in the respiratory tract. Influenza viruses are divided into three types: A, B, and C.
Influenza types A and B are the primary causes of the disease and responsible for epidemic outbreaks.
Influenza type C is a sporadic cause of predominantly upper respiratory tract disease such as the common cold and pharyngitis.
The influenza virus is unique in that its structure changes each year. Major changes cause worldwide epidemics called pandemics. Minor changes cause the annual local outbreaks. Pandemics are estimated to occur every 10 to 20years while local outbreaks occur every 2 to 3 years.
Who are at risk of getting flu?
Any person is at risk of getting flu. The risks are higher if you belong to any of the following groups:
Those who belong to extremes of age generally have low immune functions to fight the virus.
Those with chronic debilitating illnesses (e.g., asthma, emphysema, kidney disease, diabetes).
Smokers and chronic alcoholics with secondary liver dysfunction.
Children in day-care centers and adoption homes.
Children on long-term aspirin therapy.
Women in their 2nd or 3rd trimester of pregnancy.
Residents of nursing homes.
Mode of Transmission
Entry of the virus into the respiratory tract:
via droplets from an infected person through coughing talking and sneezing
through contact with the surfaces, material and clothing contaminated with discharges of an infected person
Transmission through a community is rapid, with the highest incidence of illnesses occurring within 2 to 3weeks of introduction, and with the outbreak lasting for 6 to 10 weeks.
How do you know that you have flu?
(signs and symptoms)

The incubation period of flu is 1 to 4 days–once you get infected with the virus, it takes 1 to 4 days for you to feel symptoms due to the disease.
Headaches, muscle aches, joint pains, body malaise and fatigue that can be severe during the first few days but will slowly improve.
Sore throat
Cough which starts as dry and hacking and progresses by the 3rd day to wet with thick mucus. Your cough can worsen during the next 4-7 days and can last for over 2 weeks. You have a higher risk to develop bronchitis and pneumonia if you smoke.
Fever with a temperature of 38oC to 40oC, with or without chills, within 12 hours from onset of infection. Fever is higher in children and can reach to as high as 41oC.
Nasal congestion, watery eyes or runny nose.
Vomiting and/or diarrhea. Diarrhea is more common in children less than 6 years of age.
Treatment
To prevent complications and to allow your immune system to work:
rest
comfortable room temperature
increased fluid intake
Symptomatic drug treatment:
For fever, headache, muscle and joint pains: Analgesic/Antipyretic agents – Paracetamol, Ibuprofen
For runny and stuffy nose: cold Medications -Phenylpropanolamine
For dry cough -Dextromethorphan
For productive cough: Guiafenesin, Carbocisteine, Bromhexine, Ambroxol
Other notes:
Aspirin should not be given to children.
Antibiotics to be given only to complications of influenza such as pneumonia or otitis media.
When should you call your physician?
Call your physician if you note the following:
Fever recurs after it has gone for1-2 days, or you continue to have high-grade fever after 4 or 5 days.
Cough becomes wheezy, with difficulty in breathing and the presence of bloody or yellow-green mucus and phlegm.
You have chronic illness (e.g., asthma, cancer, diabetes, kidney problems) or your chronic condition worsens.
Ear pain and/or ear discharge.
Prolonged headache, confusion, frequent muscle twitching, seizures or convulsions and general body weakness.
Bleeding in any part of your body.
Rapid or irregular heartbeat.
Prevention
influenza vaccination preferably to be given anytime from February to June
provide a separate room for a person sick with influenza
cover mouth and nose when sneezing or coughing to prevent spread of the virus
Avoid persons with the disease. Distance yourself at least 1meter from people who are coughing or are sick with influenza. Adults with flu are typically contagious for 5-7days from fever onset. In children, they are contagious for 7-10 days and even longer (up to 4 weeks) in patients with low natural defense mechanism.
wash hands frequently with soap and water
What are the complications of flu?
Pneumonia – manifests as high-grade fever, brassy cough, lack of appretite, drowsiness, difficulty in breathing, and increased phlegm and mucus production
Otitis media – can present as earache or fluid coming out of the ears
Reye’s Syndrome (rare complication) -marked by delirium, seizures, stupor, coma, and death.