Professional Documents
Culture Documents
Osteomyelitis is an infection of the bone. It can be caused by a variety of microbial agents (most common in staphylococcus aureus) and situations,
including:
An open injury to the bone, such as an open fracture with the bone ends piercing the skin.
An infection from elsewhere in the body, such as pneumonia or a urinary tract infection that has spread to the bone through the blood (bacteremia,
sepsis).
A minor trauma, which can lead to a blood clot around the bone and then a secondary infection from seeding of bacteria.
Bacteria in the bloodstream bacteremia (poor dentition), which is deposited in a focal (localized) area of the bone. This bacterial site in the bone
then grows, resulting in destruction of the bone. However, new bone often forms around the site.
A chronic open wound or soft tissue infection can eventually extend down to the bone surface, leading to a secondary bone infection.
Symptoms of osteomyelitis
Excessive sweating
Chills
Lower back pain (if the spine is involved)
Swelling of the ankles, feet, and legs
Changes in gait (walking pattern that is a painful, yielding a limp)
Targets to be achieved:
1. Pain is reduced
2. Improvement of physical mobility within the limits of therapeutic
3. Infection control
1.Immobilization of the affected area with a splint to reduce pain and muscle spasms.
2. Joints above and below the affected area should be made so that still can be moved according to the range yet gently. The wound itself is sometimes
very painful and must be handled carefully and slowly.
5. Do pain management techniques such as massage, distraction, relaxation, hypnosis to reduce pain perception and collaboration with medical for
providing analgesic.
6. Protect your bones by means of immobilization and avoid stress on the bone because bones become weak due to the infection process.
Acute leukemias have large numbers of immature leukocytes and overproduction of cells in the blast stage of
maturation.
Acute lymphocytic leukemia (ALL), also known as acute lymphoblastic leukemia, refers to an
abnormal growth of lymphocyte precursors or lymphoblasts.
Acute leukemia is a malignant proliferation of white blood cell precursors in bone marrow or lymph tissue,
and their accumulation in peripheral blood, bone marrow, and body tissues.
About 20% of leukemias are acute.
Pathophysiology
Pathogenesis isn’t clearly understood, but the pathophysiology may be explained by the following:
Accumulation. Due to the precipitating factors, immature, non-functioning WBCs appear to accumulate
first in the tissue where they originate (lymphocytes in lymphtissue, granulocytes in bone marrow).
Infiltration. These immature WBCs then spill into the bloodstream and from there infiltrate other tissues.
Malfunction. Eventually, this infiltration results in organ malfunction because of encroachment and
hemorrhage.
Schematic diagram and pathophysiology
Acute lymphocytic leukemia is more common in males than in females, in whites (especially in people of
Jewish descent), in children (between ages 2 and 5), and in people who live in urban and industrialized
areas.
80% of all leukemias between 2 and 5 years old are ALL.
Acute leukemias account for 20% of adult leukemias.
Among children, however, it is the most common form of cancer.
Incidence is 6 out of every 100, 000 people.
Causes
Research on predisposing factors isn’t conclusive but points to some combination of viruses, immunologic factors,
genetic factors, and exposure to radiation and certain chemicals.
Clinical Manifestations
Complications
Untreated, acute leukemia is invariably fatal, usually because of complications that result from leukemic cell
infiltration of the bone marrow and vital organs.
Infection. Immature WBCs are not fit to defend the body against pathogens, so infection is always a
possible complication to watch out for.
Organ malfunction. Encroachment or hemorrhage occurs when immature WBCs spill into the bloodstream
and other tissues and eventually lead to organ or tissue malfunction.
Medical Management
Systemic chemotherapy. Systemic chemotherapy aims to eradicate leukemic cellsand induce remission
(less than 5% of blast cells in the marrow and peripheral blood are normal).
Radiation therapy. Radiation therapy is given for testicular infiltrations.
Platelet transfusion is performed to prevent bleeding and RBC transfusion to prevent anemia.
Pharmacologic Therapy
ALL chemotherapy includes the following drugs and also other drugs included in the treatment:
Surgical Management
Bone marrow transplant. Bone marrow transplant is a choice that can be considered for a patient with
ALL.
Stem cell transplant. Stem cell transplant in ALL is one of the latest development in the treatment of
acute leukemias
Nursing Management
The care plan for the leukemic patient should emphasize comfort, minimize the adverse effects of chemotherapy,
promote preservation of veins, manage complications, and provide teaching and psychological support.
Nursing Assessment
The clinical picture varies with the type pf leukemia as well as the treatment implemented, so the following must be
assessed:
Health history. The health history may reveal a range of subtle symptoms reported by the patient before
the problem is detectable on physical examination.
Physical examination. A thorough, systematic assessment incorporating all body systems is essential.
Laboratory results. The nurse also must closely monitor the results of laboratory studies and culture
results need to be reported immediately.
Nursing Diagnosis
Based on the assessment data, major nursing diagnoses for the patient with ALL may include:
Absence of pain.
Attainment and maintenance of adequate nutrition.
Activity tolerance.
Ability to provide self-care and to cope with the diagnosis and prognosis.
Positive body image.
Nursing Interventions
Before treatment:
Education. The nurse should explain the disease course, treatment, and adverse effects.
Infection. The nurse should teach the patient and his family how to recognize symptoms of infection such
as fever, chills, cough, and sore throat.
Bleeding. The nurse should educate the patient and the family how to recognize abnormal bleeding through
bruising and petechiae and how to stop it with direct pressure and ice application.
Promote good nutrition. The nurse should explain that chemotherapy causes weight loss and anorexia, so
the patient must be encouraged to eat and drink high-calorie and high-protein foods and beverages.
Rehabilitation. The nurse should help establish and appropriate rehabilitation program for the patient
during remission.
Meningeal leukemia. Watch out for meningeal leukemia (confusion, lethargy, headache) and know how to
manage care after intrathecal chemotherapy.
Hyperuricemia. Prevent hyperuricemia, a possible result of rapid, chemotherapy-induced leukemia cell
lysis through encouraging fluids to 2000 ml daily, giving acetazolamide and sodium bicarbonate tablets, and
allopurinol.
Infection control. Control infection by placing the patient in a private room and instituting neutropenic
precautions.
Skincare. Provide thorough skin care by keeping the patient’s skin and perianal area clean, applying mild
lotions and creams to keep skin from cracking and drying, and thoroughly cleaning skin before all invasive
skin procedures.
Constipation. Prevent constipation by providing adequate hydration, a high-residue diet, stool softeners,
and mild laxatives, and by encouraging walking.
Mouth ulcers. Control mouth ulceration by checking often for obvious ulcers and gum swelling, and by
providing frequent mouth care and saline rinses.
Psychological support. Provide psychological support by establishing a trusting relationship to promote
communication.
Manage stress. Minimize stress by providing a calm, quiet atmosphere that is conducive to rest and
relaxation.
Evaluation
Most patients cope better when they have an understanding of what is happening to them.
Education. Based on the patient’s education, literacy level, and interest, teaching of the patient and family
should focus on the disease, its treatment, and certainly the resulting significant risk of infection
and bleeding.
Vascular access device. Management of a vascular access device can be taught to most patients or family
members, and the nurses may need to provide follow-up care for the patient.
Home care services. Coordination of home care services and instruction can help alleviate anxiety about
managing the patient’s care at home.
Documentation Guidelines
The focus of documentation should include:
Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older
than age 65, and people with health problems or weakened immune systems.
Symptoms
The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of germ causing the
infection, and your age and overall health. Mild signs and symptoms often are similar to those of a cold or flu, but they last
longer.
Signs and symptoms of pneumonia may include:
Fatigue
Lower than normal body temperature (in adults older than age 65 and people with weak immune systems)
Shortness of breath
Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and cough, appear restless or
tired and without energy, or have difficulty breathing and eating.
See your doctor if you have difficulty breathing, chest pain, persistent fever of 102 F (39 C) or higher, or persistent cough,
especially if you're coughing up pus.
It's especially important that people in these high-risk groups see a doctor:
Causes
Many germs can cause pneumonia. The most common are bacteria and viruses in the air we breathe. Your body usually
prevents these germs from infecting your lungs. But sometimes these germs can overpower your immune system, even if your
health is generally good.
Pneumonia is classified according to the types of germs that cause it and where you got the infection.
Community-acquired pneumonia
Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other health care
facilities. It may be caused by:
Bacteria. The most common cause of bacterial pneumonia in the U.S. is Streptococcus pneumoniae. This type of
pneumonia can occur on its own or after you've had a cold or the flu. It may affect one part (lobe) of the lung, a condition
called lobar pneumonia.
Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia. It typically produces milder symptoms
than do other types of pneumonia. Walking pneumonia is an informal name given to this type of pneumonia, which typically
isn't severe enough to require bed rest.
Fungi. This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and
in people who have inhaled large doses of the organisms. The fungi that cause it can be found in soil or bird droppings and
vary depending upon geographic location.
Viruses. Some of the viruses that cause colds and the flu can cause pneumonia. Viruses are the most common cause of
pneumonia in children younger than 5 years. Viral pneumonia is usually mild. But in some cases it can become very
serious.
Hospital-acquired pneumonia
Some people catch pneumonia during a hospital stay for another illness. Hospital-acquired pneumonia can be serious because
the bacteria causing it may be more resistant to antibiotics and because the people who get it are already sick. People who are
on breathing machines (ventilators), often used in intensive care units, are at higher risk of this type of pneumonia.
Health care-acquired pneumonia is a bacterial infection that occurs in people who live in long-term care facilities or who receive
care in outpatient clinics, including kidney dialysis centers. Like hospital-acquired pneumonia, health care-acquired pneumonia
can be caused by bacteria that are more resistant to antibiotics.
Aspiration pneumonia
Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs. Aspiration is more likely if something
disturbs your normal gag reflex, such as a brain injury or swallowing problem, or excessive use of alcohol or drugs.
Risk factors
Pneumonia can affect anyone. But the two age groups at highest risk are:
Chronic disease. You're more likely to get pneumonia if you have asthma, chronic obstructive pulmonary disease (COPD)
or heart disease.
Smoking. Smoking damages your body's natural defenses against the bacteria and viruses that cause pneumonia.
Weakened or suppressed immune system. People who have HIV/AIDS, who've had an organ transplant, or who receive
chemotherapy or long-term steroids are at risk.
Complications
Even with treatment, some people with pneumonia, especially those in high-risk groups, may experience complications,
including:
Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can spread the infection to
other organs, potentially causing organ failure.
Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you may have trouble
breathing in enough oxygen. You may need to be hospitalized and use a breathing machine (ventilator) while your lung
heals.
Fluid accumulation around the lungs (pleural effusion). Pneumonia may cause fluid to build up in the thin space
between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, you may need to have it
drained through a chest tube or removed with surgery.
Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics.
Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus.
Prevention
Make sure children get vaccinated. Doctors recommend a different pneumonia vaccine for children younger than age 2
and for children ages 2 to 5 years who are at particular risk of pneumococcal disease. Children who attend a group child
care center should also get the vaccine. Doctors also recommend flu shots for children older than 6 months.
Practice good hygiene. To protect yourself against respiratory infections that sometimes lead to pneumonia, wash your
hands regularly or use an alcohol-based hand sanitizer.
Don't smoke. Smoking damages your lungs' natural defenses against respiratory infections.
Keep your immune system strong. Get enough sleep, exercise regularly and eat a healthy diet.
Hypertension is another name for high blood pressure. It can lead to severe complications and increases the risk of heart disease, stroke, and
death.
Blood pressure is the force exerted by the blood against the walls of the blood vessels. The pressure depends on
the work being done by the heart and the resistance of the blood vessels.
Medical guidelines define hypertension as a blood pressure higher than 130 over 80 millimeters of mercury
(mmHg), according to guidelines issued by the American Heart Association (AHA) in November 2017.
Around 85 million people in the United States have high blood pressure.
Hypertension and heart disease are global health concerns. The World Health Organization (WHO) suggests that
the growth of the processed food industry has impacted the amount of salt in diets worldwide, and that this plays a
role in hypertension.
Normal blood pressure is 120 over 80 mm of mercury (mmHg), but hypertension is higher than 130 over 80
mmHg.
Acute causes of high blood pressure include stress, but it can happen on its own, or it can result from an
underlying condition, such as kidney disease.
Unmanaged hypertension can lead to a heart attack, stroke, and other problems.
Lifestyle factors are the best way to address high blood pressure.
Treatment
Regular health checks are the best way to monitor your blood pressure.
While blood pressure is best regulated through the diet before it reaches the stage of hypertension, there is a range of
treatment options.
Doctors recommend that patients with hypertension engage in 30 minutes of moderate-intensity, dynamic, aerobic exercise.
This can include walking, jogging, cycling, or swimming on 5 to 7 days of the week.
Stress reduction
Avoiding stress, or developing strategies for managing unavoidable stress, can help with blood pressure control.
Using alcohol, drugs, smoking, and unhealthy eating to cope with stress will add to hypertensive problems. These should be
avoided.
Smoking can raise blood pressure. Giving up smoking reduces the risk of hypertension, heart conditions, and other health
issues.
Medications
People with blood pressure higher than 130 over 80 may use medication to treat hypertension.
Drugs are usually started one at a time at a low dose. Side effects associated with antihypertensive drugs are usually minor.
Eventually, a combination of at least two antihypertensive drugs is usually required.
A range of drug types are available to help lower blood pressure, including:
calcium-channel blockers
central agonists
vasodilators
Anyone taking antihypertensive medications should be sure to carefully read labels, especially before taking any over-the-
counter (OTC) medications, such as decongestants.
Causes
The cause of hypertension is often not known.
Chronic kidney disease (CKD) is a common cause of high blood pressure because the kidneys do not filter out fluid. This fluid
excess leads to hypertension.
Risk factors
A number of risk factors increase the chances of having hypertension.
Age: Hypertension is more common in people aged over 60 years. With age, blood pressure can increase steadily as the
arteries become stiffer and narrower due to plaque build-up.
Alcohol and tobacco use: Consuming large amounts of alcohol regularly can increase a person's blood pressure, as can
smoking tobacco.
Sex: The lifetime risk is the same for males and females, but men are more prone to hypertension at a younger age. The
prevalence tends to be higher in older women.
Existing health conditions: Cardiovascular disease, diabetes, chronic kidney disease, and high cholesterol levels can lead to
hypertension, especially as people get older.
Other contributing factors include:
physical inactivity
Signs
Blood pressure can be measured by a sphygmomanometer, or blood pressure monitor.
Having high blood pressure for a short time can be a normal response to many situations. Acute stress and intense exercise,
for example, can briefly elevate blood pressure in a healthy person.
For this reason, a diagnosis of hypertension normally requires several readings that show high blood pressure over time.
The systolic reading of 130 mmHg refers to the pressure as the heart pumps blood around the body. The diastolic reading of
80 mmHg refers to the pressure as the heart relaxes and refills with blood.
The AHA 2017 guidelines define the following ranges of blood pressure:
Systolic (mmHg) Diastolic (mmHg)
If the reading shows a hypertensive crisis when taking blood pressure, wait 2 or 3 minutes and then repeat the test.
Symptoms
A person with hypertension may not notice any symptoms, and it is often called the "silent killer." While undetected, it
can cause damage to the cardiovascular system and internal organs, such as the kidneys.
Regularly checking your blood pressure is vital, as there will usually be no symptoms to make you aware of the
condition.
It is maintained that high blood pressure causes sweating, anxiety, sleeping problems, and blushing. However, in most cases,
there will be no symptoms at all.
If blood pressure reaches the level of a hypertensive crisis, a person may experience headachesand nosebleeds.
Complications
Long-term hypertension can cause complications through atherosclerosis, where the formation of plaque results in the
narrowing of blood vessels. This makes hypertension worse, as the heart must pump harder to deliver blood to the body.
High blood pressure raises the risk of a number of health problems, including a heart attack.
an aneurysm, or an abnormal bulge in the wall of an artery that can burst, causing severe bleeding and, in some cases, death
kidney failure
stroke
amputation
Diet
Some types of hypertension can be managed through lifestyle and dietary choices, such as engaging in physical activity,
reducing alcohol and tobacco use, and avoiding a high-sodium diet.
Average salt intake is between 9 grams (g) and 12 g per day in most countries around the world.
The WHO recommends reducing intake to under 5 g a day, to help decrease the risk of hypertension and related health
problems.
This can benefit people both with and without hypertension, but those with high blood pressure will benefit the most.
Moderate to excessive alcohol consumption is linked to raised blood pressure and an increased risk of stroke.
The American Heart Association (AHA) recommend a maximum of two drinks a day for men, and one for women.
4 oz. of wine
People who have or who are at risk of high blood pressure are advised to eat as little saturated and total fat as possible.
Hypertension is closely related to excess body weight, and weight reduction is normally followed by a fall in blood pressure. A
healthy, balanced diet with a calorie intake that matches the individual's size, sex, and activity level will help.
It is a flexible and balanced eating plan based on research studies sponsored by the Institute, which says that the diet:
Some evidence suggests that using probiotic supplements for 8 weeks or more may benefit people with hypertension.
Types
High blood pressure that is not caused by another condition or disease is called primary or essential hypertension. If it occurs
as a result of another condition, it is called secondary hypertension.
Primary hypertension can result from multiple factors, including blood plasma volume and activity of the hormones that
regulate of blood volume and pressure. It is also influenced by environmental factors, such as stress and lack of exercise.
kidney disease
pregnancy
sleep apnea
obesity
CKD
Treating the underlying condition should see an improvement in b
Amoebiasis is a parasitic infection caused by Entamoebahistolytica. It is the third most common cause of death
(after Schistosomiasis and Malaria) from parasitic infections. This disease generally occurs in young to middle
aged adult. Amoebiasis is usually transmitted by contamination of drinking water and foods with fecal matter, but
it can also be transmitted indirectly through contact with dirty hands or objects as well as by oral-anal contact.
Amoebiasis is mostly associated with people living in areas of poor sanitation and it is a common cause of diarrhea
among people living or traveling to developing countries, specially those located in tropical or subtropical areas,
but also coming from domestic suburbs with non hygienic conditions.
Approximately 500 cases are reported each year in New York State. About 500 million people worldwide are
believed to carry E. histolytica in their intestines. Amoebiasis is believed to cause between 40,000 and 100,000
deaths worldwide each year. The symptoms of intestinal amoebiasis include diarrhoea, abdominal cramps, bowel
movements streaked with blood or mucus, nausea or vomiting and occasionally fever. Most patients with liver
abscess are febrile and have right-upper-quadrant pain, which may be dull or pleuritic in nature and radiate to the
shoulder. Point tenderness over the liver and right-sided pleural effusion are common. Jaundice is rare It can also
spread to other organs like the liver, lungs, and brain by invading the venous system of the intestines.
General therapy relieves symptoms, replaces blood, and corrects fluid and electrolyte losses. Asymptomatic
patients can be treated with luminal agents like Liodoquinol or DiloxanideFuroate. Anti-diarrhoeal medication
may also be prescribed. Metronidazole can produce a metallic taste in the mouth and may give rise to nausea.
Several drugs are available for treating intestinal infections, the most effective of which has been shown to be
Paromomycin and diloxanidefuroate is used in the US.Clean bathrooms and toilets often. Wash hands thoroughly
with soap and hot running water for at least 10 seconds after using the toilet or changing a nappy.
Avoid eating uncooked foods, particularly vegetables and fruit which cannot be peeled before eating.
4. Wash vegetables and fruits well in flowing water before intake or cooking
7. Take care of drinking water - either opt for mineral water or water boiled for 20 minutes
8. Avoid eating uncooked foods, particularly vegetables and fruit which cannot be peeled before eating.
Practice Essentials
Viral conjunctivitis, or pinkeye (see the image below), is a common, self-limiting condition that is typically caused
by adenovirus. Other viruses that can be responsible for conjunctival infection include herpes simplex virus (HSV),
varicella-zoster virus (VZV), picornavirus (enterovirus 70, Coxsackie A24), poxvirus (molluscumcontagiosum,
vaccinia), and human immunodeficiency virus (HIV).