August 2020 ~ Medical diseases and trems ,symptoms causes TREATMENT

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what is Oligohydramnios ? definition, causes , treatment, sign and symptom

 


DEFINITION 

             ☆ Volume less than 200 ml.

             ☆ AFI less than 5cm.

             ☆ SDP less than 2 cm.

ETIOLOGY 

1.NSAIDS - This is the prostaglandin inhibitor. It is responsible to inhibit placental prostaglandin results olygohydromaniose.

2.Pre eclampsia- systemic vesoconstric result into decrease organs supply .

3. Intra  uterine growth Retardation .

4.Renal agenisis  - refer as potter syndrome .

5. Pulmonary hypoplesia.

6. Leakage of amniotic cavity. 

7. Rupture of members. 

8. Amniotic nodosum 

SIGN AND SYMPTOMS 

1. Decrease abdominal height. 

2. Decrease fetal movement. 

3. Increased risk of malpresentation .

4. Uterus is full from fetus. 

INTERVENTION 

         Amnioinfusion of isotonic solution. 



Antidotes of Drugs/Poison



 AGENTS                                        ANTIDOTES 

1. Paracetamol/         ~ N- Acetyl cysteine .

     Acetaminophen 

2. Morphine/ Opioid ~ Naloxone .

3. Heparin                  ~ Protamin sulfate. 

4. Warfarin               ~ Vitamin K/ FFP.

5. Organophosphate/ ~ Atropine .

Masrum poison

6. Atropine              ~ Physiostigmin .

7. Magnesium sulfate ~ Calcium gluconet. 

8.Iron                 ~ Deforaxamin .

9.potesium      ~ Sodium polystyrene/ sulphona(kayexalate).

10. Co2 poisoning ~ Oxygen .

11. Benzodiazepine ~ Flumazenil .

12. Methanol ~ Ethanol or Formiplazol.

13. Iodine ~ Sodium thiosulfate .

14. Nitrate ~ Methilin blue.

15. Cyanide ~ Amyl nitrate  or sodium        thiosulfate or sodium nitrate .

16. Arsenic ~ Dimercaprol .

17.Lead  ~ Dimercaprol succinic acid or

                    Or ca+ disodium edatat .

18. Copper ~ Dipenicilamine.

19. Theophylline ~ Beta blockers .

20. Isoniazid ~ vitamin B6(pyridoxine).

21. Methotrexate ~ folic acid .

22. Sulfonylurea~ Octriotide.

23. Aspirin ~ Furosemide or sodium bicarbonate 

                            Or Vitamin K.

24. Digoxin ~ Digoxin Immune fab or Digibind .

25. Dopamine ~ Fantolomine.

26. Beta/ ca+ channel blocker ~ Glucagon .

27. Unknown poisoning  ~Naloxone

                                 Thalamine or dextrous .

28. Universal ANTIDOTES ~ Activated

                                                      Charcoal .



Hyperthyroidism, cause, SIGN and SYMPTOMS, management



 DEFINITION 

    In this condition the T3 and T4 level became increased in the blood. 

ETIOLOGY 

  ● Adenoma of the thyroid gland. ( T3 and T4 increased but TSH became decrease due to negative feedback mechanisms. )

  ● Adenoma of anterior pituitary (TSH Became increased so T3 and T4 also increased. )

  ● Graves Disease 

                              It is a autoimmune disease in this condition autoantibodies are formed and it appears similar to the TSH . Now the antibodies bind with the TSH receptors and provide continuous stimulation to the follicular cells in the thyroid gland. So the T3 and T4 became increase but the TSH level became Decrease due to negative feedback mechanisms. 

SIGN AND SYMPTOMS 

    ☆ BMR increased.. 

    ☆ Heat intolerance .

    ☆ Pollycythemia  .

    ☆ Smooth skin, silky and shiny hair .

    ☆ Hyperglycemia .

    ☆ Tachycardia, Techyponea ,Hypertension. 

    ☆ Diarrhea weight loss. 

    ☆ Irritability and mood swings. 

    ☆ Insomnia.

    ☆ Menstrual cycles irregular in females. 

    ☆ Sexual disfunction in males. 

    ☆ Protruded eye ball .

    ☆ Goiter. 

MANAGMENT 

MEDICAL MANAGEMENT 

    -The antithyroid medication should be administered. Eg.  Propilthyourecil (PTU),Methamezol

    -The drug should be administered after breakfast because it can cause gastric Irritability in the empty stomach. 

    - The side effects of PTU is Leukopenia( decrease WBC caunt). So observers this patient for the chance of infection. 

    - Monitor for the toxicity of antithyroid medication ( Bradycardia and hypothermia).

SURGICAL MANAGMENT 

1. Hypophysectomy .

2. Thyroidectomy. 

Nursing responsibilities 

1.Mantain patent airway. 

2. Provide semi Fowler's position. 

3.The Tracheostomy set should be always present at the bed side of patient. 

4. Monitor the chances of bleeding ( asses in the back of neck for blood accumulation. ).

5. Monitor for the sign of hypocalcemia. eg. Titany and tingling sensation around mouth. 

The hypocalcemia indicat the accidental removal of the parathyroid hormone. 

6. Asses for the speaking ability. In this surgery the recurrent laryngeal nerve may be damaged. 

7. If nerve is damage Aphonia will occur. 

8. Frequent swallowing indicat bleeding in the period of after tencelactomy. 




    


What is Episiotomy, indication, type, selection of incision

 


DEFINITION 

      It also known as periniotomy. It is wildling of birth canal. It is 2°perineal injury. 

PERINEAL INJURY 

     A. 1° Skin .

     B. 2° Skin + Muscles + Vaginal mucosa .

     C. 3° 2° + Anus   External and internal spinture .

     D. 4° 3° +Rectal mucosa .

INDICATION 

    ☆ Primipera .

    ☆ History of previous Episiotomy.

    ☆ Precipitated Labour. 

    ☆ Rigid perineum. 

TIMING 

Just before the crowning. 

ADVANTAGE 

It prevent unwanted rupture. 

TYPE 

1. MEDIAL 

                     It is second common type.it Involves in risk of muscles damage. ( 2.5 to 3 cm medial to porchetta)

2. Lateral 

                 It start 1cm lateral to porchetta. It involves risk of Bartholin duct damage. 

3. MEDIOLATERAL 

●  It is most common type. 

● Modified 'J' shape 

● Incision about 2.5cm to 3cm also known as 5 o'clock and 7 o'clock. 

● Common side is right side. 

PROCEDURE 

 General intervention involves, 

 ☆ Lithotomy position. 

 ☆ PERINEAL care. 

 ☆ Local Anastasia.

SELECTION OF INCISION 

● Incision is deep in nature also known as triple layer cutting. 

● Suture are both absorbent and non absorbent. 

MANAGMENT 

● Perineal care 

● Instruct the mother for ambulation after 24 hours of delivery. 

● Suture removal time 5 to 6 day after procedure. 

COMPLICATION 

Pain ,bleeding, Incision extended, painful sexual intercourse. 


Rheumatic fever Definition, Etiology ,Sign and symptoms, diagnosis, and managment



 DEFINITION 

                It is a autoimmune disorder which commonly involves heart, skin, joint and brain. 

ETIOLOGY 

     ● This autoimmune disease usually develops after the infection of Beta - hemolytic streptococcus. 

  ● The antibodies against the streptococcus attacks upon multiple organs of body and cause the inflammation. 

  ● The condition is commonly seen in school going children .(10-14 years)

SIGN AND SYMPTOMS 

☆ fever. 

☆ Polyarthalgia -Aches in joint. 

☆Polyarthritis- Affected more than 4 joint. 

☆ Subcutaneous nodules.

☆ Erythema marginatum - Redness of skin and mucus membrane / pink ring. 

☆ carditis .

☆ Chorea- abnormal involuntary muscular movement due to brain involves. 

ASCOFF BODIES - It is seen in rheumatic fever commonly found in heart. 

DIAGNOSIS 

     ☆ History ( sore throat).

     ☆ Physical examination. 

     ☆ CBC, ESR INCREASED, C REACTIVATE PROTEIN INCREASED 

     ☆ ASLO ( Most informative in rheumatic fever)

 MANAGMENT 

    □  Rest .

    □ Fowler's position .

    □ Digoxin and Diuretics (if heart failure is develop) .

    □ Antipyretics .

    □ Analgesic ( Diclofenac and Tramadol).

    □ Steroids- It is the best treatment for rheumatic fever because it decrease the inflammation. They also have immunosuppressive properties. 






How to calculate body Fluids, Body Fluids

   


     

 The human body contains 60% to 65% of body Fluids. 

       It is disturbed as two compartments. 

1. INTRACELLULAR FLUID 

        The fluid which are present inside of cell is known as intracellular fluid. Potassium is present in high quantity in intracellular fluid.

           Intracellular fluid is 70% of total body Fluids. (Approximate 28 liter)

2. EXTRACELLULAR FLUID 

        The fluid which are present outside the cell body is known as extracellular fluid. Sodium is present in high quantity in extracellular fluid.

        Extracellular fluid is 30% of total body Fluids. (Approximate 12 liter)

TYPE of EXTRACELLULAR FLUID 

A.  INTERSTITIAL FLUID - 22% of extracellular fluid/ 8.8 liter .

B.   INTRACELLULAR FLUID -6% of extracellular fluid/ 2.4 liter. 

C.   OTHER - 2% of extracellular fluid/ 0.8 liter.

HOW TO CALCULATE BODY FLUID 

   We take a 70 kg weight person. 

   We know each person have 60% of body fluid of him/her weight. So

     = 70×60/100

      =42 kg 

   A 70 kg person have 42 kg fluid in him/her body weight. 


 

Tracheostomy Definition, Indication, Types,procedure, Suctioning,and contraindications



DEFINITION 

                       A Tracheostomy tube is inserted into the trachea through surgically creating stoma to establish and maintain a patient airway for long period of time. 

INDICATIONS 

Upper airway obstruction due to foreign body ,edema, tumor, stenosis. 

●Respiratory failure.

●Severe head,neck and chest injury.

●Neurological disorder of diaphragm and intercostal muscles.

●Canine biting. 

●Severe extensive burn of face.

●Intolerance of endotracheal tube (10-14 days).

●Any condition in which endotracheal tube can not be inserted. 

CLASSIFICATION 

1. Emergency/Prophylactic .

2. Temporary/ Permanent .

3. High ring (T1-T2)/ Lower ring(T3-T4).

TYPE OF TRACHEOSTOMY TUBES 

1. Double or single lumen cannula tube. 

2. Cuffed and non cuffed.

3. Fenestrated (with talking tube)and non fenestrated tube. 

4. Plastic (silicone and polyvinyl) and metal (stainless steel).

PROCEDURE 

Take consent to patient or family members. 

● Check vitals.

● Patient Npo 6 to 8 hours before procedure. 

● Talk about procedure to patient or family members. 

● First give Rose position to perform procedure. 

● Commonly 2nd and 3rd ring incisored. 

● Place the Tracheostomy tube. 

● After Tracheostomy give Fowler's position. 

SUCTIONING 

              - Suctioning should not be continued more than 5 - 10 seconds.

-Prolonged Suctioning will cause hypoxia and bradycardia (cardiac arrest).

-Hyperoxygenated with 100% Oxygen before Suctioning. 

- Apply Suctioning intermittently while rotating and withdrawing catheter.

Suction Pressure

☆Infant 60-80 mm of Hg.

☆Child 80-100 mm of Hg.

☆Adult 100-120 mm of Hg.

Suction catheter size

☆Infant- 5 to 8 Fr.

☆Child- 8to 10 Fr.

☆Adult- 12 to 18 Fr.

Time

☆First 24 hours Suctioning in every 30 minutes after then Suctioning  every 2 hours. 

Decannulation -The process removal of TT

●Inner cannula should be clean after every 2 to 4 hours with Hydrogen peroxide, Sodium bi-carbonate ,Normal saline.

●Stoma should be clean apply antibiotic ointment and vaseline ghage should be used.

Complication Of Tracheostomy 

☆Tracheomalacia - Tracheal dilation and erosion. 

☆Tracheal stenosis- Narrowing of trachea.

☆Tracheo Esophageal Fistula- Abnormal opening b/w trachea and Esophagus. 

☆Tracheo Innominate Artery Fistula- Abnormal opening b/w trachea and innominate Artery. 

☆Tube obstruction. 

☆Tube dislodgment.





 

Precipitated Labour Definition, Etiology,Risk factors,and INTERVENTION



 DEFINITION 

                        - It is a condition in which fetus delivery and placental delivery completed in two to three hours. 

  ▪︎ Cervical dilation >5cm/hours .

ETIOLOGY 

    ● commonly in multipera .

    ● Hypertonic uterus .

    ●  Lower resistance.

RISK FACTORS 

●  Most common maternal risk factors is Inversion of uterus. ( Inversion- Inside out movement of funds of uterus.)

Most common fetal risk factor is intracranial injury. 

INTERVENTION 

● Early identification of risk factors .

● Immediate hospitalization .

● Tocolytic drugs (Tocopherol).

● Planning of delivery.

● Episiotomy is a conservative managment. 

Celiac Disease Definition, sign and symptoms, Diagnosis and managment

 


Celiac disease also known as gluten eteropathy. 

DEFINITION 

                      It is an allergic condition. The patient is allergy to gluten protein.

● This protein found in BROW (Barely Raee Oat Wheat).

● When patient ingest these food particles then it enter in small intestine and it cause damage to intestinal villi.

In this Disease food absorption is disturbed due damage of villi.

● In this condition the level of glutamine amino acid is increased in the body and it cause severe toxic effects.

SIGN and SYMPTOMS 

1- Dirrhoea 

2- Abdominal distention 

3- Growth Retardation

4- Muscle Wasting 

5- Anorexia 

DIAGNOSIS 

■ Endoscopy

■Allergic test

MANAGEMENT 

●Avoid the gluten protein for lifetime. Rice and millett can be used lifelong. 

●Advice the family member to check the ingredients when the packets of food particles are bought. 

FOOD ALLOWED 

▪︎Rice,millett,milk and milk products, All the fruits and vegetables, Eggs,meat and fish.

FOOD NOT ALLOWED 

▪︎Barely,Raee,Oat,Wheat,Biscuit, Bear,Bread,Noodles, Cookies.