September 2020 ~ Medical diseases and trems ,symptoms causes TREATMENT

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HEMOPHILIA ETIOLOGY DEFINATION TYPES CLINICAL MANIFESTATION DIAGNOSIS MANAGMENT



HEMOPHILIA

        Hemophilia is a sex link inheritance disorder characterised by prolong bleeding after a cut or injury .

It also known as "Royal disorder".

ETIOLOGY 

      It is a sex link inheritance disorder .

     The defective gene of hemophilia are found upon X chromosome.

TYPES

1. HEMOPHILIA A → [CLASSICAL HEMOPHILIA]

                   * Most common type occur due to the deficiency of factor number VIII .

2. HEMOPHILIA B [CHRISMIS DISEASE]→

            * It occur due to the deficiency of factor IX .

3. HEMOPHILIA C

        * It occur due to the deficiency of factor XI .

CLINICAL MANIFESTATION

   * Prolong bleeding after a cut or injury .

   * epistaxis .

   * Risk of intra cranial hemorrhage .

   * joint bleeding risk of joint damage .

DIAGNOSIS 

      *   Bleeding time  Normal  .

      *  Clotting time increase .

      * APTT Increased [diagnosis of choice ]

MANAGEMENT 

   Advise → *  Avoid himself from injury 

                    * Avoid the out door game .

                    * If injury occur then tight bandage has been done and ice application done.

EMERGENCY MANAGEMENT  →

                                                  *   Administer FFP.

                                                  * Administer  Desmopressin  - it is drug of choice.

                                                  * Administer concentrat factor VIII /IX .


VITAMIN B12 // ABSORPTION // TEST // FUNCTION



VITAMIN B12

     * It also known as cyanocobalamin / Anti pernicious anemia factor.

     * Discovered by karl august folkers and shoaib in 1948 .

     * This is the last discovered vitamin .

     * Normal serum B12 level is 200-900 pg/ml .

     * It is a cobalt containing vitamin .

     * It synthesis by large intestinal flora lactobacillus .

     * It store in liver [4-5 mg] which sufficient for 2-3 year.

ABSORPTION

          Absorption of vitamin b12 in terminal part of ilium in the presence of intrinsic factor which secret from gastric parietal cells of stomach .

TEST 

        For vitamin B12 absorption test is schilling test.

FUNCTION 

    ** Essential for maturation of RBC in bone marrow .

     * Help in formation of WBC ,AND Platelet .

    ** Help in synthesis of DNA .

      * Act as co enzyme in synthesis of methionine .

     * Help in myelin sheath of neuron .

SOURCES

   * Colonic flora .

   * Vitamin B12 not found in plant sources or more chances of deficiency in strict vegetarian or person who depend upon vegan diet .

  * Animal diet sources →  Milk, meat ,fish ,egg ,cord liver oil [good sources].

Recommended Dietary Allowance

  * Infant 0.2 mcg/day.

  * child 0.5 to 1 mcg/day .

  * Early adolescent  13-15 year 0.5 to 1mcg/day.

  * Adult male and female 1 mcg/day.

  * Pregnancy 4 mcg /day.

  * Lactation 3 mcg /day.

DEFICIENCY

   * Pernicious anemia.


INTRA CREANIAL PRESSURE // ICP /ETIOLOGY / ASSESMENT FINDING /DIAGNOSIS/ MANEGMENT / AND NURSING MANAGMENT



 DEFINATION 

    INCREASE ICP 

          Normal ICP 5-15 mmhg.

          If the ICP  is more then 15 mmhg it indicate increase ICP.

ETIOLOGY 

      -Tumor .

      - trauma [ hematoma formation ] .

      - Hydrocephalus 

      - Meningitis .

      - Encephalitis .

      - Hyponatremia [it will cause cerebral edema]

ASSESMENT FINDING  

 *   The earliest symptom is altered level of consciousness .

 *   Headache .

projectile vomiting 

change in the vital sign 

     - hyperthermia 

     - cushing triad   - systolic BP increase , bradycardia , impaired respiration increase .

Late sign  -Seizure ,ataxia 

DIAGNOSIS 

  Physical examination 

  ventriculostomy 

MANAGMENT 

   MADICAL MANAGMENT 

          INJ. Mannitol and Acetazolamide . 

    * the diuretic therapy is provided to decrease the ICP.

SURGICAL MANAGMENT 

   The craniotomy is performed .

   * The opening of the craniotomy is called Burrholle .

   * Tumor remove can be done .

   * VP shunting procedure can be done.

NURSING MANAGMENT 

    * Provide semi fowler's position .

    * The head should be neutral position .

    * Hyperventilation the pt to decrease the PCO2 level in the blood .

    * the excessive PCO2 will cause cerebral vessels dilation and it causes increase blood accumulation in the brain so it cause increase ICP.

HYPOPARATHYRODISM , DEFINETION , ETIOLOGY , ASSESMENT FINDING ,DIAGNOSIS, MANAGMEMT



 DEFINETION

                     In this condition the level of Parathyroid hormone become decreased 

ETIOLOGY 

            1. Trauma 

            2. Suppressing tumor .

            3. Parathyroidectomy .

            4. Accidental removal of parathyroid gland during thyroidectomy,

ASSESMENT FINDING 

     * Due to decrease parathyroid hormone the serum calcium level become decrease.

     * Hypocalcemia occur and this hypocalcemia produce different symptom such as...

            - Bradycardia 

            - Hypotension 

            - Nerve transmission become irritate 

            - Tetany [hypertonic muscles construction occurs when serum calcium level more then 6 mg/dl]

            - tingling around the mouth and in the extremities

            - diarrhea 

        * Sign of hypocalcemia 

             1. CHOVISTIC SIGN 

                                         When the facial nerve is stimulated by taping at angle of mouth near the ear then the response is twisting in the facial muscles .

           2. TROSSEU'S SIGN 

                                       A blood pressure cuff is applied on the arm then it is inflated upto systolic BP     + 20 mm of hg . Now it should remain inflated for 3 minute . The response is charbopadal spasm [a spasm in the wrist and hand ],

         3. ERB'S SIGN / ERB'S WESTEPHAL SIGN 

                       When miner electrical stimulation is provided to the skeletal muscles then the response is spasmodic muscles contraction .

DIAGNOSIS

           *A diagnosis of hypoparathyroidism is made based upon identification of characteristic symptoms, a detailed patient history, a thorough clinical evaluation and a variety of specialized tests. Blood tests can reveal abnormal levels of calcium, phosphorus, magnesium, creatinine and intact parathyroid hormone. Urine tests can reveal if the body is excreting too much calcium. 

          

MANAGMENT 

      * HRT should be provided .

      * The tracheostomy set should be always available at bed side .

     * In emergency condition inj. calcium gluconate can be administration by IV route [10 ml 10% over 10 minute .

     * Provide high calcium diet . 


VITAMIN B 9 // DEFINETION // FUNCTION // SOURCES // DEFICIENCY



 VITAMIN B9 

                   * Scientific Name of vitamin B9 is folic acid / folate.

                   * The world folate derived from latin word folium .Which mean 'leaf '.

                   * Discovered by esnell and Rogor willium in 1941.

  * serum vitamin B9 level is 2-20 ng/ml'

  * color is yellow .

  * Two type of folic acid in blood 

          1. Free folate {FH3} [trihydrofolate].

          2. Bound folate {FH4}  [Tetra hydrofolate].

   * Activated form of folic acid is tetra hydrofolate.

FUNCTION OF FOLIC ACID/ VITAMIN B9
   
    * Essential for maturation of RBC in bone marrow .
    * Help in synthesis of DNA.
    * Act as co-enzyme in synthesis of methionin

SOURCES OF VITAMIN B9

  * ANIMAL SOURCES →  Milk, meat , fish, egg
  * Plant sour   →  Green leafy vegetable are good sources , fruits , cereals, pulses, soyabeen 

RECOMMENDED DIETARY ALLOWANCE 

   Infant  →  25mcg/day 
  child 1-12 year  →  50 to 100mcg /day 
          13 to 15 year  → 50to 100 mcg /day
let adolescent 16 to 18 year and adult male and female  → 100 mcg /day 
IN pregnancy  → 400 mcg/day 
IN lactation  → 300 mcg/day .

DEFICIENCY OF VITAMIN 

    Most common vitamin B9 deficiency during pregnancy .
   Deficiency of folic acid cause MEGALOBLASTIC ANEMIA.
   Deficiency of folic acid during pregnancy cause NURAL TUBE DIFECT           


SCHIZOPHRENIA DEFINATION CAUSE ,SIGN AND SYMPTOM MANAGMENT/TREATMENT



DEFINATION
⮚ ACCORRDING TO AMERICAN ASSOCIATIN 
                                                  ''Schizophrenia is not a disorder it is a syndrome characterized by major                                   impairment in behavior ,affect and thought''.
                                                  "the behavior of the patient with schizophrenia may be regressive, withdrawal , paranoid , aggressive and stupor".

ETIOLOGY
                      1. BIOLOGYCAL AND PHYSIOLOGICAL
                                   A. FAMILY HISTORY 
                                                                          It is dominant risk factor for mental disorder .
                                                            eg. The risk of schizophrenia is 40% in children if both parents are schizophrenia ,the risk of schizophrenia is 10% in children if one parent is schizophrenia.
                                   B. CONSTITUTIONAL FACTOR
                                                                        According to body personality .eg. Anxious personality in                                                                            GAD.
                                   C. PHYSICAL DEPRIVATION 
                                                                      Unable to achieve the basic life need eg. food cloth shelter.
                                   D. PHYSICAL HANDICAPED 
                                                                       Eg. deafness ,blind, physical disability .
                      2. PSYCHOSOCIAL FACTOR
                                                 1.MATERNAL DEPRIVATION → Death of mother after child birth.
                                                 2. pathological family pattern → Abnormal atmosphere in family 
                                                 3. Stress → It is circumstance which put the individual from comfort                                                                             zone to uncomfort zone .
                      3. SOCIO CULTURAL FACTOR 
                                            War and violence , economical and employment problem , social and                                         technology change. 
                      4.OTHER FACTOR 
                                            * Neurotransmitter imbalance.
                                            * psychoactive substance abuse disorder.
                                            * age group 25-40 year more common .
                                            * sex ratio male>female .
                                            * marital status unmarried>married 
                                            * socio economical status more common in low socio economic status.
TYPES OF SCHIZOPHRENIA
              1.SIMPLE SCHIZOPHRENIA
                                            * It is more common in young age group [17 year].
                                            * The behavior of pt. become withdrawal .
                                            * ECT is not effective. 
                                            * prognosis is poor .
              2.HEBEPHRENIC SCHIZOPHRENIYA 
                                            * It is common in 30to 40 year age group .
                                            * the behavior of pt. become Regressive or childish or silly behavior .
                                            * ECT is not effective .
                                            * Also known as DISORGANISED SCHIZOPHRENIA.
                                            *Poor prognosis.
             3. PARANOID SCHIZOPHRENIA 
                                             * Delusion of persecution is most dominant feature of schizophrenia .
                                             * It is common in 30 to 40 year of age group .
                                             * the behavior of pt. become persecutory or  paranoid .
                                             * ECT is effective .
                                             * prognosis is good .
                                             * It is a commonest type of schizo.
            4. CATATONIC SCHIZOPHRENIA
                                             * It is common in 25 to 40 year of age group.
                                             * The behavior of  pt. become aggressive or stupor .
                                             * THE ECT IS BEST EFFECTIV .
                                             * Best prognosis .
                                             * the catatonic schizophrenia have two form 
                                                                1.Catatonic excitement → The patient behavior like wild                                                              animal . The patient become dangerous to self or other .
                                                                 2. Catatonic stupor → The pt. become mute and motion less.
SIGN AND SYMPTOM 
     1.ACCORDING TO EUGEN BLEURER
      A. PRIMARY SYMPTOMS 
                                    a. Autism b. associative looseness c. affect inappropre d. Ambivalence
      B. SECONDORY SYMPTOM OR ASSESSORY SYMPTOM
                 These symptom may or may not present in schizo.
                  - poor personal hygiene 
                  - AUDITORY HALLUCINATION PRESENT
                  - insight is absent 
                  - cataplexy, mannerism, negativism, compulsion .
                  - thought blocking, preservation , incohorence.
                  -stupor 
        2. ACCORDING TO RECENT CONCEPT 
              A. POSITIVE SYMPTOM 
                    - Hallucination , aggression, delusion, violence, flight of ideas, cercumstantiality
                       - these symptom are treated by HELOPERIDOLE OR CPZ [TIPICAL                                               ANTIPSYCHOTIC]
             B. NEGATIVE SYMPTOM 
                        It is a deficit behavior .
                     - stupor, thought retardation, blunt effect, flat effect, apathy.
                these symptom are treated by OLENZEPINE, RESPERIDONE [ATIPICAL                                             ANTIPSYCHOTIC]

DIAGNOSIS
               - Physical examination 
               - history
               - mental status examination 
MANAGMENT
             1. ECT
             2. PSYCHOPHARMACOLOGY
                     Tab. Olanzapine , risperidone, CPZ,HELOPERIDOLE
                     Tab. TRIHEXYPHENIDYLE HCL
                     Tab. LORAZEPAM 
             3. PSYCHOTHERAPY 
                      A. Surface psychotherapy 
                      B. Conditional psychotherapy
                      C. Family therapy 
                      D. Group therapy 
                      E. Other psychotherapy



LACTOSE INTOLERANCE CAUSE, SYMPTOM, DIAGNOSIS/TEST, TREATMENT



DEFINESION 

                          Inability to digest lactose carbohydrate due to deficiency or absence of lactase enzyme is             called lactose intolerance .

LACTOSE

                      It is a disaccharide that present in milk and milk product .

        lactose   -  LACTASE ENZYME IN SMALL INTESTINE   glucose + galactose .

       * In case of lactose intolerance- small intestine enzyme is absente → Undigested lactose NORMAL FLORA IN LARGE INTESTINE  fermentation of lactose 1.Excessive gas formation  2. severe watery                                                                                                                                                     diarrhea .

SIGN AND SYMPTOME 

                     * Abdominal pain .

                     * Abdominal distention.   

                     * SEVERE WATERY DIRRHEA .

                     * Dehydration  and electrolyte imbalance .

DIAGNOSIS 

               Lactose tolerance test   

                                                    - Keep the patient NPO for 4-6 hour   

                                                    - Check the fasting sugar level 

                                                    - Administer lactose 2 gm/kg body weight by oral route .

                                                   - Check the blood sugar level after 1to 2 hour .

                        Result  →     NAGATIVE 

                                                                   The increment in blood sugar level is more then 20 mg/dl. it                                               indicate normal finding .

                                           POSITIVE → 

                                                                    The increment in blood sugar level less then 20 mg/dl .  it                                                          indicate lactose intolerance .

MANAGMENT 

                - Supplement the lactase enzyme with milk and milk products .

                - avoid the milk and milk product to prevent the symptom .

                - limit the consumption of milk at one time .

                - provide calcium supplement to prevent calcium deficiency .