February 2021 ~ Medical diseases and trems ,symptoms causes TREATMENT

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FOETAL ALCOHOL SYNDROME SIGN AND SYMPTOM , TREATMENT

                    FOETAL ALCOHOL SYNDROME
 

        This condition develop in the foetus when mother uses alcohol during pregnancy .
    Alcohol is a teratogenic substance . It can cross placenta and produced defect in the organ formation of the foetus.
SIGN AND SYMPTOM
         * Facial structure abnormality 
                  - Short palpebral fisher.
                  - Thin upper lip 
                  - Low nasal septum 
                  - Short upturned nose 
                  - Hypoplastic philtrum.
          * Chances of congestive heart failure.
          * Respiratory distress.
          * Excessive cry 
          * Seizure due to alcohol withdrawal.
TREATMENT
    * Continuously Monitor the respiratory status of the neonate.
     *  Maintain patent air way.
     *  Prevent injury during seizure { First priority in seizure }
     *  Drug of choice for alcohol withdrawal symptom is CLORDIZAPOXIDE

INTESTINAL OBSTRUCTION , TYPES , CAUSES, SIGN AND SYMPTOM, DIAGNOSIS, COMPLICATION, TREATMENT

                             INTESTINAL   OBSTRUCTION



            It is define as occlusion to the forward flow of intestinal , the common obstruction occur in ilium.

TYPES AND CAUSES OF INTESTINAL OBSTRUCTION 

      1. Mechanical intestinal obstruction

              * Adhesion most common cause .

              * Volvulus- twisting of intestine .

              * intussusception.

              * Hernia.

              * Intestinal tumour.

              * Ulcerative colitis

              * Food blockage

        2. Neurogenic intestinal obstruction

            This condition developed after the abdominal surgery due to nerve damage. It also known as Paralytic ileus.

        3. Strangulated Intestinal obstruction 

             * This condition occur due to blockage into Mesenteric artery by thrombus.

             * The condition developed suddenly the condition is characterised by acute abdominal pain , abdominal distention and vomiting.

             * The condition should be treated immediately by the use of thrombolytic drugs.

 SIGN AND SYMPTOM

       * Abdominal distention - dominant feature 

       * Severe vomiting 

       * A constant desire to defecate 

       * The patient is unable to passed stool or flatus.

       * Fluid electrolyte imbalance.

       * Fluid volume deficient.

Common complication

     * Hypovolemic shock { most important }

     * Intestinal perforation 

DIAGNOSIS

      * History.

      * Physical examination 

                          - sign of dehydration , hypotension , tachycardia, tachypnoea.

      * USG,CT Scan, MRI.

      * CBC{ PCV Increase}

      * Barium meal and enema is contraindicated.

TREATMENT

        Emergency care

                     * Nil by mouth.

                     * Monitor intake and output and vital monitor.

                     * Monitor PCV and Serum electrolyte

                     * Enema , barium and hot application are contraindication in intestinal                                      obstruction.

                     * There is no medical management of intestinal obstruction, there is only                                   surgical management.

                     * Bowel resection 

    Nursing priority monitoring

             * Fluid volume deficiency.

             * Altered Nutrition less then body requirement.

             * Anxiety.

AMNIOTIC FLUID function amount disorders

                         AMNIOTIC FLUID



                  Amniotic fluid is the protective liquid contained by amniotic sac of gravid amniote. This fluid serves as a cushion for the growing fetus, but also serves to facilitated the exchange the nutrients, water and biochemical products between mother and fetus.

    Initially amniotic fluid is develop by placenta and umbilical cord by the principle of transudate . 

    At the term maximum contribution in amniotic fluid formation given by fetus Urine.

Amniotic fluid amount manage by following -

       * Fetal swallowing - 200 - 500 ml.

       * Urine - 400 - 1200 ml 

       * Pulmonary secretion  300 - 400 ml.

       * Fetal cell contribution up to 20 week .

The amount of amniotic fluid and fetal growth response each other .

      ⮞  12Week                 -       50 ml

      ⮞  16 week                 -       100ml 

      ⮞  20 week                 -       200 ml

     ⮞   36 - 38 week          -       800-1200 ml

     ⮞   40 week                 -       600- 800 ml

     ⮞   42 week                 -       200 ml

Near term and after the term period the amount become decrease, which is related to fetus maturity .

* Ideally amniotic fluid is Isotonic in nature , After the term period it become hypotonic in nature .

COMPOSITION

      Amniotic fluid other content 

      - Urea , uric acid ,creatinine 

      - Amino acid , glucose , fatty acid 

      - Mineral , vitamin , electrolyte 

      - Chromosome , surfactant

      - Meconium ,lanugo , vernix

Nature of fluid

      * Colour less

      * Transparent 

      * Amber 

      * Turbid

      * Pale

PHYSICAL PROPERTIES

     * The Ph of amniotic fluid is 7.2.

     * Normally the fluid is colour less.

Abnormalities of amniotic fluid-

        1. Greenies 

                            Meconium may induce fetal distress 

       2. RED

                        Haemorrhage

        3. Golden colour

                       Indicate haemolysis example - Rh incompatibility

        4. Greenies yellow / Saffron colour

                       Indicate post maturity

PRETERM LABOUR CAUSES SIGN AND SYMPTOME TREATMENT

                                        PRETERM LABOUR



The character of labour present between 22 to 37 week of gestation .

CAUSES

             Maximum case are Idiopathic .

             Most common cause is infection eg. Chorioamnionitis 

   Other causes-

              Maternal severe disease 

              fetal big size or early maturity 

              placenta previa or Abruptio placenta.

SIGN AND SYMPTOMS

Signs and symptoms of preterm labor include:

  • Regular or frequent sensations of abdominal tightening (contractions)
  • Constant low, dull backache
  • A sensation of pelvic or lower abdominal pressure
  • Mild abdominal cramps
  • Vaginal spotting or light bleeding
  • Preterm rupture of membranes — in a gush or a continuous trickle of fluid after the membrane around the baby breaks or tears
  • A change in type of vaginal discharge — watery, mucus-like or bloody

 WHO GUIDELINE MANAGEMENT 

     * Administration of steroid.

     * Transfer the mother into hospital or delivery room .

     * Tocolytics drug 

     * Calcium channel blocker 

     * Prepare for delivery 

     * IV fluid and antibiotics

DOC FOR PRETERM LABOUR

                     BETAMETHASONE

DOC FOR INHIBITE PRETERM LABOURE

                                TOCOLITIC DRUGS.       

what is hyper emesis gravidarum, risk factor ,symptom, complication , treatment

                       HYPER EMESIS GRAVIDARUM



         Excessive vomiting enough to disturb activity of daily living .

RISK FACTOR

                     * Most common reason Human chorionic gonadotropin { HCG}

                     * Primipara

                     * Molar pregnancy 

                       * Empty stomach 

                     * Allergy 

                     * Smell

                     * Vitamin B and C deficiency.

SIGN AND SYMPTOM

          INITIAL- 

                       - No dehydration 

                      - vital normal

                      - shock absent 

                      - Metabolic alkalosis.

        LATE- 

                  - Dehydration

                  - hypotension 

                  - Tachycardia   

                  - Shock

                  - Metabolic acidosis

COMPLICATION

              - Vitamin B deficiency

              - Berry berry disease

              - Dry or wet vernix encephalopathy

              - Korotkoff psychosis

TREATMENT

           Definitive intervention is fluid volume replacement .{3000ml + vomiting amount----  1.5 litre dextrose + 1.5 litre NS/RL}

        * INJ. ONDASTRONE IS EFFECTIVE

        * INJ. Hydrocortisone to improve pulmonary function 

        * 

Gestational Diabetic Mellitus risk factor definition causes treatment

                     GESTATIONAL DIABETIC MELLITUS



     It characterised by hypo glycemia . GDM is neither Insulin dependent diabetes mellitus nor non Insulin dependent diabetes mellitus. Blood glucose level is 95 to 200 mg/dl . In overt diabetes 128 to 200 mg/dl.

RISK FACTOR

   * In previous pregnancy history of diabetes.

   * Big Size baby .

   * Cesarean  delivery .

   *  Dead fetus delivery .

   * In present delivery pregnancy polyhydramnios or gestational infection.

   * Risk of GDM present in 2nd and 3rd trimester .

   * Ideal time to assessment is 24 to 28 week of gestation 

   * For high risk mother assessment timing is 8 to 12 week of gestation .

 Investigation 

          Best assessment method is glucose tolerance test and fasting blood sugar test.

        * The disease complicated into labour and delivery.

Intervention

      *   Diet is the best method to control diabetes .{ 50% of carbohydrate  30% of protein, 20% of fat}.

      *  Exercise - Ideal exercise for pregnancy is swimming .

                        - other are walking and jogging .

      *  Oral drug are contraindicated .

      * management is done with or without insulin , only short acting insulin should be recommended .eg 180-220 mg/dl     - 1 unit 

                              220- 260 mg/dl    - 2 unit

                             >  260 mg/dl         - 3 unit

     * During labour use the principle of neutralization.

COMPLICATION

     METERNAL COMPLICATION

                 * Hypertension , preterm labour, prolong and obstructed labour , malpresentation, Polyhydramnios , Antepartum haemorrhage , Postpartum haemorrhage, Diabetic neuropathy, Retinopathy.

  FETAL COMPLICATION

                    * Macrosomia 

                    * Prematurity 

                    * Respiratory distress syndrome

                    * Birth injury 

                    * Intra uterine death

                    * still birth 

                    * Neonatal hypo glycemia 

Eclampsia definition causes sign and symptom diagnosis treatment

                                               ECLAMPSIA



  It Define as Pre eclampsia + convulsion , acute in nature { sudden severe }, also refer as ''sudden flash of lighting''.

 Eclampsia present in intrapartum , antepartum , and postpartum. During postpartum risk of convulsion present up to 48 hours.

ECLAMPSIA CONVULSION -

   1. Pre monitoring -

                        * Stage of invasion / Aura .

                        * 30 second stage.

                        * It involve changes in three area 

                                    - Loss of consciousness 

                                    - Eye ball fixation 

                                    - Muscles twisting start.

  2. Tonic

             * 15 to 20 second.

             * It is a stage of contraction characterised by 

                    - Total body spasm

                    - Fist formation 

                    - Respiration cessation 

                    - Cyanosis appear 

                    - Titanic contraction 

                    - Opisthotonos position 

                    - Tongue between teeth 

 3. Clonic 

              * 1 to 4 minute stage

              * It is actual stage of convulsion .

              *Maximum duration stage .

              * characterised by rapid body movement .

              * Respiration start .

              * cyanosis disappear .

              * Tongue biting , frothy saliva .

  4. Coma / Deep sleep

                 For short duration .

Priority Intervention -

     * Call for help is first priority.

     * Injury prevention / bed side railing .

    * Maintain open air way .

    * oxygen administration .

    * Suctioning if require .

    * Magnesium sulfate  administration .

General Intervention 

   * Fluid of choice RL.

           { amount of urine + 1 liter / maximum amount 2 liter}

    * Cocktail method - it is combination of 2 or more drugs .

    * Magnesium sulfate is the drug of choice in eclampsia .

   * It is a muscles relaxant work against calcium.

   * General effect following - Vasodilator , Anti convulsant , Flushing of face , Hypotension 

   * The most important assessment during mgso4 therapy is Respiratory rate.

   * First symptom of MgSo4 toxicity is loss of patellar reflex.

   * Antidot of MgSo4 is calcium gluconate .

DOSE 

                           INTRAMUSCULAR                                                INTRAVAINOUS

                                        🠟                                                                                  🠟

 Loading dose-    4 gm Iv  + 10gm{5gm+5gm}IM=14gm       4 to 6 gm/ hour

Maintenance dose- 5 gm /4hourly                                             1 to 2 gm/hour

WHAT IS HYPERTENSIVE PREGNANCY causes types

                            HYPERTENSIVE PREGNANCY



      In the pregnancy induced hypertension manly involve blood vessels and basic reaction is vasoconstriction.

  VESSELS 🠊     Vasoconstriction

                                       🠟

     Weak {Mild}                                                     Damage{Severe}

       🠟                                                                 🠟

Water + Protein                                 Water + Protein + RBC

       🠟                                                                  🠟

Edema                                                       Edema increase + Haemorrhage

Hypertension involve following conditions

        1. Chronic hypertension

                                            HTN present before the pregnancy and also available in present pregnancy . Main character is no protein urea.

       2. Pregnancy induced hypertension 

                                             It develop after 20 weak of gestation involve following-

      A. Gestational HTN -  HTN without protein urea.

      B. PRE ECLAMPSIA - Gestation + protein urea.

     B. ECLAMPSIA -  Preeclampsia + convulsion .

     D. SUPER IMPOSE - Chronic HTN + Gastational  HTN + Preeclampsia+ Eclampsia 

*  https://www.medieducator.com/2021/02/eclampsia-definition-causes-sign-and.html

https://www.medieducator.com/2020/12/pre-eclampsia-causes-sign-and-symptom.html