Human Diseases HSM 380 McNeese

CIRCULATORY FUNCTION

Cardiac cycle The heart's steady beating pumps about 5 quarts of blood every minute in an adult Comprises a network of vessels Arteries Veins Capillaries CIRCULATORY FUNCTION (cont.) The heart consists of two side-by-side pumps Two upper chambers called atria Two lower chambers called ventricles Venous blood returns back to the heart from the body and enters the right atrium Blood passes through the tricuspid valve and enter the right ventricle heart valves prevent the blood form flowing backward From the right ventricle blood is pumped through the pulmonary valve then into the pulmonary arteries then into the lungs In the lungs, carbon dioxide is removed and oxygen is added to the blood Oxygenated blood returns to the heart via pulmonary veins then enters the left atrium From the left atrium blood is moved through mitral (bicuspid) valve and into the left ventricle From the left ventricle blood goes to the aortic valve then into the aorta then to the body CIRCULATORY FUNCTION (cont.) Blood Flow Right atrium Tricuspid valve Right ventricle Pulmonary valve Pulmonary arteries Lungs Pulmonary veins Heart Left atrium Mitral valve Left ventricle Aortic valve Aorta Body CIRCULATORY FUNCTION (cont.) Heart Enclosed by the double-layered pericardium Between these layers in the pericardial cavity is serous fluid that reduces friction during cardiac movement Myocardium is cardiac muscle tissue (middle layer) Inside the cavities of the heart is a smooth serous lining called the endocardium Layers of the Heart Important Symptoms with Cardiovascular Disease Chest pain Tachycardia (fast heartbeat) Bradycardia (slow heartbeat) Dyspnea (difficulty breathing) on exertion Tachypnea (rapid breathing) Palpitations (rapid fluttering of the heart Cyanosis (slight blue color) Edema Fatigue Syncope (fainting) Coronary Artery Disease (CAD) Coronary arteries become narrowed by atherosclerotic deposits over time causing cardiac ischemia and eventually an MI (heart attack) S/S Initially asymptomatic Pain of the angina pectoris Severe pain of an MI burning, squeezing, crushing, and radiating to the arm, neck, or jaw nausea, vomiting, weakness changes in electrocardiogram (ECG) CAD (cont.) Etiology-atherosclerosis is associated with the elderly and diabetics Genetic disposition Older than age 40 Male Postmenopausal women Caucasians Smoking Residence in urban society Presence of hypertension, diabetes, obesity, or elevated serum cholesterol levels Lack of exercise Stress CAD (cont.) Diagnosis EKG-shows ischemia and possible arrhythmias Stress test (treadmill) CT scans Echocardiograms Cardiac catheterization Coronary angiogram Treatment Coronary angiogram w/angioplasty (balloon or stenting) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin receptor blockers (ARBS) Calcium channel blockers (CCB's) Beta blockers Thiazide diuretics Vasodilators Anticoagulants CAD (cont.) Patient teaching Low fat diet Weight control Exercise Cessation of smoking Stress Test Heart Cath Angina Pectoris Chest pain due to ischemia during or shortly after exertion. It is the result of decreased oxygen supply to the myocardium S/S: sudden onset of left sided chest pain, pain usually relieved by ceasing activity or by nitroglycerin tablets under the tongue or spray Etiology: atherosclerosis, coronary artery spasms Angina Pectoris (cont.) Diagnosis: patient history, ECG, (those described for CAD) Treatment cessation of strenuous activity, placing nitroglycerin tablets under the tongue (sublingual) transdermal nitroglycerin when it persists after treatment or after 20 minutes seek immediate medical attention Patient teaching carry nitroglycerin with them at all times do not expose nitro tablets to light or air...nitro should be stored in the original light-resistant bottle with a cap Myocardial Infarction (MI) Death of myocardial tissue caused by ischemia S/S severe substernal of left sided chest pain feeling of massive constriction of the chest may be burning or crushing may radiate to the left or right arm, back or jaw not relieved by nitroglycerin irregular heartbeat diaphoresis dyspnea severe anxiety nausea feeling of impending doom MI (cont.) Etiology: coronary artery is occluded by a thrombus, atherosclerotic plaque, or myocardial muscle spasm Diagnosis patient history ECG chest radiographic studies laboratory tests for cardiac enzymes creatinine phosphokinase (CPK) and troponin lactate dehydrogenase (LDH) aspartate aminotransferase (AST) MI (cont.) Prevention Exercise Low fat, cholesterol, and salt diet Control of hypertension Weight loss Smoking cessation Those who have survived an MI are advised to take aspirin and a beta blocker or ACE inhibitor for life Treatment Oxygen Aspirin Nitroglycerin drip Lidocaine or Amiodorone Thrombolytics Angioplasty (to open occlusion) MI (cont.) Cardiac Arrest Sudden, unexpected cessation of cardiac activity S/S: the person is unresponsive with no respiratory effort and no pulse Patient screening: immediate CPR and defibrillation with an AED Etiology: respiratory arrest, arrhythmia, MI, electrocution, drowning, severe trauma, massive hemorrhage, drug overdose Diagnosis: absence of respiratory effort and no pulse, ECG may show ventricular fibrillation or asystole Treatment: CPR within 4-6 minutes, AED, ambulance or other trained personnel may administer drugs such as epinephrine, dobutamine, lidocaine or amiodorone Essential Hypertension (HTN) Abnormally high blood pressure in the arterial system S/S: headaches, epistaxis, syncope, usually no symptoms-generally detected during a physical exam or during an appointment for a headache Etiology: Unknown Diagnosis: Systolic reading greater that 140mm Hg and a diastolic reading of greater than 90mm Hg, based on a series of blood pressure readings, medical history, physical exam Essential Hypertension (cont.) Risk factors: stress, age, heredity, smoking, obesity, sedentary lifestyle, poor dietary habits, hyperactive personality or type A personality Treatment Diuretics (to reduce circulating blood volume) ACE inhibitors (to produce vasodilation and to increase renal blood flow) ARBs Vasodilators (to dilate vessels) CCBs (to slow the heartbeat, to reduce conduction irritability, and to dilate vessels) Malignant Hypertension (HTN) Life threatening severe form of hypertension S/S: severe headache, blurred vision, dyspnea Etiology: Unknown Diagnosis: notable elevated blood pressure (systolic greater than 200mm Hg, and diastolic greater than 120mm Hg) Treatment: IV vasodilators Patient teaching: low fat, cholesterol and sodium diet Congestive Heart Failure (CHF) Acute or chronic inability of the heart to pump enough blood throughout the body to meet the demands of homeostasis S/S: dyspnea, anxiety, tachypnea, tachycardia, neck vein distension, edema in the ankles Right sided heart failure-liver and spleen enlargement, peripheral edema Left sided heart failure-pulmonary congestion, respiratory difficulties CHF (cont.) Etiology: MI, HTN, CAD, COPD, cardiac valve damage, arrhythmias, cardiomyopathy Diagnosis: patient history, physical exam, radiographic chest films, ECG, echocardiogram Treatment: ACE inhibitors, ARB's, diuretics, vasodilators, aldosterone antagonists, digoxin, fluid and sodium restriction, pacemakers, defibrillators, heart transplant Patient teaching: compliance with medications, low salt diet, monitor weight daily, modify activities to allow rest and avoid fatigue CHF (cont.) CHF (cont.) Cor Pulmonale Also known as right sided heart disease, results in enlargement of the right ventricle secondary to lung disease S/S: dyspnea, distended neck veins, edema of thx extremities, enlarged and tender liver Etiology: chronic pulmonary disease (emphysema, pulmonary lesion, pulmonary emboli) Diagnosis: patient history of pulmonary disease and hypoxia, presence of neck vein distention and peripheral edema Treatment: bronchodilators, oxygen, bedrest, digitalis preparations, diuretics, anticoagulants, phlebotomy, low salt diet Pulmonary Edema Fluid shift into the extravascular spaces of the lungs S/S dyspnea coughing orthopnea tachycardia tachypnea bloody frothy sputum low blood pressure cold clammy skin symptoms occur at night after the person lies down Etiology: left sided heart failure, mitral valve disease, pulmonary embolus, HTN, arrhythmias, renal failure, head trauma, drug overdose, exposure to high altitudes Pulmonary Edema (cont.) Treatment Placed in Fowlers position Oxygen Drug Therapy (diuretics, IV vasodilators, morphine sulfate, beta adrenergic drugs) Diagnosis clinical picture of dyspnea, orthopnea and bloody frothy sputum leads to diagnosis presence of diminished breath sounds with rales, rhonchi, and wheezing ABG shows decreased oxygen, increased carbon dioxide, increased bicarbonate levels and decreased blood pH radiographic chest films Pulmonary Edema (cont.) Cardiomyopathy Noninflammatory disease of the cardiac muscle causing enlargement of the myocardium and ventricular dysfunction S/S: symptoms of CHF (dyspnea, fatigue, tachycardia, palpitations, occasional chest pain, peripheral edema), syncope, murmurs Etiology: Unknown Dilated-degeneration of myocardial fibers (chronic alcoholism, autoimmune process, viral infections) Hypertrophic-left ventricular hypertrophies (genetic) Restricive-thickening of the myocardium and stiffness of the ventricles Cardiomyopathy (cont.) Cardiomyopathy Diagnosis: patient history, physical exam, radiographic chest films, ECG, echocardiogram, cardiac catheterization Treatment Therapy (dilated cardiomyopathies) Antiarrhythmic agents, digitalis, and anticoagulant drugs Limited activities Bed rest Beta-adrenergic blockers ACE inhibitors CCB's Pericarditis Acute or chronic inflammation of the pericardium S/S: fever, malaise, chest pain, dyspnea, chills, anxious, reports a pounding heart, detectable grating sound or friction rub with the heartbeat can be heard with the stethoscope, tachycardia Etiology: inflammation of infection somewhere in the body Diagnosis: elevated WBC, elevated erythrocyte sedimentation rate (ESR), elevated cardiac enzymes, ECG, echocardiogram Pericarditis (cont.) Treatment Therapy Surgical drainage and aspiration Bed rest Analgesics Antipyretics Nonsteroidal antiinflammatory drugs (NSAIDs) Corticosteroids Pericarditis (cont.) Endocarditis Inflammation of the lining and valves of the heart S/S Fever Chills Night sweats Weakness Anorexia Fatigue Endocarditis (cont.) Etiology Bacteremia Staphylococcus aureus Group A -hemolytic streptococci Escherichia coli Diagnosis: CBC, ECG, echocardiogram, blood cultures Treatment: IV antibiotics for several weeks, bedrest, surgery for any damaged valves, antipyretics, anticoagulants Prevention: must take prophylactic antibiotics before dental work, childbirth, invasive procedures Endocarditis (cont.) Mitral Stenosis Hardening of the cusps of the mitral valve that prevents a complete and normal opening for the passage of blood from the left atrium into the left ventricle S/S Dyspnea Fatigue Cough Palpitations followed by hemoptysis Cyanosis in severe cases Etiology: rheumatic heart disease Mitral Stenosis (cont.) Treatment Diuretics Surgical intervention: Commissurotomy Valve replacement Limitation of sodium intake Diagnosis: cardiac murmur, echocardiogram Mitral Insufficiency The mitral valve fails to close completely and allows blood from the left ventricle to flow back into the left atrium Symptoms Dyspnea Fatigue Heart murmur Diagnosis Patient history Physical examination Echocardiogram ECG Radiographic chest films Cardiac catheterization Mitral Insufficiency (cont.) Etiology: inflammation or vegetations (endocarditis), rheumatic fever, mitral valve prolapse, CAD, MI Treatment Bed rest Oxygen therapy Antibiotics for any infectious process Surgical repair Replacement of the valve Mitral Valve Prolapse (MVP) One or more of the cusps of the mitral valve protrude back into the left atrium during ventricular contraction S/S: chest pain, dyspnea, dizziness, fatigue, syncope, severe anxiety Etiology: abnormally long or short chordae tendineae Diagnosis: click-murmur syndrome, echocardiogram (confirms failure of the valve to close), Premature ventricular contractions (PVC's) on ECG Treatment: no treatment if asymptomatic, beta blockers, avoidance of smoking, caffeine, and large heavy meals Arrhythmias Deviation from the normal heartbeat; that is, the normal sinus rhythm S/S: palpitations, rapid heartbeat (tachycardia), skipped heartbeats, slow heart rate (bradycardia), syncope, fatigue Etiology: arise from disturbances in the normal conduction system of the heart, including the pacemaker (the sinoatrial [SA] node) atrioventricular (AV) node bundle branches purkinje fibers Arrhythmias (cont.) Diagnosis: ECG, echocardiogram, Holter monitor Treatment: drug-induced arrhythmias usually resolve with cessation of the drug administration, anticoagulants, oxygen, catheters, pacemaker, cardioverter-defibrillators Arrhythmias (cont.) Shock Collapse of the cardiovascular system, including vasodilation and fluid shift, accompanied by inefficient cardiac output S/S Inadequate perfusion of organs and tissues Pale, cold, and clammy skin Rapid, weak, and thready pulse Rapid breathing Altered level of consciousness Dizziness Extreme thirst Profuse sweating Shock (cont.) Etiology: anaphylaxis, hemorrhage, sepsis, respiratory distress, heart failure, neurologic failure, emotional catastrophe, severe metabolic insult Diagnosis: patient history, clinical picture Treatment any visible bleeding is controlled supine position with the feet and legs elevated kept warm but not overheated monitor vital signs volume replacement with IV fluids oxygen Shock (cont.) Cardiogenic Shock Inadequate output of blood by the heart S/S: see s/s for shock Etiology: any insult that disturbs the heart's ability to pump blood Diagnosis: patient history, clinical picture, ECG, continued hypotensive state, radiographic chest studies Treatment supine position with the feet and legs elevated kept warm but not overheated monitor vital signs volume replacement with IV fluids oxygen IABP (intra aortic balloon pump) Medications to improve the efficiency of myocardium Emboli Clots of aggregated material (usually blood) S/S severe pain in the area of the embolus pale, numb, and cold extremities nausea vomiting fainting eventually shock Etiology: venous stasis, cardiac arrhythmias Emboli (cont.) Diagnosis: clinical picture, history of bedrest, physical inactivity, heart failure, arrhythmias Patient Teaching: encourage those who will be traveling or sitting for long periods of time to get up and walk every hour for a few minutes Treatment Heparin or enoxaparin (Lovenox) Thrombolytics Surgical intervention Emboli (cont.) Atherosclerosis (sometimes known as hyperlipidemia) Thickening and hardening of the arteries Occurs when plaques of cholesterol and lipids form S/S: angina pectoris, dizziness, elevated blood pressure, shortness of breath Risk Factors Heredity Sedentary lifestyle Diet rich in lipids and cholesterol-producing foods Smoking Diabetes mellitus Hypertension Obesity Atherosclerosis (cont.) Diagnosis: physical exam, blood studies indicate elevated cholesterol, triglyceride, and lipid levels, HTN may be noted Treatment Dietary changes Hyperlipidemic drugs Lovastatin Simvastatin Pravastatin Rosuvastatin Atorvastatin Atherosclerosis (cont.) Aneurysm Weakening and a resulting local dilation of the wall of an artery S/S: abdominal or back pain, a pulsating mass in the abdomen, symptoms and signs of hemorrhagic shock Etiology: buildup of atherosclerotic plaque that weakens the vessel wall Diagnosis: bruit heard on auscultation is another sign of arterial dilation, radiographic studies, ultrasonography, CT, Magnetic resonance imaging (MRI) Treatment: depends on the size, location, and likelihood of rupture of the defect, surgical repair before they leak or rupture, catheter-based stent grafts Aneurysm (cont.) Blood Elements of blood RBCs WBCs Platelets Plasma Functions of blood Transports elements to body cells Removes waste products Helps to maintain homeostasis Anemia Reduction in the quantity of either RBCs or hemoglobin in a measured volume of blood, reducing the blood's ability to carry oxygen to the cells S/S Fatigue Dyspnea Headache Loss of appetite Heartburn Edema Numbness and tingling sensations Syncope Pallor Classifications of Anemia Iron-deficiency anemia: Insufficient iron intake due to hemorrhage or condition of slow bleeding such as bleeding hemorrhoids Folic acid deficiency anemia: A condition in which insufficient amounts of folic acid are available for DNA synthesis, preventing maturation of blood cells Aplastic anemia: A condition resulting from an insult to the hematopoietic cells (stem cells) in the bone marrow Sickle cell anemia: Chronic hereditary hemolytic form of anemia, in the United States found primarily in African-Americans Anemia (cont.) Diagnosis: Blood tests show decreased RBC's, decreased hemoglobin and hematocrit Treatment Varies with cause Dietary or supplemental iron administration for iron-deficiency anemias Folic acid replacement for folic acid deficiency anemia Vitamin B12 injections are the treatment of choice for pernicious anemia No cure is known for sickle cell anemia, so treatment is symptomatic Anemia (cont.) Lymphatic Diseases The lymphatic system is composed of: Lymphatic vessels Lymphatic tissue (lymph nodes, tonsils, thymus, and spleen) Lymph Swollen lymph nodes or glands may indicate trapping of microbes during an infectious process Lymphedema Abnormal collection of lymph, usually in the extremities S/S: swelling of the extremity, pain, limited movement, swollen and grossly distended extremities Etiology: infections, neoplasms, thrombus Treatment Affected limb is elevated above the heart Elastic bandages or stockings Diuretics Surgical intervention Antibiotics for infections Lymphedema (cont.) Hodgkin Lymphoma Cancer of the body's lymphatic system in which the involved cells proliferate and interfere with normal functioning by collecting in masses in various parts of the body Tumors arise in the tissue of the lymph nodes and spread to other lymph nodes, the spleen, the liver, and the bone marrow S/S Painless enlargement of the lymph nodes in the neck or mediastinum Fatigue Pruritus Fever Night sweats Weight loss Hodgkin Lymphoma (cont.) Diagnosis Excisional lymph node biopsy Immunophenotyping Blood studies Elevated ESR Bone marrow biopsy CT scans of the chest, abdomen, and pelvis Liver and kidney function tests Hodgkin Lymphoma (cont.) Prognosis: most treatable form of cancer, can be cured, 5 year survival rate 90% Treatment Chemoradiotherapy ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) therapy Other medication therapies Chlorambucil Pentostatin Prednisone Cladribine Non-Hodgkin Lymphoma (NHL) A number of heterogeneous neoplasms of the lymphoid cells S/S: Painless lymphadenopathy, Fatigue, Pruritus, Bone pain, GI symptoms Risk factors Personal or family history Previous treatment with radiation therapy, immunotherapy, or chemotherapy Infection with HIV Human T-cell lymphotropic virus (HTLV) Epstein-Barr virus Hepatitis C virus Immunosuppression Connective tissue disorders Non-Hodgkin Lymphoma (NHL) (cont.) Diagnosis Excisional biopsy of an intact, involved lymph node Immunologic, cytogenetic, and molecular studies Bone marrow aspiration and biopsy Chest radiographs and CT scans of the abdomen, chest, and pelvis Positron emission tomography (PET) scan GI endoscopy Non-Hodgkin Lymphoma (NHL) (cont.) Treatment CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) Radiation High-dose chemotherapy followed by HSCT Chemotherapy alone

Reprodutive System

· Normal Function · Human reproductive system is classified into two groups: • Gonads: Produce germ cells and hormones ○ Testes (males) ○ Ovaries (females) • Ducts: Transport germs cells · Female Reproductive · Male Reproductive · Risk Factors for Sexually Transmitted Diseases (STDs) · Has sex without knowledge of partner's history · Has sex at an early age and/or with multiple partners · Shares drug-related needles · Is a man who has sex with other men · Has skin contact with an STD-infected wound · Sexually Transmitted Diseases (STDs) · More than 20 infectious diseases are spread by sexual contact · Sexually transmitted diseases (STDs) are spread from one person to another through bodily fluids (blood, semen, vaginal secretions) during vaginal, anal, or oral sex · Some spread by direct contact with infected skin Chlamydia · Most frequently reported infectious diseases in the United States · Causes urethritis in men and urethritis and cervicitis in women · Signs and Symptoms • Females ○ Odorless yellow vaginal discharge with burning sensation ○ Itching ○ Abdominal pain ○ Pain during intercourse (dyspareunia) • Males ○ Discharge from penis with burning sensation ○ Itching ○ Burning sensation when urinating ○ Scrotum may be swollen ○ Left untreated can result in infertility · Etiology: chlamydia trachomatis · Diagnosis: DNA probe test · Treatment: single infection and/or followed with a course of oral antibiotics • PO azithromycin, erythromycin, doxycycline 7 days • Severe cases-hospitalization and IV antibiotics · Prognosis: cured with completion of antibiotics · Patient teaching • Take full course of antibiotics • Abstain from intercourse until both partners cured • Meticulous personal hygiene • Frequent handwashing Gonorrhea · Second most common reported STD · Etiology: Neisseria gonorhoeae • sexual transmission • Transmission possible during birth · Signs and Symptoms • Similar to chlamydia • 50% are initially asymptomatic • Purulent discharge • Dysuria · Diagnosis: culture from the cervix, rectum, or throat · Treatment • Ciprofloxacin • Ceftriaxone and azithromycin • Doxycycline Trichomoniasis · Protozoal infection of the lower genitourinary tract · S/S • Itching • Painful urination • Females ○ Frothy, greenish yellow discharge from the vagina ○ "strawberry cervix" • Males ○ Thin, whitish discharge from the penis · Diagnosis • examination of vaginal secretions or discharge from the male • Urinalysis • cervix examination · Treatment • Metronidazole (flagyl) • Tinidazole · Patient teaching • Do not consume alcohol while taking flagyl · Genital Herpes · Incurable, recurrent infection of the skin of the genital area, with ulcerations spread by direct skin-to-skin contact, causing painful genital sores similar to cold sores · Etiology: herpes simplex virus type 2 (HSV-2) · · S/S • One or more blister-like lesions on or around the genitals or anus • Swollen glands • Fever • Headache • Painful urination · · Patient Teaching • Frequent handwashing • Inform sexual partners • Virus can be spread when asymptomatic · Treatment • No cure • acyclovir (Zovirax) • famciclovir (Famvir) • valacyclovir (Valtrex) • Pap smear every 6 mos. • C-section if pregnant · Genital Warts · Genital infection causing raised cauliflower like growths · S/S: painless, cauliflower like growths · Etiology: human papilloma virus Treatment: warts can go away but virus stays, keratolytics, antiviral creams, surgery · Syphilis · Chronic systemic infection consisting of 4 stages · S/S • 1st stage chancre • 2nd stage-producing lesions on the skin, lymph nodes, cardiovascular system, brain, and spinal cord ○ headaches, aching of joints, mouth sores, rashes on palms of hands and soles of feet • Latent period-subclinical or asymptomatic • Late stage-gummas invade the body and organs · Etiology: spiral bacteria T. pallidum spirochete · Treatment: easily cured in the early stages with antibiotic penicillin G • If allergic to penicillin-doxycycline, azithromycin, ceftriaxone · Epididymitis · Inflammation of the epididymis · Etiology-UTI, tuberculosis, mumps, removal of the prostate gland, prolonged use of an indwelling catheter • trauma • autoimmune • N. gonorrhoeae • C. trachomatis • E.coli • pseudomonas · Diagnosis • Physical exam, elevated WBC, urinalysis, urine culture, urethral swabs · S/S • Scrotal pain that radiates to the groin • Pain with ejaculation • Enlarged, tender, firm epididymis • Difficulty walking · Treatment • antibiotics, scrotal support or elevation, anti-inflammatory drugs · Torsion of the Testicle · One of the testes is twisted out of its normal position · S/S • sudden sever pain in a testicle • nausea and vomiting • red swollen tender scrotum · Etiology: happens spontaneous from trauma · Diagnosis • patient history • ultrasound · Treatment • Requires emergency treatment • Consult to urologist • Surgery ○ bilateral orchiopexy Prostatitis · Acute or chronic inflammation of the prostate gland · S/S • enlarged tender prostate • pus may be at the tip of the penis • pain and burning during urination • low back pain • perineal pain • fever, muscular pain or tenderness • urinary frequency with urgency • blood in the urine · Etiology: infection but unknown · Diagnosis • Urinalysis • blood cultures • WBC • ultrasound · Treatment • Fluoroquinolone or trimethoprim-sulfamethoxazole • Sitz baths • Rest • Increase fluid intake • Analgesics • Antiinflammatory • Hospitalization for IV fluids and IV antibiotics · Benign Prostatic Hyperplasia (BPH) · Nonmalignant, noninflammatory hypertrophy of the prostate gland · S/S • May compress urethra and cause urinary blockage • Difficulty starting urination • Weak urinary stream • Inability to empty bladder · BPH (cont.) · Etiology: unknown and not understood · Treatment • Watchful waiting • Control fluid intake before bedtime • Avoid medications that cause urinary retention (decongestants) • Drug therapy (to relax tightened muscles inside the prostate or shrink enlarged prostate gland) • Surgery may be performed to remove urinary tract obstruction (TURP) · BPH (cont.) · Prostate Cancer · Malignancy of the prostate gland · S/S • Usually asymptomatic at diagnosis • Asymmetric areas of induration and nodules felt on digital rectal exam (DRE) • Associated with urinary obstruction ○ Weak urine flow ○ Urinary frequency ○ Urinary retention ○ Dysuria ○ hematuria · Prostate Cancer (cont.) · Diagnosis: high PSA (prostate specific antigen, abnormal DRE, prostate biopsy, TNM (tumor, node, metastasis) used for staging · Etiology • Risk Factors ○ Age-more common in older men ○ Hereditary ○ Lifestyle ○ Ethnicity ○ Diet high in animal fat · Prostate Cancer (cont.) · Prevention • Screening of serum PSA with or without DRE · Treatment-depends of the stage • Radical prostatectomy • Radiation • Brachytherapy • Active surveillance · Prostate Exam · Premenstrual Syndrome (PMS) · Physical and emotional symptoms that appear after ovulation and stop with the onset of menstruation · S/S • Anxiety • Anger • Sadness • Bloating • Food cravings • Breast pain • Irritability • Fatigue • Edema • Abdominal pain · PMS (cont.) · Etiology: fluctuations in estrogen and progesterone · Treatment • Reduced dietary intake of sodium • Increased calcium intake • Moderate exercise • Mild analgesics • Diuretics • Emotional support • Antidepressants • Birth control pills · Amenorrhea · The absence of menstrual periods • Two classifications ○ Primary: if menstruation has not occurred by age 16 ○ Secondary: no menses after a woman has been having menstrual cycles · Amenorrhea (cont.) · Etiology or primary amenorrhea • Late onset of puberty • Abnormalities of the reproductive system • Hormonal imbalances · Etiology of secondary amenorrhea • Pregnancy • Emotional factors • Illness (anorexia, malnutrition, sudden weight gain or loss) • Pituitary tumors • Thyroid disease • Excessive athletic training · Amenorrhea (cont.) · Diagnosis • Pelvic exam (rules out physical abnormalities and pregnancy) • Blood tests (detects hormone problems) • Urine samples (detects hormone problems) • Radiographic studies (detects tumors) · Treatment • Treat underlying condition if possible • Contraceptive hormones or cyclic progesterone · Dysmenorrhea · Pain associated with menstruation · Two classifications for cause • Primary ○ muscular structure of the uterus and how it reacts to the various chemicals produced during the cycle • Secondary ○ underlying disorder or disease (pelvic infections, fibroids, endometriosis, etc.) · Dysmenorrhea (cont.) · S/S • Pain or cramping shortly before or after the onset of menstrual flow • Pain in the uterine area, lower pelvis that may radiate to thighs and buttocks • Painful bowel or bladder function · Dysmenorrhea (cont.) · Treatment • Nonsteroidal antiinflammatory drugs (prescription or OTC) • Heating pad • Hormonal therapy or surgery · Ovarian Cysts · Fluid-filled semisolid or solid masses that originate within ovaries · S/S • Urinary retention • Pain • Nausea and vomitting · Ovarian Cysts (cont.) · Treatment • Small cysts are common and seldom require treatment • Large cysts can be drained or removed • Cysts that are drained are more likely to recur than those that are removed · Ovarian Cysts (cont.) · Endometriosis · Chronic condition characterized by extrauterine endometrial tissue most commonly in the pelvis, but may occur in distant sites · Risk factors • Family history of the disease • Menstrual cycles shorter than 28 days • Uterine structural abnormalities • Periods lasting longer than a week · Endometriosis (cont.) · S/S • Secondary dysmenorrhea is a classic symptom ○ constant pain and cramping in lower abdomen beginning before and lasting several days after menstruation ○ infertility ○ pelvic pain during intercourse ○ pain during defecation · Endometriosis (cont.) · Treatment • Hormone treatment for younger patients • Pregnancy, nursing, and menopause usually bring a remission of symptoms • Surgery to remove or destroy endometrial growth • Total hysterectomy with bilateral salpingo-oophorectomy may be indicated in severe cases · Endometriosis (cont.) · Pelvic Inflammatory Disease (PID) · Infection of a women's pelvis · Is self-limiting to life-threatening · S/S • Fever • Chills • Malaise • Foul-smelling vaginal discharge • Backache • Painful, tender abdomen · PID (cont.) · Etiology: usually an STD · Diagnosis • Pelvic examination (demonstrates tenderness) • Ultrasound to rule out abscess • Signs include elevated WBC count and fever • Laparoscopy is helpful to confirm diagnosis · PID (cont.) · Treatment • Aggressive antibiotic therapy • Analgesics • Without effective treatment, serious and life-threatening complications can develop · Fibroids · Noncancerous (benign) tumors of the smooth muscle within the uterus · S/S-most do not cause any symptoms • Heavy and prolonged periods • Pelvic pain and pressure • Constipation • Frequent urination • Abnormal bleeding · Fibroids (cont.) · Etiology: unknown · Treatment options • Surgery to remove tumors (childbearing age) • Hysterectomy (if bleeding continues) • Ultrasound ablation • Uterine artery embolization · Treatment depends on • Severity of symptom • Age of patient • Desire to bear children · Fibroids (cont.) · Toxic Shock Syndrome · An acute, systemic infection with Staphylococcus aureus or streptococcal toxic-like syndrome · Etiology • Fibers of superabsorbent tampon create an environment for bacteria to produce toxins • increase in staphylococcal colonization on superabsorbent tampons · Toxic Shock Syndrome · Prevention • Use tampons that are just absorbent enough to handle menstrual flow and avoid superabsorbent type · S/S • Sudden onset of high fever • Headache • Sore throat • Rash • Low blood pressure (hypotension) • Shock · Toxic Shock Syndrome · Diagnosis: clinical evaluation and laboratory tests · Treatment • Replacement of fluids to counteract shock • Antibiotic therapy-IV vancomycin • If treatment is delayed, death can result from overwhelming shock · Menopause · Represents the cessation of menstrual periods · Menstruation discontinues due to ovaries producing less estrogen, which inhibits ovulation · Changes in pituitary hormone levels bring physical and psychological changes · Menopause (cont.) · S/S • Fluctuation in menstrual cycle • Periods become lighter and less frequent • Hot flashes/night sweats • Vaginal dryness/skin changes · Menopause (cont.) · Treatment • Consists of management of symptoms • Low dose serotonin specific reuptake inhibitor (SSRI) for depression • Vaginal changes-local estrogen and lubricants • Bone loss-Fosamax, Actonel, Boniva • Weight bearing exercise • Dietary calcium (Ca) or Ca supplements with Vit. D · Uterine Prolapse · Prolapse of the uterus is a downward displacement of the uterus from its normal location in the body · S/S • Increased vagina or pelvic pressure • May feel the uterus when wiping self • Pain with intercourse • Pelvic discomfort · Uterine Prolapse (cont.) · Treatment • Exercises that strengthen the muscles of the pelvic floor after childbirth • Weight loss • High-fiber diet • Insertion of supportive uterine device (pessary) • Surgery (for serious prolapse) · Uterine Prolapse (cont.) · Pessary · Uterine Prolapse (cont.) · Cystocele · A downward displacement and protrusion of the urinary bladder into the anterior wall of the vagina · S/S • Urinary leakage • Urinary urgency • Discomfort with intercourse • In severe cases with urethral or bladder neck kinking, the bladder cannot be emptied completely · Cystocele (cont.) · Etiology • Trauma during pregnancy • Atrophy from age on genetic disposition · Treatment • Similar treatment options as those for uterine prolapse • Symptoms of incontinence may be improved by Kegel exercises • Surgery or pessary insertion are the current methods of treatment · Cystocele (cont.) · Cystocele (cont.) · Rectocele · Protrusion of the rectum into the posterior portion of the vagina · Etiology • Occurs when the posterior wall of the vagina is weakened • Could result from trauma to the area during childbirth · Rectocele (cont.) · S/S • A bearing-down feeling • Fullness in the vagina • Back pain • Pelvic pressure • Constipation · Treatment • Surgical repair of the posterior wall of the vagina • A pessary can also be used if no surgery • Prognosis is good with surgical repair · Rectocele (cont.) · Cervical Cancer · Squamous cell carcinomas • Arise in the transitional zone between the different epithelial types of the uterus corpus and the vagina · Adenocarcinoma · Cervical Cancer (cont.) · S/S • Watery, bloody, or purulent vaginal discharge • Bleeding between menstrual periods and/or after intercourse or after menopause • Abnormal Pap smear test result • Advanced symptoms ○ Pelvic/lower back pain ○ Hematuria ○ Dysuria ○ Rectal bleeding · Cervical Cancer (cont.) · Risk Factors • Not having routine Pap smears • Exposure to HPV, most often through unprotected sexual contact • Smoking • Immunosuppression • Low socioeconomic status · Cervical Cancer (cont.) · Treatment • Early stage ○ Loop electrosurgical excision procedure ○ Laser therapy ○ Cryoablation • Later stage ○ Radiation therapy, plus treatments mentioned above · Cervical Cancer (cont.) · Cervical Cancer (cont.) · Prevention • Primary prevention is vaccination against HPV • Sexually active women should obtain annual Pap smear and pelvic examination • After three consecutive normal Pap smears, screening can be less frequent as determined by doctor · Conditions and Complications of Pregnancy · Complications in pregnancy can arise at any point in the gestational period · This further emphasizes the need for early and continual prenatal care and patient education · Conditions and Complications of Pregnancy (Cont.) · Conditions and Complications of Pregnancy (Cont.) · Prenatal diagnostic tests that can identify fetal genetic or chromosomal abnormalities and detect complications • Amniocentesis • Chorionic villus sampling (CVS) • Maternal serum fetal free DNA analysis • Doppler ultrasonography · Morning Sickness · Nausea and vomiting associated with pregnancy · Affects up to 80% of pregnant women · Normally resolves by 12 to 16 weeks · Symptoms occur during the day with only 2% of women experiencing true "morning" symptoms · Morning Sickness (cont.) · Etiology • Elevated ○ Estrogen ○ hCG levels (hormone produced early in pregnancy by the placenta) ○ Emotions may also trigger episodes · Morning Sickness (cont.) · Eating smaller amounts of food and simple hydration · Rest, ginger, wrist bands, and vitamins B6 and B1 may help · Hyperemesis Gravidarum (HG) · Severe nausea and excessive vomiting that cause starvation during pregnancy • The severity of episodes causes: ○ Weight loss greater than 10% ○ Dehydration ○ Fluid and electrolyte imbalance · Hyperemesis Gravidarum (HG) (cont.) · S/S • Severe episodes of nausea and vomiting • Weight loss • Dehydration • Unable to keep food or liquid in the stomach • Abnormal urine osmolality • Hemoconcentrated blood • Elevations in WBC count · Hyperemesis Gravidarum (HG) (cont.) · Treatment • Hospitalization (in severe cases) • Intravenous fluids and electrolyte replacement • IV antiemetics · Spontaneous Abortion (Miscarriage) · Naturally occurring loss of a fetus before the 20th week of pregnancy · About 10% to 20% of all pregnancies terminate in spontaneous abortion · Majority are the result of a fetus with abnormal chromosomes · Miscarriage (cont.) · S/S • Excessive bleeding • Rapid pulse and low blood pressure • Cramping pelvic pain • Positive pregnancy test · Miscarriage (cont.) · If bleeding is not severe, the mother is treated conservatively, allowing the products of conception to pass on their own · Severe bleeding or partial expulsion of the contents of the uterus requires surgical intervention (D&C) · Ectopic Pregnancy · Occurs when the fertilized ovum implants and grows outside the endometrial canal, most often the fallopian tube · Ectopic Pregnancy (cont.) · S/S • Sudden onset of severe lower abdominal pain • Evidence of vaginal bleeding • No pain or pain on one side • Positive pregnancy test • Possible shock and death · Ectopic Pregnancy (cont.) · Diagnosis • If it is not ruptured and not causing pain, then serial ultrasounds with serial blood pregnancy tests may help make the diagnosis • Transvaginal ultrasound is the mainstay in diagnostic imaging • Culdocentesis (placing a needle into the space behind the uterus) can likewise be used in some unusual cases where the diagnosis is uncertain · Treatment of Ectopic Pregnancy · Laparoscopic surgery to terminate the pregnancy and remove the fetus and placenta · Replace lost blood · Methotrexate (instead of surgery) may be used to terminate ectopic pregnancy that has not ruptured · Treatment of Ectopic Pregnancy · Preeclampsia (Toxemia) and Eclampsia · Preeclampsia is a serious disease characterized by: • Hypertension • Proteinuria (protein in urine) · Eclampsia is when a seizure occurs in a patient with preeclampsia · Preeclampsia (Toxemia) and Eclampsia · S/S • Sudden weight gain • Edema (primarily in face, hands, and feet) • Headaches • Epigastric pain • Visual disturbance • Elevated protein in urine • Clonus • B/P greater than 140/90 · Preeclampsia (Toxemia) and Eclampsia · Treatment • Mild and far from due date ○ bedrest, frequent monitoring, monitoring of blood tests • Severe cases ○ Immediate delivery ○ Steroids ○ Magnesium sulfate · Fibrocystic Breast Condition · Common, benign breast disorder · The most common female breast disease · Symptoms • Lumps and cysts, single or multiple, smooth and rounded, can be palpated in one or both breasts • The breasts are tender on palpation • Shooting pains in the breast tissue · Fibrocystic Breast (cont.) · Diagnosis • Palpation • Mammogram • Ultrasonography may be used to determine whether lump is hollow or solid · Fibrocystic Breast (cont.) · The goal of treatment is to relieve breast pain and correct menstrual irregularity · Some physicians remove fluid (aspirate) from the cysts with a needle · Other recommendations • Wearing a firm, supporting bra • Avoiding caffeine · Fibrocystic Breast (cont.) · Mastitis · Inflammation of one or more mammary glands of the breast · Etiology • strep or staph infection that invades the milk ducts and creates inflammation and blockage · Mastitis (cont.) · S/S • Sudden pain • Redness • Sensation of heat (at either beginning or end of lactation period) • Breasts feel hot, doughy, and tough • Discharge from nipple · Mastitis (cont.) · Treatment • Firm, supportive bra • Heat applied to the painful area • Progesterone cream • Antibiotics • Rest • Analgesics • Warm soaks · Breast Cancer · Usually arises from the terminal ductal lobular unit of the breast, the functional unit of the breast tissue, which is very hormonally responsive · The most common cancer and the second leading cause of cancer death among women · Breast Cancer (cont.) · S/S • Lump • Swelling • Tenderness of breast • Irritation or dimpling of breast skin • Pain, ulceration, or retraction of nipple • Asymmetric appearance · Breast Cancer (cont.) · Risk Factors • Increased age • Female • Prolonged exposure to endogenous estrogen • Long-term use (>5 years) of estrogen/ progesterone hormone replacement therapy • Prior history of breast cancer • Alcohol usage · Breast Cancer (cont.) · Diagnosis • 90% of cases are diagnosed through abnormal mammogram findings • Remainder detected by physical examination • A biopsy should be taken of all suspicious lumps for a definitive diagnosis · Breast Cancer (cont.) · Treatment • Lumpectomy (removal of tumor and some surrounding tissue) • Mastectomy (removal of breast and nearby lymph modes) • Radiation therapy • Hormone therapy • Chemotherapy

Urinary System

· Producing, storing, and excreting urine · Kidneys facilitate reabsorption of necessary nutrients, water, and electrolytes · Cleansing the blood of waste products · Regulating the water, salts, and acids in the body fluids to ensure homeostasis · Composed of o 2 kidneys o 2 ureters o urinary bladder o urethra Kidneys · Process blood to form urine that contains waste products to be eliminated from the body · Three regions o cortex o medulla o renal pelvis · Blood enters the kidneys by way of the renal arteries and leaves through renal veins Nephrons · Each kidney is composed of about 1 million nephrons o urine is transported from the nephron to the renal pelvis and then to the ureters · Composed of: o the glomerulus, Bowman capsule, the proximal convoluted tubule o the loop of Henle, the distal convoluted tubule, and the collecting duct Disturbances in Renal Function · Infection · Scarring · Toxic necrosis · Trauma of the urinary tract · Cause urea to accumulate in blood · Congenital or acquired structural defects and tumors cause obstructive diseases Symptoms of Urinary Disease · Nausea and loss of appetite · Fever · Headache and body aches · Flank or low back pain · Edema · Decreased urinary output · Hypertension · Pruritus Acute Glomerulonephritis · Inflammation and swelling of the glomeruli of the kidneys · S/S o proteinuria o edema o hematuria o dark or coffee colored urine o decreased urine volume o hypertension related (headache, visual disturbances, malaise, anorexia, low grade fever) · Etiology: usually follows a streptococcal infection by 1-2 weeks, immune reaction · Diagnosis o clinical findings o history o urinalysis (gross blood, presence of RBC's, WBC's, renal tubular cells, casts, and protein) o blood tests (elevated BUN, hypoalbuminemia, elevated ESR o KUB (kidney, ureter, bladder films) or radiographic films or ultrasound = bilateral enlargement of the kidneys o renal biopsy · Treatment: o Antibiotics for infection o Diuretics control edema and hypertension o Sodium intake is restricted o Corticosteroids used if immune reaction is suspected Chronic Glomerulonephritis · Slowly progressive, noninfectious disease that leads to irreversible renal damage and renal failure · Results in inflammation and destruction of the glomeruli (resulting in retention of uremic poisons) · S/S o initially symptomatic, hypertension, hematuria, proteinuria, oliguria, edema o later stages § severe hypertension § azotemia (kidneys fail to remove urea from the blood) § urea excreted through sweat glands (uremic frost) § fatigue, malaise, nausea, vomiting, pruritis (from the uremic depositson the skin), dyspnea · Etiology o Immune mechanisms § antigen/antibody complexes lodge in the glomerular capsule causing an inflammatory response and glomerular injury o Renal disorders o Multisystem diseases · Diagnosis: diagnostic studies are the same as acute glomerulonephritis, abnormalities in urinalysis, elevated BUN and creatinine levels, renal biopsy Nephrotic Syndrome · Disease of the basement membrane of the glomerulus · S/S: excessive proteinuria, hypoalbuminemia, water and sodium retention, edema, hypertension, microscopic or gross hematuria, elevated plasma lipid levels, fat bodies in the urine, lethargic, depressed, loss of appetite, pale, puffy around the eyes, swollen ankles (pitting edema), weight gain · Etiology o increased permeability of the glomerulus o exposure to certain toxins or drugs o pregnancy o kidney transplants o metabolic diseases · Diagnosis o Clinical findings and the presence of gross proteinuria and lipiduria (presence of fatty casts) o Hypoalbuminemia o Hyperlipidemia · Treatment o 1st address underlying cause o Dietary intake of protein adjusted o Diuretics o Decreased sodium intake o ACE inhibitors o Corticosteroids o Monitoring urine output · Patient teaching: Refer to dietitian for instruction on high protein low sodium diet Acute Renal Failure (ARF) · Sudden and severe reduction in renal function causing nitrogenous wastes to accumulate in the blood causing an acute uremic episode · S/S: oliguria, GI disturbances, headache, drowsiness, alterations in level of consciousness · Etiology: anything that may diminish blood flow to the kidney o Renal diseases or damage o Mechanical obstruction of urine flow o Exposure to nephrotoxic substances (drugs, cleaning solvents) o Certain antibiotics · Diagnosis: clinical finding of oliguria, elevated BUN, serum creatinine, and potassium levels, kidney ultrasound, radiographic films · Treatment o 1st determine the underlying cause o evaluate for dialysis o monitor intake and output o manage nutritional support o drug therapy (antihypertensives, diuretics, antiinfectives for infection) Chronic Renal Failure (CRF) · Gradual and progressive loss of nephrons with irreversible loss of renal function and uremia · S/S: weak, tired, lethargic, hypertension, edema, arrhythmias, muscle weakness, dyspnea, metabolic acidosis, nausea, vomiting, loss of appetite · Etiology: Numerous causes including primary disease or infections of the kidneys · Diagnosis o Diagnostic studies o KUB (kidney, ureter, bladder) films, renal ultrasound, kidney scans, intravenous pyelograms (IVP's), renal arteriograms o Blood o elevated blood BUN and creatinine, decreased blood hemoglobin and hematocrit o Urinalysis o Excessive protein, glucose, leukocytes, and casts, 24 hour urine volume decreased · Treatment-1st determine underlying cause o Evaluation for dialysis or kidney transplant o Diet and nutrition modification § Increase protein and decrease sodium o Monitor intake and output o Drug therapy § diuretics § antihypertensives § antiinfectives § antiemetics § erythropoietin § calcitrol Pyelonephritis · Most common...inflammation of the renal pelvis and connective tissues of both kidneys · S/S: usually happens after a UTI, pus collection in the renal pelvis forming abscesses, fever, chills, nausea, vomiting, flank pain, foul urine odor, pyuria, hematuria, rigid tender abdomen, enlarged kidney may be palpated · Etiology: bacteria that ascend from the lower urinary tract to the kidneys o Obstruction and stasis of urine o Women are higher risk o Catheterization or diagnostic procedures · Diagnosis o Urinalysis § increased WBC's and RBC's with the presence of bacteria, pus, protein, and casts o Blood and urine cultures o Radiographic studies § swollen or enlarged kidneys · Treatment: intravenous or oral antibiotics, increased fluid intake, bedrest Infectious Cystitis and Urethritis · Inflammation of the urinary bladder (cystitis), or Inflammation of the urethra (urethritis) · S/S: urinary urgency and frequency, dysuria, possible incontinence, pressure in the pelvis, pain in the pelvic region and low back, spasm of bladder, fever, chills, burning sensation with urination, dark colored urine-maybe pink or red if blood in the urine · Etiology: ascending bacterial invasion of the urinary tract · Diagnosis o urinalysis of a clean catch urine specimen--dark yellow pink or red urine, possible blood or pus, RBC's, increased epithelial cells or leukocytes, and bacteria o urine culture--grows the causative agent for identification o cystoscopy--shows reddened, inflamed bladder wall · Treatment o organism specific antibiotic o Phenazopyridine (Pyridium)-urinary analgesic o Increased fluid intake · Prevention o drinking 8 glasses of water a day o proper use of toilet tissue when wiping o women with frequent infections are encourage to take prophylactic antibiotics consistently or after intercourse (Macrobid) · Patient teaching o encourage females to void after sexual inercourse o wipe the perineum from front to back Hydronephrosis · Dilation of the renal pelvis caused by pressure from urine that cannot flow past an obstruction in the urinary tract · S/S: vague backache, decreased urine output · Etiology: causes of obstruction o renal calculi, tumors, inflammation caused by infections, prostatic hyperplasia, bladder tumors, congenital abnormalities · Diagnosis: retrograde pyelogram, cystoscopy · Treatment: depends on the underlying cause Renal Calculi · Stones in the kidney or anywhere in the urinary tract caused by mineral salts · S/S: severe pain in the flank area, urinary urgency, nausea and vomiting, hematuria, fever, chills, abdominal distention, blood in the urine, and hydronephrosis can develop o larger calculi-staghorn calculus · Etiology: unknown, hereditary, excessive amounts of calcium and uric acid in the urine · Risk factors: prolonged dehydration, prolonged immobilization, infection, urinary stasis from obstruction, long term ingestion of certain medications, metabolic factors (hyperparathyroidism and gout) · Diagnosis: family history, clinical findings, urinalysis, radiographic KUB films, urogram, renal ultrasound, CT scans, strain urine to capture stones · Treatment o analgesics o hydration o straining urine o analysis of the calculi o surgery-usually for large calculi § lithotripsy-procedure that breaks apart the stones allowing the small particles to flush out the body § surgical procedure using a ureteroscope to capture the stone in a basket for stones trapped in the distal ureter · if this procedure unsuccessful then laser lithotripsy or electrohydraulic lithotripsy-patient usually under general anesthesia · Patient teaching o encourage patient to strain urine for stones o instruct on proper use of strainer o encourage intake of at least 8 glasses of water a day o avoid foods high in oxalates, purine, and phosphorus Diabetic Nephropathy · Renal changes resulting from diabetes mellitus · S/S: urinary retention, hypertension, nausea, protein in the urine · Etiology: diabetic glomerulosclerosis-lesions of the glomeruli · Diagnosis: elevated BUN, increase cholesterol, urinalysis show protein, albumin, and pus in the urine, hypertension, radiographic studies of the kidneys, renal biopsy · Treatment: ACE inhibitors for blood pressure control, monitoring fluid intake and output, low protein low fat diet, dialysis or evaluation for kidney transplamt

Respiratory System

· Respiration made possible by ventilation and healthy lung tissue perfused by blood · Breathing is controlled by central nervous system · Pulmonary circulation o pulmonary arteries carry deoxygenated blood o pulmonary capillaries for gas exchange o pulmonary veins return oxygenated blood to heart · Lungs and kidneys maintain pH balance · External: Oxygen inhaled from the air is exchanged with carbon dioxide · Internal: The exchange of gases between the blood and tissue cells · Inhaled and exhaled air passes through the respiratory tract · Inspiration: Diaphragm contracts, causing air to be sucked into the lungs · Expiration: Diaphragm relaxes, forcing air out of the lungs Symptoms of Respiratory Disorders · Include o chest pain o dyspnea o hemoptysis o dysphonia o chills and low or high grade fever o wheezing o fatigue Common Cold/Upper Respiratory Tract Infection · Acute inflammatory process that affects the mucous membrane that lines the upper respiratory tract · S/S: nasal congestion, discharge, sneezing, watery eyes, sore throat, hoarseness of the voice, coughing, headache, slight fever, chills, malaise · Etiology: cause include almost 200 different viruses, airborne (bacteria) · Diagnosis: physical exam and symptoms reported · Treatment: no cure, rest, drinking plenty of fluids, using a vaporizer, OTC antihistamines, decongestants, cough suppressants, mild analgesics o antihistamines help dry up nasal secretions, diminish itchy or watery eyes, and decrease flare from allergic reactions o decongestants stimulate adrenergic receptors, induce vasoconstriction of blood vessels in the nose, throat, and sinuses o cough suppressants lessen cough · Teaching: thorough handwashing and isolation to prevent transmission Sinusitis · Acute or chronic inflammation of the mucous membranes of the paranasal sinuses · S/S: frontal sinuses (headache over one or both eyes, pain and tenderness above the eye3s especially when bending over), maxillary sinuses (pain in the cheeks and upper teeth) · Etiology: viral, fungal, bacteria, swimming, diving, tooth extractions, tooth abscesses, allergies · Diagnosis: physical exam, patient history, sinus radiographic studies, CT · Treatment: saline and corticosteroid nasal sprays, broad-spectrum antibiotics and decongestants, antihistamines and oral corticosteroids Pharyngitis (sore throat) · Acute or chronic inflammation or infection of the pharynx · S/S: sore throat with dryness, a burning sensation, sensation of a lump in the throat, fever, chills, dysphonia, dysphagia, cervical lymphadenopathy · Etiology: viral infection, tonsillitis the most common cause, bacterial streptococcal, breathing in excessively heated air or chemical irritants, inhalation or swallowing irritating substances such as tobacco smoke and alcohol, seasonal allergies · Diagnosis: physical exam, patient history, CBC sinus X-rays · Treatment: lozenges, salt water gargles, ice collar, anti-inflammatory, antibiotics, bed rest, plenty of fluid Laryngitis · Inflammation of the larynx (hoarseness) including the vocal cords · S/S: hoarseness, fever, malaise, painful throat, dysphagia · Etiology: viral or bacterial · Diagnosis: laryngoscopic examination · Treatment: voice rest and bed rest, liberal fluid intake, use of cough syrup and lozenges, antibiotics if bacterial infection, corticosteroids Epistaxis (nosebleed) · Hemorrhage from the nose · S/S: bleeding usually from only one nostril; with significant blood loss---vertigo, increase in pulse, drop in blood pressure, pallor, shortness of breath · Etiology: colds and infections, direct trauma, picking the nose, presence of a foreign body, systemic disorders · Diagnosis: patient history; all medications, dietary supplements, and herbal preparations are noted to help identify contributing offenders · Treatment o Mild hemorrhage--applying constant direct pressure on either side of the bridge of the nose with the head tilted forward for 5-10 minutes, internal compression device o Persistent bleeding--local application of epinephrine followed by cauterization with silver nitrate or laser cauterization, posterior nasal packing, mild sclerosing agent injected into bleeding vessel, surgical ligation of bleeding artery Hemoptysis · Coughing or spitting up blood from the respiratory tract · S/S: sputum streaked or spotted with blood · Etiology: trauma, erosion of a vessel, calcification, or tumors can cause bronchial bleeding, as can inflammatory conditions · Diagnosis: first determine the source of the bleeding, visual exam, X-rays, pulmonary angiogram, PPD skin test to screen for TB, lung scan, CT · Treatment: Once the location and the cause of bleeding is determined the source is treated o ligation or surgical removal or repair of the involved vessels is indicated for severe bleeding o Minor bleeding-antibiotics and cough suppressant Pulmonary Embolism · Blood clot or other material lodges in and occludes a pulmonary artery · S/S o Acute-- sudden onset of dyspnea, chest pain, tachycardia, cough, chest pain, low-grade fever, tachypnea, hemoptysis o Massive—cyanosis, shock, death · Etiology: thrombi have broken loose from a deep vein in the legs or pelvis. Stasis of blood flow from immobility, injury to a vessel, predisposition to blood clot formation, thrombophlebitis, cardiovascular disease, smoking, pulmonary disease, pregnancy oral contraceptives, diabetes, myocardial infarction (MI) · Diagnosis: lung scans, CT angiography, echo, auscultation reveals rales · Treatment: oxygen, heparin, warfarin (Coumadin) o Prevention—early ambulation, low dose anticoagulants, leg stockings · Patient teaching o importance of regular blood monitoring to ensure that therapeutic levels of the anticoagulation are being maintained o side effects that should be reported to the health care provider (nosebleeds, blood in the stool, or spontaneous bruising under the skin) Pneumonia · Infective inflammation of the lungs · S/S: cough, fever, shortness of breath even while at rest, chills, sweating, chest pains, cyanosis, blood in the sputum, the infant or child may exhibit "panting" or shallow, rapid respirations o Aspiration pneumonia—aspiration of liquids or other material into the tracheobronchial tree · Etiology: viral or bacterial · Diagnosis: physical exam, patient history, arterial blood gases, bronchoscopy, sputum and blood cultures, chest X-ray · Treatment: analgesics, oxygen, bedrest, increased fluid intake, high calorie diet, postural drainage o organism-specific antibiotics are prescribed for bacterial pneumonia o penicillin is the drug of choice for a pneumococcal pneumonia o mycoplasma infections may be treated with broad-spectrum antibiotics o fungal infections require the use of various antifungal medications, whereas viral infections are treated with specific antiviral agents Pulmonary Abscess · A cavity in the lung containing infectious material · S/S: chills, fever, chest pain, productive cough, purulent, bloody, foul-smelling sputum, foul smelling breath · Etiology: complication of pneumonia caused by bacteria · Diagnosis: decreased breath sounds on chest auscultation, chest X-ray, blood and sputum cultures · Treatment: long term IV antibiotics, surgical resection Influenza · Generalized, highly contagious, acute viral disease that occurs in annual outbreaks · S/S: severe cough, fever, headache, sore throat, generalized malaise, sweating · Etiology: inhalation of viruses · Diagnosis: WBC—leukopenia, lymphocytosis, throat culture · Treatment: based on symptoms, bedrest, increased fluid intake, light diet, antipyretics, analgesics, warm salt water gargles, steam inhalation, cough syrups, Amantadine, Oseltamivir (Tamiflu) · Patient teaching: handwashing, annual influenza immunization COPD-chronic obstructive with slow irreversible progressive airway obstruction. Encompasses several diseases of the lung including: Ø Chronic Bronchitis Ø Bronchiectasis Ø Asthma Ø Emphysema Ø Cystic Fibrosis Ø Pneumoconiosis Ø Acute and Chronic Bronchitis · Inflammation of the mucous membrane lining the bronchi · S/S: deep, persistent, productive cough; thick yellow to gray sputum, shortness of breath, wheezing, elevated temp, pain in the upper chest, scattered or occasional rales, symptoms more troublesome in winter months · Etiology: Viral or bacterial, allergens, in children hypertrophied tonsils or adenoids, smoking, exposure to industrial pollution · Diagnosis: radiographic chest studies (chest X-ray, chest CT), pulmonary function tests, arterial blood gases, other blood and sputum tests · Treatment o Acute Bronchitis: aspirin, increased fluid intake, vaporizer and humidifier, bronchodilator aerosol, cough suppressant, antibiotic for secondary bacterial infection o Chronic Bronchitis: low flow oxygen, postural drainage and percussion, aerosol corticosteroids, advised to stop smoking, stay away from people with colds and avoid crowds Ø Bronchiectasis · Permanent, irreversible dilation or distortion of one or more bronchi · S/S: chronic cough producing purulent, foul smelling sputum, hemoptysis, dyspnea, wheezing, fever, general malaise, chronic halitosis · Etiology: repeated damage to the bronchial wall caused by recurrent airway infections · Diagnosis: physical exam, history, radiographic chest films (chest X-ray, high resolution chest CT), bronchoscopy, sputum culture, pulmonary function test · Treatment: antibiotics, bronchodilators, vibratory devices (acapella, flutter valve, incentive spirometer, chest compression inflatable vest), avoiding environmental irritants, surgery Ø Asthma · Chronic reversible obstructive disease causing constriction of the bronchioles and inflammation of the airway · S/S: wheezing, productive cough, difficulty breathing · Etiology: environmental and genetic factors · Diagnosis: pulmonary function test, radiographic chest films, CBC, IgE levels (elevated) · Treatment: bronchodilators, corticosteroids (including aerosol, PO or IV), supplemental oxygen Ø Pulmonary Emphysema · Destructive changes in the alveolar walls and irreversible enlargement of alveolar air spaces · S/S: dyspnea, difficulty breathing, tachypnea, wheezing, cough, pursed lip breathing to assist in exhaling, use of accessory muscles, circumoral cyanosis, barrel chest · Etiology: Unknown, possible long term cigarette smoking, repeated respiratory tract infections, ozone irritants, sulfur dioxide, nitrogen oxides, familial tendency · Diagnosis: · Treatment: avoidance of inhalation of irritating substances, advisement to receive influenza vaccine annually, supplemental oxygen, expectorants, antibiotics, inhaled corticosteroids, beta adrenergic sympathomimetic drugs, albuterol, Brethine, theophylline, pulmonary rehabilitation Pneumothorax · Collection of air or gas in the pleural cavity that results in a collapsed or partially collapsed lung · S/S: severe SOB, sudden and sharp chest pain, falling blood pressure, rapid weak pulse, shallow weak respirations, cyanosis, anxiety · Etiology o Spontaneous: erosion of the alveoli from a tumor or disease, increased pressure within the respiratory system, spontaneous tear in tissue o Traumatic: gunshot wound, stab wound, crushing type of wound to the chest · Diagnosis: patient history, physical exam, radiographic chest films (chest X-ray, chest CT) · Treatment: oxygen, fowler or semi-fowler positioning, occlusive dressing over any sucking wound, chest tube placement (closed drainage system via thoracostomy) Hemothorax · Accumulation of blood and fluid in the pleural cavity · S/S: s/s similar to pneumothorax with signs of hemorrhage (pale and clammy skin, weak thread pulse, falling blood pressure, chest pain, respirations are labored and shallow · Etiology: trauma, erosion of a pulmonary vessel, hematologic disorders · Diagnosis: diminished or absent breath sounds on the affected side, chest X-ray's or CT show blood in the pleural space, blood tests indicate hemorrhage (low hemoglobin and hematocrit), arterial blood gas (ABG) analysis show respiratory failure · Treatment: chest tube placement (closed drainage system via thoracostomy) Flail Chest · Instability of the chest wall caused by multiple rib fractures or sternum fracture · S/S: severe pain, dyspnea, cyanotic, segment of the chest involved moves inward during inspiration and outward during expiration (paradoxical breathing) · Etiology: direct trauma to the chest wall that fractures three or more adjacent ribs · Diagnosis: radiographic chest films, patient history of chest trauma, observing the paradoxical movement of the chest · Treatment: mechanical ventilation with endotracheal tube, sedation, pain medications, supplemental oxygen, rib fixation Pulmonary Tuberculosis · Chronic, acute or subacute infection of the lungs by Mycobacterium tuberculosis · S/S o asymptomatic initially o weight loss, reduced appetite, listlessness, vague chest pain, dry cough, loss of energy, fever o disease progression: cough with purulent sputum, blood streaked sputum or hemoptysis, fever, night sweats · Etiology: droplet nuclei (inhaling a dried droplet nucleus that contains the organism) · Diagnosis: Mantoux text (PPD) · Treatment: new cases reported to the department of health o Latent: INH o Active: INH with rifampin, ethambutol, or pyrazinamide · Patient teaching: consistent hand washing, respiratory precautions, quarantine Acute Respiratory Distress Syndrome (ARDS) · Acute lung injury with severe pulmonary congestion, acute respiratory distress and hypoxemia · S/S: sudden onset of severe hypoxemia, hypercapnia, acidemia, lungs are hemorrhagic, wet, boggy, congested, severe dyspnea, rapid and shallow respirations, retractions, cyanosis, mottled skin · Etiology: secondary to an insult that causes increased capillary permeability in the lungs, pulmonary edema, and respiratory failure · Diagnosis: ABG's, radiographic chest films · Treatment: no cure only supportive care o Humidified oxygen---mechanical ventilation when humidified oxygen fails, intravenous nutrition and hydration Lung Cancer · Cancer of the lung · S/S: cough with or without sputum production, dyspnea, hemoptysis, chest pain, weight loss o The brain is a common metastatic site from the lung: headache, weakness, change in mental status, seizures · Etiology: repeated carcinogenic irritation o Smoking, exposure to second hand smoke, asbestos, radon, air pollution, arsenic, radiation therapy for other types of cancers · 2 types o non-small cell lung cancer (NSCLC) o small cell lung cancer (SCLC)-occurs in smokers, has rapid growth rate, metastasize early · Diagnosis: chest radiograph, tissue biopsy via bronchoscopy, mediastinoscopy, or CT guided needle aspiration · Treatment o Early stage NSCLC: surgical resection with or without radiation and chemotherapy o Later stage NSCLC: combined treatment consisting of surgical resection, chemotherapy, radiation, palliative symptom control o SCLC: chemotherapy along with radiation

Digestive System

• Alimentary canal (digestive tract) • processes and transports the products of digestion • Accessory organs of digestion • Manufacture and secrete endocrine and exocrine enzymes essential to digestive functions • Diseases of the Digestive Tract and Oral • Interferes with • Ingestion and digestion of food • Absorption of nutrients for metabolism • Elimination of wastes • Function of the teeth is mastication (chewing) • No chewing function can be caused by ○ Decay, infection of the teeth or gums, malocclusion, missing teeth • Decrease in saliva production (xerostomia) • Causes-dehydration, medications • Can be a connection between oral infections and cardiovascular diseases, respiratory diseases, and diabetes • Missing Teeth • Permanent teeth are missing • S/S: jaw pain (temporomandibular joint disorder), bolting (inadequate chewing, expression of cosmetic concerns • Etiology: dental decay, age, congenital, disease processes • Diagnosis: oral exam, X-ray • Treatment: placement of a permanent or removable prosthesis (false tooth) • Impacted Third Molars (wisdom teeth) • Malpositioned third molar preventing normal eruption • S/S: pain • Etiology: no room to erupt because of bone structure or adjacent teeth block eruption • Diagnosis: oral exam, X-rays • Treatment: • If infection present-oral antibiotics (penicillin or amoxicillin), analgesics • Followed by tooth extraction • Gingivitis • Inflammation and swelling of the gums • S/S: red, soft, shiny gums, easily bleeding of gums with gentle tooth brushing • Etiology: plaque, vitamin deficiencies, glandular disorders, blood diseases, viral infections, use of certain medications, pregnancy, diabetes • Diagnosis: oral exam • Treatment: removal of plaque and calculus by dental hygienist, antibacterial mouthwash (chlorhexidine), cleansing of teeth and exposed teeth roots under local anesthesia • Prevention: good oral hygiene, removal of plaque at the gum line, avoidance of toothbrush trauma • Periodontitis • Destructive gum and bone disease around one or more teeth (end result of gingivitis) • S/S: in gingivitis pockets form between the teeth and gums that deepens exposing the root, causing plaque to develop • unpleasant taste in mouth, halitosis, painful chewing, sensitivity to extreme temperatures in food • Diagnosis: oral exam, X-rays, measurement of the depth of the pockets • Treatment: thorough cleaning of root surfaces (scaling/root planning/curettage), multiple daily sessions of brushing and flossing, oral and local application of antibiotic, periodontal surgery • Periodontitis • Prevention: regular cleaning and exam by dentist, lack of professional cleanings, smoking, and certain medications • Patient Teaching: patients with this oral disease need teeth cleaned every 2-4 months, diabetics need education on good oral hygiene • Temporomandibular Joint Disorder (TMD) • Inflammation, disease, or dysfunction of the TMJ • S/S: limited jaw movement, reports of hearing clicking sounds when chewing or experiences severe pain or aching in or around the ears and jaws that is worse by chewing, headache, dizziness, feeling of pressure, tinnitus, draining sensation present in both ears, deafness, reduced ability to open the jaw • Etiology: bruxism (grinding of the teeth), malocclusion, poorly fitting dentures, rheumatoid, arthritis, neoplasms, emotional stress accompanied w/grinding, habitual gum chewing • Diagnosis: oral exam, CT, MRI • Treatment: for inflammation (NSAIDS), special appliances to wear to prevent grinding, plastic bite plate, intraarticular steroid injections, PT, stress counseling, muscle relaxants • Tooth Abscesses • Pus filled sac that develops in the tissue surrounding the base of the root • S/S: toothache or throbbing, pain when biting and chewing • Etiology: decayed or dying tooth (aggressive brushing, traumatic fracture, acid erosion), severely receding gums, invading bacteria • Diagnosis: oral exam • Treatment: antibiotic therapy, root canal therapy, dental crown, filling, apicectomy • Mouth Ulcers • A lesion on the mucous membrane, exposing the underlying tissue • S/S: pale yellow spots with red borders • Etiology: aphthous ulcers (occur during stress or illness), traumatic ulcers (hot food burn, rough denture, toothbrush trauma, braces), medications, rarely a sign of a tumor in the mouth, anemia, or leukemia • Diagnosis: oral exam, if it does not heal within 10 days blood test and biopsy are needed • Mouth Ulcers (cont.) • Herpes Simplex (Cold Sores) • Viral infection that affects of the skin and mucous membranes • S/S: pain, tingling and numbness around the mouth • Etiology: herpes simplex virus type 1 (HSV-1) • exposure to sunshine and wind or the presence of another infection, stress, nicotine, stimulants (caffeine, nuts & chocolate) • Herpes Simplex (Cold Sores) • Diagnosis: oral exam • Treatment: antiviral ointments or capsules (acyclovir or penciclovir), intraoral cold sore (acyclovir-Zovirax), rest, aspirin, anesthetic mouthwash, topical cream for pain, topical healing creams (Abreva and Novitra) NO CURE • Patient Teaching: avoid close contact with others to prevent spread, no kissing, do not share personal items, touching the vesicles can result in a "whitlow" finger • Thrush • Candidiasis of the oral mucosa • S/S: sore, raised, yellow patches in the mouth and sometimes the throat, burning, when rubbed light bleeding may occur, yeast smell from the mouth • Etiology: prolonged treatment with antibiotics, chemotherapy, diabetes, glucocorticoids, removable dental prosthesis • Diagnosis: oral exam by dentist, physician, or health care provider • Treatment: nystatin swish and swallow, oral Diflucan, patients with oral prosthesis—soak prosthesis in cup of water with few drops of bleach to disinfect, OTC daily denture cleaner • Oral Cancer • Includes squamous cell carcinoma (SCC) or adenocarcinoma • S/S: white, patchy lesion or an oral ulcer what fails to heal, pain, dysphagia, odynophagia, weight loss, bleeding, referred pain in the ear or jaw • Etiology: alcohol use, tobacco use, sun exposure, betel nut chewing • Diagnosis: oral exam, fine needle aspiration biopsy, CT, MRI, PET • Treatment: surgery, laser therapy, neck dissection, radiation • Gatroesophageal Reflux Disease (GERD) • Regurgitation of stomach and duodenal contents into the esophagus frequently occurring at night • S/S: belching with a burning sensation in the chest and mouth, vomitus may regurgitate in the mouth • Etiology: overeating, pregnancy, weight gain, relaxation of the lower esophageal sphincter (LES), hiatal hernia, foods, medications • GERD (cont.) • Diagnosis: patient history, physical exam, barium swallow, EGD • Treatment: • elevating the head of the bed (HOB) • light evening meal no less than 4 hours before bedtime • Antacids • weight loss • limiting the use of alcohol and smoking • H2 receptor antagonist (ranitidine, famotidine) • proton pump inhibitor (omeprazole, lansoprazole) • Esophageal Varices- Very Common • Dilated veins of the esopahgus in patients with portal hypertension that may result in upper GI bleeding • S/S: asymptomatic, massive hemorrhage (hematemesis or melena) • Etiology: cirrhosis of the liver • Diagnosis: physical exam, history, endoscopy Hypovolemic shock- hematocrit-hemoglob labs will be low. Throwing up blood, bowel movements have blood, • Treatment: replacement of blood, endoscopic sclerotherapy and ligation- tie off or burn veins to stop bleeding), emergency portal decompression • Esophagitis • Inflammation of the esophagus • S/S: heartburn, vomiting of blood, pain, inability to speak and swallow, perforation or destruction of the esophagus • Etiology: defect of the LES, tetracycline antibiotics, chemical injury • Diagnosis: patient history, film of the GI tract • Treatment: bland diet, antacids, avoid alcohol, small frequent meals, Carafate suspension ( coats esophagus an stomach to help heal and reduce pain) Pg 385*** • Gastric and Duodenal Peptic Ulcers • Breakdown of the protective mucous membrane of the stomach or upper GI track • S/S: heartburn, indigestion, epigastric pain, nausea, vomiting, report of eating helping to relieve discomfort, nocturnal (night) pain • Etiology: Helicobacter pylori (H. pylori) infection, use of NSAIDS, alcohol use, smoking • Gastritis • Inflammation of the lining of the stomach • S/S: epigastric pain, indigestion, feeling of fullness after meals • Etiology: medications, poisons, alcohol, smoking, infectious diseases, stress, mechanical injury from swallowing a foreign object, ingestion of irritating foods, Vit. B12 deficiency (pernicious anemia) • Diagnosis: gastroscopy, biopsy specimens, fecal occult blood samples • Treatment: antibiotics, antacids, antiemetics, bland diet, Vit. B12 injections, if bleeding patient is treated with medication to constrict blood vessels • Acute Appendicitis • Inflammation of the appendix • S/S: abdominal pain usually around the navel and within a few hours localizes to the right lower quadrant • Etiology: lymphoid hyperplasia, fecaliths, parasites, foreign bodies, Crohn disease, cancer • Diagnosis: physical exam, CBC, urinalysis, ultrasound of the abdomen, maximum tenderness at McBurney point • Treatment: surgery (appendectomy), antibiotics prior to surgery • Hiatal Hernia • Defect in the diaphragm that causes a segment of the stomach to slide into the thoracic cavity • S/S: GERD usually worse when reclining or after a large meal, chest pain, difficulty swallowing, some asymptomatic • Etiology: congenital, or weakening of the diaphragm • Diagnosis: chest X-ray, endoscopy, measurement of reflux PH, examination of reflux contents for blood • Treatment: diet changes, minimize straining and coughing, loose weight, antacids, H2 blockers, PPI's, cholinergic agents, avoid lying down 4 hours after a meal, elevating the head of head on blocks • Crohn Disease (Regional Enteritis) • Chronic inflammatory disorder of the GI tract • S/S: chronic diarrhea, intermittent abdominal pain often right lower quadrant, weight loss, malaise, nausea, , anorexia, fever, abdominal fullness, blood in the stools • Etiology: Unknown • Crohns Disease (cont.) • Diagnosis: physical exam, colonoscopy, enteroscopy, anemia, leukocytosis, and hypoalbuminemeia detected in blood tests, CT • Treatment: dietary supplements, intravenous nutrition, antibiotics, steroids, azathioprine, methotrexate, infliximab, anticholinergics, narcotics, draining of abscesses by placement of percutaneous catheter, surgery if poorly controlled • Ulcerative Colitis • Chronic inflammation affecting the mucosa and submucosa of the rectum and colon • S/S: bloody diarrhea, abdominal cramping, urgency to defecate, mucoid stools, weight loss, fever, malaise, watery stool containing blood, mucus and pus • Etiology: Unknown • Diagnosis: physical exam, stool sample for blood, lab tests, X-rays, stool culture, colonoscopy • Treatment: avoid diet low in fat and bulk, recc. Diet high in protein, vitamins, and calories, anticholinergics, antidiarrheals, steroids, surgery • Gastroenteritis • Acute inflammation of the lining of the stomach and intestines • S/S: increased intestinal motility, presence of pus, mucus, and blood in the stool, dehydration, abdominal cramping, nausea, vomiting, fever, weakness, frequent loose stools • Etiology: Ingestion of disease causing bacteria or parasites, spicy or irritating food, alcohol, caffeine, aspirin, NSAIDS • Diagnosis: lab tests, stool culture, endoscopy, stool analysis • Treatment: antibiotics, antiemetics, antacids, oral or IV hydration solutions, rest, eat as tolerated, avoid antidiarrheals for travelers diarrhea • Intestinal Obstruction • Blockage of the intestines • S/S: severe pain, nausea, vomiting, bloated abdomen, no passage of stool or gas, loss of fluid and electrolytes, elevated WBC, hyperactive or absent bowel sounds • Etiology: mechanical causes, paralytic ileus • Diagnosis: X-ray, CBC • Treatment: When not resolved with conservative measures—surgery, NPO, IV fluids, nasogastric tube (NG), manual disimpaction, enemas • Diverticulosis • Defects in the muscular wall of the large bowel, where the mucosa outpouches • S/S: pain, flatulence, difficulty in defecation • Etiology: Unknown, diet lacking roughage • Diagnosis: physical exam, colonoscopy • Treatment: diet with adequate fluids and roughage, fiber supplements, stool softeners • Diverticulitis • Infection of one or more diverticula • S/S: abdominal pain, possible fever, palpable mass may be felt, constipation or loose stools, blood in stools • Etiology: lack of dietary bulk, inadequate fluid, constipation • Diagnosis: blood test, CT, colonoscopy • Treatment: antibiotics, stool softeners, liquid diet, hospitalization, surgery • Colorectal Cancer • Cancer arising in any part of the colon • S/S: abdominal pain, change in bowel habits, bloody stools, weakness, weight loss, iron deficiency anemia • Etiology: genetics • Risk factors: history of polyps, diabetes, ulcerative colitis, Crohns, family history, cigarette smoking, obesity • Diagnosis: Colonoscopy, CT • Treatment: Surgical resection, colostomy, radiation, chemotherapy • Irritable Bowel Syndrome • Functional bowel disorders • S/S: cramping or aching abdominal pain, change of bowel habits, bloating, abdominal distension, feeling of tenesmus, GERD, nausea, feeling of a lump in the throat, anxiety • Etiology: Unknown • Diagnosis: physical exam, history, tests to exclude other disease • Treatment: soluble fiber supplements, stool softeners, laxatives, ondansetron (Zofran), antispasmotics, tricyclic antidepressants • Peritonitis • Inflammation of the peritoneum • S/S: abdominal pain, nausea, vomiting, profuse sweating, fever, abdominal tenderness with direct touch • Etiology: Primary-blood borne organisms originating in the GI or genital tract, Secondary-contamination by GI secretions • Diagnosis: Ct scan, aspiration of peritoneal fluid, elevated WBC, abnormal serum electrolyte levels • Treatment: broad spectrum antibiotics, analgesics, antiemetics, NPO, parenteral replacement of fluid and electrolytes • Hemorrhoids • Varicose dilation of veins in the anal or anorectal area • S/S: rectal pain, itching, protrusion or bleeding after defecation, painful anal lump • Etiology: constipation, straining, pregnancy • Diagnosis: visual exam, proctoscopy, low hemoglobin and RBC • Treatment: stool softeners, diet changes, warm sitz baths, hydrocortisone acetate or pramoxine hydrochloride, surgery • Cirrhosis of Liver • Degenerative, irreversible damage to the liver • Etiology: chronic alcoholism, parasites, toxic chemicals, congestive heart failure • Diagnosis: physical; exam, blood tests, CT, needle biopsy, ultrasound • Treatment: rest, prevention of malnutrition, antacids, vitamin supplements, diuretics, liver transplant • Cirrhosis of Liver (cont.) • Hepatitis • Systemic infection causing inflammation of the liver and destruction of the hepatic • Common S/S for all forms of hepatitis: headache, anorexia, malaise, fever, nausea, dark urine, clay colored stool, jaundice, abdominal discomfort, myalgia • Hepatitis A • Highly contagious liver infection • S/S: only hepatits causing spiking fevers • Etiology: HAV transmitted by fecal-oral route from contaminated food, water, and stools • Treatment: rest, intramuscular injection of immune globulin within 2 weeks after exposure, avoid alcohol, rest, low fat high carb diet, medications for nausea and pain • Prevention: Hep A vaccine before travelling into prevalent areas or where sanitation is poor • Hepatitis B • Liver infection caused by Hep B virus • S/S: signs and symptoms mimic the flu • Etiology: transmitted percutaneous and permucosal routes • blood, semen, vaginal secretions, saliva • Treatment: oral antivirals, interferon, Hep B immune globulin • Diagnosis: detection of hepatitis B surface antigen (HBsAg) in the blood • Prevention: Hep B vaccine to high risk occupations • Hepatitis C • Liver infection , most common • S/S: sometimes without jaundice, liver tenderness and enlargement, elevated serum liver enzymes and bilirubin • Etiology: HCV transmitted by blood and body fluids • Diagnosis: clinical history, ultrasound of liver, elevated liver enzymes and bilirubin, liver biopsy • Treatment: Sofobuvir (Solvadi), glucocorticoids, rest, well balanced diet, gamma globulin, interferon alpha • Cholelithiasis • Calculi and gallstones that form in the bile • S/S: colicky pain, biliary colic, nausea, vomiting, flatulence, clay colored stools, jaundice, elevated liver enzymes and bilirubin • Etiology: oral contraceptive use, high calorie high cholesterol diet, diabetes mellitus, alcoholic cirrhosis • Diagnosis: ultrasound, elevated bilirubin • Treatment: asymptomatic-left alone, symptomatic-surgery • Cholecystitis • Inflammation of the gallbladder • S/S: colicky pain localizing in the upper right quadrant radiating to the right lower scapular region, nausea, vomiting, fever, juandice, clay colored stools, dark urine, pruritis • Etiology: trauma, infection • Diagnosis: physical exam, ultrasound, HIDA scan, elevated WBC and bilirubin • Treatment: NPO, NG tube, IV to replace fluids and electrolytes, antibiotics, analgesics, antiemetics, surgery • Acute and Chronic Pancreatitis • Inflammation of the pancreas • Etiology: alcoholism, biliary tract disease, trauma, infection, elevated calcium levels, hemorrhage, hyperlipidemia, gallstones, smoking • S/S: • Acute-severe abdominal pain, nausea, vomiting, diaphoretic, tachycardia, shallow rapid respirations, low B/P, elevated temp, mild jaundice, decreased bowel sounds • Chronic-anorexia, weight loss, nausea, vomiting, flatulence, constipation, malabsorption, diabetes, depression, anxiety • Acute and Chronic Pancreatitis (cont.) • Diagnosis: physical exam, elevated serum amylase and lipase levels, elevated WBC and hematocrit, hyperglycemia, CT, ultrasound • Treatment: IV fluid and electrolyte replacement, NPO, Nasogastric tube to suction, narcotic pain medications • Malnutrition • Deprivation of protein-energy or secondary to certain diseases • S/S: loss of energy, diarrhea, drastic weight change, skin lesions, loss of hair, poor nails generalized edema, delayed healing, greasy stools (from loss of fat), muscle wasting • Etiology: decreased intake of energy and protein, increased nutrient losses, increased nutrient requirement secondary to disease • Diagnosis: physical exam, laboratory tests (albumin, prealbumin), CBC, 24 hr urine • Treatment: nutritional supplements with oral and IV feedings, diet modifications, feeding through an NG tube

Adenoid hyperplasia

• Enlargement of the lymphoid tissue in the space above the soft palate of the mouth causing a breathing blockage • Etiology: Unknown cause • S/S: mouth breather, snores during sleep, sleep apnea in extreme cases • Diagnosis: pharyngeal radiographic films, nasopharyngoscopic exam • Treatment: adenoidectomy

Bronchiolitis

• Inflammation of the bronchioles • Etiology: caused by infection with RSV, parainfluenza, and adenovirus • S/S: cough, nasal congestion, wheeze, tachypnea, respiratory distress, fever, posttussive emesis, dehydration (breathing to fast to feed), apnea may occur in young infants • Diagnosis: patient history, physical exam, chest radiographs, RSV testing, viral culture of nasopharynx • Treatment: albuterol, racemic epinephrine, hypertonic saline via nebulizer, oxygen, IV fluids, intubation (extreme cases)

Syndrome

defined collection of signs and symptoms that characterize a condition

Pathogenesis

development of disease in stages

Homeostasis

internal stability of the body

Systemic health

• Also called internal equilibrium • Preserved by numerous body organs and structures that work in concert to meet specific cellular needs • Major disruptions ○ fluid and electrolyte imbalance ○ acidosis ○ alkalosis

Myasthenia Gravis

• Chronic neuromuscular disease caused by antibodies to the acetycholine receptor at nerve synapses • Etiology: Autoimmune mechanism with faulty transmission of nerve impulses to and from the central nervous system • S/S: muscle weakness, fatigue, drooping eyelids, diplopia, difficulty swallowing, chewing and talking • • Diagnosis: physical exam, Tensilon test, EMG • Treatment: rest, anticholinesterase drugs, corticosteroids, thymectomy • Drooping eyelid

Immune System

• Components of the Immune System • Lymphoid tissue • Primary: thymus, bone marrow • Secondary: tonsils, adenoids, spleen, Peyer patches, appendix • Immunocompetent • When homeostasis is maintained and immune system reacts correctly • Immunoincompetence • When the immune system responds inappropriately either too weak or too strong • Immune System Malfunctions • Hyperactive responses • Immunodeficiency disorders • Autoimmune disorders • Attacks on beneficial foreign tissue • Orderly Function of the Immune System • Activated when foreign substances enter body • Produces antibodies in response to that specific antigen • Antibodies combine with threatening cells forming antigen/antibody complex • Antibody must know the difference between self and foreign molecules • Autoimmune disease occurs when the body mistakenly recognizes its own tissue as foreign and attacks • Nonspecific defense • natural killer (NK) cells, macrophages, neutrophils • Development of Immunity • Begins when fetal liver produces stem cells • Bone marrow produces cells after birth • Some stem cells become T cells (T lymphocytes) • Some T cells seek out foreign invaders • Cytotoxic T cells (killer T cells) • Helper T cells • Suppressor T cells • Memory T cells • Immunity • Cell-mediated immunity • Defends body against viral and fungal infections • Mediates graft rejection and tumor cell destruction • Suppresses an antibody-mediated response to infection • Antigen-antibody complex inactivates the pathogen and stimulates phagocytosis • Activation of complement system involves proteins • • Body protected by active and passive immunity • Active immunity ○ when a person has had previous exposure to a disease or pathogen, or receives immunizations against a disease • Passive immunity ○ bypasses the body's immune response to afford the benefit of immediate antibody availability • Acquired Immunity • Active Immunity • Active Immunity-Exposure to antigen or immunization • Gained from birth as a result of immune response • Must be exposed to antigen by some means • Passive Immunity • Antibodies are transferred to the recipient • From mom to the fetus • Receiving antibodies from another host • Immunoglobulins • Five classes of immunoglobulins • IgM • IgG • IgA • IgD • IgE • Usually all present during an antigenic response • Immunodeficiency Diseases • Increased susceptibility to bacterial infections • Increased susceptibility to viral, fungal, and protozoan infections • Some of the conditions are genetic and present at birth • Acquired Immunodeficiency Syndrome (AIDS) • Impairment of the immune system caused by HIV • Etiology: caused by HIV type 1 or 2 and retroviruses that contain RNA attacking helper T lymphocytes (CD4 cells) • S/S: may remain healthy for years during latent period • 1-4 weeks after exposure ○ may experience a flulike illness with sore throat, fever, and body aches • Progressed disease ○ lymphadenopathy, weight loss, fatigue, diarrhea, night sweats • AIDS (cont.) • Diagnosis: ELISA, Western blot, p24 antigen, PCR, Rapid HIV antibody testing • Treatment: • Periodic measurements of CD4 T cells and HIV RNA (viral load) • HAART • AIDS (cont.) • Patient screening: medical eval needed if c/o weight lost, fatigue, swollen glands, night sweats, flu/like symptoms or reports exposure to HIV • Patient teaching: explain any diagnostic tests, how the disease is transmitted, medication regimens, dangers of noncompliance, side effects of drugs, responsibility of informing healthcare providers of diagnosis • AIDS Complications Kaposi Sarcoma Hairy Leukoplakia • Anemia • Autoimmune Hemolytic Anemia • RBC's are destroyed by antibodies • Etiology: B cell produced antibodies do not identify RBC's causing agglutination of RBC's and attacking red corpuscles • warm antibody anemia • cold antibody anemia • S/S: fatigue, weakness, chills, fever, dyspnea, itching • Autoimmune Hemolytic Anemia (cont.) • Diagnosis: Direct Coombs test, elevated bilirubin and reticulocyte (immature RBC) levels, decreased RBC, platelet, hemoglobin and hematocrit • Treatment: Find underlying cause • Warm antibody anemia ○ corticosteroids ○ cytotoxic drugs ○ splenectomy ○ IVIG administration • Cold antibody anemia ○ Avoidance of the cold • Immune Neutropenia • Decrease number of neutrophils • Etiology: infection, drug exposure, ITP, autoimmune hemolytic anemia, connective tissue diseases (SLE, RA) • S/S: malaise, fatigue, weakness, fever, stomatitis • Immune Neutropenia (cont.) • Diagnosis: WBC (reduced neutrophils) • Treatment: infants require no specific treatment, WBC transfusions, severe cases in infants and adults • corticosteroids • Immune globulin • granulocyte-colony stimulating factor • Goodpasture Syndrome • Autoimmune kidney disease • Etiology: antibodies cause tissue damage in the glomerular and alveolar basement membranes • S/S: acute glomerulonephritis, acute renal failure, proteinuria, anemia, hemoptysis, hematuria, weight loss, fatigue, fever • Diagnosis: suspected in any patient w/glomerlonephritis + pulmonary hemorrhage + acute renal failure, anti GBM antibody in the serum or kidney (ELISA, immunofluorescence, renal biopsy) • Treatment: plasmapheresis (remove anti- GBM antibody) + immunosuppressive agents, last resorts are hemodialysis and kidney transplants • Systemic Lupus Erythematous (SLE) • Chronic inflammatory autoimmune disease with unusual antibodies in the blood that target body tissues • Etiology: Unknown, possible genetic, hormonal, environmental • S/S: inflammation of the skin, joints, nervous system, lungs, kidney, butterfly rash on the face, fever, fatigue, malaise, Raynaud phenomenon, hair loss • Diagnosis: 4 or more symptoms or + laboratory tests are present • Butterfly rash on the face, discoid skin lesion, photosensitivity, nasopharyngeal ulceration, polyarthritis, seizures or psychosis, chronic pleuritis or pericarditis, false-positive serology for syphilis or Sm, cellular casts in urine, hemolytic anemia, thrombocytopenia, characteristic leukocytes (LE cells), abnormal antibodies in the blood stream, Butterfly Rash • Treatment: • Antinflammatory drugs (aspirin, NSAID, prednisone) • Antimalarial drugs • Immunosuppressive medications • Scleroderma (Systemic Sclerosis) • Chronic sclerosis (hardening) of the skin; scarring of internal organs • Diffuse • Limited • Etiology: Unknown • S/S: sclerosis (hardening) of skin or organs, skin is taut, firm, leathery, edematous skin, swelling, stiff, painful joints • Scleroderma (cont.) • Rheumatoid Arthritis (RA) • Chronic inflammatory systemic disease that affects joints • Etiology: Unknown • S/S: edema, pain, tenderness, erythema, and warmth at one or more joints in symmetric pattern • Common affected joints ○ Fingers, wrists, knees, ankles, toes • Diagnosis: review of symptoms, history, physical exam, radiographic studies, blood tests • Treatment: antiinflammatory medications, NSAID, corticosteroids, antirheumatic drugs (DMARDS), immunosuppressants, splints, surgery to correct deformity

vomitting

• Ejection through the mouth of stomach contents • Etiology: Possible causes • Overfeeding, food allergy, gastric irritation, infection, drug poisoning, elevated intracranial pressure, pyloric stenosis • S/S: mild regurgitation to projectile, distended abdomen, irritable • Diagnosis: assess causative factors through physical exam, history, vital signs, weight, nutritional status, fluid and electrolyte balance • Treatment: Depends on the cause

• Measles (rubeola)

• Etiology: caused by a paramyxovirus of the gene Morbillivirus • S/S: cough, coryza, conjunctivitis, photophobia, fever, blotchy rash, Koplik spots • Diagnosis: history of exposure and clinical picture • Treatment: Tylenol for fever, tepid sponge baths, protection of eyes, antibiotics for secondary infections

• Hospice Care

• Includes a compassionate staff pledged to respect the patient's choice for care and to provide comfort, dignity, and privacy • Focuses on comfort and support for the family • Does not postpone death • Helps patients and families mental and spiritual preparation for death • Care in a variety of settings

• Changeable predisposing factors

• Lifestyle ○ smoking and excessive drinking ○ risky sexual behaviors ○ poor nutrition and lack of exercise ○ psychological stressors • Environment ○ air and water pollution ○ chronic psychological stress ○ poor living conditions and excessive noise ○ geographic location conducive to disease proliferation

Bronchopulmonary dysplasia (BPD)

• Lungs are stiff, obstructed, and hard to ventilate • Etiology: Occurs in many premature infants after IRDS, mechanical ventilation with supplemental oxygen, and infection or pneumonia • S/S: dyspnea, including tachypnea, wheezing, cyanosis, nasal flaring, and sternal retractions, coughing, difficulty feeding • Bronchopulmonary dysplasia (BPD) (cont.) • Diagnosis: Infant reveals respiratory distress, radiographs of the chest are abnormal, ABG's are abnormal, Oxygen (O2) levels are low and carbon dioxide (CO2) levels are high • Treatment: Goal is replacement of the damaged alveoli • Supplemental oxygen and adequate nutritional support Diuretics reduce fluid accumulation in the lungs and incidence of pulmonary hypertension

Chronic Illness

• Onset is slower • Lasts longer than 6 months

• Sudden infant death syndrome (sids)

• Sudden unpredicted death of an infant under age of 1 year • Etiology: Unknown • Risk Factors: mothers age less than 20 years old, poor prenatal care, smoking and drug abuse during pregnancy, infant exposure to 2nd hand smoke, prematurity recent upper respiratory infection, sleeping prone, sibling with apnea • S/S: death occurs within seconds of sleep without sound or struggle, dead infant is mottled with cyanotic lips and fingertips • Diagnosis: complete postmortem investigation (autopsy, child's medical history, examination of the scene of death • Prevention: • Infants should not sleep prone • Avoid exposure to cigarette smoke • Firm bedding materials in crib • All blankets and pillows should be removed from crib • Good prenatal care and breastfeeding

• Ankylosing Spondylitis (AS)

• Systemic inflammatory disease of the spine • Etiology: Unknown, studies support genetic basis • S/S: morning low back pain and stiffness that improves with activity, fatigue, weight loss, diarrhea, eye pain, photophobia • Diagnosis: clinical findings, physical exam, elevated ESR and CRP • Treatment: no cure, anti-inflammatory medications, analgesics, physical therapy

Pathology

• traits, causes, and effects of abnormal conditions, causing measurable changes in structure and function

Hirschsprung Disease

(congenital aganglionic megacolon) • Impairment of intestinal motility that causes obstruction of the distal colon • Etiology: Parasympathetic nerve ganglion cells are absent in a segment of the colon • Results in lack of peristalsis in the affected portion of the colon • Diagnosis • Family history • Clinical picture • Radiographic studies • Bowel biopsy • S/S: • Neonatal-failure to thrive, obstinate constipation, vomiting, abdominal distention, difficulty feeding, bile stained or fecal vomit, worser s/s include fever and watery diarrhea • Older child-constipation, abdominal distention, foul smelling ribbon like stools, easily palpable fecal masses, visible peristalsis, appears malnourished and anemic • Treatment: Surgical intervention

Mumps

(epidemic parotitis) • Viral disease causing inflammation and swelling to one or both parotid glands • Etiology: airborne virus spread by droplet nuclei • S/S: tenderness in the neck and in front and below the ears, pain on swallowing, rash, headache, muscle aches, fever, loss of appetite, earache, tenderness of testes • Diagnosis: history of exposure, clinical picture, elevated serum amylase, PCR test • Treatment: Tylenol, warm and cold compresses soft or liquid diet, scrotal support, isolation

Rubella

(german measles) • Highly contagious viral disease that resembles measles • Etiology: caused by rubella virus , spread by direct contact with nasal or oral secretions • S/S: rose colored rash that appears of the face first and spreads downward on the body, fever, enlargement of lymph nodes • Diagnosis: history of exposure, clinical picture, throat culture, serologic studies • Treatment: mild analgesics for fever and joint pain, isolation

Clubffoot

(talipes equinovarus) • Nontraumatic deformity of the foot of a newborn where the anterior half of the foot is adducted and inverted • Etiology: Possible fetal position, or genetic factors • S/S: Anterior half of the foot is adducted and inverted, heel is drawn up, cannot be manipulated to proper position • Diagnosis: Physical exam at birth • Treatment: Cast application, splints, or surgery • Casts are reapplied at frequent intervals as the correction increases and the infant grows • Splints include a bar affixed to shoes • Surgery if casting and splinting are unsuccessful

Chickenpox

(varicella zoster) • Etiology: caused by organism varicella zoster virus (VZV), transmitted by droplet nuclei or fluid from lesions • S/S: superficial cutaneous lesions first seen on the trunk or face then spreads over the body, itching • Diagnosis: history of exposure and clinical picture • Treatment: Palliative treatment for itching (baking soda baths, cornstarch, calamine lotion), Tylenol for fever and pain, antiviral drugs

Pertussis

(whooping cough) • Highly contagious bacterial infection of the respiratory tract • Etiology: bacillus Bordetella pertussis reproduces in the respiratory tract, releases toxin causing necrosis with thick exudate • S/S • Catarrhal stage-seems to have common cold • Paroxysmal stage-high pitched inspiratory whoop, vomiting thick mucus • Convalescent stage- cough diminishes Diagnosis: bacterial studies of mucus, PCR test, elevated WBC count • Treatment: erythromycin antibiotic, fluid intake, nutritious diet, quiet, rest

Tetralogy of fallot

A combination of four congenital heart defects • VSD, pulmonary stenosis, dextroposition of the aorta, and right ventricular hypertrophy • Affected infants with severe obstruction are blue at birth • S/S: hypoxia, tachycardia, dyspnea, seizures, polycythemia, increased red blood cell (RBC) mass, delayed growth and development, clubbing, cardiac murmurs, child assumes squatting position after exercise

Congenital cardiac defects

FETAL CIRCULATION • Oxygen and nutrients are supplied by the mother's blood to the developing fetus • The maternal blood supply also carries away waste products • Umbilical vessels transport blood between placenta and fetus 50% of this blood passes into the liver, and the other 50% bypasses the liver • The ductus venosus soon joins the inferior vena cava, allowing the oxygenated placental blood to mix with the deoxygenated blood • Septum primum keeps blood from going back to right atrium • The blood shunted away from the pulmonary circulation bypasses the lungs through the fetal vessel • The blood shunted to the left atrium mixes with the small amount of blood returning from the pulmonary circulation • After the birth process, the infant's respiratory effort, and the initial inflation of the lungs, the circulatory system undergoes changes • Blood is forced against the septum primum by decreased right atrial pressure and increased left atrial pressure, and the foramen ovale closes • With the lungs expanded and taking over the function of gas exchange, the infant no longer needs the ductus arteriosus to shunt blood S/S • Signs and symptoms vary according to the nature of the anomaly, the severity of the defect, and its effect on the heart • Acyanotic: Deoxygenated and oxygenated blood do not mix • Cyanotic: Oxygenated and deoxygenated blood mix • Acyanotic defects • Oxygenated blood does not mix with deoxygenated blood • Infant usually maintains a normal pink skin color • No cyanosis VENTRAL SEPTAL DEFECT (vsd) • An abnormal opening between the right and left ventricles • Blood is shunted from the left to the right side due to high pressure in left ventricle • The characteristic murmur of VSD is described as harsh and holosystolic • Clinical features include failure to gain weight, restlessness, irritability, sweating when eating, increased heart rate and respirations Patent Ductus Arteriosus (PDA) • Results when the ductus fails to functionally close • Circulation of oxygen is compromised allowing oxygenated blood to recirculate through the lungs • Infant's growth and development may be slowed, with various signs of heart failure, will hear machinery murmur and palpitation reveals a thrill • Closure may be attempted by drug therapy using an antiprostaglandin or ibuprofen • Surgical closure is also an option Coarctation of the Aorta • A narrowed aortic lumen, causing a partial obstruction of the flow of blood through the aorta • Include signs of left ventricular failure with pulmonary edema Patient is pale and cyanotic with weakness, dyspnea, and tachycardia Atrial Septal Defect (ASD) • ASD is an abnormal opening between the right and left atria • Small defects may be undetected or cause symptoms, such as fatigue, shortness of breath, and respiratory tract infections A large defect causes pronounced cyanosis, dyspnea, and syncope • Transposition of the Great Arteries • The aorta and pulmonary artery are reversed • Results in closed-loop circulatory systems • One between the heart and the lungs, and the other between the heart and systemic circulation • Etiology: Cause unknown, may result from • Chromosomal abnormalities • Environmental conditions • maternal infections • mothers use of certain drugs • S/S: cyanosis, tachypnea, signs of heart failure • Diagnosis: physical exam, diagnostic tests (EKG, heart cath, blood tests, chest films, echocardiogram) • Treatment: dependent on the severity of the defect, surgical intervention (reconstruction or replacement of heart valve; repair or join blood vessels), medications to regulate heart beat, prophylactic antibiotics

Integumentary System

Function of Integumentary System • Skin and accessory organs • Hair, Nails, Glands • Roles of skin • Protection from body trauma, infection, and chemicals • Synthesizes Vitamin D • Regulation of body temperature and excretion • Skin contains millions of nerve endings called receptors • Touch • Pressure • Pain • temperature Layers of the skin • Epidermis (outer layer) • Thin, cellular, multilayered membrane responsible for production of keratin and melanin • Dermis (middle layer) • Dense, fibrous layer of connective tissue that gives skin its strength and elasticity • Subcutaneous • Thick, fat-containing section that insulates the body Normal Skin Skin lesions see textbook p.267-268 • Macule: Different color than normal skin • Papule: Small, firm elevated lesion • Nodule: Palpable elevated lesion • Pustule: Usually contains purulent exudate • Vesicle: Thin-walled lesion containing blister • Plaque: Large, slightly elevated lesion with a scale • Crust: Dry surface of dried exudate or blood • Lichenification: Thick, dry, rough surface • Keloid: Increasing mass of collagen resulting from excessive scar tissue • Fissure: Small, deep, linear crack or tear • Ulcer: Cavity with loss of tissue • Erosion: Shallow, moist cavity in epidermis • Comedo: Blocks the opening of a hair follicle dermatitis Inflammation of the skin--pruritis, erythema, cutaneous lesions • Seborrheic Dermatitis • Contact Dermatitis • Atopic Dermatitis (eczema) Seborrheic Dermatitis Inflammatory condition of sebaceous glands • Most common is cradle cap during infancy • S/S: skin is reddened and covered by yellowish, greasy appearing scales, mild itching • Etiology: Unknown, hereditary, emotional stress • Diagnosis: skin biopsy • Treatment: cortisone cream, OTC dandruff shampoos • cradle cap- massaging to loosen scales, daily shampooing with mild soap, mineral oil, prescribed lotion or cream Seborrheic Dermatitis Cradle cap Contact Dermatitis Acute Inflammation response of the skin triggered by a chemical or substance • S/S: erythema, edema, small vesicles that ooze, itch, burn, or sting • Etiology: poison ivy, oak, sumac, airborne by burning plants, dyes, latex, furs, metals, cleaning compounds, makeup, chemicals acids, forms of radiation • Diagnosis: physical exam, medical history • Treatment: 1st thorough cleaning of skin from irritant, topical steroid cream, oral steroid Contact Dermatitis (cont.) Atopic Dermatitis (eczema) • Chronic inflammation of the skin • Common in patients with family history or history of allergic reactions • S/S: rash with vesicular and exudative eruptions in children, dry, leathery vesicles in adults • Etiology: Unknown, inherited, hypersensitivity • Triggers: stress, climate, wool clothing or blankets, handwashing without moisturizing • Treatment: skin moisturizers, sunlight therapy, vitamin D, cortisone creams, oral NSAIDS (protopic and elidel), antihistamines, tranquilizers Atopic Dermatitis (eczema) (cont.) Uticaria (hives) Severe itching, redness, and swelling (wheal) in a localized area of the skin • Etiology: Hypersensitivity and release of histamine (vasodilation of capillaries) • Foods • Drugs • Insect stings • S/S: • Scattered lesions anywhere on the skin • GI involvement (abdominal colic) • Pharyngeal mucosa (obstructed airway) • Deeper tissues (angioedema) Uticaria (cont.) • Treatment: antihistamines, epinephrine injection, oral prednisone, corticosteroid creams and ointments Psoriasis Thick, flaky, red patches covered with white silvery scales • S/S: scales that develop into dry plaques; dry, cracked, encrusted skin • Etiology: Unknown, genetic, may be autoimmune • Treatment: UV light, topical steroid creams and ointments, coal tar preparations, creams containing retinoids and vit. D, antihistamines, oatmeal baths, chemotherapy for severe cases, antibiotics Psoriasis (cont.) Acne vulgaris Inflammatory disease of the sebaceous glands and hair follicles • S/S: papules, pustules, comedones, nodules (deeper boil like lesions) • Etiology: Unknown, hormonal changes of adolescence, hereditary, overproduction of sebum • Treatment: topical or systemic antibiotics, benzoyl peroxide gels, retinoids, accutane Acne vulgaris (cont.) Herpes zoster (shingles) Inflammatory dermatomal eruption of painful vesicles, occurs in a bandlike pattern along the peripheral nerves • S/S: • Pain begins 2 or 3 days before the appearance of the lesions • Begins as a rash that rapidly develops into vesicles • Skin that overlies affected dermatome/dermatomes becomes reddened and blistered • Etiology: Herpes varicella-zoster virus • Treatment: analgesics, tranquilizers or sedatives, antipruritics, steroids, drying agent, oral antivirals, oral antibiotics to prevent secondary infection, topical capsaicin, lidocaine and nerve blocks for sever pain • Diagnosis: culture from vesicle scrapings, blood sample Herpes zoster (shingles) impetigo Contagious superficial skin infection • S/S: lesions with a honey colored crust, small vesicles surrounded by a circle of reddened skin, pruritis • Etiology: Streptococcus or Staphylococcus aureus • Insect bites, scabies infestation, poor hygiene, anemia, malnutrition, impairment of skin related to eczema • Treatment: Systemic antibiotics, cleaning 2-3 x day, bactroban ointment • Diagnosis: physical exam, Tzanck test Impetigo (cont.) Furuncles and carbuncles Furuncle (boil)-pus containing abscess involving the hair follicle and subcutaneous tissue Carbuncle-large furuncle or multiple furuncles • S/S: area is red, swollen, painful, edematous • Etiology: Staphylococcus, usually S. aureus • Treatment: hot compresses, surgical incision and drainage (I&D), oral antibiotics cellulitis Bacterial infection of skin and subcutaneous tissue • S/S: erythema, pitting edema, tenderness, hot to touch, fever, malaise • Etiology: Streptococcus or Staphylococcus that enters skin via a small cut lesion • Treatment: • affected limb immobilized and elevated • cool magnesium sulfate (epsom salt) solution compresses • warm compresses • systemic antibiotics Cellulitis (cont.) Dermatophytoses (tinea) Chronic superficial fungal infection • Tinea Capitis • Tinea Corporsis (ringworm) • Tinea Pedis • Tinea Cruris Tinea capitis • Round, gray, scaly lesions on the scalp Tinea coporosis • Lesions that are round, ringed, and scaled with vesicles Tinea pedis • Intense burning, stinging pruritus between toes and soles of the feet Tinea cruris • Raised, red, pruritic vesicular patches located in the groin area Dermatophytoses • Treatment • Topical or oral antifungals • Affected skin must be kept clean and dry • Loose fitting clothing • Limit exercise • Selsun shampoo Decubitus ulcers Localized area of dead skin that can affect the epidermis, dermis, and subcutaneous layers • S/S: shiny, reddened skin appearing over a bony prominence, blisters, erosions, necrosis, and ulceration • Etiology: impairment or lack of blood supply • Treatment: • Absorbable gelatin sponges and granulated sugar • Karaya gum patches and antiseptic irrigations • Débriding agents and antibiotics Decubitus ulcers (cont.) Scabies and pediculosis • Itch mites (scabies) • Pediculosis (lice) • Three types of lice • Lice are wingless parasites with sucking mouths to feed on human blood • lay their eggs on body hair • S/S: pruritis, sensation of something crawling on the skin • Scabies (rash, intense itching worser at night) • Lice (rah or wheals, presence of nits (eggs) on hair shafts, skin, or clothing Scabies and pediculosis (cont.) • Both are spread easily by close physical contact, family members and others who have had direct contact with the infected person must be treated • Treatment of Lice • a special shampoo must be used and then repeated in 7 to 10 days • follow with meticulous combing with a special fine-toothed comb to dislodge the nits • Body lice are removed with soap and water or shampoo used for head lice • Pubic lice are treated with shampoo, creams, or lotions • Treatment of Scabies • use of special shampoos, sulfur preparations, and topical steroids Scabies and pediculosis (cont.) Malignant melanoma Most serious, arises in epidermal melanocytes, cells that make the brown pigment, melanin • S/S: Most occur as solitary lesions • Changes of indication ○ Change in size, color, or shape ○ Change in elevation or the surface; change in surrounding skin • Etiology: Risk factors • Sun-sensitive skin type • History of severe sunburn • Geographic location closer to the equator • Use of tanning bed Malignant melanoma (cont.) • Treatment: complete excision of the cancerous lesion with wide margins • Diagnosis: ABCDEs of Malignant Melanoma • A = Asymmetry (lack of equality in the diameter) • B = Border (notched, scalloped, or indistinct) • C = Color (uneven, variegated—ranging from tan, brown, or black to red and white) • D = Diameter (usually larger than 6 mm) • E = Evolving

Endocrine System

Function of the Endocrine System The endocrine and nervous systems interact to: Maintain homeostasis Respond to stress Nervous system creates an immediate but short-lived response Endocrine system has a slower onset and longer duration of action, uses hormones to control its response Major Glands of the Endocrine System Anterior and posterior pituitary Thyroid and parathyroid Adrenal cortex and adrenal medulla Pancreas, ovaries, and testes Thymus and pineal gland Major Glands of the Endocrine System (cont.) Hormones of the Endocrine System Regulate critical body functions Urinary output Cellular metabolic rate Growth and development Hormonal secretions typically are regulated by negative feedback Hormones and Endocrine Glands Tropic hormones stimulate secretion of other hormones Hormones regulate body function and promote health The pituitary gland plays a central role in regulating most of the endocrine glands The Pituitary Gland Has a cascading effect on glands it stimulates Divided into anterior and posterior lobes The hypothalamus controls many activities of the pituitary gland Pituitary dysfunction can affect some or all of the glands that are targets of hormones Gigantism Abnormal pattern of growth and stature Etiology: Anterior pituitary adenoma causing excessive production of human growth hormone (hGH) before puberty S/S: gigantism, retardation of sexual and mental development Diagnosis: clinical picture, serum GH laboratory testing, MRI and CT of pituitary, radiographs of bones Treatment: surgery Gigantism (cont.) Gigantism (cont.) Andre the Giant Acromegaly Metabolic condition of adults caused by hypersecretion of GH Etiology: pituitary tumor or adenoma causing excessive secretion of GH after puberty S/S: overgrowth of bones of the face, hands, and feet, larger spaces between the teeth, joint pain Diagnosis: clinical picture, serum blood levels of GH and IGF-1 are elevated, MRI of pituitary, glucose tolerance test (GTT) Treatment: surgery Acromegaly (cont.) Acromegaly (cont.) Hypopituitarism Deficiency or absence of any pituitary hormones produced by the anterior pituitary lobe Etiology: pituitary tumor, hypothalamus tumor, congenital deficiency, damage to the pituitary gland S/S: metabolic dysfunction, sexual immaturity, growth retardation Thyrotropin deficiency (TSH)-symptoms of hypothyroidism Corticotropin deficiency (ACTH)-salt imbalances and nutrient metabolism Gonadotropin deficiency-impaired sexual development, menstruation, and libido Hypopituitarism (cont.) Diagnosis: history of head trauma, radiation, surgical procedure to the gland, serum levels of all pituitary hormones, radiographic studies of the skull (CT, MRI, etc) Treatment: depends on the underlying cause, severity of deficiency, and age Hypopituitarism (cont.) Dwarfism Deficiency of GH in children causing short stature Etiology: congenital, cranial tumor, hemorrhage after birth, secondary hypopituitarism, head trauma, infection S/S: growth retardation, delayed secondary tooth eruption, fat deposits in lower trunk Diagnosis: physical exam, low serum GH levels, CT for cranial tumor Treatment: somatotropin (hGH) Dwarfism (cont.) Diabetes Insipidus Disturbance in water metabolism causing extreme thirst and excessive secretion of dilute urine Etiology: posterior pituitary gland releases decreased amounts of vasopressin (antidiuretic hormone [ADH]) Hereditary Insult to the hypothalamus Nephrogenic Unknown Diabetes Insipidus (cont.) S/S: Polyuria Polydipsia Fatigue Symptoms of dehydration (dry mucous membranes, hypotension, dizziness, poor skin turgor Diagnosis: Urinalysis, water restriction test Treatment: vasopressin injections or nasal spray, oral desmopressin acetate (DDAVP), thiazide diuretics Teaching: fluid intake and output, when to call the MD (increase in symptoms), medic alert bracelet Diabetes Insipidus (cont.) Simple Goiter An enlargement of the thyroid gland causing swelling in the neck Etiology: lack of iodine in the diet S/S: neck swelling, difficulty swallowing, weight loss, heat intolerance, tachycardia, anxiety, increased sweating Diagnosis: physical exam, thyrotropin, T3 and T4 blood levels, radioactive iodine uptake test, thyroid ultrasound Treatment: potassium iodide, avoidance of goitogenic drugs or food Simple Goiter (cont.) Teaching: take medications at the same time each day, symptoms of adverse effects of thyroid preparations Hashimoto Thyroiditis Chronic disease of the immune system that attacks the thyroid gland Etiology: hereditary S/S: painless lumpy enlargement of the thyroid gland, pressure in the neck, difficulty swallowing, symptoms of hypothyroidism as it progress Diagnosis: serum TSH, radioactive iodine uptake scan Treatment: lifelong replacement of thyroid hormones Hyperthyroidism (Graves Disease) Hypertrophic thyroid gland from over productions of thyroid hormones Etiology: Autoimmune S/S: rapid heartbeat, palpitations, nervousness, excitability, insomnia, looses weight, profuse perspiration, intolerance to hot weather, loss of hair, tremor, exopthalmos Thyrotoxicosis-results from increased thyroid hormone secretion Hyperthyroidism (cont.) Diagnosis: physical exam, history, T3 and T4 levels are elevated, TSH hormone is low, thyroid scan Treatment: Antithyroid drugs Beta Blockers Radioactive iodine therapy Surgery (thyroidectomy) Hyperthyroidism (cont.) Hypothyroidism, Myxedema and Myxedema Coma Hypothyroidism-low production of thyroid hormone Myxedema Coma (hypothyroid crisis)-untreated hypothyroidism, life threatening Etiology: Congenital-impairment in the body's ability to synthesize T4 Acquired-Hashimoto thyroiditis Hypothyroidism, Myxedema and Myxedema Coma Diagnosis: clinical features, decreased levels of thyroid hormones, increased thyroid stimulating hormone (TSH) Treatment: lifelong thyroid replacement therapy Myxedema coma-levothyroxine sodium (T4) orally or IV Hypothyroidism, Myxedema and Myxedema Coma Patient teaching: Taking medication the same time each day on a empty stomach Signs of overmedication Clinical response to medication may take several weeks Blood tests to monitor blood levels of medications Thyroid gland self examination Hypothyroidism (cont.) Hyperparathyroidism Excess secretion of parathyroid hormone (PTH) from one or more parathyroid glands Etiology: Primary hyperparathyroidism- excessive growth of one of the parathyroid glands Secondary hyperparathyroidism- increased secretion of PTH from decreased levels of calcium or vitamin D S/S: hypercalcemia muscle weakness, atrophy, GI pain, nausea, low back pain, renal calculi (kidney stones), easy fracturing of bones Hyperparathyroidism (cont.) Diagnosis: elevated serum PTH level, increased serum and urine calcium level, decreased phosphorus levels, increased alkaline phosphatase levels, demineralization of bones Treatment: Adenoma- removal Hyperplasia- 3 ½ of the 4 glands are removed Secondary- treat underlying cause Hyperparathyroidism (cont.) Patient teaching: Explanation of the disease Easily occurring fractures Dosage schedule for medications Caution against OTC medications Hypoparathyroidism Decreased secretion of PTH from parathyroid glands Etiology: Accidental surgical removal Acquired Autoimmune genetic or congenital S/S: hypocalcemia numbness and tingling of fingertips, toes, ears, and nose, twitching of hands and feet, tetany, emotional changes, confusion, irritability Hypoparathyroidism (cont.) Diagnosis: clinical picture, injury to the parathyroid glands, decreased serum calcium levels, increased serum phosphate levels, EKG changes, decreased PTH levels, + Trousseau sign Treatment: calcium replacement therapy with Vit. D, calcium gluconate IV, high calcium diet Cushing Syndrome Hypersecretion of cortisol from adrenal cortex Etiology: hyperplasia of adrenal gland, excessive secretion of corticotropin (ACTH) from pituitary gland, tumor of adrenal cortex, prolonged administration of large doses of glucocorticoids S/S: fatigue, muscle weakness, weight gain, fat deposits in scapular area (buffalo humps) and trunk (protruding abdomen), salt and water retention, moon face, hyperlipidemia, red or purple striae (stretch marks) Cushing Syndrome (cont.) Diagnosis: clinical presentation, elevated serum cortisol levels Treatment: dependent on underlying cause Surgery or radiation for tumors Drugs to suppress ACTH levels Cushing Syndrome (cont.) Addisons Disease Failed adrenocortical function (decreased production of cortisol and aldosterone) Etiology: Destruction of the adrenal gland S/S: fatigue, weakness, anorexia, agitation, confusion, weight loss, gastrointestinal disturbances, bronze skin color, irregular pulse, orthostatic hypotension, inability to retain salt and water, dehydration, hyperkalemia, electrolyte imbalances Addisons Disease (cont.) Diagnosis: Decreased: blood and urine cortisol levels, sodium and glucose levels Elevated: BUN, lymphocyte, and hematocrit Treatment: lifelong hormone replacement therapy, correction of salt and potassium levels, dietitian referral Patient teaching: Medication regimen Avoidance of stress and infections F/U appointments Addisons Disease (cont.) Diabetes Mellitus Disorder of carbohydrate, protein, and fat metabolism resulting from lack of insulin or inability of tissues to use insulin Etiology: familial or acquired Type I - infection early in life may trigger autoimmune response Type II - occurs in older overweight adults Diagnosis: patient history, at least 2 + tests of fasting blood glucose and presence of acetone in urine Diabetes Mellitus (cont.) S/S: hyperglycemia, polyuria, polyphagia, polydipsia, weight loss, fatigue, pruritis, fruity odor to the breath Treatment: insulin, oral medication, exercise, blood and urine testing, hygienic measures Two Types: Type I (IDDM)- occurs usually before age 30, abrupt onset little or no insulin secreted Type II (NIDDM) - occurs usually older than age 30...more in people over age 55, gradual onset, symptoms controlled with diet and oral meds Diabetes Mellitus (cont.) Patient teaching: Monitoring technique Routine monitoring of weight Techniques of insulin administration S/S of worsening disease Foot and dental care Diabetes Mellitus (cont.) Gestational Diabetes Damaged ability to process carbohydrates at the onset of pregnancy Risk factors: family history of diabetes, obesity, over age 25 S/S: asymptomatic, polyuria, polyphagia, polydipsia Diagnosis: glucose in urine, elevated fasting blood glucose, hemoglobin A1C levels, oral glucose tolerance tests Treatment: exercise, oral hypoglycemics, diet, monitoring blood glucose levels Patient teaching: blood glucose monitoring, insulin administration, dietary management Hypoglycemia Low blood glucose level Etiology: insulin overdosage, failure to eat, excessive exercise, excessive secretion of insulin by pancreas, cancer of the pancreas S/S: sweating, nervousness, trembling, weakness, hunger, dizziness, palpitations Diagnosis: blood glucose level less than 50mg/dl Treatment: glucagon, complex carbohydrate and protein snack Hypoglycemia (cont.)

Eye

Functional process of vision · Image is formed on the retina · Rods and cones are stimulated · Nerve impulses are conducted to the brain Eyeball layers · Sclera: Outermost · Choroid: Middle o continuous with ciliary body and iris · Retina: Innermost · Optic nerve penetrates the fibrous layers at the optic disc o optic nerve sends impulses to the brain · Conjunctiva o covers anterior externally visible portion of the sclera · Anterior chamber is between the iris and anterior cornea · Vitreous body is behind the lens Light Rays · Rays enter the eye and pass through the cornea, aqueous humor, lens, and the vitreous humor o rays travel in straight line or at an angle · Refraction: Bending light rays · Image formed on retina is reversed · Adjustments are made in the eye to facilitate the image in relation to the viewer's distance · Intrinsic muscles respond to light levels and change pupil size Common Symptoms of Eye Diseases and Condition · Eye redness · Pain, itching, or burning in or around the eye · Swollen red eyelids · Drainage from the eyes · Lesions/sores in or around the eyes · Visual disturbances · Unequal pupils, sudden loss of vision, persistent pain Diagnostic Tests for Eye Conditions · Eye charts and vision field tests · Tonometry to measure intraocular pressure · Eye cultures to identify viral or bacterial infectious agents · Electronystagmography to measure the direction and degree of nystagmus · Electroretinography to measure electric activity of the retina Refractive Errors · Hyperopia: Farsightedness o light focused behind retina · Myopia: Nearsightedness o causes blurred vision · Astigmatism: Irregular focusing of the light rays · Presbyopia: Loss of elasticity in the lens · May be genetic · Treatment: Artificial lenses or surgery Nystagmus · Repetitive or involuntary eye movements · S/S: blurred vision, involuntary eye movement · Schedule a comprehensive ophthalmic examination for a patient c/o "jerky movements of the eye" · Can be congenital or acquired o acquired managed by treating underlying condition o congenital lessened by using the Kestenbaum procedure · Diagnosed by external examination of eyes Strabismus · Failure of the eyes to look in the same direction · S/S: esotropia (both eyes turn inward), exotropia (both eyes turn outward), diplopia if acquired as an adult o esotropia usually develops in infancy or early childhood · Diagnosis by examination, radiographic studies, blood tests · Should be treated as soon as possible corrective glasses, treatment to minimize amblyopia, or surgery Disorders of the Eyelid · Hordeolum (stye) · Chalazion (stye) · Keratitis · Blepharitis · Entropion · Ectropion · Blepharoptosis · Conjunctivitis Hordeolum (stye) · Painless abscesses of eyelid follicle or eyelid sebaceous gland · S/S: pain, swelling, redness, and pus formation · Styes are the result of a staphylococcal infection and can be secondary to blepharitis · Treat with warm compresses or antibiotics · Recurrence can be common · Apply eye compresses correctly as prescribed Chalazion · Small, firm, non-mobile, painless subcutaneous nodule of the eyelid · Signs of infection are redness, swelling, and pain · Caused by a blockage of fluid originating from one of the meibomian glands · Treated with warm compresses and topical antibiotics o larger chalazion may require surgical removal · When surgery is required, remind patients it is minor Keratitis · Inflammation of the cornea · S/S: decreased visual acuity, irritation, tearing, photophobia, and mild redness · Caused by an infection resulting from the herpes simplex virus · Administration of a broad-spectrum antibiotic or antiviral can effectively eradicate the infection · Prompt treatment decreases risk of ulceration · Patients should adhere to strict hand hygiene Blepharitis · Inflammation of the margins of the eyelids involving hair follicles and glands · S/S: redness and crust of eyelid; itching or burning · Ulcerative form of blepharitis is usually the result of a staphylococcal infection · Nonulcerative blepharitis can be caused by allergies or exposure to smoke, dust, or chemicals Use warm wet compresses and cleanse with baby shampoo and water, severe cases require antibiotic ophthalmic ointment Entropion · The eyelid margins turn inward · Symptoms are the sensation of a foreign body in the eye, tearing, itching, and redness · Entropion most often affects older people · In diagnosis, visual examination reveals an inversion of the eyelid · A minor surgical procedure on the eyelid usually corrects the problem · Don't rub the eyes in order to avoid infection Ectropion · Lower eyelid everts from the eyeball · S/S: dry eye, tearing · Usually occurs in the elderly as a result of decreased elasticity of the lower eyelid · The problem can be detected easily by visual examination · Minor surgical procedure is all that is needed to correct the condition · Teach proper technique for instilling ophthalmic ointment and eye drops Blepharoptosis · Permanent drooping of the upper eyelid · Can occur at any age, is often familial, and if severe, obstructs the vision of the affected eye · Caused either by weakness of the third cranial nerve or weakness of the muscle that raises the eyelid · Blood tests and imaging may be ordered · An operation can be performed to elevate the eyelid position Conjunctivitis · Inflammation of the conjunctiva, mucous membranes of the eyeball, and eyelids · S/S: redness, swelling, foreign body sensation and itching of the conjunctiva; eyes may tear excessively and be extra sensitive to light · Conjunctivitis can be caused by infection and also by irritation resulting from allergies or chemicals · To identify bacterial or viral organisms, samples of the discharge can be taken · Treatment varies depending on the causative agents · Avoiding the offending agents can result in resolution of the symptoms Disorders of the Globe of the Eye · Corneal abrasion or ulcer · Episcleritis/scleritis · Cataracts · Glaucoma · Acute angle-closure glaucoma · Macular degeneration · Diabetic retinopathy · Retinal detachment · Uveitis · Exophthalmos Corneal Abrasion or Ulcer · Corneal abrasion-painful loss of outer layer of the cornea Corneal ulcer-infection of the cornea · S/S: pain, redness, tearing, vision impairment · Prompt medical care is indicated · Causes o abrasions: Foreign bodies being trapped between the cornea and eyelid, by direct trauma to the cornea, dirty/scratched contacts o when abrasions not treated an ulcer can develop · Treated with antibiotic ointment Cataracts · Opacification of the lens of the eye · S/S: report poor night vision, a yellowing or fading of colors, or loss of brightness of color · Most common cause is opacification of the lens caused by the aging process o may be congenital or caused by trauma or systemic disease; often have familial occurrence · Surgery is advised when the cataracts begin to interfere with the lifestyle of the patient Glaucoma · Increased intraocular pressure · Major cause of blindness · Risk factors include age older than 60 years, nearsightedness, blood relatives with glaucoma, and African-American descent · By the time symptoms appear, damage has already occurred · The best way to detect is periodic routine ophthalmic exams · In chronic open-angle glaucoma, a block at the level of the trabecular meshwork impairs aqueous humor reabsorption · Diagnosis is done with patient history and several exams · If not treated promptly, the disease can lead to blindness o usually treated with medication to decrease the production of aqueous humor Types of Glaucoma Macular Degeneration · Deterioration or breakdown of the macula of the retina · S/S: mild distortion of central vision, seeing wavy lines, or opaque spots in visual field · Age, genetic factors, and prolonged exposure to bright light are all causative factors · Thorough examination is needed for diagnosis · No definitive medical cure is known · Demonstrate the use of the Amsler grid for home monitoring Diabetic Retinopathy · Alteration and proliferation of the retinal blood vessels · S/S: microaneurysm, hemorrhages, dilation of retinal veins, macular edema, and formation of abnormal vessels · Occurs about 8 to 10 years after the onset of diabetes mellitus · Treatment with laser photocoagulation is usually effective · Stress the importance of good diabetic care Retinal Detachment · Detachment of the retina from the choroid · S/S: patient sees floaters and light flashes, may see dark shadow · May be partial or complete and usually is associated with a retinal tear or hole in the retina · The patient is brought to the physician's attention for immediate dilated examination · Commonly associated with severe diabetic retinopathy · Treatment consists of either photocoagulation or surgery Exophthalmos · Abnormal protrusion of the eyeballs · S/S: report dryness, a gritty feeling in the affected eye(s), double vision, and movement restriction · Caused by enlarged extraocular muscles, retrobulbar mass, or edema of the soft tissue that lines the bony orbit of the eye · Diagnosis determines therapy needed o surgery may be needed in severe cases · Explain purpose and dosage schedule of medication

EAR

Functioning Organs of Hearing · Outer ear o made up of external ear and auditory canal · Middle ear o contains tympanic membrane and three ossicles, eustachian tube, and oval window · Inner ear o contains two membrane-lined chambers called the cochlea and the labyrinth Disorders of Conduction · Impacted cerumen · Infective otitis externa · Swimmer's ear · Otitis media · Otosclerosis Impacted Cerumen · Accumulation of cerumen in the outer ear canal · If secretion accumulates excessively, a gradual loss of hearing may occur and feeling of a plugged ear, tinnitus, and earache · Can be caused by dryness and scaling of the skin or by excessive hair in the ear canal · Impacted cerumen must be removed o May have to be softened first with oily drops and then irrigated with water · Reinforce not putting anything into the ear that would push or pack the earwax

• Multiple Sclerosis (MS)

Inflammatory disease of the central nervous system • Etiology: Unknown, possible immune system involvement, possible virus triggers the immune system to turn against the body • S/S: weakness or numbness, optic neuritis, loss of vision in one eye, diplopia, unsteady gait, vertigo, difficulty urinating

• Infant respiratory distress syndrome (IRDS)

§ Infant suffers from acute hypoxemia caused by infiltrates in the alveoli § Etiology: Lungs of the neonate lack the surfactant needed to allow the alveoli to expand § S/S: exhibits signs of respiratory distress, including nasal flaring, grunting respirations, and sternal retractions, becomes cyanotic, mottled skin, blood gas studies show reduced oxygen § Infant respiratory distress syndrome (IRDS) (cont.) § Diagnosis: increased respiratory efforts with a history of prematurity, chest x-ray indicates presence of infiltrate or hyaline § Treatment: Administration of carefully titrated supplemental oxygen, usually administered by mechanical ventilation and positive end-expiratory pressure □ Aerosol infusion of surfactant allows alveoli to expand § Prevention is the best treatment

Hydrocephalus

• • Increased amount of CSF or circulation is blocked causing enlargement of the head and pressure changes in the brain • Etiology: • impairment of the circulation of the CSF in the ventricular circulation may be caused by a lesion within the system or by a congenital structural defect • impairment of the flow of the CSF in the subarachnoid space prevents the CSF from reaching the areas where it normally would be reabsorbed • S/S: head circumference increases at a faster rate than expected, high pitch cry, irritable, projectile vomiting, downward displacement of the eye, abnormal muscle tone • Diagnosis: clinical picture, physical exam, radiographic studies of the brain • Treatment: surgical intervention to place a shunt in the ventricular or subarachnoid spaces to drain off the excessive CSF • empty into the peritoneal cavity or right atrium

leukemia

• A cancer of blood forming tissues with an increase in immature WBC's • Etiology: Unknown • S/S: anemia, prolonged bleeding time (reduction of platelets), fever, easy bruising, pallor, weakness, weight loss, bone and joint pain • Diagnosis: peripheral blood smear, uric acid levels, electrolytes, kidney and liver function, coagulation studies, bone marrow aspiration, chromosome analysis, lumbar puncture • Treatment: chemotherapy, bone marrow transplant

Cancer

• A group of diseases characterized by uncontrolled cell proliferation or growth • Leads to the development of neoplasms (growing mass of abnormal cells that proliferates at the expense of the healthy organism) • Tumors • Malignant or Benign • Cell type and tissue of origin • Benign Tumors ○ Develop slowly ○ Can arise from any tissue ○ Usually remain encapsulated (self-contained) ○ Well differentiated-they resemble tissue of origin ○ Rarely recur after surgical removal • Malignant Tumors ○ Cells multiply rapidly ○ Do not usually resemble the tissue of origin ○ Invade surrounding tissue ○ Often recurrent ○ Infiltrates to distant sites (metastasize) • Cancer Prevention • Diet rich in fruits, vegetables, and whole grains • Eliminate exposure to cigarette smoke • Limit skin exposure to sunlight • Limit use of alcohol • Avoid excessive exposure to radiation and radon • Avoid chemical agents known to be carcinogenic • Increase physical activity • Maintain a healthy weight • Protect against sexually transmitted infections, including getting the human papillomavirus (HPV) vaccine • Cancer Screening • Treatment more likely to succeed if cancer is detected early • Elevation of blood serum in tumor markers: • helps determine diagnosis of cancer • evaluates response to therapy • screens for disease recurrence • Men • PSA test (prostate specific antigen) antigen) • Testicular self-exam • Women • Pap smear • Mammogram • Breast self-exam • Stages of Cancer • TNM staging system • Size and extent of primary tumor • Extent of regional lymph node involvement by the tumor • Number of distant metastases • Stage I is best prognosis; stage IV is most advanced • Other factors can affect prognosis • Age • Serum concentration • Time between diagnosis and treatment • Cancer Treatments • Surgery • Radiation • Chemotherapy • Hormone Therapy • Immunotherapy • Palliative therapy • Consequences of Cancer Therapy • Chemotherapy and radiation are toxic to the body • Patients are predisposed to other malignancies • Effects are dramatic in children • growth retardation and cognitive impairment • Cancer therapies are constantly evolving

Developmental dysplasia of the hip (DDH)

• Abnormal development of the hip joint that ranges from an unstable joint to dislocation of the femoral head from the acetabulum • Etiology: Cause is unknown. Possible result of softening of the ligaments caused by the maternal hormone relaxin and breech presentation • S/S: physical exam, asymmetric folds of the thigh, limited abduction of the hip, shortening of the femur • Diagnosis: physical exam, positive Ortolani and Barlow maneuvers, ultrasound of the hip • Treatment: After the femoral head is returned to its proper position in the acetabulum, the legs are held in place by • Pavlik harness • Splint • Cast • Surgical intervention if no improvement

Retinopathy of prematurity

• Abnormal growth of the blood vessels in the retinas of infants • Occurs most often in infants born before 28 weeks' gestation • Etiology: Vascularization of the retina begins at central part of the eye, as vessels grow out (in premature infants this vascularization is incomplete) • S/S: no visible symptoms • The entire retina is visualized to determine the stages of development of the blood vessels • Diagnosis: made by ophthalmologist • There are no specific risk factors • Greater risk prone with the more premature and the lower birth weight • High supplemental oxygen concentrations are responsible for many incidents • Certain drugs given for immature lungs • Most mild forms resolve without treatment

Signs

• Abnormal objective findings found by physical exam or diagnostic testing • Examples: redness, swelling, purulent drainage, fever

Necrotizing enterocolitis (NEC)

• Acute inflammatory process caused by ischemic necrosis of the mucosal lining of the small intestine, large intestine, or both • Etiology: unknown • Thought to be a breakdown in normal defense systems of the GI tract, allowing the normal flora of the GI tract to invade the intestinal mucosa • S/S: feeding intolerance, abdominal distention, bile-colored emesis, diarrhea, blood in the stool, decreased or absent bowel sounds, lethargy, body temp instability • Necrotizing enterocolitis (NEC) (cont.) • Diagnosis confirmed by: • s/s • complete blood count (CBC) shows elevated white blood cell (WBC) count • guaiac stool test + for blood • blood and stool cultures may be + for bacteria • Imaging of the intestine confirms the diagnosis • Treatment: Aggressive and immediate intervention is necessary • Feedings are stopped, and a tube is inserted into the stomach • Fluids and antibiotics administered by IV • Respiratory status and pH monitored by arterial blood gases (ABGs) • Weight, intake, output, and abdomen monitored • Prognosis: Death without immediate treatment, surgery can lead to bowel obstruction or malabsorption syndrome • Patient teaching: Meticulous handwashing

• Nonchangable predisposing factors

• Age ○ complications during pregnancy and postpartum ○ maladies associated with aging • Gender • Heredity ○ family histories ○ factors affect males and females equally • Immunodeficiency ○ risks depend on which components of immune system are inadequate • Inflammation and Repair • Acute Inflammation • Normal protective physiologic response to tissue injury and disease • Accompanied by: ○ redness ○ heat ○ swelling ○ pain ○ loss of function • Widespread inflammation • Fever • Malaise • Loss of Appetite • Acute Inflammation • Attempts to wall off, destroy, and digest bacteria and dead or foreign tissue • Prevents the spread of infection through antibody action and other chemicals released by cells • After insult is contained, repair can begin • When inflammatory response is chronic or too intense, damage to the affected tissue can result • Infection • Caused by pathogens • Signs • redness and swelling • heat and pain, fever • pus and enlarged lymph glands • Symptoms • fever, headache, body aches • weakness, fatigue, loss of appetite • Infection (cont.) • Endogenous • Inside the body • Exogenous • Outside the body • Modes of transmission • Direct or indirect physical contact • Inhalation • Ingestion of contaminated food or water • Inoculation by insect or animal • Superbugs Antibiotic-resistant strains of bacteria • MRSA to blame for skin and tissue infections • Leading cause of surgical wound infections • Excellent hygiene practices help prevent spread • VRE is a problem in chronic care facilities • CRE is another cause for concern • Occurs among patients receiving treatment for other infections

• Cystic fibrosis (CF)

• Autosomal recessive inherited disorder that causes chronic dysfunction of the exocrine glands • Etiology: • Inherited • Transmitted as autosomal recessive trait • S/S: • Copious thick and sticky mucus • Dry paroxysmal cough • Exercise intolerance • Pneumonia • Bulky diarrhea • Vomitting • Bowel obstruction • Diagnosis: genetic testing prenatally, family history, pulmonary function test, radiographic chest film, stool studies, sweat test Treatment: high calorie high sodium chloride diet, chest physiotherapy, vitamin supplements (A,D,E,K), increased fluid intake, pancreatic enzyme supplements, insulin, antibiotics to treat infections, breathing treatments, oxygen, lung transplant

Cleft lip and palate

• Birth defect where there is a hole in the middle of the roof of the mouth (palate) • Etiology: Genetic disorder with failure of the embryonic development of the fetus • S/S: Difficulty with nasal regurgitation, difficulty feeding • Diagnosis: Obvious during clinical inspection at birth • Treatment: Surgical intervention, special feeding devices, speech therapy

• Cyanotic defects

• Central cyanosis • The infant appears cyanotic with a blue tinge to the lips, tongue, and nail beds

Asthma

• Chronic reversible obstructive disease with increased reactivity of the tracheobronchial tree • Etiology: hereditary • Triggers • stress, heavy exercise, infection, inhalation of allergens, air pollutants and irritants, smoke, cool air, emotional upset • S/S: productive or nonproductive cough, expiratory wheeze, rapid shallow respirations, rapid pulse, pallor, profuse perspiration, nasal flaring, retractions, anxious, reports tight chest, diminished breath sounds with wheezes and rhonchi • Diagnosis: pulmonary function tests, radiographic chest films, intradermal skin testing, CBC, immunoglobulin E (IgE) levels • Treatment: cromolyn sodium, albuterol, theophylline, aerosol corticosteroids, allergy shots • Severe attacks: steroid injections, oxygen, endotracheal intubation, hospitalization

Hypertrophic cardiomyopathy (HCM)

• Congenital disorder where portion of the heart muscle thickens • Etiology: Myocardium becomes thickened, normal alignment of myocardial cells is disturbed resulting in disruption of cardiac electrical impulses • S/S: Collapse followed by sudden cardiac arrest, usually in healthy athletes during strenuous exercise or event. Chest pain, syncope, hypertension, palpitations, shortness of breath (SOB) • HCM (cont.) • Diagnosis: made on autopsy, S/S, drop in blood pressure (b/p) during exercise, unexplained syncope, family history, arrhythmias, EKG, MRI echo • Treatment: • Arrhythmias-beta blockers and calcium channel blockers, pacemaker or implantable cardioverter-defibrillator (ICD) • Surgical myectomy • Avoidance of strenuous exercise and stressful situations

Developmental process

• Fertilization and conception • Prenatal stages • Embryonic: Initial 2 months of gestation • Fetal: Remainder of gestation until birth • Perinatal: During the birth process • Postnatal (neonatal): Up to 1 month after birth ○ Congenital anomalies ○ Mental or physical ○ May be present at birth or diagnosed later ○ Limbs or organs may be malformed, duplicated, or entirely absent ○ Causes: genetic, nongenetic, or both ○ Team approach is ideal, including medical assessment by physicians and appropriate therapy Methods od prenatal diagnosis • Amniocentesis ○ Take amniotic fluid sample between 15 and 18 weeks of pregnancy ○ Test cells for chromosomal abnormalities or presence of abnormal substances • Ultrasound Identify spine and skull abnormalities in early pregnancy Prematurity: • Birth before 37 weeks' gestation • Low weight • Leading cause of death in neonatal period • Incomplete development of organ systems High-risk infants for serious health problems • Symptoms and signs ○ Little subcutaneous fat, palms and soles with few creases, undescended male testes, prominent female clitoris ○ Lack ability to suck or swallow, underdeveloped lungs, immature neurologic system • Etiology ○ Causes of premature labor resulting in a premature infant are: § An incompetent cervix, bicornate uterus, toxic conditions, maternal infection, trauma § Premature rupture of the amniotic membranes § Intrauterine fetal growth retardation, and other physical conditions of the mother (hypertension, diabetes, heart disease, kidney disease) ○ Treatment of prematurity ® Intravenous fluids and hyperalimentation encourage growth and development ® Airway management and pulmonary functioning are monitored ® Pulse oximeters monitor oxygen saturation and heart rate ® Body temperature is monitored/maintained ® Technology in an NICU □ Prognosis varies depending on gestational age, weight, and the occurrence of anomalies ® Risks: Cerebral bleed, underdevelopment of pulmonary system ® Accepted gestational age is 24 weeks □ Preventing prematurity requires good prenatal care, adequate nutrition, and assessment

• Congenital pyloric stenois

• Gastric obstruction with narrowing of the pyloric sphincter at the exit of the stomach • Etiology: Exact cause unknown, hereditary, more often in males • S/S: projectile vomiting after feedings, fails to gain weight, appears hungry, small hard mass palpated in the region of pyloric sphincter, if left untreated the infant becomes • Dehydration • Electrolyte imbalances • Diagnosis: Physical condition, history, upper GI radiographic studies, ultrasound of the pylorus • Treatment: Surgical intervention Pylorus is incised and sutured to relieve constriction

Down Syndrome

• Genetic disorder where the person has 47 chromosomes instead of the usual 46 • Etiology: Infants are born with an extra chromosome number 21 (trisomy 21) • S/S: Mental retardation, heart defects, small head with flat back skull, slanted eyes, flat nasal bridge, low set ears, small mouth with protruding tongue, short hands, deep horizontal crease across the palm (simian line), space between big and little toes • Down syndrome (Cont.) • Diagnosis: Prenatally by ultrasound, blood tests, and/or amniocentesis. Severe forms identified at or before birth. Milder forms identified later. Small white dots on iris, and karotype • Treatment: No cure. Multidimensional approach to improve motor and mental skills. Surgical correction of cardiac defects, antibiotics for susceptibility to pulmonary disease

Cerebral Palsy (CP)

• Group of disorders involving the brain and nervous system • May be congenital or acquired, bilateral or unilateral causing nonprogressive paralysis damaging the central nervous system • Etiology: • Inadequate blood or oxygen supply to the brain, Most common is interruption of blood flow to brain during labor and delivery or from infection or head trauma during 1st month of life • Signs and Symptoms: difficulty sucking and swallowing, floppy or stiff muscles, reduced voluntary movement, when infant lifted from behind legs are difficult to separate and may cross legs • Spastic CP: hyperactive reflexes, scissor gait • Athetoid CP: involuntary muscle movements, speech difficulty • Ataxic: lack of control over voluntary movements, poor balance, wide gait • Diagnosis: S/S, clinical picture, neurologic exam findings • Treatment: No cure, physical therapy, speech therapy, special education, orthopedic interventions (casts, braces, traction, surgery), anticonvulsants for seizures, muscle relaxants for spastic muscle activity • Prevention: Prevention of oxygen deprivation, prevention of head injury or brain infection

Immune Disorders

• Hypersensitivity reaction (allergy) • Autoimmune disease • Immunodeficiency disorders • Hypersensitivity (allergen) • Exposure to allergen, which acts as antigen • Triggers stimulation of immunoglobulin antibodies • Subsequent exposures trigger the allergic response, causing the release of histamine • Range from mild and self-limiting to severe and life-threatening • Allergies controlled with proper diagnosis and treatment • Autoimmune Diseases and immunodeficiency • Autoimmune diseases • Marked by an inappropriate or excessive response of the body's defense system • Antibodies are formed against self-antigens mistakenly identified as foreign • What triggers autoimmune response is a mystery • Immunodeficiency • Depressed or absent immune response • Causes can be primary or secondary • Aging • Onset of "immunosenescence" • Yearly physical exam recommended after age 50 • Older adults have many life stresses • loss of loved ones, rising health care costs • Drug therapy • Changes in body composition • Decreased total body water • Severe cognitive impairment

epiglottitis

• Inflammation of the epiglottis • Etiology: most common cause is Haemophilus influenzae type B (HIB) bacteria • S/S: sore throat, croupy cough, fever. respiratory distress, red and swollen epiglottis, signs of emergency when dyspnea and drooling • Diagnosis: radiographic films of the neck, inspection of the throat • Treatment: If the airway is obstructed hospitalization is required for tracheostomy or endotracheal intubation, and parenteral antibiotics

• Polymyositis

• Inflammation of the muscle fibers usually closest to the trunk or torso • Etiology: Unknown, thought to be autoimmune • S/S: muscle weakness, difficulty swallowing, skin inflammation, rash • • Diagnosis: history, physical examination, serum blood tests • Treatment: steroids, immunosuppressive agents, IV immunoglobulin, exercise therapy

Infantile colic

• Intermittent distress in the newborn or during early infancy • Etiology: Unknown • Possible hypothesis: improper feeding techniques, overeating or swallowing of excessive air • S/S: draws up legs, clenches the fists, cries if in pain, pass gas by mouth and rectum • Diagnosis: physical exam and symptoms • Treatment: elimination of causative factors, probiotics, simethicone

Idiopathic Thrombocytopenic Purpura (ITP)

• Isolated deficiency of platelets • Etiology: Unknown cause, may occur after a viral infection (rubella, mumps) • S/S: spontaneous hemorrhages in the skin, mucous membranes, or internal organs, petechiae, ecchymoses. epistaxis, GI bleeding, menorrhagia, hematuria, easily bruising • Diagnosis: clinical findings, CBC, peripheral blood smear, Prolonged bleeding time, reduced platelet count • Treatment: corticosteroids, IVIG, blood transfusion, vitamin K, therapeutic plasma exchange, splenectomy (last resort)

• Wilms tumor (nephroblastoma)

• Malignant neoplasm of the kidney • Affect children younger than 10 years • 4th most common childhood cancer • Etiology: Adenosarcoma arising from abnormal fetal kidney tissue left behind during embryonic life • S/S: mass in the kidney region, hematuria, pain in the abdomen or chest, hypertension, anemia, vomiting, intestinal obstruction, constipation, weight loss, fever • Diagnosis: Physical exam to palpate the kidney mass, Blood tests, abdominal ultrasound, CT scan, urinalysis, surgery for tumor staging • Treatment: • Surgical removal • Chemotherapy with or without radiation

Diagnosis of Disease

• Medical history during patient interview • interview helps establish a treatment plan • Physical exam (systems review) • inspection, auscultation, percussion • Diagnostic studies and laboratory tests • microscopic examination of cells and tissues and chemical analysis • Treatment of Disease • Preventive measures • Therapeutic procedures, administration of medications, measures for relief of pain • Surgery, physical therapy, diet modification, psychotherapy, patient education, and follow-up care • Patients make choices to promote recovery

Meningocele

• Meninges protrude through an opening in the spinal column, forming a sac the becomes filled with cerebrospinal fluid (CSF) • Etiology: cause unknown, posterior portion of the neural tube fails to close, possible reduced levels of Vit. A and folic acid • S/S: no nerve involvement, sac formed over the defect permits the passage of light during transillumination • Meningocele (cont.) • Diagnosis: physical exam, verification of the presence of a sac, radiographic studies • Treatment: surgical intervention within 24-48 hours of life

anencephaly

• Most severe neural tube defect, failure of the cephalic aspect of the neural tube to close • Etiology: Unknown, possible that a mothers diet and vitamin may be involved • S/S: no cranial vault, little cerebral tissue • Diagnosis: ultrasound of the fetal head when blood tests of the mother indicate an elevated AFP level • Treatment: None, infants die shortly after birth

Acute Illness

• Onset is usually abrupt • Runs brief course (usually less than 6 months) • Symptoms present over hours to days

• Pain

• Pain is subjective • Can be physiologic or psychological • Everyone describes pain in different ways • Pain should be categorized • Intensity of pain depends on many factors • Pain measuring scales can be used • Assessment of pain is noted when vitals are taken • Pain Rating Scales and Instruments (Wong/Baker faces rating scale) • Pain Classification • Acute • Blood pressure and pulse increase • Chronic • Patients often exhibit weight loss or gain, insomnia, anorexia, or inability to continue normal activities • Intractable is debilitating and can cause depression • Transient is often not significant • Pain Relief • Acute pain • Narcotics or opioid-related drugs; analgesics • Chronic pain • NSAIDs • Antidepressants • Anticonvulsants • Alternative methods • Physical therapy and massage

Acute tonsillitis

• Painful inflammatory infection of the tonsils • Etiology: caused by many organisms but group A beta-hemolytic streptococci is the most common • S/S: mild to severe sore throat, chills, fever, headache, malaise, anorexia, muscle and joint pain, tonsils appear inflamed and swollen w/yellow exudate, enlarged lymph glands • Diagnosis: throat exam, throat culture, WBC count • Treatment: 10 day course of antibiotics (penicillin), liquid diet, saline throat irrigations, tonsillectomy

Spina bifida occulta

• Posterior arches of the vertebrae fail to fuse, but there is no herniation of meninges or spinal cord • Etiology: unknown, associated with exposure to ionizing radiation, reduced levels of Vit. A and folic acid during pregnancy • S/S: asymptomatic, dimpling, a tuft of hair or hemangioma over the site where the vertebrae have not completely fused • Spina bifida occulta (cont.) • Diagnosis: maternal blood levels of AFP, prenatal ultrasound, postnatal physical exam, neurologic symptoms, spinal ultrasound • Treatment: usually no treatment, if symptomatic with neurologic problems then surgical intervention Prevention: avoiding exposure to ionizing radiation during pregnancy, increased intake of folic acid during early pregnancy

Muscular dystrophy (MD)

• Progressive degeneration and weakening of skeletal muscles • Most common is Duchenne MD • Etiology: genetic defect, caused by an absence of dystrophin, affects only males, inherited through female carriers • S/S: waddling gait, toe walking, lordosis (other spinal deformities), difficulty climbing stairs and running, easily falling, difficulty getting up, contractures, susceptible to pulmonary infections • Diagnosis: symptoms, muscle biopsy, EMG, elevated serum CK levels, DNA blood test • Treatment: No known successful treatment, PT, exercise, surgery, use of orthopedic devices, corticosteroids, anticonvulsants for seizures, antibiotics for respiratory infections • Spina bifida • Posterior portion of the bony canal containing the spinal cord is completely or partially absent • Due to the failure of the posterior spinal processes to close • Types • Occulta • Meningocele Myelomeningocele

myelomeningocele

• Protrusion of a portion of spinal cord and meninges through a defect in the spinal column • Etiology: neural tube fails to close causing meninges, spinal nerves, and spinal cord to herniate through posterior spinal column, genetic factors • S/S: neurologic symptoms, musculoskeletal malformation, immobile joints, or paralysis of the lower extremities, possible bowel and bladder control issues • Myelomeningocele (cont.) • Diagnosis: physical exam, imaging, surgical exploration • Treatment: surgical intervention within 24hrs of life, additional procedures may be required to correct evolving problems, PT (leg braces, crutches, ambulation training) • Prognosis: irreversible nerve damage, surgery may delay progression of paralysis

• diarrhea

• Rapid passage of stool through the intestinal tract with a change in frequency, fluid content, appearance, and consistency • Etiology: Cause may be unknown, possible causes • Infection, medications, allergic reactions, emotions, anatomic abnormalities, malabsorption syndromes, mechanical or chemical irritation, toxicity • S/S: intestinal cramping, weakness, nausea, irritability, fever • Prolonged (dehydration, electrolyte imbalances, metabolic acidosis, lethargic, hyperventilation • Diagnosis: to determine underlying cause • History on onset • Severity of symptoms • Blood testing • Stool analysis and culture • Treatment: directed at the cause • Diet restrictions • IV fluids • Antibiotics if an infection present • Electrolyte therapy if any imbalances

• anemia

• Reduction in the concentration of RBC's or in hemoglobin • Etiology: Iron deficiency, acute on chronic blood loss, decreased blood formation, nutritional deficiency disorders, hemolytic diseases, inhibition or loss on bone marrow, sickle cell • S/S: pallor, weakness, fatigue, listlessness, palpitations, tachycardia, cardiac enlargement, juandice, metal sluggishness • Diagnosis: physical exam, laboratory testing • Treatment: dependent on underlying cause • Pernicious Anemia • Caused by chronic atrophic gastritis • Decreased gastric production of hydrochloric acid • Shortage of intrinsic factor • Etiology: Intrinsic factor must be present in gastric mucosa for Vit. B12 (needed for RBC formation) absorption • RBC's become deformed • decreased number of RBC's • Diagnosis: clinical findings, Schilling test, bone marrow studies, peripheral blood smear, blood tests reveal • decreased hemoglobin and RBC • increased mean cell volume (MCV) • Treatment: weekly then monthly IM injections of Vit. B12, blood transfusion (severe cases), diet rich in Vit. B12 • Vit. B12 also available sublingual

• Helminth (worm) infestation

• Roundworms, pinworms, hookworms, and tape worms (helminthes) take up the GI tract • Etiology: pinworm is most common cause, transmitted by children through contaminated hands into their mouths • S/S • Pinworm eggs hatch in intestine • Female worms migrate to perianal are at night • Eggs are laid • Mild to intense irritation to perianal area • Diagnosis: detection of eggs or worms in the anal opening by placing transparent tape in the perianal area, stool culture • Treatment: full course of antihelmintic agents

croup

• Severe inflammation and obstruction of the respiratory tract • Etiology: viral disease involving larynx, trachea, and bronchi causing edema and spasm of the vocal cords • S/S: hoarseness, fever, harsh high pitched cough, stridor during inspiration, dyspnea • Diagnosis: blood and throat cultures, laryngoscopy, radiographs of the airway • Treatment: antipyretics, rest, increased fluid intake, cool air humidification, antibiotics if the cause is bacterial, steroids, in severe cases oxygen and endotracheal intubation

Preventive Health Care

• Strategies to prevent illness or injury • Identify risk factors and employ specific screening tests • Use available medical measures • Public education • Infection Control and Prevention • Protect patients against hospital-acquired infections • continuing education requirements • awareness programs for alcohol abuse • wellness program initiatives • Improved safety measures • Protective labeling and packaging • General public safety education • Vaccines are important; side effects occur

Symptoms

• Subjective patient reports • Examples: difficulty swallowing, pain, fatigue, headache