"The Bright Side"

WPW

2010-01-17T22:14:00.000-08:00

DEFINITION

Wolff-Parkinson-White syndrome is a heart condition in which there is an extra electrical pathway (circuit) in the heart. The condition can lead to episodes of rapid heart rate

Wolff-Parkinson-White is one of the most common causes of fast heart rate disorders in infants and children.

CAUSES

Normally, electrical signals in the heart go through a pathway that helps the heart beat regularly. The wiring of the heart prevents extra beats from occurring and keeps the next beat from happening too soon.

In people with Wolff-Parkinson-White syndrome, there is an extra, or accessory, pathway that may cause a very rapid heart rate. This is called supraventricular tachycardia.

SYMPTOMS

How often the rapid heart rate occurs depends on the patient. Some people with Wolff-Parkinson-White syndrome may have just a few episodes of rapid heart rate. Others may have the rapid heart rate once or twice a week. Sometimes there are no symptoms, and the condition is detected when a heart tests are done for another reason.

A person with WPW syndrome may have: * Chest pain or chest tightness * Dizziness * Light-headedness * Fainting * Palpitations (a sensation of feeling your heart beat) * Shortness of breath

EXAMS AND TESTS

An exam performed during a tachycardia episode will reveal a heart rate greater than 230 beats per minute and blood pressure that is normal or low. A normal heart rate is 60 - 100 beats per minute in adults, and under 150 beats per minute in neonates, infants, and small children.

If the patient is currently not having tachycardia, the physical exam may be completely normal.

A test called EPS may help identify the location of the extra electrical pathway.

Wolff-Parkinson-White syndrome may be revealed by the following tests: * ECG (electrocardiogram) may show an abnormality called a "delta" wave. * Continuous ambulatory monitoring (Holter monitor)

TREATMENT

Medication may be used to control or prevent rapid heart beating. These include adenosine, antiarrhythmics, and amiodarone.

If the heart rate does not return to normal with medication, doctors may use a type of therapy called electrical cardioversion (shock).

The current preferred therapy for Wolff-Parkinson-White syndrome is catheter ablation. This procedure involves inserting a tube (catheter) into an artery through a small cut near the groin up to the heart area. When the tip reaches the heart, the small area that is causing the fast heart rate is destroyed using a special type of energy called radiofrequency.

Open heart surgery may also provide a permanent cure for Wolff-Parkinson-White syndrome. However, surgery is usually done only if the patient must have surgery for other reasons.

Franky mode....

2010-01-17T04:37:00.000-08:00

Frank-Starling curve

Definition

(1) A curve that show the contractility change in an intact heart.

(2) A graph to show the relationship (or ratio) between the atrial pressure (plotted along the x-axis) and the cardiac output or stroke volume (plotted along the y-axis).

Supplement

This graphical representation indicates that the more blood is returned to the heart, the more blood is pumped from it without the extrinsic signals.

A graph in which cardiac output or stroke volume is plotted against mean atrial or ventricular end-diastolic pressure; with increasing venous return and atrial pressure the output increases until further increments overload the heart and the output falls. proportionately

Douglas Pouch...,

2010-01-16T04:07:00.000-08:00

Douglas, James(1675–1742), British anatomist. Douglas was the author of a number of books and papers on human, comparative, and pathological anatomy. In 1707 he published an important book on muscles.In 1730 he published a detailed study of the peritoneum which contained his original description of the pouch of Douglas.

The Pouch of Douglas is the extension of the peritoneal cavity between the rectum and back wall of the uterus in the female human body. It is also known by the names Douglas pouch, Douglas space, Douglas cul-de-sac, rectouterine pouch, and rectouterine excavation. In women it is the deepest point of the peritoneal cavity, posterior to (behind) the uterus and anterior to (in front of) rectum. The corresponding region in men is the Excavatio rectoversicalis between the urinary bladder and rectum.

TENOSYNOVITIS

2010-01-15T00:18:00.000-08:00

Tenosynovitis involves inflammation of the tendon and tendon sheath. Examples of tenosynovitis include de Quervain tenosynovitis of the wrist (ie, abductor pollicis longus a nd extensor pollicis brevis tendons), volar flexor tenosynovitis (ie, trigger finger), pyogenic flexor tenosynovitis, which can be from gonococcal infections and other infectious etiologies.

Pathophysiology

Flexor tendons of the hand

run in tight fibroosseous tunnels. Visceral and parietal layers of synovium lubricate and nourish the tendons. These layers are usually collapsed unless infection, which follows the path of least resistance along the tendon sheaths or inflammation, is present.

Infection can be introduced directly into the tendon sheaths through a skin wound (most often) or via hematogenous spread, as occurs with gonococcal tenosynovitis. Gonococcal infection originates as a mucosal infection of the genital tract, rectum, or pharynx. Dissemination occurs in approximately 1-3% of patients with mucosal infection. Approximately two thirds of patients with disseminated gonococcal infection develop tenosynovitis.

A history of recent trauma to the involved area is not uncommon and is believed to be a predisposing factor for the development of pyogenic flexor tenosynovitis.Overuse leads to inflammation in de Quervain tenosynovitis. Etiology of volar flexor tenosynovitis is unknown.

The synovium is a lining of the protective sheath that covers tendons. Tenosynovitis is inflammation of this sheath. The cause of the inflammation may be unknown, or it may result from:

Infection
Injury
Overuse
Strain

The wrists, hands, and feet are commonly affected. However, the condition may occur with any tendon sheath.

Note: An infected cut to the hands or wrists that causes tenosynovitis may be an emergency requiring surgery.

The goal of treatment is to relieve pain and reduce inflammation. Rest or keeping the affected tendons still is essential for recovery.

You may want to use a splint or a removable brace to help immobilize the tendons. Applying heat or cold to the affected area should help reduce the pain and inflammation.

Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen can relieve pain and reduce inflammation. Local injections of corticosteroids may be useful as well. Some patients need surgery to remove the inflammation surrounding the tendon, but this is not common.

For tenosynovitis caused by infection, your health care provider will prescribe antibiotics. In some severe cases, surgery may be needed to release the pus around the tendon.

After recovery, do strengthening exercises using the muscles around the affected tendon to help prevent the injury from coming back.

Epinephrine (BOSMIN)

2010-01-15T00:14:00.000-08:00

Bosmin - General Information:

The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics.

Pharmacology:

Bosmin is indicated for intravenous injection in treatment of acute hypersensitivity, treatment of acute asthmatic attacks to relieve bronchospasm, and treatment and prophylaxis of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome). The actions of epinephrine resemble the effects of stimulation of adrenergic nerves. To a variable degree it acts on both alpha and beta receptor sites of sympathetic effector cells. Its most prominent actions are on the beta receptors of the heart, vascular and other smooth muscle. When given by rapid intravenous injection, it produces a rapid rise in blood pressure, mainly systolic, by (1) direct stimulation of cardiac muscle which increases the strength of ventricular contraction, (2) increasing the heart rate and (3) constriction of the arterioles in the skin, mucosa and splanchnic areas of the circulation. When given by slow intravenous injection, epinephrine usually produces only a moderate rise in systolic and a fall in diastolic pressure. Although some increase in pulse pressure occurs, there is usually no great elevation in mean blood pressure. Accordingly, the compensatory reflex mechanisms that come into play with a pronounced increase in blood pressure do not antagonize the direct cardiac actions of epinephrine as much as with catecholamines that have a predominant action on alpha receptors.

Bosmin for patients

Bosmin Interactions

Epinephrine should be used cautiously in patients with hyperthyroidism, hypertension and cardiac arrhythmias. All vasopressors should be used cautiously in patients taking monoamine oxidase (MAO) inhibitors.

Epinephrine should not be administered concomitantly with other sympathomimetic drugs (such as isoproterenol) because of possible additive effects and increased toxicity.

Combined effects may induce serious cardiac arrhythmias. They may be administered alternately when the preceding effect of other such drug has subsided.

Administration of epinephrine to patients receiving cyclopropane or halogenated hydrocarbon general anesthetics such as halothane which sensitize the myocardium, may induce cardiac arrhythmia.. When encountered, such arrhythmias may respond to administration of a beta-adrenergic blocking drug. Epinephrine also should be used cautiously with other drugs (e.g., digitalis, glycosides) that sensitize the myocardium to the actions of sympathomimetic drugs.

Diuretic agents may decrease vascular response to pressor drugs such as epinephrine.

Epinephrine may antagonize the neuron blockade produced by guanethidine resulting in decreased antihypertensive effect and requiring increased dosage of the latter.

Bosmin Contraindications

Epinephrine is contraindicated in patients with known hypersensitivity to sympathomimetic amines, in patients with angle closure glaucoma, and patients in shock (nonanaphylactic). It should not be used in patients anesthetized with agents such as cyclopropane or halothane as these may sensitize the heart to arrhythmic action of sympathomimetic drugs.

Epinephrine should not ordinarily be used in those cases where vasopressor drugs may be contraindicated, e.g., in thyrotoxicosis, diabetes, in obstetrics when maternal blood pressure is in excess of 130/80 and in hypertension and other cardiovascular disorders.

Dr. Randas Batista (Batista Operation)

2010-01-15T00:04:00.000-08:00

The Batista Operation - What is it ?

The Batista Operation is technically called a REDUCTION LEFT VENTRICULOPLASTY. It is an open-heart operation performed with the aid of a heart lung machine to maintain circulation while the heart is stopped. The essence of the procedure is to remove a wedge of left ventricle muscle (weighing about 40 to as much as 250 grams) and stitch together the two edges of the ventricle. In this manner the size of the left ventricle is reduced, and the ventricle is remodelled as well.

In addition, sometimes, the mitral valve (which lies between the left ventricle and left atrium) may need to be removed and replaced with an artificial valve. In patients who have heart rhythm disturbances as well, an artificial implantable defibrillator device may be implanted. If the coronary arteries are diseased, they may be grafted too (CABG operation).

About the Batista procedure

The Batista procedure was an experimental open-heart surgery that had been studied to reverse the effects of remodeling in cases of end-stage dilated cardiomyopathy. In this case, patients suffer from an enlarged left ventricle that cannot pump blood efficiently.

Though the Batista procedure seemed promising at first, it was later found to have little benefit and considerable risk. Today, the Batista procedure is not a recommended treatment for dilated cardiomyopathy. In this form of cardiomyopathy, the heart fails to respond to conventional therapy, and patients suffer from severe heart failure. However, while the surgery has generally fallen out of favor, a few research groups are still examining the Batista procedure among patients who are unsuitable for heart transplantation, such as the elderly.

History of the Batista procedure

The standard treatment for patients with advanced end stage heart failure is to take medication and wait for a donor heart. However, there is a serious shortage of donor hearts. Dr. Randas Batista saw the effects of this shortage first-hand in his native country (Brazil), where many heart failure patients were dying before a heart donor could be found. He was inspired by this experience to develop the Batista procedure as an alternative to heart transplantation. He performed this new surgery for the first time in 1983 and afterward performed it hundreds of times.

Dr. Batista’s work caught the attention of physicians at the Cleveland Clinic, which sent a group to Brazil to study the technique. According to information presented by the Cleveland Clinic at the 1997 conference of the American College of Cardiology, survival rates at six-month follow-up were similar to those associated with heart transplantation, and a significant number of patients no longer needed to be on the list for a donor heart.

However, later results were not as promising. Researchers from the Cleveland Clinic reported disappointing results with the Batista procedure in 2000. Though the conditions of 25 percent of the patients improved following the surgery, conditions rapidly deteriorated in 33 Tachycardia is an unusually fast heartbeat (more than 100 beats per minute).percent of patients. The remaining patients experienced a temporary improvement in cardiac function followed by a return to gradually declining function. The patients also experienced a high rate of abnormal heart rhythms, or arrhythmias. Because of these findings, researchers discontinued the clinical study.

About the same time, a Batista procedure study conducted by the New England Medical Center was also concluded early because of poor results. Researchers, however, credit Dr. Batista for inspiring the investigation of other strategies to reverse or correct remodeling of the left ventricle with heart failure.

Later studies, in 2005, examined the Batista procedure among elderly people (over age 65) and found that the surgery could be tolerated and may be considered among patients who were not eligible for transplantation. In this case, the risks and benefits of the Batista procedure are similar for elderly and younger people, but may represent a short-term improvement among elderly people who cannot have a heart transplant, thus altering the risk/benefit ratio in favor of the procedure. Still other researchers have examined the effectiveness of the Batista procedure combined with heart valve transplantation.

Dissociative Disorder

2009-12-27T02:59:00.000-08:00

Dissociative Disorder - disruption in integrative functions of memory, consciousness, or identity.

Dissociative identity disorder (multiple personality)
--- Two or more fully developed distinct and unique personalities exist within the person.
--- The host is the primary personality and the other personalities are referred to as alters.
--- The alters may be aware of the host but the host is not usually aware of the alters.

Dissociative amnesia
--- Inability to recall important personal information because it provokes anxiety.

Dissociative Fugue
--- The client assumes a new identity in a new environment.

When the fugue lifts, the client returns home and is unable to recall the fugue state.

DEPERSONALIZATION disorder
--- An altered self-perception in which one's own reality is temporarily lost or changed.

"usapang ketong"

2009-12-10T01:25:00.000-08:00

Leprosy is an ancient disease and is a leading cause of permanent physical diability among the communicable diseases.

It mainly affects the skin, peripheral nerves, eyes and the mucosa of the upper respiratory tract.

Infectious agent: "mycobacterium leprae"

detected by Slit Skin Smear (SSS)

Method of transmission:

Airborne
Prolonged skin to skin contact

Susceptibility: Children especially twelve years and below

Signs and Symptoms:

Early Signs and Symptoms

change in skin color (raddish or white)
loss of sensation on the skin lesion
dec. loss of sweating and hair growth over the lesion
thickened or painful nerves
muscle weakness or paralyss of extremities
pain and redness of the eyes
nasal obstruction or bleeding
ulcers that do not heal

Late Signs and Symptoms

loss of eyebrow (madrosis)
inability to close eyelids (lagopthalmos)
clawing of fingers and toes
contractures
sinking of the nosebridge
gynecomastia
chronic ulcers

Prevention:

BCG Vaccination
Good personal Hygiene
Adequate Nutrition
Health Education
Avoid close contact or prolong skin to skin contact with active or untreated leprosy case.

Treatment: Multi-Drug Therapy

pg.250 (DOH Book)

Some bright facts about Maternity and Newborn Medications

2009-11-23T18:04:00.000-08:00

METHYLORGONOVINE, an ergot alkaloid, is an agent that is used to prevent or control post partum hemorrhage by contracting the uterus. Methylorgonovine causes continuous uterine contractions and may elevate blood pressure. A priority assessment before the administration of the medication is to check the blood pressure.

Respiratory distress is common in premature neonates and may be due to lung immaturity as a result of surfactant deficiency. The mainstay of treatment is the administration of EXOGENOUS SURFACTANT, which is administered by the intratracheal route.

OXYTOCIN stimulates uterine contractions and is a common pharmacological method to induce labor. An adverse reaction associated with administration of the medication is hyperstimulation of uterine contractions. Therefore, oxytocin infusion must be stopped when any signs of uterine hyperstimulation are present.

Magnesium toxicity can occur from MAGNESIUM SULFATE therapy. Signs of magnesium sulfate toxicity relate central nervous system depressant effects of the medication and include respiratory depression, lost of deep tendon reflex, and a sudden drop in fetal heart rate and maternal heart rate and blood pressure. Therapeutic serum levels of magnesium are 4-7.5 meq/L.

OPIOIDS (Narcotics) are used for epidural analgesia. An adverse reaction of epidural analgesia is a delayed respiratory depression. NALOXONE (narcan) is a opioid agonist, which reverses the effect of opioids and is given for respiratory depression.

BETHAMETHASONE (celestone), a glucocorticoid, is given to stimulate fetal lung maturation. It is used for clients in preterm labor between 28 to 32 weeks if the labor can be inhibited for 48 hours.

Rh incompatibility can occur when an Rh-negative mother becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus that is Rh-positive. During pregnancy at delivery, some of the baby’s Rh-positive blood can enter the maternal circulation, causing the woman’s immune system to form antibodies against Rh-positive blood. Administration of “Rh (D) immune globulin” prevents the woman from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen.

Diazepam as a skeletal muscle relaxant

2009-11-12T20:21:00.000-08:00

Diazepam is a benzodiazepine drug that is used to treat acute muscle spasms as well as spasticity caused by chronic disorders. Other uses of diazepam include treatind anxiety, alcohol withdrawal, and seizures. It seems to work by promoting the inhibitory effect of the neurotransmitter gamma-aminobutyric acid on muscle contraction.

The negatives: sedation and tolerance

Diazepam can be used alone or with other drugs to treat spasticity, especially with patients with spinal cord lesions and, occasionally, in patients with cerebral palsy. It's also helpful in patients with painful, continous muscle spasms who aren't too susceptible to the drug's sedative effects. Unfortunately, diazepam's use is limited by its central nervous system effects and the tolerance that develops with prolonged use.

How atropine speeds the heart rate?

2009-11-12T19:44:00.000-08:00

To understand how atropine affects the heart, first consider how the heart's electrical conduction system functions.

Without the drug
When the neurotransmitter acetylcholine is released, the vagus nerve stimulates the sinoatrial (SA) node (the heart's pacemaker) and atrioventricular (AV) node, which controls conduction between the atria and ventricles of the heart. This inhibits electrical conduction and causes the heart rate to slow down.

With the drug
When the patient receives atropine, a cholinergic blocking drug, it competes with acethylcoline for for binding with the cholinergic receptors on the SA and AV nodes. By blocking acetylcholine, atropine speeds up the heart rate.

(Clinical Pharmacology: Incredibly Easy pg. 31)

OTITIS MEDIA

2009-11-11T04:29:00.000-08:00

Otitis Media

an inflammatory disorder usually caused by an infection of the middle ear occurring as a result of a blocked Eustachian tube, which prevents normal drainage.
a common complication of an acute respiratory infection.

"Infants and children are more prone to otitis media"

Rationale: Infant and children has shorter, wider and straighter Eustachian tube

ASSESSMENT:

fever
irritability and restlessness
loss of appetite
rolling of head from side to side
pulling on or rubbing the ear
earache or pain
signs of hearing loss
purulent ear drainage

"ADMINISTRATION OF MEDICATION"

In a child younger than age 3, pull the lobe down and back.
In a child older than 3 years old, pull the pinna up and back.

ISO

2009-11-04T03:26:00.001-08:00

----ISO is a set of internationally-applicable technical standards, and it plays no role in assessing if a particular hospital's clinical (ie. medical) activities are adequate, only if the buildings and systems are up to scratch.

----When a hospital gets ISO certified, the processes are supposedly under control, which yields 15-20 per cent benefit. The next step, the critical one is continual improvement.

"Why did one hospital pursue certification to ISO 9001:2000?"

+++ One hospital was looking to enhance its healthcare quality management system. What makes ISO unique is that it relies on the individual organization to establish, document, implement and maintain a quality management system and continually improve its effectiveness. ISO assists the organization in designing and ensuring its documented processes are effective and support its mission.

"Benefits of ISO 9001:2000 as the framework for managing all Healthcare Quality Certifications"

+++ ISO 9001:2000 offers a means for evaluating processes at an organizational level. It also enables the organization to define organization specific goals and methods for quality management. Finally, ISO 9001:2000 offers a monitoring or audit system for maintaining the healthcare quality management system.

Benefits of ISO 9001:2000 as a Quality Management System

+++ If a healthcare provider is certified to ISO 9001, any other survey process for healthcare quality certifications will be much simpler and less costly regarding both preparation and compliance demonstration

>Systemic breakdowns are recognized and addressed

>Development of “Best practice” hospital-wide processes, with reference to supporting documentation

>Ensures conformance to and effectiveness of documented processes

>Focuses on Patient Care, Satisfaction, and Safety

>Reduce errors associated with ”hand-offs”

>Improve documentation and records

>Improve employees’ understanding of roles and responsibilities within the healthcare quality management system

>Strengthen customer/community confidence and relationships

>Alignment of Hospital-wide, Departments, Individual objectives

>Foundation for on-going improvement initiatives

2009-10-28T18:58:00.001-07:00

You Captivated Me

My myocardium contracts faster
And no time for repolarization
I don’t need a calcium blocker
To ease these abnormal contractions

It is not palpitations
Nor a worsening heart condition
I’m aware of these manifestations
It doesn’t require any interventions

I don’t need more oxygen consumption
Nor sodium or water excretion
I refuse ordered medication
Because of one reason

You captivated me
And it is not an illusion
Or a part of hallucination
It’s all about your incantation

By: Krapsydal

Tetanus Toxoid

2009-10-28T18:40:00.000-07:00

Giving Tetanus Toxoid

a. Shake the vial

b. Clean the skin with a cotton ball, moistened with water and let skin dry.

c. Place your thumb and index finger on each side of the injection site and grasp the muscles, slightly. The best injection site for a woman is outer side of the left upper arm.

d. Slightly pull the plunger back before injecting to be sure that vaccine is not injected to a vein.

e. Quickly push the needle into the space between your finger, going deep in the muscle.

f. Inject the vaccine. Withdraw the needle and press the injection spot quickly with a piece of cotton.

NOTE: Shake the vial before every injection.,

ANXIETY

2009-10-26T05:37:00.000-07:00

Level 1: critical
--Severe difficulty breathing, pale diaphoretic
Resuscitation
--Immediate treatment, many resources needed, staff at bedside.

Level 2: High Risk
--Confusion, Suicidal behavior, Altered mental status
Emergent
--Do not delay treatment, notify physician, multiple diagnostic studies

Level 3: Moderate risk
--Palpitations, Difficulty functioning, extremely anxious
Urgent
--refer for treatment as soon as possible, monitor for change in condition, contact crisis worker

Level 4: Low Risk
--Hyperventilation, profuse sweating, persistent upset stomach
Semi Urgent
--provide bag and hyperventilation instructions as necessary, reassess while waiting, offer comfort measures.

Level 5: Lower Risk
--no physical symptoms, history of anxiety episodes and now asymptomatic
Non-Urgent
--offer comfort measures, may need an examination only..

PAIN

2009-10-25T17:39:00.001-07:00

Definition of PAIN
 It is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

 Pain is highly subjective and individual and it is the body’s defense mechanism indicating that there is a problem.

Types of Pain
Pain is described in terms of

 Location
 Duration
 Origin
 Cause / physiologic basis

Location in the body :

 Radiating pain: it is perceived from the source of the pain and extends to near by tissues. Eg cardiac pain

 Referred pain: pain from one part of the abdominal viscera may be perceived in an area of the skin remote from the organ causing pain
 Intractable pain: which is highly resistant to relief
eg: Pain in advanced malignancy

 Neuropathic pain: due to result of disturbance of the peripheral CNS, which is often severe
(shooting or stabbing pain)‏

 Phantom pain: painful sensation perceived in a part of the body that is missing

According to Origin:

 Cutaneous pain: sharp pain arising from skin and subcutaneous tissue

 Deep somatic pain: diffuse pain arising from ligaments,tendons,bones,blood vessels and nerves eg: sprain

 Visceral pain: due to stimulation of pain receptors in the abdominal cavity, cranium and thorax
eg: burning aching feeling of pressure caused by muscle spasm in obstructed bowel

According to Duration:

 Acute pain - lasts upto 6 months
- sudden & slow onset
- mild to severe pain

 Chronic pain - lasts more than 6 months
- difficult to relieve
- eg. Chronic malignant pain

Comparison of acute & chronic pain
Acute pain

 Warns of injury
 Recent onset
 Mild –severe
 Lasts few seconds to 6 months
 Anxiety follows

eg. Surgical interventions, trauma

Chronic pain

 No purpose
 Continuous/ intermittent
 Mild – severe
 Lasts long 6 months and more
 Depression follows

eg. cancer, arthritis, trigeminal neuralgia

Responses to pain

Acute pain:

 Increased Pulse rate
 Raised BP/ fall in BP & shock
 Increased respiration
 Dilated pupils
 Diaphoresis
 Muscle tension
 May rub, cry / hold area
 Reports pain
 Reduced GI motility

Chronic pain:

 Vital signs –usually normal
 Pupils normal or dilated
 Dry or warm skin
 Depression, irritability
 Withdrawal from interests & relationships
 Disturbed sleep
 Reduced libido
 Reduced appetite

According to the physiologic basis of pain

 Mechanical - trauma
- blockage of body duct
- tumor
- muscle spasm

 Thermal - extreme heat or cold
 Chemical - Tissue ischemia --> Blocked artery --> stimulation of pain receptors --> accumulation of lactic acid

Community Acquired Pneumonia

2009-10-25T17:08:00.000-07:00

Community-acquired pneumonia (CAP) is an infection of alveoli, distal airways, and interstitium that occurs outside the hospital setting. CAP is a common illness and can affect people of all ages; it is often causes problems like breathing, fever, chest pains and a cough. CAP occurs because the area of the lung, which absorbs oxygen from the atmosphere, become filled with fluid and cannot work effectively.

CAP occurs throughout the world and is leading cause of illness and death. Causes of CAP include bacteria, virus, fungi, and parasites. CAP can be diagnosed by symptoms and physical examination alone, thought x-rays, examination of the sputum, and other tests are often used. Individuals with CAP sometimes require treatment in a hospital. CAP is primarily treated with antibiotic medication. Some forms of CAP can be prevented by vaccination.

CAP manifest in four general patterns the Lobar pneuminia, Bronchopneumonia, Interstitial Pneumonia, Miliary pneumonia. Lobar Pneumonia involve the entire lung lobe, in the Bronchopneumonia it has a patchy consolidation in one or several lobes, usually in dependent lower or posterior portions centered around bronchi and bronchioles, Interstitial pneumonia is the inflammation of the interstitium, including the alveolar walls and connective tissue around the bronchovascular tree and in Miliary pneumonia a numerous discrete lesions due to hematogenous spread.

Freud's Psychosexual Stage

2009-10-25T00:12:00.000-07:00

INFANT:
Oral Stage - Child explores the world by using mouth, especially the tongue.

TODDLER:
Anal stage- Child learns to control urination and defecation.

PRESCHOOLER:
Phallic Stage- Child learns sexual identity through awareness of genital area.

SCHOOL AGE CHILD:
Latent Stage- Child personality development appears to be nonactive or dormant.

ADOLESCENT:
Genital Stage- Adolescent develops sexual maturity and learns to establish satisfactory relationships with the opposite sex.

Infancy

2009-10-24T20:06:00.000-07:00

>The infant period is from 1 month to 12 months. Children typically double their birthweight at 4 to 6 months a nd triple it at 1 year.

>Infants develop their first tooth at about 6 months; by 12 months, they have to six to eight teeth.

>Important gross motor milestones during the infant year are lifting the chest off a bed at 2 months, sitting at 6-8 monts, creeping at 9 months, "cruising" at 10 to 11 months, and walking at 12 monts.

> Important fine motor accomplishments are the ability to pass an object from 1 hand to the other hand (7 months) and a pincer grasp (10 months)

> Important milestones of language development during the first year are differentiating a cry (2 months), making simple vowel sounds (5-6 months) and saying two words beside mama and dada (12 months). The more infants are spoken to, the easier it is for them to acquire language.