Notes for Student Nurses

Introduction: Acute Rheumatic fever: Acute Rheumatic Fever (ARF) is an acute autoimmune disease that occurs as a sequel  of group A- streptococcal infection which is characterized by inflammation of connective tissue, primarily affecting the joints and heart. Rheumatic Heart Disease is a condition that occurs when rheumatic fever causes long term damage to the heart and its valves. Etiology: Most initial attack of ARF occur 1 to 5 weeks (average 3 weeks) after a streptococcal throat infection or infections of the upper respiratory tract. Peak incidence among children between ages 6 to 15.  A family history of Rheumatic fever and lower economic status are additional factors. Pathophysiology: Clinical Manifestations: Major Manifestations: (JONES Criteria) Carditis : Manifested by systolic or diastolic murmur, prolonged PR and QT interval on ECG, and possibly by signs of CHF in echo. Poly-arthritis: Pain and limited movement of two or more joints. Joints are swollen, red, warm, and tend

Systemic Lupus Erythematous (SLE) is a chronic, multisystem, inflammatory, autoimmune disorder characterised by formation of autoantibodies directed against self-antigens and immune-complex formation resulting in damage to essentially any organ. Clinical Manifestations : Assessment and Diagnostic Findings : Diagnosis of lupus is difficult because sign and symptoms vary considerably from person to person. Signs and symptoms lupus may vary over time and overlap with those of many other disorders. No one test can diagnose lupus. The combination of blood and urine tests, sign and symptoms and physical examination findings leads to the diagnosis .  Laboratory and imaging tests include : 1. Complete Blood count  2. Erythrocyte sedimentation rate  3. Kidney and liver assessment 4. Antinuclear antibody ( ANA ) test 5. Chest X-ray  6. Echocardiogram 7. Urinalysis The American College of Rheumatology has established criteria for the classificatio

Introduction:                      Congestive Cardiac Failure (CCF) is a clinical syndrome that can result from any structural and functional cardiac disorders that impairs the ability of ventricles to fill with and pump sufficient blood to meet the needs of the tissues for oxygen and nutrients.

Hydrocephalus is the abnormal accumulation of cerebrospinal fluid in the intracranial spaces. It occurs due to imbalance between production or absorption of CSF or due to obstruction of CSF pathways. It results in the dilation of the cerebral ventricles and enlargement of the head. Etiology  / Causes : It may occur due to congenital or acquired causes. Congenital Hydrocephalus:           It occurs due to following conditions: Intrauterine infections : mainly in rubella, cytomegalovirus  Congenital brain tumor obstructing the CSF flow. Intracranial hemorrhage Congenital malformation like aqueduct stenosis, displacement of brainstem and cerebellum, blocking of septum or membrane of outlet of the 4th ventricle. Malformation of arachnoid villi. Acquired Hydrocephalus:           It occurs usually in following conditions : Inflammation : meningitis, encephalitis Trauma : birth trauma , head injury , intracranial  haemorrhage  Neoplasm : space occupying lesi

Terminal Illness Definition : It is a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of patient with a short period of time. A patient who has such illness may be referred as terminal patient or terminally ill patient : often a patient is considered terminally ill when their estimated life expectancy is six months or less. Stages of Terminally Illness: Different patients react to the news that they have a terminal illness in different ways. In general , almost all patients go through various stages of acceptance when disease like cancer has been diagnosed. A) First stage : The first stage is disbelief. There is extreme anxiety  especially about unknown. Shock , despair and anger are common in this phase . The patient may also experience guilt about feeling angry and this can increase the feeling of anger . This phase usually lasts from few days to few months .  B ) Second stage : The second stage is d

Introduction:       Acute Myocardial Infarction (AMI), commonly known as a heart attack is the irreversible necrosis of heart muscle secondary to prolonged ischemia. Results from an imbalance is oxygen supply and demand, caused by plaque rupture with thrombus formation in a coronary vessel, resulting in an acute reduction of blood supply to a portion of the myocardium. Risk factors: Non-modifiable risk factors: Age. Sex. Genetic Influence. Race. Modifiable risk factors: High Blood pressure. Smoking. High cholesterol. Weight and inactivity. Diabetes. Causes: Age: Individuals aged >40 years have 8 times greater risk for AMI. Sex: Men- >55 years. Women- >65 years. Smoking: Increases the risk by 4 times. Obesity: people who have excess body fat especially at the waist are most likely to develop heart disease. Lack of physical exercise: has been linked to 7- 12% of the cases. Acute and prolonged intake of high quantity of alcohol: increases

COAGULATION FACTORS. F reshers P arty T oday C ome L et's S ing A nd C all S eniors P lease H ave F un. I) F ibrinogen. II) P rothrombin. III) T hromboplastin. IV) C alcium. V) L abile factor. VII) S table Factor. VIII) A nti Haemolytic factor A. IX) C hristmas Factor. X) S tuart prower factor. XI) P TA ( Plasma Thromboplastin Antecedent. XII) H ageman factor. XII) F ibrin stabilizing factor. PS: Coagulation factor VII is no longer used.

        Nursing Management  Fig. Patient having pain due to trigeminal neuralgia  1. Nursing Assessment : Detailed history and physical examination : it should include detailed patient history , medical past   history , chief complaints of sudden unilateral , severe , stabbing , paroxysmal and recurrent pain. Physical examination of ear , mouth , teeth and temporal mandibular joint. Look thoroughly for SWEET criteria.  Assessment of nutritional status and dehydration Assess patient's anxiety and depression  2. Nursing Diagnosis and Interventions : a) Chronic pain related to activation of trigger zones along the nerve pathways .  Assess current pain management strategies and effectiveness .It is done for measuring the      effectiveness of new pain strategies.   Assess patient's knowledge of specific trigger activities for pain.This is done to identify factors that can be manipulated by pain control interventions .  Explore acceptability of cognitiv

               Trigeminal Neuralgia  Anatomy of trigeminal nerve         The trigeminal nerve is the largest of 12 cranial nerves. Its main function is transmitting sensory information to the skin, sinuses and mucous membranes in the face. It also stimulates movement in the jaw muscles.        The trigemnial nerve has three different divisions. Each division has different functions .  Opthalmic division :  The opthalmic division conveys sensory information from the : scalp forehead upper parts of the sinuses upper eyelid and associated mucous membranes  cornea of the eye bridge of the nose                                 Maxillary division : Like the opthalmic division, the maxillary division of trigemnial nerve has a sensory component. It transmits sensory information from the : lower eyelid and associated mucous membranes middle part of the sinuses nasal cavity and middle part of the nose  cheeks upper lip some of the teeth of the upper jaw a

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Intestinal Obstruction:              Intestinal obstruction is a partial or complete blockage of the small or large intestine resulting in failure to pass intestinal contents through the bowel normally.              It is one of the most common surgical emergency during childhood and need prompt intervention. Types: Mechanical Obstruction:          Bowel is physically blocked and its contents cannot get passed normal ways. May be acute or chronic. Common causes are adhesion, hernia, tumor, volvulus, intussusceptions etc. Non- mechanical Obstruction:        Also called paralytic ileus because of impairment of intestinal peristalsis activity an common after surgery. Causes: Congenital Cause: Atresia: abnormal narrowing of opening. Incarcerated hernia: occurs when herniated tissue becomes trapped and cannot easily be moved back to place. Imperforate anus. Mackel's diverticulum: congenital abnormality of small intestine caused by incomplete obliteration

Easy way to memorize Glasgow coma scale;      Glasgow coma scale is a neurological scale which aims to give a reliable and objective way of recording the state of person's consciousness for initial as well as subsequent assessment. Highest Score- 4 + 5 + 6 = 15  Lowest score- 1 + 1 + 1 = 3 Eye Response: (ESPN)  CRITERIA                                                           SCORE Spontaneous E ye Opening                            4 To S timulus                                                   3 To P ain                                                          2 N o response                                                    1 Verbal Response: ( O UR C OUNTRY WIN.) CRITERIA                                                         SCORE O riented to time and place & person            5 C onfused                                                          4 Inappropriate W ords                                       3 Inappropriate S ound