INTEGRATED SCIENCES

Heart Disease: Modern Treatments and Lifestyle Changes

2026-03-14T07:47:00.000-07:00

Heart Disease: Modern Treatments and Lifestyle Changes

Heart disease is one of the leading causes of death worldwide. It refers to a range of conditions that affect the heart, including coronary artery disease, heart attacks, arrhythmias, and heart failure. Understanding modern treatments and lifestyle changes is crucial for preventing and managing heart-related problems.

Causes and Risk Factors

Several factors can increase the risk of heart disease:

High blood pressure (hypertension)
High cholesterol levels
Obesity
Diabetes
Smoking and alcohol consumption
Sedentary lifestyle
Family history of heart disease

Modern Treatments for Heart Disease

Medications:
Modern medicine offers a variety of drugs to manage heart disease. These include:
- Statins to reduce cholesterol
- Beta-blockers to control heart rate and blood pressure
- ACE inhibitors to relax blood vessels
- Antiplatelet drugs (like aspirin) to prevent blood clots
Surgical and Non-Surgical Procedures:
- Angioplasty and Stenting: A minimally invasive procedure to open blocked arteries and restore blood flow.
- Coronary Artery Bypass Grafting (CABG): Surgery to bypass blocked arteries using vessels from other parts of the body.
- Pacemaker or Defibrillator Implantation: Devices to regulate irregular heartbeats.
- Heart Valve Repair or Replacement: Surgical correction of malfunctioning heart valves.
Emerging Treatments:
- Stem cell therapy and regenerative medicine are being researched to repair damaged heart tissue.
- Wearable heart monitors allow continuous monitoring and early detection of abnormalities.

Lifestyle Changes to Prevent and Manage Heart Disease

Modern treatments work best when combined with healthy lifestyle choices:

Balanced Diet: Eat plenty of fruits, vegetables, whole grains, and lean proteins. Reduce salt, sugar, and saturated fat intake.
Regular Exercise: At least 30 minutes of moderate activity like walking, jogging, or swimming most days of the week.
Quit Smoking and Limit Alcohol: Smoking is a major risk factor for heart disease. Alcohol should be consumed in moderation.
Stress Management: Practice yoga, meditation, or deep breathing exercises to reduce stress.
Regular Health Checkups: Monitor blood pressure, cholesterol, and blood sugar levels regularly.
Maintain a Healthy Weight: Obesity increases the risk of heart disease; a balanced diet and exercise help control weight.

Conclusion

Heart disease is a serious condition, but with modern medical treatments and proper lifestyle changes, it can be managed effectively. Early detection, medication, medical procedures, and healthy daily habits work together to reduce risks and improve quality of life. Staying informed and proactive is the key to a healthy heart.

Kidney Infection Causes

2012-08-18T09:20:00.000-07:00

Kidney and urinary tract infections may be caused by bacteria invading the urine, which is normally a sterile body fluid. Bacteria most commonly gain access to the urine through the urethra, which can be exposed to bacteria from outside of the body.

Common sources of bacteria invading the urinary system are the vagina, anus, and skin. Because of the shorter length of urethra in women, urine infection is more common in women compared to men. There are some factors that may predispose people to urinary tract infections.

Sexual intercourse may increase the risk of urine infection in women. Kidney infection may be facilitated by the introduction of bacteria from outside (vagina) to the urinary system through the urethra.

Pregnant women may also be at higher risk for developing develop urinary tract infections. This may be caused by slower transit of urine from the ureters into the bladder because of increased pressure on the ureters from the enlarged uterus. Approximately 10% of pregnant women may develop kidney and urinary tract infections during their pregnancy.

Kidney stones are another factor that may increase the likelihood of urinary tract infection. Stones can cause partial or complete obstruction to the flow of urine from the kidneys and ureters. This obstruction may act as a focus of infection in the urinary system, leading to urinary tract infections.

Bladder catheters (Foley catheters) are sometimes placed into the bladder in order to aid the outflow of urine from the bladder. These are used in many settings, for example, paralysis with nerve damage to the bladder causing accumulation of urine without adequate emptying, bladder obstruction from an enlarged prostate, or immobilized or hospitalized patients who are not able to independently urinate. These catheters may act as a vehicle for bacteria to gain access to the urine inside the bladder causing urinary infections.

In children some risk factors include female gender, an uncircumcised male, or a structural abnormality of the urinary system.

The most common bacteria causing urinary tract infection or kidney infection are naturally those that may be seen in the vagina, gastrointestinal tract, or skin. By far, the most common organism causing urinary tract infection is Escherichia coli (E. coli), responsible for up to 80% of kidney and urinary infections. Other common bacteria include Klebsiella, Proteus, Pseudomonas, Enterococcus, and Staphylococcus saprophyticus.

heart disease

2012-08-04T09:11:00.000-07:00

Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease.

Causes, incidence, and risk factors

Coronary heart disease (CHD) is the leading cause of death in the United States for men and women.

Coronary heart disease is caused by the buildup of plaque in the arteries to your heart. This may also be called hardening of the arteries.

Fatty material and other substances form a plaque build-up on the walls of your coronary arteries. The coronary arteries bring blood and oxygen to your heart.
This buildup causes the arteries to get narrow.
As a result, blood flow to the heart can slow down or stop.

A risk factor for heart disease is something that increases your chance of getting it. You cannot change some risk factors for heart disease, but others you can change.

The risk factors for heart disease that you CANNOT change are:

Your age. The risk of heart disease increases with age.
Your gender. Men have a higher risk of getting heart disease than women who are still getting their menstrual period. After menopause, the risk for women is closer to the risk for men. See: Heart disease and women
Your genes. If your parents or other close relatives had heart disease, you are at higher risk.
Your race. African Americans, Mexican Americans, American Indians, Hawaiians, and some Asian Americans also have a higher risk for heart problems.

Many things increase your risk for heart disease:

Diabetes is a strong risk factor for heart disease.
High blood pressure increases your risks of heart disease and heart failure.
Extra cholesterol in your blood builds up inside the walls of your heart's arteries (blood vessels).
Smokers have a much higher risk of heart disease.
Chronic kidney disease can increase your risk.
People with narrowed arteries in another part of the body (examples are stroke and poor blood flow to the legs) are more likely to have heart disease.
Substance abuse (such as cocaine)
Being overweight
Not getting enough exercise, and feeling depressed or having excess stress are other risk factors.

Symptoms

Symptoms may be very noticeable, but sometimes you can have the disease and not have any symptoms.

Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. How bad the pain is varies from person to person.

It may feel heavy or like someone is squeezing your heart. You feel it under your breast bone (sternum), but also in your neck, arms, stomach, or upper back.
The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin.
Other symptoms include shortness of breath and fatigue with activity (exertion).

Women, elderly people, and people with diabetes are more likely to have symptoms other than chest pain, such as:

Fatigue
Shortness of breath
Weakness

Signs and tests

Many tests help diagnose CHD. Usually, your doctor will order more than one test before making a diagnosis.

Tests may include:

Coronary angiography/arteriography -- an invasive test that evaluates the heart arteries under x-ray
CT angiography -- a noninvasive way to perform coronary angiography
Echocardiogram
Electrocardiogram (ECG)
Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries -- the more calcium, the higher your chance for CHD
Exercise stress test
Heart CT scan
Magnetic resonance angiography
Nuclear stress test

Treatment

You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your doctor's directions closely to help prevent coronary artery disease from getting worse.

Goals for treating these conditions in people who have coronary artery disease:

Blood pressure less than or equal to 140/90 (even lower for some patients with diabetes, kidney disease, or heart failure)
Glycosylated hemoglobin (HbA1c) levels less than or equal to 7% for people with diabetes
LDL cholesterol level less than or equal to 100 mg/dL (even lower for some patients)

Treatment depends on your symptoms and how severe the disease is. Your doctor may give you one or more medicines to treat CHD, including:

ACE inhibitors to lower blood pressure and protect your heart and kidneys
Aspirin, with or without clopidogrel (Plavix) or prasugrel (Effient) to help prevent blood clots from forming in your arteries
Beta-blockers to lower heart rate, blood pressure, and oxygen use by the heart
Calcium channel blockers to relax arteries, lower blood pressure, and reduce strain on the heart
Diuretics ("water pills") to lower blood pressure and treat heart failure
Nitrates (such as nitroglycerin) to stop chest pain and improve blood flow to the heart
Statins to lower cholesterol

Bulimia Nervosa

2011-05-22T03:25:00.000-07:00

Bulimia Nervosa, often referred to as 'Bulimia' is a serious eating disorder commonly found in girls in adulthood. It is very rarely found in men. Person with bulimia eat a lot in a short amount of time (bingeing). This binge eating usually ends with abdominal discomfort and then the patient attempts to undo the consequences of the binge through self-induced vomiting, misuse of laxatives, severe caloric restriction, diuretics, enemas, or excessive exercising and fasting etc.

Bulimics may devour huge quantities of food, during a binge, most typically foods that would normally be not allowed in a healthy/weight reduction diet. It usually includes foods high in carbohydrates or sweets, meat, cheese etc.

There are also two subtypes of bulimia nervosa, purging and non-purging. The Purging type describes individuals who regularly compensate for the binge eating with self-induced vomiting, laxative abuse, diuretics, or enemas. The Non-Purging Type is used to describe individuals who compensate through dietary fasting or excessive exercising.

The use of vomiting by bulimics can easily become addictive. Although at first they may have done it to get rid of excess food calories, it soon becomes a form of security. They are afraid to stop because they fear their eating habits are out of control and without the use of vomiting they fear they will become grossly overweight. Self induced vomiting could also lead to further hunger and binging, thus creating a cycle.

The bulimic is dominated by a sense of lack of control over the eating. It can occur together with other psychiatric disorders such as depression, obsessive- compulsive disorder, substance dependence or self injurious behavior. Characteristics of persons with bulimia is the worry about weight and shape and tendency to go on strict diets to achieve an ideal figure

Diabetes

2011-05-22T03:12:00.001-07:00

Healthy routine helps to minimize the risk of developing complications of diabetes. One can keep blood glucose levels normal by a healthy diet and maintaining physical fitness. Eating right, controlling your weight and exercising regularly will help you to control sugar level.

Excess consumption of alcohol is harmful as it may lower blood glucose levels and cause weight gain. Smoking is very harmful to diabetes patients, because it increases the risk of long-term complications. Foot care is important because diabetes can increase the risk of skin infections and ulcers on the feet. You must clean your feet daily and if a sore develop on your feet, consult the doctor promptly. Diabetes patients have an increased risk of high blood pressure, so regular monitoring is important.

Low-fat, vegetarian diets are ideal for diabetics. In most cases, diabetics can manage their disease much better with a food plan that gets most of its calories from complex carbohydrates while minimizing fats.

Diet for Diabetes :

With a near-vegetarian diet and exercise program, one can maintain their sugar levels with out taking any medications. Ideal diet program for a diabetic is a low fat vegetarian diet, reducing meats, high-fat dairy products, and oils. At the same time increasing grains, legumes, and vegetables.

Have your meals at regular timings and limit your overall intake.
Eat five servings of fruits and vegetables every day. Soluble fibers mainly found in fruits, vegetables and some seeds are good for diabetics. They reduce or slow down the absorption of glucose from the intestines.
Diabetes patients should include leafy vegetables, vegetable soups and juices in their diet. Vegetables like tomato, cucumber, bitter gourd, carrot, cooked kidney beans, pumpkin, snake gourd, beans, cabbage, lady finger, brinjal, onion, spinach, inner part of banana stem, drum sticks etc. are good for diabetes. Fruits and fruit juices of apple, guava, lemon etc. are good. Avoid fruits like banana, mango, grapes, papaya, jack fruit etc. and vegetables like potato, tapioca, sweet potato etc. containing lot of carbohydrates.
Eat more starches such as bread, cereal, and starchy vegetables. Aim for six servings a day or more.
Eat sugars, sweets and fat and fat-fried items in moderation.
It is better to avoid cakes, jaggery, honey, ghee, butter, cool drinks, biscuits, dried fruits like badam and excess use of oil while cooking.

Home Remedies

Some home remedies help to regulate the blood sugar level. You can try out some of these remedies which compliment along with the diet for diabetics and regular exercises to lower blood sugar levels and protect from diabetes related damages.

Have

1 litre of cinnamon water daily. Cinnamon contains a chemical to help utilize blood sugar naturally in your body. Add 3 table spoon of cinnamon to 1 litre of boiling water. Simmer for 20 minutes in a low flame, then strain the mixture.
Fresh or dried bitter gourd (bitter melon) or 2 ounces of its juice every day. Bitter melon increases the insulin secreting cells in the pancreas and daily intake of juice reduces the risk of developing diabetic retinopathy.
Wild (Black) cumin boiled in water regularly.
Equal quantities of turmeric powder and dried gooseberry powder with honey or drink equal quantities of gooseberry juice and fresh turmeric juice in an empty stomach regularly.
Regularly, the juice of crushed 'touch me not' with its roots.
First thing in the morning, have the juice of crushed fish-berry (amruth) soaked in water for a day.
Make coffee with powdered fried fenugreek and wheat, taken in equal quantities.
Garlic every day early in the morning in an empty stomach.
Tender curry leaves (fresh) twice a day.
Crush guava leaves, a handful and 3 grams of cumin together. Boil with one glass of water and make it half.
Drink 8 glass of water in the morning and walk for one hour.

The leaves of gymnema sylvestre (Gurmur- a climbing vine), a traditional Ayurvedic medicine for diabetics, significantly reduces the metabolic effects of sugar by preventing the intestines from absorbing the sugar molecules during the process of digestion. Add 3 quarters of gymnema powder to one glass of boiling water, strain and drink it warm twice a day, 1 hour before breakfast and 1 hour before dinner for best results. The leaves can also be ground and had. It has the property of blocking sugary taste and thus curbs the craving for sweet things.

Hepatitis

2011-01-24T18:40:00.000-08:00

Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses, referred to as types A, B, C, D and E.

Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids (e.g. from blood transfusions or invasive medical procedures using contaminated equipment). Hepatitis B is also transmitted by sexual contact.

The symptoms of hepatitis include jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Hepatitis A

Key facts

* Hepatitis A is a viral liver disease that can cause mild to severe illness.

* It is spread by faecal-oral (or stool to mouth) transmission when a person ingests food or drink contaminated by an infected person's stool.

* The disease is closely associated with poor sanitation and a lack of personal hygiene habits, such as hand-washing.

* An estimated 1.4 million cases of hepatitis A occur annually.

* Epidemics can be explosive in growth and cause significant economic losses: 300 000 were affected in one Shanghai outbreak in 1988.

* Improved sanitation and the Hepatitis A vaccine are the most effective ways to combat the disease.

Hepatitis A is a liver infection caused by the hepatitis A virus (HAV). The virus is spread when an uninfected (or unvaccinated) person eats or drinks something contaminated by the stool of an HAV-infected person: this is called faecal-oral transmission. The disease is closely associated with inadequate sanitation and poor personal hygiene. Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms.

Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. Worldwide, HAV infections account for an estimated 1.4 million cases annually. Epidemics related to contaminated food or water can erupt explosively, such as an epidemic in Shanghai in 1988 that affected about 300 000 people.

The disease can wreak significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school or daily life. The impact on food establishments identified with the virus, and local productivity in general, can be substantial.

Symptoms

The symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-colored urine and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is infected will have all of the symptoms. Adults have signs and symptoms of illness more often than children, and the severity of disease and mortality increases in older age groups. Infected children under six years of age do not usually experience noticeable symptoms, and only 10% develop jaundice. Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70% of cases. Most people recover in several weeks - or sometimes months - without complications.

Who is at risk?

Anyone who has not had been infected previously or been vaccinated can contract hepatitis A. People who live in places with poor sanitation are at higher risk. In areas where the virus is widespread, most HAV infections occur during early childhood. Other risk factors for the virus include injecting drugs, living in a household with an infected person, or being a sexual partner of someone with acute HAV infection.

Transmission

HAV is usually spread from person to person when an uninfected person ingests food or beverages that have been contaminated with the stool of a person with the virus. Bloodborne transmission of HAV occurs, but is much less common. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water. Casual contact among people does not spread the virus.

Treatment

There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and take several weeks or months. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Prevention

Improved sanitation and Hepatitis A immunization are the most effective ways to combat the disease

Adequate supplies of safe-drinking water and proper disposal of sewage within communities, combined with personal hygiene practices, such as regular hand-washing, reduce the spread of HAV.

Several hepatitis A vaccines are available internationally. All are similar in terms of how well they protect people from the virus and their side-effects. No vaccine is licensed for children younger than one year of age.

Precipitate and Emergency Delivery

2011-01-24T18:33:00.000-08:00

GENERAL

There are times when labor progresses so rapidly that the nurse is faced with the task of delivering the baby even within the confines of a hospital setting. And, in addition, there are times when a woman begins labor in a variety of physical settings and during a variety of climatic disturbances away from a medical facility. During these situations is when the nurse has the primary responsibility for providing a physically and psychologically safe experience for the woman and her baby. It is important that the nurse maintains composure and keeps calm. Whenever possible, the patient should be told what to anticipate and what she can do to cooperate effectively. Working as a team is essential and can be accomplished if confidence is instilled by competence in both the physical and emotional aspects of care.

TERMS AND DEFINITIONS

a. Precipitate Delivery. This refers to a delivery which results after an unusually rapid labor (less than three hours) and culminates in the rapid, spontaneous expulsion of the infant. Delivery often occurs without the benefit of asepsis.

b. Emergency Delivery. This refers to an unplanned, non delivery room, non-hospital birth which occurs as a result of precipitous labor, geographical distance from the hospital, or other cause for the unexpected delivery.

FACTORS THAT MAY PREDISPOSE A WOMAN TO A PRECIPITATE DELIVERY

There are common factors which may cause a woman to deliver rapidly. These factors include:

a. A multipara with relaxed pelvic or perineal floor muscles may have an extremely short period of expulsion.

b. A multipara with unusually strong, forceful contractions. Two to three powerful contractions may cause the baby to appear with considerable rapidity.

c. Inadequate warning of imminent birth due to absence of painful sensations during labor.

Urinary Tract Infection UTI

2010-10-10T23:34:00.000-07:00

A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. The main etiologic agent is Escherichia coli. Although urine contains a variety of fluids, salts, and waste products, it does not usually have bacteria in it. When bacteria get into the bladder or kidney and multiply in the urine, they may cause a UTI.

The most common type of UTI is acute cystitis often referred to as a bladder infection. An infection of the upper urinary tract or kidney is known as pyelonephritis, and is potentially more serious. Although they cause discomfort, urinary tract infections can usually be easily treated with a short course of antibiotics. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine.

Most common in females because of anatomy of the lower urinary tract: urethra is short and meatus is close to the anus.
Peak incidence occurs at 2 to 5 years of age.

Prevention

The following are measures that studies suggest may reduce the incidence of urinary tract infections.

A prolonged course (six months to a year) of low-dose antibiotics (usually nitrofurantoin or TMP/SMX) is effective in reducing the frequency of UTIs in those with recurrent UTIs.
Cranberry (juice or capsules) may decrease the incidence of UTI in those with frequent infections. Long term tolerance however is an issue.
For post-menopausal women intra vaginal application of topical estrogen cream can prevent recurrent cystitis. This however is not as useful as low dose antibiotics.
Studies have shown that breastfeeding can reduce the risk of UTIs in infants.

A number of measures have not been found to affect UTI frequency including: the use of birth control pills or condoms, voiding after sex, the type of underwear used, personal hygiene methods used after voiding or defecating, and whether one takes a bath or shower.

Therapeutic interventions.

antibiotics to eliminate infection.
Identiry and correct structural anomalies if present.
Bland, high-protein, high carbohydrate diet.
Prevent recurrence; preserve renal function.

Principle of growth and development

2010-08-31T08:21:00.000-07:00

Children may vary among each othe i their rate of growth and dvelopment. But stil all of them follow certain principles as follow.

Growth and development is a continuos prcess from conception to adolescence. The rate of growth varie at different ags. During prnatal d infancy period the eate of growth is very rapid. This growth rat gradully declines during early childhood During te middle hilhood the growth rate is slo. the growth rate again becomes rapid durn puberly. Thus infancy and puberty ar two specific periods of rapid growth.
The development takes place:

a. In the cephalo-caudal directin.That means development proceeds from head to toe. For example the first step towards walking is head control then sitting abilility.

b. Fom general to specific: That means general development takes place before special development. For example during skill development the gross motor skills will be developed before fine motor skills.

Developmental Tasks

2010-08-05T00:09:00.000-07:00

In the process of physical growth and the development of abilities and skills the children are expected to carry out certain responsibilities or tasks at certain stages of dvelopment. These tasks are called developmental tasks. Havighurst, a psychologist, has defined the developmental task as "the task which arieses at certain periods in the life of an individual, the successful accomplishment of which leads to satisfaction and success with later tasks while the failure leads to dissatisfaction and difficulty with later life." Some of these developmental tasks arise out of physical maturation e.g. learnng to sit, stand or walk. Wereas other developmental taks arise from social pressure e.g. learning to play , speak, read etc. and some developmental tasks arise out of personal values and desires e.g. preparing for a vocation.

Purposes of developmental tasks

Developmental taks serve as guidelines to know what the chiild is expected to do at different ages.
Developmental tasks enable the parents to motivate children to do what is expected of them.

Developmental taks enable the parents to know what lie ahead and what the child is expected to do in the successive stages.

Stages of growth and development

2010-07-21T07:15:00.001-07:00

Although growth and development is a continuous process it varies among children of different ages. Their needs and problems also vary at different ages. Erik Erikson a well known psychologist had divided the period of childhood into 5 stages. he considered that each of these stages is characterised by a crisis situation having favorable and unfavourable components which the child must resolve before progressing to te next stage.

The successful resolution of the crisis situation leads to easy progress to next stage whereas the unsuccessful resolution leads to difficulty in porgressing to next stages.

Stages of childhood and their crisis components as expressed by Erik Erikson.

S.N. Stages of childhood Crisis components

Infancy Trust versus mistrust
Toddler Autonomy versus shame and doubt
Preschool Intiative versus guilt
Shool age Industry versus inferiority
Adolesence Identity versus isolation

Intrauterine period.
Infancy period
Early childhood
Middle childhood
Late childhood

Growth and Development

2010-06-25T02:08:00.000-07:00

Growth and develpoment are two improtant characteristics of human begings. The term growth and development generally refers to the process by which the fertilised ovum develops into a mature adult. This maturation occurs through successive changes in both physical structure and functional abilities.

Growth is an essential feature of childhood. Growth refers to physical matureation. In other words, its is the increase in size of the body resulting from increase in the number and size of the cells of body. The increase in body size leads the child to be taller, broader and heavier. These changes in height and breadth (eg. head circumference) can be measured in terms of centimetres or inches and the heaviness or weight in terms of kilogram or pounds. Thus growth is a quantitative change and can be measured easily.

In general the rate of growth is more important than the actual size of the child . so to assess the growth rate, the measurement of height and weight shuld be done at regular intervals.

Development is defined as th functional or physiological maturation that follows physical maturation. In ohter words it is the acquisition of skills and the ability to adopt to environment. It is measured in terms of various behavioural achievemetns or abilities known as milestones. Development is complex qualitative change. Hence it is difficult to measure.

Characteristics of a Child

2010-06-04T07:06:00.000-07:00

A child is not a miniature adult but a unique individual wih special needs and qualities. An Adult is a mature being in terms of body structure and functions whereas a child is at a varying stage f rowth and development from birth to adolescence. That means he is an immature inividual in erms of his body structure and functions necessitating a different kind of care. The characteristics of children can be discussed under the follwoing heaidngs.

body structure
physiological processess
intellectual abilites
emotional responses.

Body structure

In relation to body structure, the proportional size of the body parts is an important feature. For example an infant has a heavier and bigger head in comparison to his body size and weight. It makes handling of infants different from older children and adults. The infants head must be supported while holding or lifting him. Injury to head can occur more commonly in infants than in the older children.

In neonates the skull bones are joined by membranous spaces called sutures and fontanelle. So any increase in the intracranial pressure in infant causes the suture lines to be widened and fontanelle to be bulged out, thereby increasing the size of the head. But in older children and adults increase in intracranial pressure does not increase the size of the head.

Physiological processes

The difference in the physiological characteristics of childrean at different ages makes it necessary to provide different kinds of care to children at the different ages.

In terms of unit body weight, younger children need more nutritious food than older children because of their rapid growth rate, increased level of body activity and high basal metabolic rate. If young children do not get adequate food, they develop nutritionla deficiencies such as marasums, kwashiorkor, rickets, xerophthalmia etc. much more rapidly that in the older children.

Child care in early civilization

2010-05-11T09:03:00.000-07:00

Value of children changed gradually as people started settling in the fertile lands. Some cultures valued physical beauty as an essential characteristics of person. These people cared for children well so that the children would have well formed bodies.

Some cultures valued large families as a blessing of god. Children in these cultures were considered as the gifts of god and so were taken care of well. Some cultures valued cleanliness and food as essential in life. These practices influenced greatly on the health of mother and child.

Historical overview of child care
The knowledge of historical trend in child care helps to understand the present care in the light of the past and it enables one to determine the fututre direction for better care.
Care of the child at any period is believed to be influenced by the people's way of living, their belief about health and their values for their children.

Child health status

2010-04-17T20:08:00.000-07:00

Health is a complex phenomena. According to World Health Organization, health is not merely the absence of disease of infirmity but is a stateof complete physical, mental and social well being. From this definition child health means a state of physical, mental and social harmony of the child which pro,otes his ottimum growth and development. However in estimating the health status of children in a country, the commonly used indicators are the absence commonly used indicators are the absence of disease (ie morbidity ) a death ( mortality)

The IMR can be divided into neonatal mortality rate (NMR) and post neonatal mortality rate ( PNMR). The NMR includes death of children less that 28 days of age and PNMR includes death of children from 28 days until 1 year of age.

Role of the paediatric nurse

2010-04-05T10:12:00.001-07:00

Nursing care of children aims at achieving the highest possible health in children and promoting their optimum growth and development. In rder to achieve this aim, the paediatric nurse should play multiple roles as depicted in the following.

Care Provider

As a care provider , the nurese is responsible to care for the sick children in meeting their physical and emotionl needs. The responsibility to administer the prescribed medicines and treatments also falls on her. She is held accountalbe for all her nursing actions. So she must carry out her responsibilites with knowledge and dedication.

To demonstrate her sense of accountablity,she should use nursing process in her care. The use of nursing process enables her:

to assess each child's need through nistory taking and physical examination.
to identify the health needs of the child
to plan and implement nursing ations
to evaluate the outcome of nursing actions

A child specially the young one, is totally dependent on his parents or care givers to fulfill his basic needs such as food, toileting and clothing. So the parents should be included in the care of their children as far as possible.This enhances their responsibility as parents and help to build their confidence in child care at home.

Health Educator

Health education is oneof the important roles of the nurse. health education of children aims at giving essentail health information to the parents and guardians for the promotion and maintenance of the health of children. health education arouses awareness of the parents regarding child care and influences their child care practive . Some of the important topics of health education are:

child's nutrition
immunisation
prevention of accidents
personal adn environmental hygiene
oral rehydration therapy
child spacing

Introduction to child care

2010-03-31T09:43:00.000-07:00

Child is a young human being who has not reache the age of discretion or maturation. This literally childhood is the period from the birth until the achieves full maturation: physically, mentally and socially. the period of childhood ends with the initiation o adulthood period.
The branch of medicine dealing with children is called paediatrics. The term paediatrics is derived from the Greek words "paidos", "iatrike" and "ics". The word "paidos" means a child, iatrike" means treatment and "ics" means science. The paediatrics means the science of child care and treatment of childhood diseases. Since the intrauterine health of child greatly affects his extrauterine health, the intrauterine period of the child is also included in paediatrics. thus, broadly speaking the term paediatrics would mean the study of the child from conception to adolescence.

The specialist doctor who treats children is called paediatrician. The intra uterine health of the child is usually taken care by the obstetrician andmidwife through regular antenatal care.
Paediatric nursing is the branch of nursing that is concerned with the care of children not only during illness but also during health by providng preventive care to them.

The facts about trachoma:

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Trachoma (a repeated conjunctivitis infection) is found worldwide. Though eradicated in most developed countries, it remains a significant public health problem in parts of the developing world. It is closely linked to poverty.

The facts about trachoma:

The World Health Organization estimates that trachoma affects about 84 million people
8 million of these are visually impaired
Trachoma is the second most common cause of blindness after cataract.

Where is it found?

Trachoma is found in hot and dusty parts of the world. It is often endemic in rural areas without basic sanitation, where washing hands and faces is difficult. Trachoma spreads rapidly in crowded households or neighbourhoods.

Children and trachoma

Demographically, active trachoma is most prevalent in children, although the scarring doesn't usually become visible until the early 20s. For those who have suffered since childhood, trichiasis normally sets in during their 40s - or even earlier in the worst-affected areas.

Women and trachoma

Women are much more susceptible to trachoma than men because they spend far more time in contact with children, providing childcare.

Prevention

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Although trachoma was eliminated from much of the developed world in the last century, this disease persists in many parts of the developing world particularly in communities without adequate access to water and sanitation. In many of these communities, women are three times more likely than men to be blinded by the disease, due to their roles as caretakers in the family.

Without intervention, trachoma keeps families shackled within a cycle of poverty, as the disease and its long-term effects are passed from one generation to the next.

National governments in collaboration with numerous non-profit organizations implement trachoma control programs using the WHO-recommended SAFE strategy, which includes:

Surgery to correct advanced stages of the disease;

Antibiotics to treat active infection, using Zithromax (azithromycin) donated by Pfizer Inc through the International Trachoma Initiative;

Facial cleanliness to reduce disease transmission;

Environmental change to increase access to clean water and improved sanitation.

Surgery: For individuals with trichiasis, a bilamellar tarsal rotation procedure is warranted to direct the lashes away from the globe. Early intervention is beneficial as the rate of recurrence is higher in more advanced disease.

Antibiotic therapy: WHO Guidelines recommend that a region should receive community-based, mass antibiotic treatment when the prevalence of active trachoma among one to nine year-old children is greater than 10 percent.[8] Subsequent annual treatment should be administered for three years, at which time the prevalence should be reassessed. Annual treatment should continue until the prevalence drops below five percent. At lower prevalences, antibiotic treatment should be family-based.

Antibiotic selection: (single oral dose of 20 mg/kg) or topical tetracycline (one percent eye ointment twice a day for six weeks). Azithromycin is preferred because it is used as a single oral dose. Although it is expensive, it is generally used as part of the international donation program organized by Pfizer through the International Trachoma Initiative. Azithromycin can be used in children from the age of six months and in pregnancy.

Facial cleanliness: Children with grossly visible nasal discharge, ocular discharge, or flies on their faces are at least twice as likely to have active trachoma as children with clean faces. Intensive community-based health education programs to promote face-washing can significantly reduce the prevalence of active trachoma, especially intense trachoma . If somebody is already infected washing one’s face is strongly encouraged, especially a child, in order to prevent re-infection.
Environmental improvement: Modifications in water use, fly control, latrine use, health education and proximity to domesticated animals have all been proposed to reduce transmission of C. trachomatis. These changes pose numerous challenges for implementation. It seems likely that these environmental changes ultimately impact on the transmission of ocular infection by means of lack of facial cleanliness. Particular attention is required for environmental factors that limit clean faces.

Causes of Trachoma

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Causes

Trachoma is caused by Chlamydia trachomatis and it is spread by direct contact with eye, nose, and throat secretions from affected individuals, or contact with fomites (inanimate objects), such as towels and/or washcloths, that have had similar contact with these secretions. Flies can also be a route of mechanical transmission. Untreated, repeated trachoma infections result in entropion—a painful form of permanent blindness when the eyelids turn inward, causing the eyelashes to scratch the cornea. Children are the most susceptible to infection due to their tendency to easily get dirty, but the blinding effects or more severe symptoms are often not felt until adulthood.

Blinding endemic trachoma occurs in areas with poor personal and family hygiene. Many factors are indirectly linked to the presence of trachoma including lack of water, absence of latrines or toilets, poverty in general, flies, close proximity to cattle, crowding and so forth. However, the final common pathway seems to be the presence of dirty faces in children that facilitates the frequent exchange of infected ocular discharge from one child’s face to another. Most transmission of trachoma occurs within the family.

Trachoma

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Trachoma (Ancient Greek: "rough eye") is an infectious eye disease, and the leading cause of the world's infectious blindness. Globally, 84 million people suffer from active infection and nearly 8 million people are visually impaired as a result of this disease. Globally this disease results in considerable disability.

Signs and symptoms

The bacterium has an incubation period of 5 to 12 days, after which the affected individual experiences symptoms of conjunctivitis, or irritation similar to "pink eye." Blinding endemic trachoma results from multiple episodes of reinfection that maintains the intense inflammation in the conjunctiva. Without reinfection, the inflammation will gradually subside.

The conjunctival inflammation is called “active trachoma” and usually is seen in children, especially pre school children. It is characterized by white lumps in the undersurface of the upper eye lid (conjunctival follicles or lymphoid germinal centres) and by non-specific inflammation and thickening often associated with papillae. Follicles may also appear at the junction of the cornea and the sclera (limbal follicles). Active trachoma will often be irritating and have a watery discharge. Bacterial secondary infection may occur and cause a purulent discharge.

The later structural changes of trachoma are referred to as “cicatricial trachoma”. These include scarring in the eye lid (tarsal conjunctiva) that leads to distortion of the eye lid with buckling of the lid (tarsus) so the lashes rub on the eye (trichiasis). These lashes will lead to corneal opacities and scarring and then to blindness. Linear scar present in the Sulcus subtarsalis is called Arlt's line(named after Carl Ferdinand von Arlt). In addition, blood vessels and scar tissue can invade the upper cornea (pannus). Resolved limbal follicles may leave small gaps in pannus (Herbert’s Pits).

Further symptoms include:

Eye discharge

Swollen eyelids

Trichiasis (turned-in eyelashes)

Swelling of lymph nodes in front of the ears

Corneal scarring

Further ear, nose and throat complications.

The major complication or the most important one is corneal ulcer occuring due to rubbing by concentrations, or trichiasis with superimposed bacterial infection.

Paracetamol comes as:

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Paracetamol comes as:

tablets, caplets (torpedo-shaped tablets that may be easier to swallow) or capsules for swallowing a powder or tablet to dissolve in water, or a liquid/syrup forma suppository, for inserting into the rectum (back passage)You can buy paracetamol from pharmacies in packs of 32 tablets. You don't need a prescription.

For safety reasons, you can't buy more than 100 tablets at any one time from a pharmacy. In other shops, such as supermarkets or convenience stores, the packs contain a maximum of 16 tablets. It's crucial that you don't take more paracetamol than the dose recommended on the packet.

Over-the-counter painkillers - ones you buy without a prescription - are only meant to be taken occasionally. If you have to take painkillers for more than three days you should ask your GP or pharmacist about what to take and what else might help. Taking painkillers too often or for too long may make headaches worse.

It's always best to get advice from your GP if you need daily pain relief. Many GPs advise using paracetamol for problems such as painful joints.

Always read the patient information leaflet that comes with your medicine.

Avoiding accidental overdose

Paracetamol comes as tablets, but it is also contained in several other over-the-counter cold and flu remedies, such as powders that you make up into flavoured hot drinks (eg Lemsip). Make sure you count the paracetamol in all the medicines you have taken.

Children and paracetamol

The dose for a child depends on their age and weight and is clearly given on the medicine's container. On a doctor or nurse's advice, you can give paracetamol to young babies after they have had vaccinations, but otherwise it's not recommended for babies under three months old. Syrups containing paracetamol (eg Calpol) can be easier for younger children to take. The children's version of paracetamol syrup contains 120mg of paracetamol per 5ml (teaspoon). Sugar-free versions are available.

Special care

Check with your doctor or pharmacist before taking paracetamol if: you know that your kidneys or liver are not working properly you are a very heavy drinker (both paracetamol and alcohol can harm the liver)you are malnourished

If you're pregnant

As with any drug, it's always wise to discuss your situation with your pharmacist or doctor. However, in general, paracetamol is not known to be harmful in pregnancy.

If you're breastfeeding

Very little paracetamol gets into breast milk so experts say that it's usually safe for nursing mothers to take it.

Side-effects

When taken at the recommended dose, side-effects of paracetamol are rare. Skin rashes, blood disorders and a swollen pancreas have occasionally happened in people taking the drug on a regular basis for a long time.

One advantage of paracetamol over aspirin and similar drugs (eg ibuprofen and diclofenac) is that it won't upset your stomach or cause it to bleed.

A paracetamol overdose is particularly dangerous because the liver damage may not be obvious for four to six days after the drug has been taken. Even if someone who has taken a paracetamol overdose seems fine and doesn't have any symptoms, it's essential that they are taken to hospital urgently. An overdose of paracetamol can be fatal.

Interactions with other medicines

Check with your doctor or pharmacist before you take any other medicines or herbal remedies at the same time as paracetamol.

You may need to adjust your usual dose of anticoagulants (eg warfarin) if you take paracetamol regularly. Check with your anticoagulation clinic. Otherwise there are no serious interactions between paracetamol and other drugs

Paracetamol

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Published by Bupa's health information team, March 2007.

This factsheet is for people who would like information about paracetamol and how to use it safely.

Paracetamol (known as acetaminophen in the USA) is a painkiller that lowers a high temperature. Provided that you take the correct dose at the right intervals, paracetamol is relatively safe. An overdose is dangerous.

Why would I take it?How does paracetamol work?How to take paracetamolAvoiding accidental overdoseChildren and paracetamolSpecial careSide-effectsInteractions with other medicinesParacetamol productsFurther informationQuestions and answersSourcesWhy would I take it?

Paracetamol can be taken to relieve a variety of common aches and pains including headache, muscle and joint pain, backache and period pains.

Paracetamol brings down a high temperature caused by a cold or flu. It can be given to children after they have had vaccinations to prevent a high temperature after immunisation. It's often included in cough, cold and flu remedies, which you can buy in pharmacies and shops (see Paracetamol products).

How does paracetamol work?

No one is sure how paracetamol works. It probably acts by blocking the way in which pain signals are processed in the brain. It doesn't have the anti-inflammatory action of NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin. You can't get addicted to paracetamol.

How to take paracetamol

The recommended dose for adults is 500mg to 1000mg - that's usually one or two tablets (depending on tablet size) - every four to six hours with a maximum of 4000mg (usually eight tablets, but make sure you check the size of your tablets) in 24 hours.

However, just twice this dose can be dangerous and you should never exceed the recommended dose. Keep all medicines out of the reach of children.

Paracetamol uses

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Adults

The recommended dosage of paracetamol in adults is two 500mg tablets (i.e. 1gm paracetamol) every four to six hours, not exceeding eight tablets (4gms) in any 24 hour period (1). This dosage may be continued for several days. If pain relief is required for a longer period it should be with the supervision of a doctor.

Children

Children's dosages vary with the age of the child and the type of product, therefore the instructions on the pack should always be followed.

In general, children's dosages are based on a single dose of 10mg paracetamol per kilogram bodyweight, which can be repeated 4-6 hourly, not exceeding four doses per 24 hours.

On a doctor's recommendation only, paracetamol may be given to a 2 month old child following immunisation as a single dose of 60mg (i.e. 2.5mL paracetamol liquid (oral suspension) at a strength 120mg per 5 mL).

For children under 3 months, on a doctor's advice only, the dosage is 10mg paracetamol per kilogram body weight (5mg/kg if jaundiced).

For a child 3 months to 1 year of age a dose of between 60mg and 120mg (i.e. 2.5mL to 5mL of paracetamol liquid (oral suspension) at a strength of 120mg/5mL) may be repeated every 4-6 hours to a maximum of 4 doses in 24 hours.

For a child 1 to 5 years of age 120mg to 250mg (i.e. 5mL to 10mL of paracetamol liquid (oral suspension) at a strength of 120mg/5mL) may be repeated every 4-6 hours to a maximum of 4 doses in 24 hours.

For a child 6 to 12 years of age 250mg to 500 mg (i.e. 5mL to 10mL paracetamol liquid (oral suspension) at a strength of 250mg/5mL) may be repeated every 4-6 hours to a maximum of 4 doses in 24 hours.

These dosages have been found to be effective, well tolerated and safe (2) in OTC usage and there are no circumstances in which they should be exceeded. If this dosage is not proving effective, then a pharmacist or doctor should be consulted for further advice.

Prescription Use

In general the recommended dosages shown above should be followed. If, in a hospital setting, a higher dosage is considered desirable it is the responsibility of the prescribing physician. As there is no clear threshold at which toxicity may occur in an individual patient, it has been recommended that where a higher dosage is prescribed for an extended period, liver function should be monitored (2).

References:

1 British National Formulary, Vol. 40; September 2000

2 OICPC Therapeutic Highlights; Progress in Palliative Care (2000); 8 (4); 198-202.

Management of stable COPD

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Bronchodilators

Bronchodilators are medicines that relax smooth muscle around the airways, increasing the calibre of the airways and improving air flow. They can reduce the symptoms of shortness of breath, wheeze and exercise limitation, resulting in an improved quality of life for people with COPD. They do not slow down the rate of progression of the underlying disease. Bronchodilators are usually administered with an inhaler or via a nebulizer.

There are two major types of bronchodilator, β2 agonists and anticholinergics. Anticholinergics appear to be superior to β2 agonists in COPD. Anticholinergeics reduce respiratory deaths while β2 agonists have no effect on respiratory deaths. Each type may be either long-acting (with an effect lasting 12 hours or more) or short-acting (with a rapid onset of effect that does not last as long).

β2 agonists

β2 agonists stimulate β2 receptors on airway smooth muscles, causing them to relax. There are several β2 agonists available. Salbutamol or albuterol (common brand name: Ventolin) and terbutaline are widely used short acting β2 agonists and provide rapid relief of COPD symptoms. Long acting β2 agonists (LABAs) such as salmeterol and formoterol are used as maintenance therapy and lead to improved airflow, exercise capacity, and quality of life.

Anticholinergics

Anticholinergic drugs cause airway smooth muscles to relax by blocking stimulation from cholinergic nerves. Ipratropium is the most widely prescribed short acting anticholinergic drug. Like short-acting β2 agonists, short-acting anticholinergics provide rapid relief of COPD symptoms and a combination of the two is commonly used for a greater bronchodilator effect. Tiotropium is the most commonly prescribed long-acting anticholinergic drug in COPD. It is has more specificity for M3 muscarinic receptors so may have fewer side-effects than other anticholinergic drugs. Regular use is associated with improvements in airflow, exercise capacity, quality of life and possibly a longer life.

Corticosteroids

Corticosteroids act to reduce the inflammation in the airways, in theory reducing lung damage and airway narrowing caused by inflammation. Unlike bronchodilators, they do not act directly on the airway smooth muscle and do not provide immediate relief of symptoms. Some of the more common corticosteroids in use are prednisone, fluticasone, budesonide, mometasone, and beclomethasone. Corticosteroids are used in tablet or inhaled form to treat and prevent acute exacerbations of COPD. Well-inhaled corticosteroids (ICS) have not been shown to be of benefit for people with mild COPD, however, they have been shown to decrease acute exacerbations in those with either moderate or severe COPD. They however have no effect on overall one-year mortality and are associated with increased rates of pneumonia.

Other medication

Theophylline is a bronchodilator and phosphodiesterase inhibitor that in high doses can reduce symptoms for some people who have COPD. More often, side effects such as nausea and stimulation of the heart limit its use. In lower doses, it may slightly reduce the number of COPD exacerbations. The investigative phosphodiesterase-4 antagonists, roflumilast and cilomilast have completed Phase-2 clinical trials. Tumor necrosis factor antagonists such as infliximab suppress the immune system and reduce inflammation. Infliximab has been trialled in COPD but there was no evidence of benefit with the possibility of harm.

Supplemental oxygen

Oxygen can be delivered in different forms: in large containers, in smaller containers with liquid oxygen, or with the use of a oxygen concentrator (shown here) which derives oxygen from room air. The latter two options improve mobility of people requiring long-term oxygen therapy.

Supplemental oxygen can be given to people with COPD who have low oxygen levels in the body. Oxygen is provided from an oxygen cylinder or an oxygen concentrator and delivered to a person through tubing via a nasal cannula or oxygen mask. Supplemental oxygen does not greatly improve shortness of breath but can allow people with COPD and low oxygen levels to do more exercise and household activity. Long-term oxygen therapy for at least 16 hours a day can improve the quality of life and survival for people with COPD and arterial hypoxemia or with complications of hypoxemia such as pulmonary hypertension, cor pulmonale, or secondary erythrocytosis. High concentrations of supplemental oxygen can lead to the accumulation of carbon dioxide and respiratory acidosis for some people with severe COPD; lower oxygen flow rates are generally safer for these individuals.

Pulmonary rehabilitation

Pulmonary rehabilitation is a program of exercise, disease management and counselling coordinated to benefit the individual. Pulmonary rehabilitation has been shown to improve shortness of breath and exercise capacity. It has also been shown to improve the sense of control a patient has over their disease as well as their emotions.

Nutrition

Being either underweight or overweight can affect the symptoms, degree of disability and prognosis of COPD. People with COPD who are underweight can improve their breathing muscle strength by increasing their calorie intake. When combined with regular exercise or a pulmonary rehabilitation programme, this can lead to improvements in COPD symptoms.