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DESCRIPTION
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

Types of anemia
Anemia due to B12 deficiency Anemia due to foliate deficiency
Anemia due to iron deficiency Anemia of chronic disease
Hemolytic anemia Idiopathic a-plastic anemia
Megaloblastic anemia Pernicious anemia
Secondary aplastic anemia Sickle cell anemia

Causes and risk factors
While many parts of the body help make red blood cells, most of the work is done in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form blood cells.
Healthy red blood cells last between 90 and 120 days. Parts of your body then remove old blood cells. A hormone called erythropoietin made in your kidneys signals your bone marrow to make more red blood cells.
Hemoglobin is the oxygen-carrying protein inside red blood cells. It gives red blood cells their red color. People with anemia do not have enough hemoglobin.
Possible causes of anemia include:
Certain medications
Chronic diseases such as cancer, ulcerative colitis, or rheumatoid arthritis
Genetics: Some forms of anemia, such as Thalassemia, can be inherited
Kidney failure
Blood loss (for example, from heavy menstrual periods or stomach ulcers)
Poor diet
Pregnancy
Problems with bone marrow such as lymphoma, leukemia, or multiple myeloma
Problems with the immune system that cause the destruction of blood cells (hemolytic anemia)
Surgery to the stomach or intestines that reduces the absorption of iron, vitamin B12, or folic acid
Too little thyroid hormone (underactive thyroid, or hypothyroidism)
Testosterone deficiency

Symptoms
Possible symptoms include:-
1 Chest pain
2 Dizziness or light-headedness (especially when standing up or with activity)
3 Fatigue or lack of energy
4 Headaches
5 Problems concentrating
6 Shortness of breath (especially during exercise)

Treatment
Treatment should be directed at the cause of the anemia, and may include:-
1 Blood transfusions
2 Corticosteroids or other medicines that suppress the immune system
3 Erythropoietin, a medicine that helps your bone marrow make more blood cells
4 Supplements of iron, vitamin B12, folic acid, or other vitamins and minerals.

Fig.1
DESCRPITION
DEFINITION
Nebulization is the process of medication administration via inhalation. It utilizes a nebulizer which transports medications to the lungs by means of mist inhalation.

INDICATION
Nebulization therapy is used to deliver medications along the respiratory tract and is indicated to various respiratory problems and diseases such as:
• Broncho-spasms
• Chest tightness
• Excessive and thick mucus secretions
• Respiratory congestions
• Pneumonia
CONTRAINDICATIONS
In some cases, nebulization is restricted or avoided due to possible untoward results or rather decreased effectiveness such as:
• Patients with unstable and increased blood pressure
• Individuals with cardiac irritability (may result to dysrhythmias)
• Persons with increased pulses
• Unconscious patients (inhalation may be done via mask but the therapeutic effect may be significantly low)
EQUIPMENTS
• Nebulizer and nebulizer connecting tubes
• Compressor oxygen tank
• Mouthpiece/mask
• Respiratory medication to be administered
• Normal saline solution
PROCEDURE
1. Position the patient appropriately, allowing optimal ventilation.
2. Assess and record breath sounds, respiratory status, pulse rate and other significant respiratory functions.
3. Teach patient the proper way of inhalation:
o Slow inhalation through the mouth via the mouthpiece
o Short pause after the inspiration
o Slow and complete exhalation
o Some resting breaths before another deep inhalation
4. Prepare equipments at hand
5. Check doctor’s orders for the medication, prepare thereafter
6. Place the medication in the nebulizer while adding the amount of saline solution ordered
7. Attach the nebulizer to the compressed gas source
8. Attach the connecting tubes and mouthpiece to the nebulizer
9. Turn the machine on (notice the mist produced by the nebulizer)
10. Offer the nebulizer to the patient, offer assistance until he is able to perform proper inhalation (if unable to hold the nebulizer [pediatric/geriatric/special cases], replace the mouthpiece with mask.
COMPLICATIONS
Possible effects and reactions after nebulization therapy are as follows:
• Palpitations
• Tremors
• Tachycardia
• Headache
• Nausea
• Broncho-spasms (too much ventilation may result or exacerbate Broncho-spasms)

• TEACHINGS
As nurses, it is important that we teach the patients the proper way of doing the therapy to facilitate effective results and prevent complications (demonstration is very useful). Emphasize compliance to therapy and to report untoward symptoms immediately for apposite intervention.

Auscultatory gap is the temporary disappearance of sounds normally heard over the brachial artery when the cuff pressure is high and the reappearance of the sounds at a lower level.

Provide excellent clues to the physiological functioning of the body.
• Alterations in body flexion are reflected in the body temp, pulse, respirations and blood pressure.
• These data provide part of the baseline info from which plan of care is developed.
• Any change from normal is considered to be an indication of the person’s state of health.

DESCRIPTION:-
Sir Alexander Fleming discovered penicillin in 1928 from Penicillin notatum. In 1941 penicillin was available for therapeutic use. Penicillins are one of the most important groups of antibiotics. Penicillin is now obtained from the fungus Penicillin chrysogenum for therapeutic use.
MECHANISM OF ACTION:- Beta lactam antibiotics act by inhibiting cell wall synthesis in the bacteria. The rigid cell wall of the bacteria protects the bacteria from lysis. Therefore, cell wall is essential for the survival of bacteria. Peptidoglycon is an important component of the cell wall which gives rigidity to cell wall. The Synthesis of this peptidoglycan requires enzymes called transpeptidases. Beta -Lactam antibiotics inhibit these transpeptidases and thus inhibit the synthesis of peptidoglycon. This results in the formation of bacteria with weak cell wall. Such bacteria undergoes lysis .
CLASSIFICATION:- a. Natural e.g. penicillin
b. Semi-synthetics
NATURAL PENICILLINS :-
Penicillin G (Benzyl Penicillin) :- Anti bacterial spectrum:- Penicillin G has narrow antibacterial spectrum and is effective against gram-positive cocci and bacilli and a few gram negative cocci.
Resistance:- Many Organism like staphylococci produce penicillinase which is a beta –lactamase.It opens the Beta Lactam rings and inactivates penicillin’s.
Penicillin may not bind to the bacteria because of changes in the target proteins. This also leads to resistance.
Pharmacokinetics:- Penicillin G is destroyed by gastric juice, food interferes with its absorption – hence, it is to be given 2 hours after food. It has a short t half life of 30 minutes.
Preparation and Dose:- Penicillin G is mainly given parentrally. Oral penicillin is used only in minor infection.
Adverse effect:- Hypersensitivity:- It is the most common cause of drug allergy.
Jarisc h-Herxheimer Reaction:- When penicillin is injected in a patient with syphilis, there is sudden destruction of spirochetes and release of its lytic products. These triggerers a reaction with fever, myalgia, exacerbation of syphilitics lesions and vascular collapse.

Definition:- This is other type of ante-partum hemorrhage . In this form of APH where bleeding due to premature separation of normally situated placenta.
Types :-
(1) Revealed:- Following separation of placenta in blood insiuates downward between membrane & deciduas ultimately blood comes out by cervical canal to be visible externally .
(2) Concealed:- :- The blood collects behind separated placenta or collected between in membrane & decidua .
(3) Mixed:- In this type of placenta some part of blood collect inside & a part is expelled out .

Etiology :-
-The exact cause of abruptio placenta is obscure or unknown
-Advancing age of mother
-High birth order pregnancy
-Poor socio economic condition
-Malnutrition
-Hypertension in pregnancy
-Any trauma
-Sudden uterine decompression
-Sick placenta
Clinical Features :-
-Depend upon degree of separation of placenta
-Small to moderate amount of bright or dark red vaginal bleeding
-Acute abdominal pain followed by vaginal bleeding
-General condition of pts is shock
-Fetal heart sound usually present in revealed or usually absent in concealed.
-Fetal part can be identified usually easily in revealed & difficult in concealed.
-Urine output normal in revealed & usually diminish in concealed .
Diagnostic Investigation :-
–History collection
–Physical examination
–USG
–Blood for hemoglobin
–Urine for protein
–Coagulation profile
–Complete blood count
Management:- The following guidelines may be helpful in prevention :-
– Prevention, early detection & effective therapy of pre-eclampsia.
– Needle puncture during amniocentesis.
– Avoidance of trauma.
– Avoid sudden decompression of uterus.
– Avoid supine hypotension.
– Routine administration of folic acid
The Pts is shift to equipped hospital as early as possible –Assessment of case (amount of blood, time , gestation period, bleeding ,pts is in labour or not).
-If patient is in labour , the labour is increased by low rupture of membrane .
-IF patients is not in labour & pregnancy 37 weeks or more, the induction of labour is done by low rupture of membrane.
Keywords:-
-Placental membrane
-Bleeding
-Pregnancy
-Hemorrhage
-Ultrasound
-Fetal heart sound

Anatomy of the eye.
The eye is the organ of sight. It is situated in the orbital cavity and is supplied by the optic nerve . It is almost spherical in shape and about 2.5 cm in diameter. The space between the eye and orbital cavity is occupied by adipose tissue . The bony walls of the orbit and the fat protects the eye from injury.
STRUCTURE- There are three layer of tissue in the walls of the eye:-
• The outer fibrous layer :sclera and cornea
• The middle vascular layer or uveal tract:consisting of the choroid,ciliary body and iris
• The inner nervous tissue layer :the retina
SCLERA AND CORNEA:- The sclera ,or white of the eye ,forms the outermost layer of the posterior and lateral aspects of the eyeball and is continous anteriorly with the cornea.
CHOROID:- The choroid lines the posterior five-sixth of the inner surface of the sclera and it is rich in blood vessels and it absorbs light which enters in the eye through the pupil.
Ciliary body:The ciliary body is the anterior continuation of the choroid consisting of the ciliary muscle and secretory epithelial cells.
Iris: The iris is the visible coloured ring at the front of the eye and extends anteriorly from the ciliary body,lying behind the cornea and in front of the lens.
Lens: The lens is a highly elastic circular biconvex body,lying immediately behind the pupil .
RETINA:- The retina is the innermost lining of the eye. It is extremely delicate structure and well adapted for stimulation by light rays.
BLOOD SUPPLY TO THE EYE:- The eye is supplied with arterial blood by the ciliary arteries and the central retinal artery. These are branches of ophthalmic artery.
Venous drainage is by a number of veins ,including the central retinal vein.
NERVE SUPPLY TO THE EYE:- The eye is supplied by the optic nerve ,which is the second cranial nerve.

Meningitis is an inflammation of the linings around the brain and spinal cord caused by bacteria .
Causative agents:- Streptococcus pyogenes , niesseria meningitides and haemophilus influenza.
Risk factors:- -winter and early spring season.
-Viral upper respiratory infection.
-Otitis media.
-Immune system deficiency.
PATHOPHYSIOLOGY:- Once the causative agent enters the bloodstream,it crosses the blood brain barrier and proliferates in the cerebro spinal fluid. The host immune response stimulates the release of cell wall fragments and lipopolysaccharides ,facilitating of the subarachnoid and pia mater.
Because the cranial vault contains little room for expansion ,the inflammation may cause increased intracranial pressure. Crebro spinal fluid circulates through the subarachnoid space ,where inflammatory cellular materials from the affected meningeal tissue enter and accumulate,as a result clinical manifestation occurs.
CLINICAL MANIFESTATION:- Initial symptoms are headache and fever.
. Neck immobility.
. Positive kerning sign.
.Positive brudzinskis sign.
.Photophobia.
.Disorientation and memory impairement.
.Lethargy, unresponsiveness and coma.
.Seizures and increased intra cranial pressure.
.Brain stem herniation.
.Septicemia.
.Shock.
.Disseminated intravascular coagulation .
DIAGNOSTIC EVALUATION:- . Positive clinical manifestation.
. CT scan and MRI.
.Bacterial culture and gram staining .
.Glassgow coma scale.
MEDICAL MANAGEMENT:- . Vancomycin hydrochloride in combination with one of the cephalosporins is administered intravenously.
. Dexamethasone is administered 15 to 20 minutes before the first dose of antibiotic and every 6 hours for the next 4 days.
.Fluid volume expanders is given.
. Phenitoin is given to control the seizures.
NURSING MANAGEMENT:-
1. Neurological status and vital signs are assessed regularly.
2. Protecting the patient from injury secondary to seizures activity.
3. Preventing complications associated with immobility , such as pressure ulcers and pneumonia.
4. Instituting infection control precautions until 24 hours after initiation of antibiotic therapy.
5. Blood pressure is assessed for incipient shock ,which precedes cardiac or respiratory failure.
6. Insertion of a cuffed endotrachial tube and mechanical ventilation may be necessary to maintain adequate tissue ventilation.
7. Monitoring daily body weight ,serum electrolytes and urine volume ,specific gravity and osmolality ,especially if the syndrome of inappropriate anti diuretic hormone is suspected.