Category: SCIENCE BLOG

DEFINITION:-
It is a collection of air in the pleural space normally the pressure in the pleural space is negetive compare to atmospheric presure. This negetive pressure is require to maintain lung inflation.

ETIOLOGY:-
It may be due to internal or external trauma which can be differentiate according to the type of trauma & site of involve it.
TYPES:-
1. Closed pneumothorax:-
There is no association with external injury or wound this is most common form of sponteneous pneumothorax.

Cause:-
A. Injury to the lungs due tio any mechanical ventilation

B. Injury to the lungs due to any broken ribs
C. Rupture of the bells & belbs
D. Perforation
E. Under weight smokers

2. Open pneumothorax:-
In this type of pneumothorax air enter into pleural space due to external injury or trauma. for eg:- stab wound , gun shoot , any surgical procedure of thorax
3. Tension pneumothorax:-
Pneumothorax with rapid accumulation of air into pleural space causinghigh intrapleural pressure with result in tension of heart & blood vessel.
Clinical features :-
1. Lungs may collapse
2. Mediastinal shift

4.Hemothorax-
Accumulation of bloos in intrapleural space . it is mostly associated with open pneumothorax.

Causes:-
1. Cheast trauma
2. Lung malignancy
3. Comlication of anticoagulant therapy
4. Pulmonary embolism
5. Tearing of pleural adhesions
5.Cyclothorax:
If pneumothorax is mild tachycardia &dyspnea will occur . if it is severe in condition respiratory distress, severe dyspnea, rapid breathing &air hunger which isa severe form of respiratory distress , chest pain , cough with or without haemoptysis , anxiety

DIAGNOSTIC EVALUATION:-
1. Physical examination on auscultation no breath sounds over the affected area
2. Cheast x rays shows the pressure & shadow of pneumothorax
3. Examination of purcussion shows hyper ressonance.
Medical management :-
1. It depends on cause or severity of the diseasecondition in mild cases constructive treatment ilke oxygen administration should be provided
2. In severe cases cheast drainage should be done small chest trube is inserted into the second intercostal space , in caes of severe accumulation the tube is inserted into 4th intercostal space to remove the accumulated air .


SURGICAL MANAGEMENT:-
1. In case of repeated pneumothorax pleuroctomy may be done
2. Pleurodysis:-
Artificial production of adhesions between visceral 7 parietal pleura with the help of chemical agent.
3. Needle venting :-
Pricking a large bore needle into the thorax to remove accumulated air
NURSING MANAGEMENT :-
1. PROVIDE SUPPLIMENT OXYGEN PLACE THE PATIENT IN SEMIFOWLERS POSITION.
2. OBTAIN TRAY FOR DRAIN OUT THE ACCUMULATED SUBSTANCES
3. AFTER DRAINAGE ASK THE PATIENT TO REPORT ANY INCREASE DYSPNEA
4. PALOPATED FOR SUBCUTENEOUS EMPHYSEMA IN UPPER CHEAST & NECK REGION.

Defination- Major histocompatibility complex is tightly linked clusterof genes whose product play role in intercellular recognition and to make defference between self and nonself molecule.MHC molecule act as a antigen presenting structure. T cell recognize antigen only when it is combined with an MHC molecule.
Types- MHC molecule have two types
1) Class I MHC molecule 2) Class II MHC molecule
Structure- Type I MHC- It has a 45 KD alpha chain associated noncovalently with a 12 KD beta 2 microglobulin molecule. Alpha chain is a trans membraneglycoprotein encoded by A, B, C region in human HLA complexes and by K, D/L region in mice. Association of alpha chain and beta 2 microglobulin require for expression of class I molecule on cell membrane. Alpha chain bind to plasma membrane by its hydrophobic transmembrane segment and hydrophilic cytoplasmic tail. Alpha chain is made up of three external domain(α1,α2,α3). Each domain have 90 amino acid, a trans membrane domain have 25 hydrophobic amino acid, a short segment of hydrophilic amino acid and a cytoplasmic segment of 30 amino acid. Peptide which bind to class I MHC is made up of 8-9 amino acid.
Type II MHC- Class II MHC bind to peptide and present these peptides to CD4 T celles. These peptides derived from exogenous protein. Peptide degred with in the endocytic processing pathway Class II MHC peptide contain 13-18 amino acid. Peptide binding cleft in class II MHC molecule is open at both ends and allow peptide to extend at both ends like a long hot dog in a buns.Peptide have an internal sequence containing 7-10 amino acid. This sequence has an aromatic or hydrophobic residue at the amino terminus and 3 additional hydrophobic residue in the middle portion and carboxy terminal end of the peptide.

DEFINITION:- It is the collection of fluid in the pleural space. It is a type of primary disorder and due to this secondary sign and symptoms will occur.
TYPES:-
1. Transudate ( Hydrothorax)
2. Exudate

1. Transudate:-
In this type fluid passess through the membranes.
2. Exudate:-
It is a leakage of fluid from the blood vessels into the tissues.

TRANSUDATE occurs in non inflammatory condition. It is a process of accumulation of proteins poor, cell poor fluid which move across intact capilliaries walls. For eg.;- increased hydrostatic pressure in the congestive heart fauilure, decrease onchotic pressure in renal and liver disease.
Accumulation of fluids and cells in an area of inflammation for eg;- Any inflammatory condition , pulmonary malignancies, nephrotic syndrome occurs due to exudate condition.
PATHOPHYSIOLOGY:-
TRANSUDATE:-
Any alteration in the formation and reabsorbation of pleural; fluid due to imbalance in hydrostatic and onchotic pressure . It has low content of protein & the nature of fluid is clear & pale yellow./

EXUDATE:-
It occurs due to any inflammation and bacterial infection, tumors which causes exudation process . It has a high protein content & fluid is dark yellow & amber.

Pleural effusion

CLINICAL FEATURES:-
1. Pleuritic pain
2. Progressive dyspnea
3.Decreased cheast wall movement
4. fever
5. chills
6. Malignant effusion may result in dyspnea and coughing
7. Malaise
DIAGNOSTIC EVALUATIONS:-
1. Physical Examination
2. Pleural biopsy
3. Chest X-ray
4. Pleural fluid analysis
5. C T scan
6. Thoracentesis

MEDICAL MANAGEMENT:-
1. To discusss he underlying cause to prevent reaccumulation of fluid to relief discomfort &dyspnea are the purpose of management including thoracentessis aspiration through syringe.
2. Provide appropriate antibiotics
3. Provide diuretics therapy

NURSING MANAGEMENT:-
1. Take care of patient and prepare him for thoracentesis procedure
2. Reduce the pain by maintain the position &administering analgesics
3. Educate the patient & his family regarding care of drain tube if the client is an out patient.
4. Frequent turning of the patient position will facilitate drainage of the accumulation fluid.

Description:- Basal Cell Carcinoma
Definition:- Basal cell carcinoma is a type of skin Cancer; Basal cell carcinoma often appears as a Waxy bump, though it can take other form. Basal cell carcinoma occurs most often on areas of the skin that are often exposed to the sun, such as own face and neck.
Causes:- (1). Basal cell carcinoma occurs when one of the skin’s basal cell develops a mutation in its DNA, a Mutation in the DNA causes a Basal Cell to multiply rapidly and continue growing when it would normally die. Eventually the accumulating abnormal cell may form a Cancerous tumor
(2). Ultraviolet light & other causes; Much of the damage to DNA in basal cells is thought to result from ultraviolet(UV) radiation found in sunlight and in commercial tanning beds.But sun exposure doesn’t explain skin cancers that develop on skin not ordinarily exposed to sunlight. This indicates that other other factors may contribute to own risk of skin cancer , such as being exposed to toxic substances or having a condition that weakens own immune system
Symptoms:- Although a general warning sign of skin cancer is a sore that won’t heal or that repeatedly bleeds and scabs over, basal cell cancer may also appear as:-
1) A pearly white or waxy bump,
2) Often with visible blood vessels, on face , ears or neck.
3) A flat, scaly, brown or flesh-colored patch on back or chest.
4) More rarely, a white, waxy scar

Remedies:-
1). Eat at least 5 servings of fruits and vegetables each day, especially those food rich in the Antioxidants Beta Carotene, vitamin C , and citrus fruits.
2). Include in Diet plenty of whole grains, sea vegetables, beans and soyabeans, hot peppers, cabbage, tomatoes, onions, rosemary, garlic grapes, licorice root, green tea, white fish, mushrooms.
3). Avoid red Meat, processed foods, red and yellow dyes, monosodium glutamate, nitrites(found in cured meats), saccharin sugar, dairy products, alcohol, caffeine containing drinks.

Definition-:Diabetes melietus is a metabolic disorder which is characterized by hyperglycemic condition due to defective functioning of insulin hormone…
It may be due to abnormal secretion of insulin & altered functioning of insulin hormone which secrets by beta cells of pancreas…
Etiology-: according to etiology it divides in 3 types;
• Insulin dependent diabetes melietus
• Non insulin dependent diabetes melietus
• Gestational induced diabetes melietus….
Absolute or relative lack of insulin produce by beta cells resulting in hyper glycemia….
Impaired secretory respons of insulin to rises in glucose & due to this gluneogenesis may occurs..
IDDM:-it may cause due to following reasons-
• Autoimmunity
• Viral infections
• Environmental theories
• Other disease conditions.
• Old age
NIDDM:-It may cause by following reasons-
• Hereditary
• Genetic
• Obesity
• Beta cells defect
GIDM:-It define as glucose intolerance occurring during pregnancy &disappear after delivery…

Clinical menifestations:-there are many sign & symptoms :
1. Hyperglycemia
2. Weight loss
3. Poly urea
4. Poly depsia
5. Poly phagia
6. Blurred vision
7. Altered tissue perfusion
8. Poor wound healing
9. Recurrent infection
10. Skin infection may be appear
11. Dry skin
12. Kitoacidosis
13. Dehydration
Diagnostic evaluations:-many tests are useful for evaluation
• Glucose tolerance test
• Fasting glucose test
• Blood test
• Urine test
• Physical examinations
• History taking
Management;-management of this divided in 3 types;-
1. Medical management
2. Dietary management
3. Exercise
• Medical management: many hypoglycemic agents are given for reduce level of glucose:-
Eg; tolbutamide; metformine; glycazideetc;
• Dietary management;-dietary control with caloric restriction of carbohydrate maintain ideal body weight .
The goal of meal planning is to control blood glucose level& weight reduction is another goal;;
• Exercise:-regular schedule of exercise also helpful in reduction of blood glucose level
Complications:-
1. Diabetes keto acidosis
2. Cerebral vascular disease
3. Retinopathy
4. Neuropathy
5. Peripheral vascular disease
6. Cardiac disorders

1. HAND WASHING:
The infection can be transferred from person to person through contaminated hands. Carefully washing of the hands rediouses the number of bacteria.
The points to be kept in mind while washing hands are:
– Cuts short finger nails.
– Remove the jewellery of any type.

ARTICLES NEEDED:
– Soap with soap disc/ antiseptic solution.
– Nail cutter
– Nail brush
– Towel

TYPES:
– Medicle hand washing [ elbow to finger tip]
– Surjicle hand washing [ finger tip to finger]

PROCEDURE:
– Open the tap and wet hand and forearm
– Always holds the hands below the elbow level because hands are considered to be more contaminated then the elbow
– Hence the water should flow from the lessor contaminated area to more contaminated area
– Wash hands thoroughly
– Apply soap
– Wash hands thoroughly
– Rinse hands under the running water by keeping the hands well below the elbow level
– The water flows from the elbow to the hands.

GOWN TECHNIQUE

-The isolation gown should be made with long sleeves, long skirt and high neck to cover the clothing of the wearer
– The isolation gown should be used only once and then discarded.

POINTS TO BE REMEMBERED WHILE USING GOWN:
– Remove watch and ring
– Wash hands and dry
– Hold the gown at the neck on the inside permitting to unfold
– Slide hands and arms down the sleeves by hands
– Fasten the ties at the neck
– Overlap the gown at the back as much as possible
–
THE POINTS TO REMEMBERED WHILE REMOVING THE GOWN:
-Untie the waist bed
-Wash hands
-Untie the neck band
-Slide the drown gown the arms and over the hands by holding the inside of the sleeves
-Hold the gown with both the hands at the shoulders, arms.
-The gown is turned inside out
-The hands arm are broad together and the gown is holded and discarded in the container provided.

FACE MASK
– Face mask are generally used to prevent the spread of micro organism to and from the client through the respiratory tract
– Mask should be worn only once and then discarded
– Mask that become wet are less effective and should be discarded
– Mask should be not worned more than 1 – 2 hrs at a time
– The masks is not worn outside the unit
– The mask should cover both nose and mouth

GLOVES :

– Gloves are used in the medical asepsis to the protect nurse pathogens
– They serve as a barrier.
– When the nurse handles articles contaminated by the body discharge gloves may be worn by the nurses to protect to client with poor resistance.

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