Care of Adults with Sodium and Fluid Imbalances

Care of Adults with Sodium and Fluid Imbalances

Important Eletrolytes in the Human Body. :: Kenyan all the time, keeping you informed all the time

Important Eletrolytes in the Human Body. :: Kenyan all the time, keeping you informed all the time

characteristics of a Proffessional Nurse.

Characteristics of a Professional Nurse

A professional nurse:

•       Displays high standards of performance and integrity in nursing practice

•   Seeks constantly to improve her/his technical and interpersonal skills through continuing education and research

•       Uses sound judgement and discretion in dealing with patients/clients and their relatives

•       Provides holistic care to patients, family and community

•       Deals competently with crisis situations

•       Puts what is good for professional services to patients ahead of self-interest

•     Coordinates and evaluates nursing services in cooperation with members of other health services (collaboration and networking)

•       Is not overly concerned with the materialistic aspects of nursing

•       Expects to find satisfaction and spiritual values in their work

•       Feels responsible for the status of nursing and tries to advance and never to retard it

•      Has inner resources to which she/he can turn to, for renewal of faith and courage when weary and discouraged

•       Is proud of her/his profession and considers it to be at par with other professions like medicine or law or any other vocation practised for compensation, which at the same time contributes in its own unique way to the welfare of humanity

Prevention of Mental Illness using the Public Health Model.

Disease evolves over time and the pathological changes become less reversible as the disease process continues. The main aim of health care services is to reduce or to reverse the changes as early as possible, thereby preventing further damage to the body tissues and organs.

A three level model for intervention, based on the stages of disease was developed in 1965 by H.R Leavell and E.G Clark.

The three levels of the model are:

• Primary prevention of disease
• Secondary prevention of disease
• Tertiary prevention of disease

Now move on to look at each of these levels individually.

Primary Prevention

This is the true prevention of disease. The actions of primary prevention are carried out before the disease or dysfunction has occurred in the body. Primary prevention actions are directed at depressing the risks of acquiring disease. The activities include health education, environment sanitation, supply of clean safe water, adequate nutrition, rest, sleep, recreation, personal hygiene, good working conditions, good housing, regular physical checkups, screening for disease, genetic screening and counselling.

Additional activities are immunisation against specific diseases, avoidance of home accidents, preventing road, rail, air, sea and industrial accidents.

Secondary Prevention

This focuses on preventing the development of complications in persons who are already suffering a health problem. Secondary preventive actions are aimed at diagnosing disease early and treating it promptly so that the condition of the diseased individual does not worsen.

The main goal is to cure the disease completely in its early stages or when a cure is possible. If a cure is impossible, secondary prevention slows the progression of disease as well as preventing complications and limiting disability. Some of the secondary prevention activities are: 

• Screening tests to detect early pre-symptomatic physiological and anatomical 
• indications of disease, for example, Pap smear, random blood sugar test, etc.
•  Case finding and case holding
•  Screening surveys and examinations
•  Mass treatment campaigns
• Adequate treatment of disease
•  Follow-up of treated clients of special clinics and home visits. 

Functional Disorders

These can occur in the form of manic-depressive psychosis, depressive or manic phase. Depression is the most common form, and may result in suicidal ideation, guilt and/or negative feelings towards the baby. For example, the mother may think that the child has a serious ailment and for that reason she should kill it to save it from suffering.

Schizophrenia

This tends to develop sooner and is more acute than depression.

Schizoaffective Disorders

Schizoaffective disorders incorporate features of schizophrenia and affective disorder, which appear in the same person at the same time.

The clinical presentation will depend on the presenting condition.

Tertiary Prevention

When a disease or a dysfunction causes permanent disability, tertiary prevention is used to limit the severity of the disability in the early stages of the disease. In those cases where residual damage is being experienced, disability is permanent and tertiary prevention takes the form of rehabilitation.

Tertiary prevention activities include restoration of functioning and
rehabilitation through:

• Retraining and education to maximise use of
  remaining capacities
• Selective placement
• Work therapy
• Modification of environment
• Home nursing and health visiting

Tertiary prevention care aims at helping the patient achieve as high a level of functioning as possible, despite the limitations caused by illness or impaired functioning.

Psychiatry has traditionally focused on secondary and tertiary prevention. Secondary prevention involves lowering the disability rate by shortening the average duration of nervous disturbances through early diagnosis and effective treatment. Tertiary prevention involves reduction of disability in individuals with long-standing and incurable psychiatric disorder.
By contrast, primary prevention is total prevention.

Alternatively one can use the modified public health model.

The Public Health Model

The public health model of 'primary, secondary and tertiary prevention' has been modified in order to provide distinction between prevention and treatment. Prevention efforts are classified into three sub-categories: universal, selective and indented intervention.

Universal Intervention

These are efforts aimed at influencing the general population, mainly concerned with two tasks:

• Altering the conditions that cause or contribute to mental disorders, also known as risk factors.
• Establishing conditions that foster positive mental health, also known as protective factors.

Universal intervention includes biological, psychological and socio-cultural efforts.

Biological Measures - This includes the development of adaptive life style, improvement of diet, having routine exercise, and overall good
health habits.

Psychosocial Measures - Here opportunities to learn physical, intellectual, emotional and social competencies are provided. For example an individual is assisted to develop skills needed for effective problem solving, for expressing emotions constructively and for satisfying relationships
with others.

The person may also be helped to acquire an accurate frame of reference on which to build their own personality. The patient should be prepared
for problems they are likely to encounter during certain stages of life, for example, problems associated with pregnancy and child rearing
must be discussed with women.

Socio-cultural Measures - These measures ensure a reciprocal relationship between an individual and their community. They also encourage social conditions that promote healthy development and functioning individuals, and incorporate services ranging from public education and social security to economic planning and social legislation directed at ensuring adequate health care for all citizens.

Selective Intervention

This model involves the establishment of programs that prevent the development of disorders, before people become so involved with certain behaviour patterns that future adjustments become difficult or impossible.

Examples of successful programs include:

• Education programs, which involve the provision of information to the groups at risk.
• Intervention programs involving the identification of high-risk groups and taking the necessary measures.
• Peer group influence programs, which help youngsters to overcome negative pressures from peers by being assertive.
• Programs to increase self-esteem, which enable the individual to overcome pressure from more dominant peers.

Indicated Intervention

This program emphasises the early detection and prompt treatment of maladaptive behaviours in a person's family and community setting. For example, in a crisis after a disaster, immediate and relatively brief intervention is carried out to prevent any long-term consequences

What you need to know about Syphilis.

Syphilis.

Syphilis is one of the infections that cause genital ulcers but it is different from chancroid in that it follows serious disease stages as it advances. Also the mode of transmission is slightly different, although the main mode is sexual contact.

Causative Organisms.

A spirochete organism called treponema pallidum causes syphilis. As you already know, the most common mode of transmission is sexual contact. However, it can also be transmitted from the mother to the unborn baby. This is known as vertical transmission and may lead to congenital syphilis. It also can be acquired by coming into physical contact with a patient in the secondary stage of infection that has mucosal or cutaneous lesions and through blood transfusion.

Syphilis can be transmitted through:

·         Sexual contact

·         Blood transfusion

·         Vertical transmission

·         Physical contact

The clinical features will depend on the stage of infection the patient presents himself or herself in. As mentioned earlier, there are four stages of syphilis namely primary, secondary, latent
and tertiary.

The stages of infection will be addressed individually.

Primary Syphilis.

After an incubation period of 10 to 90 days, a primary chancre develops at the site of inoculation. The chancre is typically painless, indurated with a clean base and raised edges and does not bleed on contact, although it oozes clear fluids containing Treponema pallidum. At this stage there is usually one lesion. In a female the chancre is on the cervix or the vulva, while in the male the lesion is most commonly on the gland penis, the foreskin, and the coronal sulcus or on the penile shaft. The primary chancre resolves spontaneously if left untreated over several weeks but disease progresses to the secondary stage.

Secondary Syphilis.

This stage follows a few weeks or months after the appearance of the primary chancre. It is during this stage that the micro-organisms begin to affect other systems in the body. Also, it is at this stage that signs and symptoms become manifest. These include skin rashes that take different forms like papular, macular or pustular. In moist areas of the body, soft, raised condylomata lata may be seen. These condylomata lata do not itch.

There may also be patches on the mucous or oral ulceration, sometimes referred to as snail track ulcer. Also, in addition to its cutaneous manifestation, secondary syphilis may present with fever and general malaise as a result of systemic illness. There could also be generalized lymphadenopathy, nephritis, hepatitis, meningitis or uveitis. These lesions generally resolve after several weeks but the disease progresses to the next stage.

Latent Syphilis.

In the absence of adequate treatment, the disease enters in latent stage. At this stage there are no clinical manifestations but there is history of syphilis and a blood test will give positive serological evidence. This patient is liable to develop tertiary syphilis in the future.

Tertiary Syphilis.

This is the last stage and it accounts for the morbidity and mortality of syphilis. It begins during the third to fifth year of disease and sometimes it takes an extended period of time to manifest. Lesions of tertiary syphilis fall into three categories, namely, gamma, cardiovascular disease, and central nervous system disease.

Gamma Lesions.

The gamma lesions are painless ulcers with little or no inflammation, which sometimes affect bones, making them fragile.

Cardiovascular lesions.      

The lesions affect the aorta and may cause aortitis or aortic valve disease. They also cause coronary ostial occlusion.

Neurological lesions.

The micro-organisms cross the blood brain barrier to reach the cerebrospinal fluid (CSF) and cause symptomatic neurosyphilis, presenting as epilepsy, hydrocephalus, general paralysis of the insane, syphilitic meningo-encephalitis, cranial nerve palsy or dementia.
There could also be asymptomatic neutrosyphilis where the patient is clinically normal, yet the cerebral spinal fluid (CSF) shows the presence of treponema pallidum.

Congenital Syphilis.

As mentioned earlier if an infected pregnant woman is not treated, she is likely to pass the infection to the foetus in utero through the placenta barrier and therefore, the baby will be born already infected. This type of disease is referred to as congenital syphilis and is acquired through vertical transmission. Signs of congenital syphilis in a neonate include syphilitic pemphigus, (which is highly contagious) anaemia, jaundice, hepatospleenomegaly, cleft lip and cleft palate. In addition, there may be ulcers of the nasoperiosteum leading to watery nasal discharge.

The babies are born small and they do not thrive well. At birth the baby might appear normal but later develops the characteristic rash affecting the soles and palms, then persistent nasal discharge, which is sometimes blood stained. This progresses to anaemia, jaundice and hepatospleenomegaly. The prognosis is poor but the few who live longer or reach adolescent age develop late congenital syphilis, which is like tertiary syphilis in adults. Those who reach this stage, manifest in bone and dental abnormalities, and inflammatory lesions of the cornea (interstitial keratitis).

Diagnosis.

This will start with the history given by the patient. It is followed by a physical examination. This may reveal an ulcer in the genital region suggestive of syphilis but clinically it could be impossible to distinguish syphilitic primary chancre from other genital ulcers. This is why you should use the NASCOP Syndromic Flow Chart for Genital Ulcer Disease to treat all genital ulcer diseases. However, if there is no improvement, you should refer the patient for further investigation. In serological diagnosis, that is, blood tests, you may receive positive results, which are normally reported as VDRL, which is Venereal Disease Research Laboratory Test. This will indicate the presence of treponema antibody, but in vertical transmission, a positive maternal test gives sufficient reason to start the neonate on treatment.

Breast Disorders During The Puerperal Period

Breast Disorders During The Puerperal Period